Neuromotor Speciality Clinics
The Neuromotor Speciality Clinics include the following:
- Cerebral Palsy Clinic
- Feeding Clinic
- Neuromuscular Disease Clinic
- Orthotics Clinic
- Tone Management Clinic (Botox, 2D and 3D Gait Anaylsis, Kenisiotaping, Serial Casting & Orthopaedic Clinics)
Cerebral Palsy Clinic
This multidisciplinary clinic is to review children with Cerebral Palsy as they develop into adulthood
Chilren's skills are assessed by a team, on a regular basis (yearly or bi-yearly), in areas such as mobility, tone, self care, communication, coping, resources/equipment, nutrition and sexuality.
The SCCR team liaise with local therapists and school staff who carry out treatment programs and recommendations.
Children are referred for specific services following their clinic visit. This may include:
- spasticity management program,
- orthotics clinic,
- team intensive
Children who are new to the SCCR, with diagnoses Cerebral Palsy, are seen via the Cerebral Palsy Clinic.
Photo Caption: This CP patient works with Neuromotor Team physiotherapist.
The Feeding clinic consists of Speech Language Pathology, Dietetics, Occupational Therapy, Physiotherapy, Psychology and Social Work. Therapists are involved based on the needs of the child and family.
Who we help:
- Children (and their caregivers) with neuromotor and developmental diagnoses who have difficulty at mealtimes
- Local therapists who are looking for input
Difficulties could include:
- limited food choices (picky eater)
- chewing and swallowing problems
- dislike or avoidance of certain food textures
- anxiety at mealtimes and lack of interest in food
- trouble going from eating through a tube to eating by mouth
- poor nutrition
- poor awareness of food in the mouth
Neuromuscular Disease Clinic
The Neuromuscular Disease Clinic provides services and support to children and their families affected by a variety of neuromuscular disorders. We use a holistic and family-centered approach to care. Our goal is to help children and adolescents maximize their potential. We work together as a team to find effective and practical solutions to meet your child's needs.
We accept referrals from your family doctor or paediatrician.
Orthotics Clinic (on site and outreach)
What are they?
Orthotic leg braces are made with hard plastic materials, which fit around part of the lower leg and foot. Orthotics can be custom made by a certified orthotist or ordered prefabricated through a reputable company. At SCCR, a team of health care professionals, such as the physiotherapist, orthotist and physician will assess the child's needs for orthotics.
What are they used for?
Orthotics can be used to help a child who is already walking to walk better by improving the movement or position of the ankle and foot, or knee. For example, children who walk on their toes may come down on their heels when wearing orthotics. As well, children who drag their feet when they walk may be able to pick up their feet when wearing orthotics. They can also be used to improve the position of the feet for someone who is standing, sitting or walking with feet that are rolling inwards or outwards.
Tone Management Clinic
(Botox, 2&3D Gait Analysis, Kinesiotaping, Serial Casting, Orthopaedic Clinic)
What is it?
Botulinum Toxin is a nerve-impulse blocker, delivered by injection. By binding to nerve endings, it prevents signals that would normally allow a muscle to contract. BOTOX is usually used to prevent abnormal or increased muscle contraction.
By blocking the nerve impulse, it can lower or possibly eliminate the tightness in certain muscles, and increase function.
The injection tends to work within 72 hours to loosen the muscle and lasts for three to four months. The toxin is a very small amount of concentrate and this is diluted with normal saline (salt and water solution).
How is it done?
Prior to the procedure, a therapist (Physio or Occupational) will evaluate and videotape your child's motor function. They will also measure flexibility, strength and muscle tone. This will take 1.5 hours. For the injection procedure, you or another family member should be present with your child and the physician.
A local anesthetic cream may be applied 1 hour before injections. The procedure takes 10-20 minutes; each injection lasts only 5-10 seconds. The doctor cleans the skin with an alcohol swab. The medication is injected directly into the muscle with a small needle. Depending on the pattern of muscle tightness, several injections may be required.
For some children the injections can only be done under sedation meaning that a hospital or may need to be booked. This is decided case by case.
2 & 3D GAIT Analysis
What is it?
Clinical gait analysis is used in many forms in clinical practice by the physiotherapist, physiatrist and other practitioners involved in analysis of gait.
How is 2D GAIT Analysis done?
The most common form of gait analysis is observational gait analysis (OGA) which is usually performed in the clinic setting by observing the client walk in the sagittal (from the side) and/or coronal (frontal) planes.
Other instrumentation may be used along with this type of procedure including stop watches, videotape analysis (real time or slow motion) and foot markings.
It is well known that although this method is the most convenient for gait analysis, there are problems with both validity and reliability in the planes it is intended to measure. In other words, it is very difficult to track what the body is doing during such quick motion in a 2- dimensional field. Also, this type of analysis assumes that the walking motion is planar which is a false assumption.
How is 3D GAIT Analysis done?
3- dimensional gait analysis uses sophisticated technology to track motion, in this case walking, in order to carefully examine how the body segments move in space. Highly reflective markers are placed on the patient's skin at specific anatomical points over the patient's body.
Electromyography (EMG) markers may also be placed to measure muscle activity. The markers are not painful in any way. 8 infrared cameras are placed around the gait laboratory in order to pick up reflective signals from the skin markers, and in this way track movement. Force plates are imbedded in the floor in order to measure forces from the foot. This gives us further information on joint torque and power as the patient walks.
What is it?
Kinesio Tex® tape is a woven tape that stretches length-wise. It is made of cotton and does not require the use of an under wrap. Kinesio Tex® tape does NOT contain latex.
Why is it done?
The tape is used to assist a joint to hold a position, so an overstretched muscle is provided time to shorten. Overstretched muscles are at a disadvantage to work and therefore are often very weak. Once the muscle is given time to return closer to a typical length, it can be recruited for use more efficiently.
This type of taping is also used:
- to provide tactile input and increase proprioception or awareness of a muscle or joint. As sensory awareness increases, more attention is given to an area of the body, which increases use and in turn increases strength.
- to assist in the release of facial restrictions or to relax an overused muscle. This allows more optimal alignment and decreased pain in an area.
- to position a part of the body in better alignment and allow muscles to contract and work in a better position - as these muscles contract in daily activities, they gain strength and control.
- to decrease swelling, edema and bruising - this will allow for more rapid healing and decreased pain.
Photo Caption: A child's left arm is taped using Kinesiotape.
What is it?
Children who have lost joint movement may be treated by using plaster or fiberglass casts to apply a slow stretch to the muscles and soft tissues around this joint. The casts are typically worn for 3 to 5 days and then removed. The following casts incorporate whatever gain in movement that has been achieved by the previous cast. Most children require 3 to 4 casts in a series, which may take several weeks.
Why is it done?
Serial casts are used to
help decrease muscle
tightness and allow for better function and movement of a joint. It is the next step to use if stretching routines have not been effective for the child. Serial casts are often used after a growth spurt.
How is it done?
Serial casts are usually done with a child sitting on an examination table, or lying on their stomach. The body part being casted will be wrapped in padding and cotton layers before applying the cast material. The therapist will hold the desired position of the body part until the cast is set. In the case of a foot cast, the therapist will finish the cast by applying a heel. Usually, children are asked not to walk on the cast until it has set unless using rigid fiberglass. This is stronger material than a standard plaster cast and allows the child to weight-bare sooner.
Photo Caption: Paediatric physiotherapist casts a patient.
Orthopaedic Clinic (on site)
The Orthopaedic Clinic is a multidisciplinary clinic, in partnership with the orthopaedic department at the IWK in Halifax, Nova Scotia. Children are assessed by SCCR clinicians, physiatrists and by visiting an IWK orthopaedic surgeon.
Clinics are run multiple times throughout the year at the SCCR. Children may be referred to the Orthopaedic Clinic by SCCR physiatry.