25.1 Aims of the Chapter

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  To outline the role of physiotherapy for children with early onset scoliosis, the importance of family involvement, and the use of play for assessment and treatment;

  
  
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  To review the physiotherapy program that immediately follows surgical intervention;

  
  
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  To consider ongoing development through play and activity.

With the vast changes in the surgical options available for treating children with early onset scoliosis that have been made over the last 10 to 20 years have come changes regarding the aims of therapy and the approach to therapy. The framework provided by the International Classification of Functioning Disability and Health (ICF) ² highlights the importance of activity and participation in a person’s life. It describes mobility as “changing location or transferring from one place to another.” It is therefore inevitable that the more effective and close to optimal a child’s mobility can be, the easier will be the child’s execution of activities and the greater will be his or her ability to participate. The ICF has underscored the need for therapists to provide a holistic approach to treatment, focusing not only on exercises, stretches, and what a child is unable to do, but also on the child’s abilities. The approach to therapy is functional and questions whether a child can actively participate with his or her current level of function. If not, an assessment must be made of what can be done to achieve participation. Many factors are involved, including the pathology of the child’s condition, family input and expectations, the child’s environment, the equipment needs, and the ability to access services. This assessment is necessary to establish what is required for each individual.

25.2 Physiotherapy Assessment

A physiotherapy assessment is required for children with early onset scoliosis to enable them to function to their fullest potential within society. Assessments provide a baseline for future interventions and establish goals that are appropriate and achievable for the child and the family within their environment.

An initial assessment may consist of observation of the child at play. This is most appropriately undertaken within the home environment, where the child will be most at ease and will play with his or her own toys. However, this may not always be possible. Play provides many benefits for both child and therapist:

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  Creates a happy and fun environment;

  
  
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  Is achievable;

  
  
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  Can be done by children with varying levels of mobility;

  
  
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  Allows an assessment of functional muscle strength, range of movement, and compensatory movements;

  
  
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  Is active;

  
  
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  Is interactive;

  
  
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  Enables development appropriate for the child’s age and preexisting abilities;

  
  
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  Enables the child to participate with peers;

  
  
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  Is enjoyable.

Play is the most likely way in which rapport will be established between the child and the therapist, but it also provides the opportunity to observe a variety of factors:

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  In what position does the child play?

  
  
  
  
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    Lying on the floor or a bed

    
    
    
    
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      Supine

      
      
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      On the side

      
      
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      Prone

    
    
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    Sitting on the floor or at a table

    
    
    
    
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      Propped

      
      
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      Unsupported

      
      
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      With compensatory fixed postures

    
    
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    Standing

    
    
    
    
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      Freestanding

      
      
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      Holding onto an object (e.g., furniture) for support with one hand or two

      
      
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      With asymmetries

  
  
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  Does the child move from one position to another?

  
  
  
  
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    Does the child remain fairly static throughout play, ignoring toys out of reach?

    
    
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    Does the child move to nearby toys, but not those at a greater distance?

    
    
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    Does the child move to toys well out of reach?

    
    
    
    
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      By reaching from within his or her base of support?

      
      
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      By moving out of the base of support?

    
    
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    Can the child move from one position to another, or is he or she placed in a position that compromises freedom of movement?

  
  
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  How does the child move?

  
  
  
  
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    Does the child remain in a sitting position, crawl from one toy to another, or stand up and walk to toys placed at a greater distance?

  
  
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  When does the child move?

  
  
  
  
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    Does the child move regularly throughout the play session or a limited number of times?

    
    
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    Does the child move with ease or great effort?

    
    
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    With compensatory patterns?

  
  
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  What motivates the child in his or her play?

  
  
  
  
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    Finding a task that motivates the child will make the introduction of new concepts easier and increase the child’s compliance.

  
  
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  What kind of toys does the child choose?

  
  
  
  
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    Static toys, moving toys, noisy toys, functional toys?

The role of the physiotherapist is multifaceted as he or she considers ways to improve the quality of life of each child and family. Law et al studied therapy programs for children with cerebral palsy; however, their concepts of “family-centered functional therapy” are relevant to children with musculoskeletal disorders, such as early onset scoliosis. They discuss how their “therapy programmes included identification of constraints within the person, environment, or activity and [how] therapy intervention aimed to change these constraints and enable function.” ³ Thus, it is important within the role of physiotherapist to consider the following:

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  The child’s abilities, needs, hobbies;

  
  
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  Needs of the family members and what is important to them;

  
  
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  Role of the child within the family, especially if the child has siblings;

  
  
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  The environments inside and outside the home to which the child has access and the child’s level of activity and participation.

The physiotherapist serves as a resource for the family members to enable them to have access to and be able to participate in their choice of activities, and also discusses hindrances to activity, function, and participation. An integrated team approach involving the child and family makes it possible to identify appropriate functional goals and work toward them.