Unit 2: Physiotherapy

2.1 Physiotherapy – definition, aims, scope

2.2 Modalities used in physiotherapy for persons with mental retardation

2.3 Movements and postures of human body

2.4 Specific conditions and physiotherapy management – cerebral palsy, spinabifida, muscular dystrophy and poliomyelitis

2.5 Integrating Physiotherapy into classroom context









2.1 Physiotherapy – definition, aims, scope

According to the definition adopted by WHO, physiotherapy is "the art and science of treatment using therapeutic exercise and physical agents such as heat, cold, light, water, massage, electricity, etc. In addition, physiotherapy includes the execution of manual and electrical tests to determine the level of intervention required to recover muscle strength, joint movement and the range of vital capacity, as well as diagnostic aids for monitoring recovery. Physiotherapy aims to develop, maintain and restore the maximum degree of functional capacity in people with somatic, psychosomatic and organic disorders, or in those whose health or quality of life has been negatively affected.

Objectives  of Physiotherapy

Physical therapy (PT) is care that aims to ease pain and help you function, move, and live better. Specifically, physical therapy looks to achieve these objectives for their patients:

Physical Therapy: Methods And Treatments

At the first physical therapy session, the physical therapist assesses your needs. A history of your pain, symptoms, ability to move and your medical history will be taken.

Tests will measure:

Treatments can include the following:

Physical Therapy Benefits: Physical therapy is the conservative approach to managing health problems, and in many cases the first resort advocated by doctors and health professionals.  Indeed, it may help people of all ages who have medical conditions, illnesses, or injuries that limit their regular ability to move and function.

Physical therapy can be a benefit for the following conditions:

2.2 Modalities used in physiotherapy for persons with mental retardation

Physiotherapy is a discipline that works to develop, maintain or restore the functional ability of a person. Where a person has had their normal body function compromised through a health and/or disability condition, injury or other trauma, physiotherapists apply therapeutic treatments to ease discomfort or increase the person’s abilities to move and perform activities of daily living. A health assistant in physiotherapy is a person employed to assist a physiotherapist to provide physiotherapy services in a safe, effective and efficient manner.

Therapeutic treatment can include the use of modalities.

 A modality (treatment) is a therapeutic agent or method used to treat an injury, disability or disorder and to promote, maintain or restore a person’s physical and psychological wellbeing.

The use of therapeutic modalities may help to:

·         reduce pain or discomfort.

·         improve physical function and the person’s ability to complete activities of daily living and participate in life roles.

·         facilitate independence.

·         help the person adapt or adjust to the effects of an injury or health and/or disability condition so that they can have maximum wellbeing and achieve their goals.

Physiotherapy modalities include:

·         standardised treatment programmes

·         thermal treatment (hot and cold).

·         application of orthoses (splints and braces).

·         TENS (Transcutaneous Electrical Nerve Stimulation).

·         electrotherapy agents.

·         paraffin wax baths.

·         laser therapy.

·         ultrasonic therapy.

An agent is the particular equipment or activity that is used with the person you are supporting. The method is how that equipment or activity is used with the person to bring about the desired therapeutic effect.

As health care providers, physiotherapists are also involved in the prevention and promotion of health, including mental health. It is their responsibility to inform individuals adequately about mental health, eliminate misconceptions about mental illness and refer them when necessary to specialized professionals in mental health and psychiatry.


‘Physical health‐related’ approach

The physical health‐related approach aims to improve the global physical health of the person with mental health problems. Studies have shown that people with mental health problems are more susceptible to inactivity and are at risk of a sedentary lifestyle. In addition, the use of psychotropic drugs can result in the development of metabolic syndrome, obesity, osteoporosis and cardiovascular disease. The physical health‐related approach is consistent with the recent recommendations of the World Health Organization (WHO) about the relationship between individuals’ ‘physical inactivity’ and poor health and a serious threat to their quality of life 

Psychosocial‐related and psychophysiological approaches

The psychosocial‐related approach emphasizes the acquisition of mental and physical skills related to the ‘moving body’ and support of people's ability to function independently in society and to improve their quality of life. The activities aim at learning, acquiring and training psychomotor, sensomotor, perceptual, cognitive, social and emotional proficiencies. Other elementary proficiencies are stressed, such as relaxation education, relaxation skills, stress management, breathing techniques, psychomotor and sensory skills and also cognitive, expression and social skills. Through exercises, patients acquire a broader perspective and can experience their own abilities. Moreover, the learning of the basic rules of communication is integrated. The psychophysiological approach involves the use of physical activity to influence mental health problems such as in the treatment of depression and anxiety disorders. In the literature, the benefits of physical activity for mental health are well accepted. Physical activity has a positive influence on mental well‐being, self‐esteem, mood and executive functioning. Through these effects, a downward spiral that leads to dejection can be stopped. Well‐balanced and regularly executed endurance activities (walking, biking, jogging and swimming) power training (fitness training) and mindfulness‐derived exercises) augment physical and mental resilience; improve the quality of sleep; enhance self‐confidence, energy, endurance and relaxation; and, in general, decrease physical complaints.

Psychotherapeutic‐oriented physiotherapy approach

The psychotherapeutic‐oriented physiotherapy approach uses the motor domain as a gateway to ameliorate social affective functioning. This approach puts less emphasis on the acquisition of skills but more on the awareness of psychosocial functioning and facilitating a process of change. Using movement activities, the physiotherapist creates a setting that favours the initiation and development of a process aimed at helping patients to gain greater insight into their own functioning. During these activities, patients are invited to venture outside their comfort zone, think outside the box, experience new things, become more in touch with their inner self and cope with numerous emotions (depressive feelings, fear, guilt, anger, stress, feelings of unease, estrangement and dissatisfaction) and negative thoughts (intrusion, obsession, morbid preoccupations and worrying). Moreover, they are confronted with their behaviour (i.e. impulses and lack of abilities) or cognitive symptoms (i.e. derealisation and lack of concentration). Through psychomotor therapy, an alternative perspective on experiences can be proposed. Experiencing the possibility that an alternative may exist triggers new emotions and experiences, and a discrepancy between reality and the patient's perception of reality emerges. Consequently, it is important to note that it is not the physical activity itself but the patient's experiences and inner perception that play the central role. The careful guidance and encouragement of the physiotherapist and the opportunity to experience feelings in a safe environment allow the patient to develop behaviour, which would not have developed otherwise. Although the underlying problems are not necessarily resolved, the therapist tries to improve problem management of the patient. The patient shares his behaviour, feelings, and thoughts with the therapist initially and, eventually, with his peers. More emphasis is placed on experiences and how reactions to these experiences function as a dynamic source of power


2.3 Movements and postures of human body

The body uses the brain, nerves, sense organs and its musculo-skeletal system, (i.e. bones, muscles, tendons and ligaments) to be able to either move or keep joints still. The combination of movement and stabilisation enables us to:

• Adopt fairly static positions, e.g.

1)   Standing

2)   Sitting

3)   Lying

4)   Kneeling

• Balance, e.g.

1)   To be able to stay fairly still by using very small movements

2)   To be able to get back to the position we were in if we are put slightly off balance

3)   To step or reach to ‘save’ ourselves if we are put more off balance

• Move in order to do something, e.g.

1)   Reaching our arm to pick up a cup

2)   Turning our head to look at something

3)   Walking to the toilet

4)   Transferring from bed in to a wheelchair

• Move to avoid harm to ourselves, e.g.

1)   Moving our hand automatically if it touches something hot

2)   Moving our foot away automatically if it stands on something sharp

3)   Automatic bending of our knee if our calf muscle is being over-stretched.

Definition of Normal Movement:

“Normal movement may be considered as a skill acquired through learning (or development) for the purpose of achieving the most efficient and economical movement or performance of a given task and is specific to the individual.”


Posture can simply be defined as a ‘position’ or ‘arrested movement’. It considers the position of the body and its relationship to whatever is supporting it (i.e. a chair, the floor, a table that’s being leaned on).

As with movement, different postures are used for different purposes and goals. Although it is common for people to talk about ‘good posture’ or ‘bad posture’ they are really talking about ‘good alignment’ and ‘bad alignment’.

Postural alignment is the composite of the positions of all the joints and limbs of the body at any given moment. Optimal postural alignment is a prerequisite for optimal movement function. It allows postural stability – the ability to maintain the position of the body, and specifically the centre of body mass within specific boundaries of space.

2.4 Specific conditions and physiotherapy management – cerebral palsy, spinabifida, muscular dystrophy and poliomyelitis

Cerebral Palsy

Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people and over time. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, swallowing, and speaking.

There is no one developmental play for treating people with cerebral palsy with physical therapy. Each individual case is handled uniquely starting off with a diagnosis. Therapists will conduct a multitude of tests to asses the person’s severity of Cerebral Palsy. Examinations will test and examine the following:

Physiotherapy exercises for children with Cerebral Palsy

Weight exercises with good Posture – Putting weight on your arms or legs not only encourages muscles, but it has shown tremendous improvement in the mobility and flexibility for individuals with cerebral palsy. Therapists have discovered that when children with cerebral palsy perform weight exercises paired with good posture, they show a more normal muscle response. This form or therapy can be performed in a multitude of ways:

Balanced Weight Shift –  One major issue for children with cerebral palsy is being able to balance their weight properly. Uncontrolled weight shifts project unbalanced movements and lead to falling easily. Being able to train the body for children with cerebral palsy helps this area of therapy tremendously. When starting balanced weight shifting, children usually begin lying on the floor, then working to being able to roll on the ground. This is a fun activity that children usually do over and over once they learn how to roll over. This is a fun exercise that not only the child, but parents should engage in to increase the health and well being of your child. Soon enough the child is able to move independently and increase muscle movement and joint flexibility.

Closed Kinetic Chain Exercises – This form of therapy is used to improvement movement and posture. This type of movement has shown to provide less likely involuntary movements and unnatural movements which helps the child with cerebral palsy greatly. These exercises are tremendous for individuals for multiple reasons shown below:

Joint Balancing – This form of therapy has shown to help in controlling movement for children with cerebral palsy. Therapists help hold the uncontrollable joints of children while guiding movements for them. This helps the therapist and family members find areas of opportunity for increasing movement patterns. The main goal of this form of treatment is to help the child to become able to perform movement independently, and without and help.



Spina Bifida is a congenital disease and is more common among children. The condition starts when the fetus’ meninges (surrounding lining) of the central nerve is not completely closed during pregnancy. The condition become serious when the meninges protruded from the lining.

The effects of spina bifida will vary according to the type, location and amount of nerve damage in the spinal cord. In mylomeningocele there may be:

The effects of spina bifida can impact enormously on a child's function and physiotherapy should commence as soon as possible in order to maximise a child's potential and quality of life. Treatment will vary according to the severity of the condition. Our specialist physiotherapists can provide treatment which may include:

Muscular dystrophy

Muscular dystrophy (MD) is a group of genetic diseases caused by a change or mutation in one of the genes located on the chromosomes (DNA) in human cells. It is not caused by an injury or harmful activity. Muscular dystrophy causes progressive muscle weakness and a decrease in muscle mass over time. It affects people of all races and ages worldwide. Nine types of dystrophies have been identified, and many types have variations or subtypes, resulting in more than 30 different forms of genetic disorders. 

Physical therapists help children with muscular dystrophy maintain function by managing complications of the disorder’s progression, such as muscle weakness and contractures. Each child with muscular dystrophy has unique needs based on age, the type of dystrophy, and the progression of symptoms. Physical therapists work with children and their families, as well as with other health care professionals, to develop individualized treatment plans to help children reach their full potential.

The physical therapist is an important partner in health care and fitness for anyone diagnosed with muscular dystrophy. Physical therapy should begin as soon as possible after diagnosis and before joint or muscle tightness has developed. Physical therapists identify muscle weakness, and work with each child to keep muscles as flexible and strong as possible, help reduce or prevent contractures and deformities, and encourage movement and mobility for optimal function throughout all the stages of life. Each treatment plan is designed to meet the child’s needs using a family-centered approach to care. If assistive devices are needed, the physical therapist may collaborate with other professionals to determine the best walking aids, braces, or wheelchair for each child.

Physical therapists know the importance of addressing the child's needs with a team approach, including all involved health care professionals, in order to provide holistic care to ensure mobility throughout the life span.

Passive and active stretching. Your physical therapist will perform gentle “passive” stretches for your child, gently moving their legs and arms, and teach you and your child how to perform active stretches in order to increase joint flexibility (range of motion) and prevent or delay the development of contractures.

Exercises to maintain strength. Your physical therapist will teach you and your child exercises to maintain muscle and trunk strength and to use good posture and body mechanics throughout the life span. Your therapist will identify games and fun tasks that promote strength. As your child grows, your physical therapist will identify new games and activities to reduce the risk of obesity and increase heart health. Activities such as bike riding and swimming are great to consider; your physical therapist will help you make sure these activities are not too strenuous or fatiguing. Overexercising can damage muscles. Parents are encouraged to seek physical therapist services early in order to identify the best strengthening activities for their child.

Exercises for breathing. Your physical therapist may provide a program to maintain good respiratory strength, or may work with respiratory therapists or speech therapists to design such a program.

Improvement of developmental skills. Your physical therapist will help your child learn to master motor skills such as crawling, getting up to stand, walking, and jumping. Your therapist will provide an individualized plan of care that is appropriate based on your child's developmental level and motor needs.

Physical fitness and activity. Your physical therapist will help determine the specific exercises, diet, and community involvement that will promote your child’s good health. When needed, mobility aids such as wheelchairs, splints and braces, and home devices may be prescribed to help maintain mobility.

Physical therapy may be provided in the home or at another location, such as a community center, school, or a physical therapy outpatient clinic. Your child's needs will vary greatly as they age, and your physical therapist will adjust treatments as needed. Physical therapists work with other health care professionals, including speech/language pathologists or occupational therapists, to address each individual's needs as treatment priorities shift.

If your child is expected to have corrective orthopedic surgery for scoliosis or contractures, your physical therapist can assist in evaluating the need for equipment, orthopedic appliances used for support, or bracing that might be needed to foster a quick recovery during postop rehabilitation. Your physical therapist can also work on early mobilization postop to help with recovery and maximize your child’s independence.


Poliomyelitis, also commonly known as Polio, is an extremely infectious disease caused by the poliovirus, for which there is no cure. The virus, which mainly affects children under 5 years of age. attacks the central nervous system through the brain. It was originally thought to have entered via the spinal cord, but this has now been proved to not be the case, and can cause temporary or permanent paralysis, leading it to sometimes being termed infantile paralysis Symptoms of Polio can manifest within a few hours or after several days, in up to 70% of infections there are no symptoms at all. 

Physiotherapy is a cornerstone of management of polio and post polio syndrome. There is an increasing evidence base for the effectiveness of physiotherapy in alleviating PPS (post polio syndrome) associated physical problems. Patients with prior polio or post polio syndrome should have access to regular physiotherapy assessment, and treatment should be made available when needs are identified.

There is no cure for PPS and to date there are no pharmaceutical treatments that have been identified at being effective in stopping or reversing the deterioration or symptoms. Emphasis is currently on managing symptoms and the role of the physiotherapist is important to help people with PPS find suitable aids and interventions to lead independent lives.

Physiotherapy is safe and effective when carefully prescribed and monitored by experienced health professionals. Cardiopulmonary endurance training is usually more effective than strengthening exercises. An intense strengthening programme using resistance or weights may be counterproductive as they can fatigue and already weaken compromised muscles. All exercise should be carefully monitored and any signs of further weakness, increased fatigue or long periods of recovery time should be an indicator to either revise the programme or stop exercise completely until recovery is evident.

Modalities used for Polio

Electrical stimulation has been used to strengthen weakened muscles or to reeducate muscles weakened through disuse, as well as to decrease pain

For myofascial pain, consider heat, electrical stimulation, trigger point injections, stretching exercises, biofeedback, muscle relaxation exercises, or static magnetic fields for trigger points. Exercise therapy and training programs in PPS patients should be carefully customized and planned by physiotherapists to avoid both overuse and disuse, and the level of physical activity should be modified to decrease pain.

2.5 Integrating Physiotherapy into classroom context

Several factors important to the successful integration of physical therapy services into early intervention and preschool classroom routines were identified in this study. Informants provided insight about the essential interactions among classroom personnel, the environment, and the child needed for successful intervention. It is unlikely that any one service delivery model is adequate to meet the complex and interacting needs of all children. Although the integrated service delivery model was embraced by informants as an important strategy for preschool intervention, integrated therapy was always supplemented by other forms of service delivery such as pull-out or consultation. There are many successful and varied approaches to integrated service, but the themes that emerged appeared to be important to each of the informants.


The Child


Administrative Policies

Service Delivery Options