Trust Issues in Physical Therapy

Patients can be uncooperative when they do not trust the safety of Physical Therapy Intervention. I have a 2 year old patient that it took awhile before he can bear weight on his legs when I hold his hands. But he can bear weight on legs while he is holding on the furniture. I let him stand and cruise on the furniture while little by little I applied a little support on hands to let go of furniture. He is now able to step with support on both hands.
There are also cases that the patients can walk with support of the PT but not cooperative with their parent. Sometimes patient can trust PT more than their parent because we see them a lot and do physical activities with them. When the parent start to do it they are not used to it so they do not trust them very much.
Avoid fall during standing or walking activities when the patient is too apprehensive. It can lower their trust to their physical abilities.

Exercises Stages in Developing Children

How do we start with kids to develop movement. 

1. When there is no movement yet

Developmental Mileage

Although babies develop differently, majority of the babies develops just like the following.

0 to1 month: Head aligned when held vertically. Rotates head and move legs while lying on stomach. When the head rotates to the right, the right arms and legs extend. Rolls to back when placed in side lying position. Arms and legs move while lying on their back.
 2 to 3 months: Head aligned and stiffens legs when bounced three times.  Raised head and chest then bear weight on arms while lying on stomach. Bear weight on legs for three seconds and show stepping reflex when placed in standing position. When pulled up to sitting the head maintain its alignment. Kick legs simultaneously while lying on their back.
4 to 5 months: Head and body aligned when supported around the waist. Reach toys up on eye level while lying on stomach. Bear weight on legs when supported three seconds. While lying on back, grabs the feet, and pull self to sitting when assisted. From lying on back, they roll to the side.
6 to 7 months: Maintain sitting while playing toy for about a minute. Bear weight on hands and crawl about three feet while lying on stomach. Rolls from back to stomach. 4. Pull self to sitting with better head control when assisted. From lying on back they can reach toys from the side.
8 to 9 months: Maintain sitting while pivoting the body and leans forward when falling backward. Move around while sitting and crawls about five feet. Bounce while assisted to standing and rolls using counter rotation on hips and shoulder. Pull self to sitting by holding on stable furniture.  Maintain hands and knees stationary position while reaching forward.
10 to 11 months: Get up to sitting and reach forward for toys. Creeps forward with hands and knees. Walk sideways while holding on stable furniture and lowers body slowly. Raises to standing while holding onto stable furniture. 5. Balance in standing for three seconds and walk with one hand supported.
12 to 14 months: Maintain kneeling position. Creeps over parent’s legs and creeps up two steps stairs. Creeps forward with hands and feet. Pick up toys, walk about 5 steps, and turns half circle while standing. Roll the dodge ball and fling the tennis ball.
15 to 17 months: Creep backward down stairs about three steps. Walk forward, sideward and backward about 10 feet. Walk on stairs while holding on railings with dominant leg leading. Attempt to kick the ball slowly. Stand in straightforward line.
18 to 23 months: Stand up without holding on furniture or support. Walk on balance beam with one foot off the balance beam. Jump up two inches, down the 4 inches, and forward with one foot leading and jump forward. Kick the dodge ball forward. Pick up tennis ball and throw it while standing. Run about 10 feet. Walk on stairs about four steps with same foot leading while holding on railings.
24 to 29 months: Walk up stairs with alternate stepping but still walks down with same foot leading. Jump down the 16 inches chair or curb. Stand on one foot for a second. Walk on balance beam about three steps. Walk in different directions. Throw tennis or dodge ball about 7 feet forward.
30-35 months: Stand up with less effort. Walk up and down the stairs with alternate stepping. Catch, throw, and kick the ball. Jump down 18 inches chair, over 3 inches obstacle, and forward 24 inches. Stand and hops on one foot.
36 to 41 months: Pedals tricycle about 10 feet. Walk on stairs with alternate stepping independently. Jump forward 26 inches and down the 24 inches chair. Catch ball with hands while elbow bent. Stand on one foot for 5 seconds and hops 5 times.
42 to 47 months: Overhead throw tennis or dodge ball aiming at object. Catch tennis ball. Jump over 6 inches obstacle. Stand on tiptoes with hands on head and on one foot for 10 seconds. Hops on one foot 10 times.


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9 Exercises for Neck and Shoulder Pain

  1. If you wanted to start the exercises you have to put your two fingers on the top of your forehead resist bending head forward then hold it for couple of seconds.
  2. Resist movement by using light pressure with fingertips into the temple on the sides of the forehead area. Keep the resistance by pushing the head to the side.
  3. Apply side resistance by using the light pressure with fingertips, press into the side of the head about the ear. You can resist by bending head sideways.
  4. Apply light pressure with fingertips at the back of the head. Resist backward bending of head. Hold it for a couple of seconds.
  5. Full head straight by keeping jaw and I level bed shrug shoulder up, down, forward and backward.
  6. Gently pull on elbow with opposite hand, until stretch is found in the shoulder. You can gently pull an elbow with opposite hand until I stretch is felt in shoulder.
  7. In the next exercise you need a towel. Pull involved arm behind the back by pulling towel.
  8. Assume an all fours position. While positioned comfortably on hands and knees gently lean forward, smoothly and without pain. Stay in this position for a couple of minutes.
  9. Scratch your opposite shoulder blade by by lift hand up behind you head, low behind your back, up in front of your chest, and low in front of your chest

Compensatory Movement

Gross motor training is the most scientifically proven concept in the field of physical therapy. Most of the functional activities can be master by good gross motor training. There are two functional movement one is fine motor where the OT concentrates on and there is gross motor which falls in the field of PT. When there is an impairment the easiest way to compensate with it is to use the rest of you body that is not impaired. For example if your back is injured and you can’t bend forward to lower your body, you can use your knees to lower your body. If you injured the right arm, you can use the left arm. These are the example that is easy to figure out. In some cases it is hard to figure out how to move with compensatory movement, for example if you have pain on neck while lying down how can you find the compensatory position?
It is a lot easier if you do the movement or positioning very slowly at the beginning to figure out how to learn the compensatory movement. The main thing to remember is you have to move while preventing the pain. When you find that movement, you have to master that movement. After you master the movement offer some challenges later on. Your body should be able to brace the injured area while doing some activities. Compensatory movement must be coordinated to minimize stress to injured area.

6 Simple Lower Back Exercises

  1. While lying on back flatten back tightening stomach muscles and buttocks. Repeat as much as you can.
  2. While lying on back, bring one knee to the chest. Repeat as much as you can.
  3. While lying on back, bend both knees together. Slowly rock knees side to side in a small pain free range. Allow back to rotate slightly.
  4. While lying on stomach, tighten buttocks while pressing pelvis to the floor.
  5. While lying on stomach, rise on elbows as high as possible, keeping hips on floor.
  6. While leaning back to the wall, keep head, shoulder and back against the wall with feet out in front and slightly wide then shoulder width. Slowly lower buttocks while sliding down wall, until thigh are parallel to floor. Keep back flat.

6 Simple Leg Exercises in Sitting

  1. Place the front ankle to the back of the opposite ankle. Push it together then straighten it.
  2. Straighten the knee alternately.
  3. Bend the hips alternately.
  4. Move leg widely apart, then together again.
  5. Place a foot on smooth surface. Slowly slide foot back as far as possible.
  6. Raise heels, then rock back on heels and then raise toes.

6 Simple Standing Training

  1. While sitting on the armchair, push hands on the arms of chair and push body up out of chair.
  2. While standing holding on the top of back chair or other furniture, slowly bend knees. Keep both feet on the floor.
  3. While standing close to  side of table. Hold the table then bend knee as far as possible.
  4. While standing holding on furniture, raise the leg out to side. Keep the toes pointing forward.
  5. While holding on furniture, raise the leg out backward with knees straight.
  6. Stand on one leg for few seconds. Stay close to wall or furniture to hold on when you fall.