Pediatric Rehabilitation
Conditions We Treat
Browse the conditions we specialize in
Cerebral Palsy
What Is Cerebral Palsy? Cerebral palsy (CP) is a permanent condition affecting movement and posture that arises from damage or abnormal development of the growing brain before birth, during birth, or in early childhood. "Cerebral" refers to the brain, and "palsy" means weakness in muscle control. Cerebral palsy is not a progressive disease; the brain damage itself does not worsen over time. However, the secondary effects on affected muscles and joints may change as the child grows. Types and Symptoms of Cerebral Palsy Spastic CP (most common): Increased muscle tone; movements are stiff and uncontrolled. Reflects upper motor neuron damage. Dyskinetic CP: Characterised by uncontrolled, involuntary movements (athetosis, dystonia). Ataxic CP: Balance and coordination disorders are prominent; gait is unsteady. Mixed type: Carries characteristics of more than one type. It is also classified by the affected body area as hemiplegia (one side), diplegia (both legs), or quadriplegia (whole body). Cerebral Palsy Rehabilitation at ROMMER At ROMMER, cerebral palsy rehabilitation is conducted with a family-centred approach aimed at maximising the child's existing motor potential, increasing functional independence, and improving quality of life: Neurodevelopmental Therapy (NDT/Bobath): Applied to normalise abnormal movement patterns and develop functional movements. Intensive Physiotherapy: Individual exercise programmes are created for muscle strength, balance, coordination, and postural control. Botulinum Toxin Application: Provides temporary relaxation in spastic muscles, increasing the effectiveness of rehabilitation. Robotic and Technology-Assisted Therapy: Balance platforms, robotic walking devices, and virtual reality are used to make rehabilitation more intensive and measurable. Occupational Therapy: Fine motor skills, hand functions, and daily living activities are worked on. Speech and Language Therapy: Communication skills and swallowing functions are evaluated and treated. Orthopaedic Support: The need for splinting and orthotics is regularly reviewed; surgery planning is carried out in collaboration with paediatric orthopaedics when necessary. Family Participation and Home Programme At ROMMER, the family is an indispensable part of the rehabilitation process. Parents are trained in positioning, handling techniques, and home exercise programmes. Consistent application of the home programme between clinic sessions is one of the most important factors determining the child's progress.
Spinal Muscular Atrophy (SMA)
What Is Spinal Muscular Atrophy (SMA)? Spinal muscular atrophy (SMA) is a genetic neuromuscular disease caused by mutation of the SMN1 gene, resulting in degeneration of the motor neurons in the spinal cord. As a result, voluntary muscle groups gradually weaken and lose their function. SMA is one of the most common genetic causes of infant mortality. With the new generation of disease-modifying treatments (nusinersen, onasemnogene abeparvovec, risdiplam), the life expectancy and quality of life of patients have increased significantly. Types of SMA SMA Type 1 (Werdnig-Hoffmann): Most severe; symptoms appear before 6 months of age, and without treatment patients cannot sit independently. SMA Type 2: Patients can sit but cannot walk; symptoms appear between 6–18 months of age. SMA Type 3 (Kugelberg-Welander): Patients can walk; symptoms appear after 18 months of age. SMA Type 4: Adult onset; mild clinical course. Rehabilitation Approach at ROMMER With the new generation of disease-modifying treatments significantly changing the natural history of SMA, rehabilitation has become even more critical for maximising the functional gains achieved by these treatments: Respiratory Physiotherapy: Respiratory muscle support exercises, secretion management, and cough assistance techniques (manual, mechanical) are planned to protect respiratory capacity. Motor Skill Development: Sitting balance, trunk control, transition movements, and upper limb functions are worked on according to the child's motor level. Hydrotherapy: Thanks to the buoyancy of water, muscle strengthening and range of motion exercises can be performed with less effort. Contracture Prevention: Regular stretching programmes and appropriate positioning techniques prevent joint stiffness. Orthotics and Assistive Technology: Spinal orthoses for scoliosis management, ankle-foot orthoses, power wheelchairs, and communication devices are provided. Nutritional Support: Dysphagia management and adequate calorie/nutrient intake are monitored in collaboration with the dietician. Multidisciplinary Approach SMA management requires a comprehensive team including physiotherapist, pulmonologist, cardiologist, dietician, speech-language therapist, and orthopaedic surgeon. At ROMMER, a treatment plan tailored to the family's needs and the child's current goals is prepared together and regularly updated.
Brachial Plexus Injury
What Is Brachial Plexus Injury? The brachial plexus is a network of nerves that originates from the spinal cord at the level of the neck and controls movement and sensation in the shoulder, arm, and hand. Brachial plexus injury is a condition in which these nerves are stretched, torn, or compressed, usually due to birth trauma or accidents, resulting in partial or complete loss of function in the arm. In children, it most commonly occurs during difficult deliveries (shoulder dystocia, forceps or vacuum-assisted delivery). Types of Brachial Plexus Injury Erb's Palsy (Upper Trunk - C5-C6): The most common type; shoulder and elbow movements are primarily affected. The arm hangs by the side, rotated inward (waiter's tip position). Klumpke's Palsy (Lower Trunk - C8-T1): Wrist and finger movements are affected; hand grip is weak. Total Plexus Injury: The entire arm is affected; all movement and sensation is lost. Rehabilitation at ROMMER Brachial plexus rehabilitation in children must be started as early as possible — ideally within the first weeks of life. At ROMMER, treatment is planned according to the type and severity of the injury: Range of Motion Exercises: Passive and active-assisted movements are applied daily to prevent contracture of the shoulder, elbow, wrist, and fingers. Neuromuscular Electrical Stimulation (NMES): Electrical impulses are used to stimulate recovering nerve-muscle connections and prevent muscle atrophy. Constraint-Induced Movement Therapy (CIMT): The healthy arm is temporarily restrained so the affected arm is actively used, increasing its functional capacity. Sensory Stimulation: Tactile stimulation programmes such as massage, brushing, and various textures are used to support sensory recovery. Developmental Support: Developmental guidance and family training are provided to ensure the infant reaches motor milestones appropriate for age. Surgical Planning: In cases not responding to conservative treatment, nerve repair or muscle-tendon transfer surgery is planned in collaboration with the neurosurgeon and paediatric orthopaedist. Long-Term Prognosis Early-diagnosed and intensively treated cases have a good prognosis; the majority of children with Erb's palsy show significant functional recovery within the first year of life. In more severe injuries, long-term rehabilitation and sometimes surgical support may be needed. At ROMMER, periodic evaluations track the child's progress and the programme is updated accordingly.
Spina Bifida
What Is Spina Bifida? Spina bifida is a neural tube defect that occurs when the spinal column does not close completely during fetal development, leaving part of the spinal cord exposed or incompletely protected. It ranges from a minor bony defect (spina bifida occulta) to a sac protruding through the back containing spinal cord tissue (myelomeningocele). The severity of symptoms depends on the level of the defect and the extent of nerve involvement. Types of Spina Bifida Spina Bifida Occulta: A small gap in the vertebrae with no visible opening; the spinal cord is usually unaffected. Often discovered incidentally. Meningocele: The protective membranes (meninges) protrude through the gap, but the spinal cord itself is not displaced. Neurological symptoms are generally mild. Myelomeningocele: The most severe form; both the meninges and part of the spinal cord protrude. Results in varying degrees of paralysis, sensory loss, and bladder/bowel dysfunction below the level of the defect. Rehabilitation at ROMMER Children with spina bifida (especially myelomeningocele) require lifelong interdisciplinary management. At ROMMER, the rehabilitation programme is tailored to the child's neurological level and functional goals: Mobility Training: Depending on the lesion level, children are supported to achieve the highest possible mobility — standing, walking with orthotics/crutches, or independent wheelchair use. Orthotic Management: Ankle-foot orthoses, knee-ankle-foot orthoses (KAFO), or hip-knee-ankle-foot orthoses (HKAFO) are prescribed and monitored. Neurogenic Bladder and Bowel Programme: Clean intermittent catheterisation (CIC) training, bladder management, and bowel routines are established in collaboration with urology and gastroenterology. Prevention of Secondary Complications: Pressure ulcer prevention, scoliosis monitoring, and hip surveillance are integral parts of the programme. Cognitive and Learning Support: Many children with spina bifida have associated hydrocephalus; educational support and neuropsychological assessment are coordinated. Family and Caregiver Training: Parents receive comprehensive training in positioning, catheterisation, skin care, and home exercise programmes. Long-Term Management Spina bifida is a lifelong condition, but with appropriate rehabilitation, many children achieve meaningful functional independence. At ROMMER, goals are regularly reassessed as the child grows, and the programme is updated to meet changing developmental and functional needs.
Hydrocephalus
What Is Hydrocephalus? Hydrocephalus is a condition in which cerebrospinal fluid (CSF) accumulates excessively in the cavities (ventricles) of the brain, increasing pressure within the skull. This pressure can damage brain tissue and impair neurological development. In children, it may be congenital (present at birth, often associated with spina bifida or brain malformations) or acquired (following infection, haemorrhage, or tumour). Symptoms In infants, the most characteristic sign is rapid increase in head circumference. Other symptoms include a bulging fontanelle, downward deviation of the eyes ("sunset sign"), irritability, vomiting, and feeding difficulties. In older children, headache, visual disturbances, nausea, and cognitive changes are more prominent. Treatment and the Role of Rehabilitation The primary treatment is surgical — either ventriculoperitoneal (VP) shunting to drain excess CSF, or endoscopic third ventriculostomy (ETV) to create an alternative drainage pathway. However, surgery addresses fluid accumulation; rehabilitation is essential to manage the neurological effects and support developmental outcomes: Developmental Physiotherapy: Motor milestones — head control, rolling, sitting, standing, walking — are supported through targeted exercise and handling techniques according to the child's developmental level. Cognitive Rehabilitation: Attention, memory, visual-perceptual, and executive function difficulties are addressed with structured cognitive exercises and educational strategies. Speech and Language Therapy: Language development, articulation, and communication skills are monitored and treated from early age. Occupational Therapy: Fine motor skills, hand function, and school-related tasks (writing, cutting) are worked on to support academic participation. Visual Rehabilitation: Children with hydrocephalus frequently have strabismus and visual field deficits; collaboration with ophthalmology is maintained. Family Training: Parents are educated about shunt malfunction warning signs, positioning, stimulation activities, and home exercise programmes. Long-Term Follow-Up Children with hydrocephalus require lifelong monitoring for shunt function, neurological status, and developmental progress. At ROMMER, each child's programme is updated as they grow to address evolving educational, social, and functional needs.
Torticollis
What Is Torticollis? Torticollis (wry neck) is a condition characterised by abnormal tilting and rotation of the head due to shortening or excessive contraction of the sternocleidomastoid (SCM) muscle on one side of the neck. In children, the most common form is congenital muscular torticollis (CMT), which is usually detected in the first weeks or months of life. It may be associated with difficult deliveries, vacuum or forceps use, or intrauterine positioning. Symptoms Head tilt to one side (towards the shortened SCM) Chin rotated towards the opposite shoulder A palpable firm lump (fibrotic mass) in the SCM muscle in newborns Asymmetric facial development (plagiocephaly) if left untreated Restriction in neck range of motion Treatment at ROMMER With early diagnosis and appropriate physiotherapy, the vast majority of children with congenital muscular torticollis achieve full recovery without surgery. At ROMMER: Stretching Exercises: Passive and active-assisted cervical stretching exercises are performed to lengthen the shortened SCM and restore neck range of motion. Parents are trained to continue these exercises at home. Strengthening Exercises: Neck muscles on the affected side are gradually strengthened to achieve symmetrical head control. Positioning and Handling: Parents are educated on positioning during feeding, carrying, and play to encourage the baby to use the full range of neck movement. Tummy Time Programme: Supervised prone positioning promotes head righting and neck strengthening. Plagiocephaly Management: If positional head flattening is present, repositioning strategies and — when indicated — helmet therapy are discussed. Botulinum Toxin: In resistant cases with significant muscle tightness, targeted Botox injection to the SCM can facilitate stretching and improve treatment response. When Is Surgery Considered? Surgical lengthening (SCM release) is considered only in cases that do not respond to conservative treatment by around 12–18 months of age, or in older children with significant residual limitation. At ROMMER, post-surgical rehabilitation is carefully planned to consolidate the gains from surgery.
Muscular Dystrophy
What Is Muscular Dystrophy? Muscular dystrophy (MD) refers to a group of inherited genetic disorders characterised by progressive weakening and degeneration of the muscles that control movement. The most common and severe form in children is Duchenne Muscular Dystrophy (DMD), caused by a mutation in the dystrophin gene on the X chromosome, affecting almost exclusively boys. Other forms include Becker MD, limb-girdle MD, facioscapulohumeral MD (FSHD), and congenital MD. Symptoms and Disease Progression In DMD, early symptoms — waddling gait, difficulty climbing stairs, frequent falls, and calf pseudohypertrophy — typically appear between ages 3–5. The ability to walk is usually lost between ages 9–12 without treatment. Respiratory muscle weakness and cardiomyopathy become significant in the later stages. New disease-modifying treatments (exon-skipping therapies, corticosteroids) are slowing this progression. Rehabilitation at ROMMER Rehabilitation in muscular dystrophy is not about curing the disease — it is about preserving function for as long as possible, preventing complications, and maintaining quality of life at every stage: Ambulatory Phase: Stretching and strengthening exercises to delay contracture formation and prolong walking ability. Gentle aerobic activities (swimming, cycling) maintain cardiovascular fitness without overloading weakened muscles. Transition to Wheelchair: Power wheelchair prescription, seating and posture optimisation, and upper limb function training to maintain independence. Respiratory Physiotherapy: Breathing exercises, assisted cough techniques (manual, mechanical insufflation-exsufflation), and secretion clearance to protect respiratory capacity. Non-invasive ventilation (NIV) support when indicated. Contracture and Scoliosis Management: Regular stretching, night splinting, and spinal orthoses to slow progression. Surgical scoliosis correction is planned when indicated in collaboration with spinal surgery. Cardiac Rehabilitation: Monitored low-intensity exercise programme to support cardiac function, in coordination with cardiology. Occupational Therapy: Adaptive equipment, home modifications, and assistive technology to support participation in education and daily life. Psychosocial Support Living with a progressive condition profoundly affects children and families. At ROMMER, psychological support, peer connection, and family counselling are integral parts of the care plan — not add-ons.
Birth Trauma-Related Neurological Conditions
What Is Neurological Birth Trauma? Neurological birth trauma refers to damage to the brain or nervous system that occurs during the birth process. It may result from oxygen deprivation (hypoxic-ischaemic encephalopathy — HIE), mechanical injury (intracranial haemorrhage, skull fracture, nerve injuries), or infections around the time of birth. The severity and type of neurological consequences depend on the timing, duration, and extent of the injury. Common Forms Hypoxic-Ischaemic Encephalopathy (HIE): Brain injury from lack of oxygen during or around birth. Severity ranges from mild (full recovery likely) to severe (risk of cerebral palsy, epilepsy, cognitive impairment). Intracranial Haemorrhage: Bleeding within or around the brain, most common in premature infants. May lead to hydrocephalus, periventricular leukomalacia, or motor deficits. Brachial Plexus Injury: Nerve injury from shoulder dystocia causing weakness or paralysis in the arm (Erb's palsy, Klumpke's palsy). Facial Nerve Injury: Compression of the facial nerve during forceps delivery causing temporary or persistent facial weakness. Rehabilitation at ROMMER Following neurological birth trauma, rehabilitation is initiated as early as possible to harness the brain's plasticity during the most critical window for recovery: Neurodevelopmental Therapy (NDT/Bobath): Normalises abnormal tone and movement patterns; supports age-appropriate motor milestone development. Sensory Integration Therapy: Addresses difficulties in processing tactile, proprioceptive, and vestibular input that commonly accompany birth-related brain injury. Feeding and Swallowing Therapy: Oral motor difficulties and dysphagia are common in neonates after HIE; early intervention by a speech-language therapist is essential. Visual Stimulation Programme: Cortical visual impairment (CVI) is frequent after perinatal brain injury; structured visual stimulation promotes cortical visual development. Cognitive and Communication Development: Language, attention, and early communication skills are monitored and supported from the earliest months. Family Support and Education: Parents are trained in handling, positioning, stimulation activities, and signs that require medical review. Prognosis and Long-Term Follow-Up The outcome after neurological birth trauma varies widely. Mild HIE typically resolves with minimal lasting effects. Severe cases may result in cerebral palsy, epilepsy, or developmental delay requiring long-term interdisciplinary management. At ROMMER, children are followed longitudinally, with the programme adapted at each stage of development.
Mental Motor Developmental Delay
What Is Intellectual and Motor Developmental Delay? Developmental delay refers to a child not reaching motor, cognitive, language, or social milestones at the expected ages. When both motor and intellectual development are affected together, the delay is often related to an underlying neurological, genetic, or metabolic cause. Common associated conditions include Down syndrome, chromosomal abnormalities, foetal alcohol syndrome, congenital infections, and perinatal brain injury. Signs of Developmental Delay Not holding head steady by 4 months Not sitting without support by 9 months Not walking independently by 18 months Limited or absent babbling / first words by 12–18 months Poor eye contact or social engagement Hypotonia (low muscle tone) — floppy appearance Difficulty with age-appropriate play and problem-solving Rehabilitation at ROMMER At ROMMER, developmental delay is approached with a comprehensive, family-centred programme tailored to the child's unique profile of strengths and challenges: Physiotherapy: Targeted exercises to develop motor milestones — head control, rolling, sitting, crawling, standing, and walking. Muscle tone normalisation and balance training are core components. Occupational Therapy: Fine motor skills, hand-eye coordination, self-care activities (feeding, dressing), and sensory processing are addressed to support functional independence. Speech and Language Therapy: Communication development, language comprehension and expression, and feeding/swallowing difficulties are evaluated and treated from early age. Cognitive Stimulation: Structured play, problem-solving activities, and learning strategies are incorporated to support cognitive development. Sensory Integration: Many children with developmental delay have difficulties processing sensory information; targeted sensory activities reduce distress and improve engagement. Family Coaching: Parents and caregivers are equipped with strategies to support development at home — creating enriched environments, daily routine activities, and responsive interaction techniques. Early Intervention Is Key The earlier intervention begins, the greater the benefit — the developing brain is most responsive to targeted stimulation in the first 3 years of life. At ROMMER, even when an underlying diagnosis is not yet established, early developmental therapy is initiated and adjusted as the child's profile becomes clearer.
Metabolic Muscle and Skeletal Disorders
What Are Metabolic Musculoskeletal Disorders in Children? Metabolic musculoskeletal disorders in children encompass a range of conditions in which abnormal metabolic processes affect the development, strength, or integrity of bones, muscles, and connective tissue. These include rickets (vitamin D deficiency), osteogenesis imperfecta (brittle bone disease), juvenile osteoporosis, hypophosphataemia, and various inborn errors of metabolism that affect the musculoskeletal system. Children may present with bone pain, fractures, deformities, muscle weakness, and reduced exercise tolerance. Common Conditions Rickets: Softening and weakening of bones due to vitamin D, calcium, or phosphate deficiency. Causes bowing of legs, widening of wrists, and delayed walking. Osteogenesis Imperfecta (OI): Genetic disorder causing fragile bones that fracture with minimal trauma. Ranges from mild (a few fractures in childhood) to severe (multiple fractures and significant deformity). Juvenile Osteoporosis: Reduced bone density in children, often secondary to prolonged immobility, steroid use, or chronic illness. Increases fracture risk. Metabolic Myopathies: Inherited enzyme deficiencies (e.g., glycogen storage diseases, mitochondrial myopathies) causing muscle weakness, exercise intolerance, and fatigue. Rehabilitation at ROMMER Rehabilitation in metabolic musculoskeletal conditions must be carefully calibrated to protect fragile tissues while still building strength and function: Safe Exercise Programme: Low-impact, joint-protective exercises — aquatic therapy, gentle resistance training, and proprioceptive exercises — are prescribed to build bone density and muscle strength without fracture risk. Posture and Alignment: Postural assessment and correction, orthotic support, and adaptive seating address spinal and lower limb deformities. Fracture Rehabilitation: After fractures (particularly in OI), careful rehabilitation planning ensures recovery of function and prevention of further injury. Mobility and Independence: Assistive devices, adapted sports, and activity modification support participation in daily life and school activities. Nutritional Collaboration: Close collaboration with dietetics and endocrinology ensures that calcium, vitamin D, and other metabolic needs are optimised alongside physical rehabilitation. Family Education: Safe handling techniques, fall prevention strategies, and activity guidelines are provided to families to manage risk at home and in community settings. Interdisciplinary Management Metabolic musculoskeletal disorders require coordination between paediatric rehabilitation, endocrinology, orthopaedics, dietetics, and genetics. At ROMMER, the rehabilitation programme is embedded within this wider care team to ensure that physical therapy supports and is supported by the medical management plan.
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