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The loving mother teaches her child to walk alone. She is far enough from him so that she cannot actually support him, but she holds out her arms to him. She imitates his movements, and if he totters, she swiftly bends as if to seize him, so that the child might believe that he is not walking alone. … And yet, she does more. Her face beckons like a reward, an encouragement. Thus, the child walks alone with his eyes fixed on his mother’s face, not on the difficulties in his way. He supports himself by the arms that do not hold him and constantly strives towards the refuge in his mother’s embrace, little suspecting that in the very same moment that he is emphasizing his need of her, he is proving that he can do without her, because he is walking alone.

—KIERKEGAARD, 1846

Introduction

Little did Kierkegaard realize over a century and a half ago that he was describing not only the responsibilities of a mother to nurture her child and then allow the child to go alone but also the role of the physical therapist in serving children. The therapist’s responsibility is to provide support, guidance, and specific interventions and also to prepare the child and family for the time when our services are no longer needed. Competent therapists work themselves out of a job. This is not to say that all children achieve their desired goals and objectives, but rather that therapists help the children to achieve their greatest potential and then recognize when they can no longer contribute to the advancement of the child’s goals and objectives. It is often difficult for therapists to discharge a child from services, especially when the child has not achieved the desired goals, just as it is sometimes difficult for a mother to let her new walker walk alone, or her teenager drive the family car. The therapist’s direct role is episodic, with services provided at different times over many years with different objectives.

Throughout this text the role of the physical therapist in meeting the physical therapy needs of children and their families in a culturally appropriate context will be described. Each body system will be discussed in terms of examination, evaluation, diagnosis, prognosis, and intervention for children with a wide range of diagnoses, impairments in body structure and function, limitations in activities, and restrictions in participation in the community. In some areas there is evidence to guide clinical decision-making related to the frequency, intensity, and specifics of interventions; however, more commonly there is limited empirical support, and therapists must rely on experience, professional judgment, and consensus decision-making to inform their clinical reasoning.

This chapter covers a number of diverse topics that set the stage for meeting the physical therapy needs of children and their families. A brief history of pediatric physical therapy is provided so that the reader can understand ...

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