Expert Opinion: Development in Context - Pediatric Rehabilitation by Ushma Goradia

Introduction - Being a physiotherapist since 30 years, I have experienced various changes in the field of neurology and pediatrics. Not only therapists know much more about HOW the brain functions, but we are also witness to change in the frequency of occurrence of various diagnoses. Until the 90s, we treated children with Cerebral palsy, Down syndrome, Spina bifida, etc. clinical presentations that were obvious to the eye.  Rehabilitation terms changed from handicap and disability to later physically challenged, and now to special needs and specially abled. A glaring change is the increasing numbers of conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The signs and symptoms of ASD and ADHD fall along a wide spectrum, not so obvious to the common eye unless quite severe, and can be confusing to parents. 

Therapy – Despite these changes, the ultimate reason for therapeutic intervention is to make the child as functional as possible. It is mostly a bottoms-up approach where, through the right therapy, we influence the development of the brain in the right direction.

Therapists generally assess not only whether the child moves (turns over, crawls, walks, jumps) but also the quality of posture and movement - which reflects neuromotor maturity.

Young parents find themselves in a dilemma when they sense that all is not well with their child while at the same time grandparents or friends advise them to wait and watch. Denial that a child is atypical is a major issue in our fiercely competitive society where we wish only academic success. However, it is crucial to recognize that academic development cannot occur without the foundation of robust sensory & motor systems.

Myths prevalent about children in Indian society—

Spend a year or more with a larger joint family, and the child will start speaking.

Put the child in playschool, and he/she will learn to walk.

Child’s father / mother also walked on toes, and the problem was outgrown.

All is fine, except that there is no speech.

Walking, jumping, climbing…no problem, BUT my child does not sit still.

This kid is so smart that he can use an ipad / phone/tablet and teaches himself.

Crawling is just a missed milestone, does not matter.

And many more….

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