In most cases, the first person to work with a child diagnosed with hemiplegia will be a paediatric physiotherapist, who will be concerned with all problems relating to movement and posture.
What physiotherapy involves
In the case of a child with hemiplegia, the specific aim of physiotherapy will be to make them as physically two-sided as possible. The physiotherapist may work on such things as balance, weightbearing on the affected side, developing sensitivity in the affected hand. The child’s limbs may tend towards spasticity (increased muscle tone i.e. over-tightening of muscles), so the therapist will spend a lot of time stretching them. While the child is still very young, much of the therapy will be a question of doing things to them; as they grow, they will be encouraged to take a more active part in it themselves.
Exercising at home
Of course, for maximum benefit, the exercises that the physiotherapist does with the child need to be practised every day, so an important part of their task is to teach you to do them at home, and also to integrate therapy techniques into everyday activities. Parents might, for example, encourage their child to reach with their affected hand when they are passing them toys or food, or remind them to use both hands when appropriate - holding a beaker, for instance. Progress may seem slow, and you and your child will both get sick of the phrase ‘both hands, please’! Try not to feel guilty if you seem to be getting nowhere – too much pushing can be counterproductive, and your child will work out for themselves whether a skill is useful or not.
Treatment may also include hydrotherapy (therapy in a special pool), since it is easier to exercise stiffer limbs in warm water.
The physiotherapist will also advise on special shoes or boots, or splints to help with standing and walking or with hand position. They can also tell you about specially adapted bikes and trikes.
As the child grows older, he or she will increasingly prefer an alternative approach to physiotherapy, based on activities they enjoy. Read more about this in A Second Bite at the Cherry: an article on alternative approaches to physiotherapy by physiotherapist David Scrutton.
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