A comprehensive paediatric neuro-physiotherapy assessment evaluates how a child’s neurological condition affects their body's movement and function. The assessment is structured into three main phases: History Taking, Observation and Play, and the Physical Examination.

History Taking

The initial phase focuses on gathering detailed background information. This includes the Birth and Medical History, which covers details of the pregnancy, birth, and any past illnesses or injuries; this is important for understanding the potential cause of the neurological condition/delay and the child's overall health status. Crucially, the therapist collects a thorough Developmental History to determine when the child reached key motor milestones like rolling, sitting, and walking. By comparing this to typical developmental timelines, the physiotherapist can accurately identify specific areas of developmental delay.

Observation and Play

During this phase, the physiotherapist watches the child while they are engaged in natural activities. The therapist closely observes Movement Patterns, noting how the child sits, stands, walks (gait), and moves between different positions (transitions). This allows them to identify any abnormal or compensatory movements the child uses due to their neurological impairment. By observing the child during Play and Function, the therapist assesses their overall coordination, problem-solving skills, and current level of independence in their environment.

Physical Examination

The hands-on examination assesses the physical impact of the neurological issue:

• Muscle Tone: The therapist tests whether the child's muscles are too stiff (spasticity or hypertonia) or too floppy (hypotonia). Tone issues are a primary indicator of nervous system damage and directly influence the type of treatment required.

• Strength and Range of Motion (ROM): The physiotherapist measures muscle strength and how far a child's joints can move. This is essential for detecting muscle weakness and for preventing or addressing joint stiffness and contractures.

• Balance and Coordination: This part evaluates the child's ability to maintain a steady position and execute smooth, controlled movements. This directly affects their safety and ability to perform daily activities.

Finally, the therapist works with the family on Goal Setting, establishing functional and motivating objectives (e.g., walking without assistive devices, climbing stairs) that will guide the tailored treatment plan, helping the child achieve their maximum physical potential.

A paediatric neuro-physio treatment session is a highly individualised, dynamic, and goal-oriented process. Its primary aim is to use play and specialised handling to help the child's nervous system learn more typical and efficient movement patterns, maximising their function.

1. Warm-up and Observation

The session always starts gently. The physiotherapist begins by observing the child during spontaneous movement or simple play to assess their current physical status, joint flexibility, and muscle tone on that particular day. This brief observation helps prepare the child’s body for the active work to follow.

2. Goal-Focused Play

This is the core of paediatric neuro-physiotherapy. Therapeutic exercises are seamlessly integrated into fun, age-appropriate activities. For example, a baby might be encouraged to reach across their body for a colourful toy to practice rolling, or an older child might navigate a soft-play obstacle course to challenge their balance and coordination. The purpose is to make movement practice highly repetitive and motivating, which is essential for effective motor learning.

3. Handling and Facilitation

The therapist uses their expert 'hands-on' skills to apply specific contact points (often at the hips, trunk, or shoulders) to guide and support the child through the desired movement pattern. For a child learning to walk, this might involve guiding their legs to take a step with a more normal gait pattern. This technique helps the child feel the correct, most efficient way to move, promoting neuroplasticity—the brain's ability to reorganise and form new neural pathways.

4. Strengthening and Balance

Specific activities are incorporated to improve the child's physical capacity. This includes exercises designed to build core stability and muscle strength, such as climbing, or performing movements while standing on unstable surfaces (like a wobble board or soft mat). This capacity is crucial for enabling independence and ensuring they have the control needed for all daily activities.

5. Postural Management

For children with significant movement challenges or tone issues, time is dedicated to ensuring proper postural alignment. The therapist uses specialised equipment—such as standing frames, wedges, or supportive seating—to position the child correctly. This management is vital for protecting joints and bones from long-term deformity and allowing the child to experience important weight-bearing activities.

6. Home Programme Review

Before the session concludes, the therapist reviews or teaches new exercises, activities, or stretches to the parents and caregivers. The ultimate goal is to ensure consistent practice and carryover of skills into the child's daily routine, accelerating their progress and making therapy a natural part of their life.

Weathertop Physiotherapy has four American Miniature Horses to use to support a child’s therapy. Due to their size, children over the age of 3 years are unable to ride the ponies, however children of all ages are able to complete groundwork with the ponies.

Equine-assisted therapy in a paediatric physiotherapy context typically refers to Hippotherapy, where the movement of the horse is used as a highly dynamic treatment tool. While hippotherapy involves the child mounted on the horse, equine-assisted groundwork refers to activities conducted alongside the horse.

Groundwork specifically supports paediatric neuro-physiotherapy goals through sensory, motor, and psychological benefits:

1. Enhancing Gross Motor Skills and Coordination

Groundwork activities, such as leading a horse through an obstacle course, require the child to engage large muscle groups and plan their movements:

• Motor Planning: The child must plan and sequence their movements to guide the animal, requiring continuous adjustments in speed, direction, and pace. This actively works on motor planning and praxis, which are often challenging for children with neurological conditions (e.g., dyspraxia or cerebral palsy).

• Balance and Stability: Walking alongside a horse on uneven terrain (like an arena surface) or stepping over poles constantly challenges the child's balance and static/dynamic stability, even without being mounted.

• Weight Shifting: Activities like grooming the horse (reaching, bending, stabilising the trunk) require complex weight shifts, improving core strength and postural control.

2. Improving Sensory Processing and Regulation

The stable environment and interaction with the horse provide rich, multi-sensory input:

• Proprioception and Deep Pressure: Brushing, grooming, and leading the horse provides deep pressure input through the hands and arms, which can be calming and help a child better understand their body's position in space.

• Tactile and Auditory Input: The feel of the horse's coat, the sound of hooves, and the smell of the barn provide varied sensory experiences. For children with Sensory Processing Disorder (often co-occurring with neurodevelopmental delays), this exposure can help improve tolerance and sensory regulation.

• Vestibular System: Even simple walking beside a horse stimulates the vestibular system (balance system) due to head position changes and continuous movement.

3. Addressing Psychological and Engagement Barriers

A horse offers profound motivational and psychological support that is difficult to replicate in a traditional clinic setting:

• Motivation and Compliance: Therapy with a horse is often perceived as fun and engaging, not as "work." This dramatically increases the child's motivation, compliance, and effort, leading to more intensive and effective therapeutic practice.

• Confidence and Self-Efficacy: Successfully guiding or caring for a large animal fosters immense confidence and a sense of responsibility and capability. This psychological lift can transfer to the child's willingness to attempt challenging physical tasks outside of the barn.

• Emotional Regulation: Horses are highly attuned to human emotion. A child must learn to approach and interact with the horse in a calm, clear manner, which teaches them to regulate their own emotions and behaviour—a crucial skill for neurodevelopmental conditions like Autism Spectrum Disorder (ASD).

Hydrotherapy is the use of a specially heated pool to facilitate the treatment of children with neurological conditions. It provides a unique, multi-sensory environment that allows children to achieve movements that might be impossible or painful on land, making it a highly effective complement to traditional land-based neuro-physiotherapy.

Hydrotherapy leverages the physical properties of water—specifically buoyancy, resistance, hydrostatic pressure, and warmth—to achieve targeted therapeutic effects:

1. Buoyancy

Buoyancy supports the child's weight, effectively counteracting the force of gravity. This is immensely beneficial for children experiencing significant muscle weakness or high levels of spasticity. By reducing the effect of gravity, the child can move their limbs and practice fundamental gross motor skills, like standing or walking, with reduced effort and less pain, allowing them to focus purely on the movement pattern.

2. Resistance

Water provides uniform resistance in all directions of movement, and this resistance increases the faster the movement is performed. This property acts as a natural strengthening tool. Movements that are typically slow and difficult on land can be performed repeatedly against gentle, uniform resistance, effectively improving muscle power and endurance without the need for external weights.

3. Hydrostatic Pressure

The pressure exerted by the water around the body, known as hydrostatic pressure, increases with depth. Therapeutically, this pressure provides deep pressure sensory input, which can be profoundly calming and help children with sensory regulation difficulties. Furthermore, the pressure provides supportive compression around the joints and limbs, which can improve postural awareness and overall stability.

4. Warmth

Hydrotherapy pools are typically maintained at a warm temperature (around 32−35∘C). This warmth helps to relax stiff or spastic muscles (reducing high muscle tone) and can alleviate pain. The relaxed state of the muscles allows the physiotherapist to achieve a greater range of motion and perform stretching more effectively.

Rebound therapy leverages the unique physics of a trampoline to achieve specific therapeutic goals, which complement traditional land-based techniques:

1. Promoting Neurological Development and Motor Control

The continuous, gentle movement on the trampoline creates a dynamic and constantly changing base of support.

• Balance and Postural Control: The child must constantly adjust their muscles to maintain their centre of gravity in response to the bounce. This repetitive, spontaneous adjustment works the postural control muscles (especially the core and back) far more intensely than on a static floor, rapidly improving both static and dynamic balance.

• Proprioception and Body Awareness: The powerful sensation of acceleration and deceleration provides massive amounts of proprioceptive input (the sense of where the body is in space) to the joints and muscles. This helps children with neurological impairments—who may have poor body awareness—to better perceive and control their movements.

2. Physical Conditioning and Muscle Tone

The trampoline allows for safe, controlled physical activity that targets strength and muscle tone issues.

• Muscle Strengthening and Endurance: Jumping and bouncing is a highly repetitive, high-volume activity that naturally builds muscle strength and cardiorespiratory endurance. The therapist can easily grade the activity, starting with gentle rocking for a low-tone child and progressing to vigorous bouncing.

• Modulation of Muscle Tone: For children with high muscle tone (spasticity), the gentle, rhythmic bouncing can be calming and help to temporarily relax the tight muscles. Conversely, for children with low muscle tone (hypotonia), the active bouncing requires muscular effort to resist the effect of gravity, thereby stimulating muscle activation and improving resting tone.

3. Sensory Integration and Motivation

Rebound therapy is inherently fun and stimulating, which boosts compliance and therapeutic engagement.

• Vestibular Input: The movement provides intense yet safe stimulation to the vestibular system (the inner ear system responsible for balance and spatial orientation). This helps children who are under- or over-reactive to movement to regulate their sensory processing.

• Motivation and Engagement: Children typically view the trampoline as a play activity rather than a therapy session. This high level of engagement means they are more likely to participate, sustain effort, and practice the necessary repetitive movements required for neuroplasticity.

• Communication: Many exercises involve counting, following instructions, or responding to verbal cues, naturally integrating cognitive and communication goals into the physical therapy session.

The fundamental aims of postural management are to maintain a functional body shape, maximize comfort, and facilitate participation in daily activities.

1. Preventing Deformity and Maintaining Body Shape

Children with neurological conditions, such as Cerebral Palsy, often have abnormal muscle tone (either high spasticity or very low tone) and spend significant time in static positions. Over time, gravity and abnormal muscle pull can lead to severe issues:

• Contractures: The shortening of muscles and connective tissues around joints.

• Skeletal Deformity: Conditions like severe curvature of the spine (scoliosis) or hip displacement.

Postural management counters these forces by using prescriptive equipment that keeps the joints and trunk in optimal, symmetrical alignment, thereby supporting the developing skeleton and gently stretching tight tissues over long periods.

2. Facilitating Function and Participation

While prevention is key, proper positioning is a direct route to functional improvement:

• Improved Head and Trunk Control: When the child's pelvis and trunk are well-supported by equipment, they expend less energy fighting gravity. This frees up energy and muscular effort, allowing them to better control their head and upper limbs. This greatly improves their ability to feed, communicate, and play.

• Enhanced Physiological Function: Correct, upright positioning assists vital bodily systems. For example, a supported upright posture helps to free the diaphragm, making breathing easier, and also aids in digestion and circulation.

Effective postural management requires interventions across the child’s entire day, as maintaining optimal positions is a continuous process:

• Daytime - Standing frames, floor based equipment (wedges/rolls), therapy programmes.

• Nighttime (Rest/Sleep): The hours spent sleeping are critical. Custom sleep systems are used to gently cradle the child's body in a specific, symmetrical position. This continuous support during sleep directly counteracts the effects of gravity and abnormal muscle tone, preventing the harmful shortening of tissues that occurs when a child sleeps in the same undesirable posture every night.

Superstars is a playgroup based in Shepley for children of all abilities, providing you and your child with a space to grow and develop. With structured sessions, free play and activities focused on maximising their potential through fun and play.

The focus of the playgroup is for the child to move towards their next physical developmental milestone, no matter their age or ability.

The playgroup also allows parents and their children access to regular specialist physiotherapy support.