Pediatric Series 3: Cerebral Palsy

The term cerebral palsy is not one that most of us are familiar with unless we have a loved one or have interacted with an individual with cerebral palsy.

At Rebound Hawaii, we want to educate family and friends about the diagnosis so that we can do our part to inform our community in addition to providing treatment.

What is cerebral palsy?

Cerebral palsy is a diagnosis that is caused by brain injury during fetal development, birth, or after birth before the age of three years old.

This diagnosis manifests as a movement disorder, causing significantly delayed early milestones such as an inability to roll, sit, crawl, or walk independently– even well past the expected age.

The brain injury causes involuntary or decreased control of muscle movement.

It also leads to abnormal muscle tone where the muscle feels like it is constantly tight or inactive. Depending on the site and severity of injury, vision and cognition may be affected.

How is it diagnosed?

Typically, cerebral palsy is determined within the first few years of life. Your baby’s pediatrician may notice abnormal muscle tone and/or developmental delay during wellness visits.

The pediatrician may want to monitor your baby’s development over a period of time before referring to a neurologist. Imaging is needed to confirm the diagnosis and to clarify the type of brain injury.

If you suspect that your child is not meeting developmental milestones on time, don’t be alarmed, as developmental delay does occur in children without cerebral palsy.

Rather, communicate your observations with the pediatrician so you may have all your concerns addressed.

For more information on when your baby should meet her gross motor milestones, please see our blog post on Developmental Milestones.

How is it treated?

Treatment involves a medical care team consisting of doctors and therapists. There are varying levels of functioning dependent on the severity of the brain injury.

A child with cerebral palsy will likely need some form of orthotics to correct foot posture and improve walking pattern.

There is adaptive equipment that help children who have cerebral palsy walk and negotiate their environment so that they can maximize their experiences and functional mobility.

A doctor’s primary role is to follow the care of the child, provide various surgical procedures, administer medication to improve tone, and refer to therapy and other specialists.

Why physical therapy?

At Rebound Hawaii, physical therapy treatment would focus on improving balance, range of motion, strength, and functional mobility.

We help individuals with cerebral palsy acquire orthotics and adaptive equipment. Cerebral palsy is not typically a progressive diagnosis, meaning that it does not rapidly worsen over time.

However, it does impair development and functional mobility.

Therefore, the right medical and therapeutic treatments are needed to optimize quality of life.

Pediatric Series, #2 – Developmental Milestones

Is your child hitting developmental milestones on time? Let’s go over what your child should be demonstrating at various months before turning 1 year old.

Keep in mind that you should be considering your baby’s corrected age when making comparisons, if he or she was born a preemie. Children develop at different speeds and your child may be 1-2 months ahead or behind “schedule”.

If significantly behind, address your observations with your baby’s pediatrician. Your child may require physical therapy if there is concern for an untypical delay.

At Rebound, we will use objective tests to determine how behind your child is and create a treatment plan to help your child reach important milestones.

1 – 2 Months

Your baby can start to turn his or her head when lying on the back and belly. He or she will be able to briefly lift his or her head up during tummy time.

You will notice random arm and leg movements. Your little one can see objects 8-10 inches in the distance and will be most interested to look at your face and highly contrasted auditory toys, such as a black and white rattle.

3 Months

Baby should be tolerating tummy time for at least 60 minutes a day.

While on the tummy with forward forearm prop, he or she will be able to keep his or her head more upright and visually track objects to each side with head rotation.

He or she will be able to move arms and legs more symmetrically; i.e. bring both hands to mouth or body and straighten both legs.

4 – 5 Months

Neck muscles become strong enough to keep the head up against gravity when you pull your baby up to sitting by his or her hands.

Your baby will start to reach his or her hands to knees and feet.

He or she will be able to roll from tummy to back and begin to roll from back to belly, over both sides.

6 – 7 Months

Your baby will start to look steadier sitting independently; he or she may play with a toy while sitting and will put hands forward to prevent loss of balance.

He or she will prefer to be on his or her belly and will roll easily to do so when placed on his or her back.

You may start to notice your baby pivoting around on his or her belly or push up on hands and knees.

8 – 9 Months

Baby is on the move! You might observe your baby scooting on his or her bottom and/or belly to explore.

Crawling, getting into and out of sitting, kneeling, and pulling up to stand will also occur during this time.

10 – 12 Months

Cruising along furniture will happen before independent walking. Parents may have the notion that their child should start walking by 12 months old, and if not, believe there may be something wrong.

But typical babies may walk anywhere between 9 to 18 months old.

Pediatric Series, #1 – Torticollis

What is torticollis and does your child have it? We will discuss what the word means, what to look for, how is it caused, and how to get help for your little one.

What is Torticollis?

Torticollis in Children

Torticollis is a neck deformity where the head constantly tilts or rotates to one side, or a combination of both.

This coincides with a stiff neck where there is muscle tightness on the side of the tilt and a decrease in range of motion in the opposite direction of the tilt and rotation.

In infancy, if the torticollis remains untreated, “plagiocephaly” or skull and facial deformities may develop.

The Causes of Torticollis

There are multiple causes which further classify pediatric torticollis into “congenital torticollis” and “acquired torticollis”.

Congenital torticollis means your baby was born with the torticollis due to either shortened and tight muscles on one side of the neck from positioning in the womb, known as “muscular torticollis”, or Klippel-Feil syndrome (much less common).

Klippel-Feil syndrome is a genetic phenomenon where two or more vertebrae in the neck are fused during fetal development.

Acquired torticollis occurs after birth and may result from several situations.

One such situation being imbalanced positioning during the first few months of life when your baby does not have the strength to correct her head positioning against gravity.

If your baby is unknowingly and consistently being placed in a position where her head is leaning to only one side, that side with eventually tighten and she will have developed ‘muscular torticollis’.

A second situation may be lymph node swelling from a cold or an ear infection, in which case your child may hold her head in a position of comfort in response to inflammation and pain.

In this case, the torticollis should resolve itself after your child gets over the illness.

Another situation may be head or neck trauma. Again, your child may position the head away from midline for comfort. In this last case, be sure to determine the method of injury and ask your child’s doctor about any concerns to rule out more serious injury.

If my child has it, what do I do?

If your baby presents with congenital torticollis, typically the pediatrician will catch this early on, during your baby’s wellness first few visits.

Your baby’s doctor will be able to determine whether the torticollis is due to shortened neck muscles, or another cause.

If your child has muscular torticollis, the pediatrician may show you some stretches and recommend physical therapy.

Here at Rebound Hawaii, we treat muscular torticollis through stretching, positioning, and strengthening.

We also educate parents and equip them with a therapeutic program to carry over treatment at home to optimize success.

It is important to address torticollis early to reduce the appearance of plagiocephaly and prevent compensations related to vision, posture, muscle imbalance, and gait pattern.

If you have any questions, do not hesitate to contact us!

When to Use Ice or Heat For Pain

When your muscles are screaming for relief, it can be difficult to decide between using heat or ice to treat the pain.

We’re making it real simple for you to remember so that you’ll know which to use right away!

When to use ICE:

Rule of thumb – ice is for injuries.

  • Immediately after an injury
    Ice slows down the blood flow which controls pain, reduces bruising, and relieves inflammation.
  • Strained, pulled, or torn muscles
    Ice relieves inflammation and controls the pain by slowing down the blood flow to the injured muscle.
  • Headaches or migraines
    Ice will numb the throbbing pain. Ice cubes in a food storage bag or a frozen bag of peas work just as well as store-bought ice packs (and you probably already have these in your freezer!).
  • Cuts or Bruises
    Ice will slow down the blood flow and help numb the pain. Elevate the bruised area while sitting or lying down as you apply ice therapy to it.

Ice should not be applied longer than 20 minutes at a time to avoid damage to your skin. Once your pain is numb, remove the ice pack. Ice should never be applied directly to the skin as well (always use a thin cloth buffer).

Check your skin every 5 minutes for redness to avoid freezer burn (your skin will turn red as if it were burned by heat).

When to use HEAT:

Rule of thumb – heat is for muscles and joints.

  • Arthritis
    Heat soothes stiff joints and helps increase blood circulation which delivers nutrients quickly. Blood vessels will dilate which increases the flow of oxygen to the damaged joints. (If the joints are bruised or swollen, use ice instead.)
  • Shoulder pain
    If the shoulder muscles aren’t inflamed, heat therapy can be effective for treating the pain. Just injured your shoulder? Ice it first. Remember, heat should only be applied to non-inflamed muscles since blood circulation will increase.
  • Knee Pain
    Applying heat on a knee injury can relax the muscles and increase the lubrication around the joints. Gentle exercises while applying heat to the knee will help strengthen and restore flexibility.
  • Non-Inflamed Muscles
    Heat is generally safe to use on muscles or joints after an injury is about 2 or 3 days old since many fresh injuries involve swelling, tears, and bruises.

Generally, the longer heat is applied, the better; however, it also depends on the magnitude of the injury.

Fifteen to 20 minutes of heat therapy should suffice for minor muscle tension, while 30 minutes would be more beneficial for more intense muscle injuries.

Just like ice, heat should never be applied directly to the skin (always use a cloth buffer).

Have you used ice or heat therapy? Share your experience with us in the comments section!

How to Keep Your New Year’s Fitness Resolutions

With the new year just around the corner, people are starting to make their resolutions and exercise is pretty close to being at the top of mostly everyone’s list.

If you’ve made exercise a new year’s resolution in previous years, but never kept up with it, don’t beat yourself up. You’re human!

Follow our seven tips that will help you keep your fitness resolutions for the rest of the year!

Focus on what you want to gain instead of what you want to lose.
For example, “I want to gain muscle” is more encouraging than “I want to lose 20 pounds”. It also puts you in a positive mindset that will keep you motivated on what you want to achieve, not lose.

Say Goodbye to the “All or Nothing” mentality.
Too many people start the new year with a go-getter spirit only to be let down when they don’t meet the high expectations they initially set for themselves.

When you catch yourself saying, “I just don’t have time to exercise!” perform a quick HIIT (high intensity interval) workout!

See how many squats you can do while brushing your teeth, take the stairs more often, or do jumping jacks while you wait for the microwave.

Change one thing at a time.
Instead of attempting to go from 0 – 100 on January 1st, commit to practicing one small workout habit until you’ve mastered it for a week. When you’ve got that habit down, move on to another workout habit.

Warm up!
You’re pumped and ready to get your workout on so you jump right into it when all of a sudden… ouch! Don’t skip out on your warm up.

Take five minutes to get the blood flowing into your muscles and raise your heart rate! Think of your muscles like rubber bands.

Stretch a cold rubber band to its max and it’ll snap. But if you warm up the rubber band by doing light dynamic stretching first before taking it to its max, it’ll last much longer and you can reuse it again.

Same idea with muscles!

Get rolling.
Using a foam roller before and after every workout will increase your mobility. Focus on your back, glutes, calves, ankles, and hips with slow and steady motions.

Be sure to roll along the entire length of the muscle or tissue. If you find a tender spot (usually a knot in the muscle), stop on that spot to apply pressure for about 20 seconds, then continue rolling.

Get more sleep.
This should be at the top of your fitness new year’s resolutions! Hitting the sack is just as important as hitting the gym.

Muscle is rebuilt, cortisol levels decrease, and your immune system strengthens when you get 7 to 8 hours of quality sleep.

Reward yourself.
Treat yourself with every milestone you accomplish. Ran a 5K in half an hour? Reward yourself with those running shoes you’ve been eyeing.

Drink 8 glasses of water everyday for a week? Go get that hydro flask you’ve been wanting. Rewarding yourself will motivate you to keep going!

Kick the new year off right and build a better you! We’re rooting and cheering you on! We want to hear from you!

What’s one thing that you find almost always stops you from keeping up with your fitness goals? Leave a comment!

Relax…Like a Boss

Massage therapy is often considered a luxury or a treat for a special occasion. Very few people consider it as a form of medical treatment when it is actually the oldest form of medicine!

5 Ways Massage Therapy Can Benefit You

When you get a cramp in your calf, what is your initial reaction? You place your hand on your calf and rub that cramp!

When you feel a strain in your back, what do you immediately do? You grab your back and rub the strained muscle!

These are actions that are instinctively performed which is the core basis of massage therapy – physical touch heals.

Here are 5 ways massage therapy can benefit you:

Reduces recovery time. Massage therapy helps improve blood flow through the muscles.

While breaking down any adhesions and stretching muscle tissues, the swelling in joints are flushed out reducing the amount of time it takes for muscles to recover.

Reduces muscle spasm. Although it may hurt at first, pressure on the muscle spasm from a massage will alleviate the pain.

Lactic acid is released from the muscle after a massage, and blood and oxygen will begin flowing through the muscle again.

Reduces pain. Massage increases blood circulation to stiff joints and muscles, and also releases natural endorphins called opioids in the brain.

Oxytocin, the hormone that relaxes muscles, is also released quickly which can lead to feeling relaxed and calm.

Reduces stiffness. Vigorous muscle use such as exercise can definitely stiffen up a person’s muscles.

Although it’s been verbally reported that massage can ease the pain associated with muscle stiffness, a study published in the February 1st issue of Science Translational Medicine found that massage reduced cytokines, an important compound in inflammation, and stimulated the mitochondria which converts glucose into energy (fundamental for cell repair!).

Promotes stress relief. Stress affects more than just our minds – it affects our whole body.

Too much tension can lead to stiff muscles, but it also leads to headaches, difficulty sleeping, stomach issues, and fatigue. The physical touch of a massage can promote the relief of stress!

If you have questions about how massage therapy can help you or a loved one, we encourage you to give us a call at (808) 674-9998. We’d be happy to help you bounce back to life

Does Physical Therapy Hurt?

Have you ever thought to yourself, “Is physical therapy going to hurt?

We get it – it’s a common misperception. Today we reveal six benefits of physical therapy (that can help you bounce back to life today!).

Physical therapy can provide customized plans to help individuals improve their quality of life by returning to what they considered normal prior to the conditions that limit their regular ability to move.

Here are 6 benefits of physical therapy that address a variety of issues.

6 Benefits of Physical Therapy

Management of age-related issues.
Osteoporosis and arthritis are common issues that develop when individuals age. Physical therapy can help manage and reduce the development of such conditions.

An evaluation of the patient’s abilities will be conducted, and a physical therapist will create a program to include screenings, education, and exercises to prevent further decline so that the aged individual can maintain their independence.

Prevent or recover from sports-related injuries.
Ankle sprains, pulled muscles, achilles tendinitis, and Runner’s Knee are common injuries that physical therapists understand happen with different sports.

Many athletes often “tough it out” and wait for the injury to heal on its own.

Physical therapy can treat and prevent these injuries from prolonging the athlete’s play and practice time, getting them back in the game!

Pain reduction or elimination.
Chronic pain such as fibromyalgia, osteoarthritis, neuropathic pain, and chronic headaches can be reduced or eliminated by physical therapy.

It’s important to understand that a combination approach of physical therapy is essential in achieving the ease of chronic pain.

A consistent exercise routine is effective in reducing pain, and regularly exercising therapeutically will help maintain the patient’s ability to move rather than be disabled by their chronic pain.

Manage women’s health issues.
Pelvic floor dysfunction affects millions of women. Pregnancy, child birth, trauma, surgery, and chronic constipation are just a few of the conditions that can cause pelvic floor dysfunction.

Physical therapy treatment options may include home exercise programs, hot and cold therapy, transcutaneous electrical nerve stimulation (TENS), and appropriate muscle awareness activities.

Manage lung and heart disease.
Physical therapy can help patients clear the fluid in their lungs to improve their quality of life through conditioning, strengthening, and breathing exercises.

For patients with heart-related issues, a physical therapist can help develop an active lifestyle by focusing on lifestyle changes, mobility issues, and physical activities structured for the patient’s goals.

Recover from a stroke.
A stroke can happen at any age and often leaves one side of the body paralyzed.

During the first few weeks and months, physical therapy can help stroke survivors keep the affected muscles stimulated and toned, even before the patient is able to voluntarily move those muscles.

During therapy, basic functions are usually practiced first such as moving from a chair to a bed.

Once that is accomplished, balance exercises, basic coordination skills, grasping objects, and walking usually follow.

If you have questions about how physical therapy can help you or a loved one, we encourage you to give us a call at (808)674-9998. We’d be happy to help you bounce back to life!