Pediatric Physical Therapy: Focusing on the Whole Child
by Gail A. Hatch

Editor's Note: Many blind children today have additional disabilities. It is not uncommon for a blind baby, toddler, preschooler, or older child to work with many different specialists, such as an occupational therapist, a speech therapist, and a physical therapist. The physical disabilities which create the need for these services may vary from mild and eventually correctable, to profound and life-long. The following article was submitted by Carol Castellano, a frequent contributer to this magazine and a national and state leader in the National Organization of Parents of Blind Children. Her daughter, who currently has no other disability besides blindness, needed physical therapy for several years. Carol found the following approach and information helpful and wanted to share it with other parents and professionals. Here it is:

As a pediatric physical therapist, my goal is to facilitate functional and efficient movement in a child and to promote motor development. During my training and education, however, I realized the need for a more holistic approach to physical therapy. A child is more than just a group of muscles. A child is an individual with a set of interacting emotions, physical and mental capabilities. In addition, a child is an integral part of a large system of relationships which strongly influence the child's development.

In order for a child to move, suggests Esther Thelen, psychologist and author of many research articles, the child's perception, motivation, and sense of well being interact with the system of bones and muscles. Since the child's relationships affect his or her motivation and self-esteem, the therapist must be sensitive to them. As a pediatric therapist, I interact with parents, siblings, and peers, as well as with the child. Families have different cultural and religious beliefs, structures, and expectations, all of which have an impact on the child and all of which must be respected.

I am a professional coming into the life of the family to help mold motor development. I need to gain the parents' trust. The reaction of parents is very important because it will be directly reflected to the child, who must also have a trusting relationship with me, in order for therapy to be effective.

As a professional working with children and parents, therefore, I must respect the family's needs, priorities, and goals. I can help parents focus on their child's abilities, not limitations, in an effort to support their bond with each other and to set expectations and goals. Depending on the needs of a parent or child during a particular session, motor goals may become secondary. Work on motor skills at a time of great stress for the family may not be of greatest benefit.

I have utmost respect for parents of children with special needs. I try to bolster their strength, support their efforts, and empathize in their moments of grief. Many parents have questions about their child's abilities which they need to have answered in order to set goals. Many times, I share a family's stress when they hear a diagnosis or when they have one more overwhelming doctor's appointments to attend. In the midst of all this, parents are trying to develop a bond with their child, a child who may not be able to respond easily. I have felt helpless during times of great difficulty for a family and have wished that I could predict success for the child. I wish that I always knew the right things to say and that I could do more than just listen and offer support.

Parents are the most competent people in their child's life. Much of the success the child demonstrates is attributable to the parents' work, since the parents are with the child so much of the time. The other part of success is attributable to the child's hard work. Every child has abilities and these need to be emphasized and built upon. Parents and children have their own needs, priorities, and goals, and as a professional dealing with the whole child, I must respect these. For it is only then that I can truly say that I have done the best I can for the child.