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Physical Medicine and Rehabilitation in Children and Adolescents

The aim of pediatric rehabilitation (in children and adolescents) is to improve the functional ability of children with physical disabilities. Motor development is important for children's overall development in which they learn and develop cognitively and physically. An examination by Physical Medicine and Rehabilitation (PM&R) specialist is done to assess the musculoskeletal status in children. The aforementioned usually includes the posture, gait, spine, joints, and foot examination. It is crucial to spot the problem in time in order to prevent possible consequences on growth and development. If necessary (and depending on the clinical status) another diagnostic may be performed. The most common musculoskeletal problems in children are faulty posture, sports injuries (trauma), overuse syndromes, scoliosis, and foot deformation (flat feet). In addition to physiatrists and physiotherapists, parents play a key role in this process, so it is extremely important to educate not only children but parents as well on how to perform therapeutic exercises.

In St. Catherine Specialty Hospital, our physician Stjepan Čota, M.D., Physical Medicine and Rehabilitation Specialist, who examines children aged five and more, is at your disposal. His field of interest is orthopedic and trauma rehabilitation in children, overuse syndromes, scoliosis, kyphosis, and rehabilitation of inflammatory rheumatic diseases in children. Feel free to contact our team of the Center for physical medicine and rehabilitation and make an appointment.

Treatment of scoliosis and kyphosis in children

The spine gives our body structure and support. Its complex anatomy and biomechanics are still an area of ​​interest for numerous research. In an upright position (seen from the back), our spine is straight, and when observed from the side, it has three curves - cervical lordosis, thoracic kyphosis, and lumbar lordosis.

Scoliosis is the most common deformity of the spine with an incidence of 1-3%. It is defined as a lateral curvature of the spine of 10 or more degrees measured on a standard X-ray of the spine in a standing position (Scoliosis Research Society). However, the curvature of the spine is not only in one (frontal) but in all three planes, thus the rotation of the vertebrae results in a complex deformation. Mostly, the cause of scoliosis is unknown, so we say it is idiopathic. Depending on the age of onset,  we distinguish between infantile, juvenile, and adolescent scoliosis. Adolescent idiopathic scoliosis is the most common and occurs more often in girls. In addition to idiopathic scoliosis, we differentiate between congenital, degenerative, and neuromuscular scoliosis.

Early diagnosis is of extreme importance, as it prevents further progression of the curve. Treatment of scoliosis is divided into non-operative (therapeutic exercises, orthotic treatment) and operative.

Katarina Schroth's exercises are recognized as the most established scoliosis-specific exercises. The exercises require high motivation and understanding, and are suitable for children older than 11 years old. Schroth therapy aims to stop the further growth of scoliosis and to reduce the curvature degree of the spine (before growth is complete). In this way, we indirectly affect the pain reduction caused by scoliosis itself. Due to the fact that scoliosis is a deformation of the spine in all three planes, exercises according to K. Schroth treat the spine three-dimensionally (3D). The concept of exercises consists of breathing exercises, stretching, and derotation of the trunk. Therefore, proper and controlled breathing, muscle symmetry, and posture are the three basic postulates of the therapy.

Sports rehabilitation - overuse syndromes in children

Day by day human body in sports reaches unimaginable physical and psychological limits. Being a professional athlete requires a lot of sacrifices, discipline, as well as mental stability. Sport often gives identity to the athlete. We have been playing sports since early childhood and have witnessed numerous sports injuries, which in recreational athletes occur due to inadequate activity preparation. Often, children who play sports 'hit the field' without doing adequate conditioning training, as well as stretching exercises. This brings us to the basic postulate - the key to injury (in addition to trauma in professional athletes) is an imbalance between muscle groups due to inadequate conditioning, and that every 'weak' muscle is also a tense muscle.

The aim of sports rehabilitation is a quick, targeted, and individual approach to solving injuries. The rehabilitation process starts immediately after the injury or surgical treatment and is divided into phases. The most important thing is to create good mental stability and motivation for the athlete. In addition, the aim is to maintain the muscle strength of the segment treated surgically, but also to maintain the physical stability and strength of the entire body. Stability, retention of proprioception, and biomechanical mistakes correction are only a part of the prerequisites that must be met.

Sports rehabilitation in St. Catherine Specialty Hospital unites an athlete, physician, and physiotherapist. Shared effort and a positive attitude of the whole team results in an excellent outcome.

Manual techniques - Kaltenborn/Evjenth approach

Manual therapy according to the Kaltenborn/Evjenth approach consists of a specific examination and therapy. An examination of the muscles, joints, and nerves is done along with provocation and relaxation tests. We use stabilization (in the case of hypermobility) or mobilization (in the case of a limited range of motion). Manual therapy according to Kaltenborn/Evjenth uses three levels of joint mobilization. The first two are used to reduce pain, and the third is to increase the range of motion (in a joint with contracture). Manipulation is the last stage of mobilization. The therapy gives excellent results in all conditions where a limited range of motion persists, especially after joint distortions.

Rehabilitation of children with inflammatory rheumatic diseases

Juvenile idiopathic arthritis (JIA) is the most common inflammatory arthritis in children (up to 16 years old) with an incidence of 1 in 1000. It is characterized by joint inflammation (similar to rheumatoid arthritis in adults), and joint tenderness, swelling, and stiffness can begin gradually or suddenly. Treatment for JIA varies depending on disease type and severity. A well-rounded plan includes medication (conventional synthetic and biologics Disease-Modifying Antirheumatic Drugs), and rehabilitation with healthy lifestyle habits. Early rehabilitation with the aim of muscle strengthening and joint contracture prevention is of utmost importance.

Orthopedic and trauma rehabilitation in children

Musculoskeletal injuries are becoming more frequent, even in children. The most common injuries of this type are strains and muscles, tendons, and ligament (complete or partial) tears, alongside bone fractures. Depending on the injury type and size, conservative vs. surgery treatment is the treatment of choice.

Post-traumatic rehabilitation aims to reduce swelling and joint tenderness and to induce circulation to stimulate the repair process of the injured tissue and its healing. It is essential to restore the full range of motion of the injured joint, as well as the strength and flexibility of the surrounding muscles.

Entrust yourself to our team of experts that will adjust the rehabilitation program and process according to the injury your child has suffered.

Dynamic neuromuscular stabilization (DNS)

With this method, every movement begins with the stabilization of all body segments because good stabilization is a prerequisite for the balance, safety, and efficiency of a normal movement. DNS is currently a method of choice for deep stabilization of the musculoskeletal system. It is based on the developmental ontogenesis of an infant.

Read more about Dynamic Neuromuscular Stabilization (DNS) and find out why this method is so popular.

Kinesio taping

The Kinesio taping method is a specific therapeutic technique of placing elastic straps for therapeutic purposes (alleviation of pain and facilitation of lymphatic drainage by microscopically lifting the skin). It stimulates superficial skin receptors, supports muscle function and its contraction or relaxation, increases lymph and blood circulation, reduces muscle and tendon tension around the joints, and increases the range of movements.

Emmett technique

The Emmett technique is a quick method that, when activating the right muscle, gives effective results as soon as the muscle correction (applying pressure on the muscle) is carried out. The spots where pressure is applied are the so-called ‘Emmett spots’ - sensory or receptor and muscle overlapping points. With this method, stored causes of poor movement and/or balance are activated. By removing them, new patterns of movement are created without pain and with better balance – depending on the clinical presentation and difficulties which the patients present to us.

Bowen method

The Bowen method is a therapy that involves gentle but precise manipulations of the soft tissue. The movements performed are rolling movements using the therapist’s forefinger and thumb across the muscles, tendons, and nerves with minimal pressure. Such movements provide a piezoelectric effect on the fascia, tendons, and internal organs, and send a signal to the brain that something is wrong with that part of the body. The brain reacts to stimulation by relaxing the surrounding musculature, thus improving local circulation and regeneration processes. Bowen therapy is applied to various difficulties due to its holistic approach to healing.

Passive procedures

The passive procedures we use in St. Catherine Specialty Hospital for children and adolescents are Magnetotherapy, Laser, Therapeutic Ultrasound, and Electrotherapy.

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