Therapeutic Exercise
The exercise program should be developed in relation to the assessment of the child, the identified long- and short-term goals, and the functional abilities of the child.
Upgrade the difficulty of the program to progress the child to greater achievement in strength, endurance, and coordination.
Active movement and much repetition are needed for a child to "learn" a movement.
Avoid prolonged holding in static positions during treatment (smoothly graded transitions in movement with brief holding of midline or neutral alignment is more desirable)

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..............Imposed weight shifts and transitions in move*ment should be varied, both in speed and range, so that the child cannot anticipate rhythmic displacements.
Weight shifts and transitions in movement must be practiced in different positions for improved function.
Focus on:
Strength.
Endurance.
Balance and coordination.
Dissociation (break of mass movement).
Use of external support
Address the sensory problems
Address musculoskeletal changes.

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...........To increase strength:
Progress the movement from a gravity-eliminated movement to one that is working against gravity,
Alter the amount of assistance given by the therapist so that the child has to use greater force and control.
Specific resistance exercise for targeted area
To improve endurance:
Increasing the number of repetitions of a movement
Lengthening the time of exercise.
...............Dissociation:
Focus on dissociation of one limb from the opposite limb and limbs from body.
Emphasis should be placed on achieving greater differentiation of the joints within a limb as well.

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...............Use of external support:
E.g., therapist's hands or a piece of equipment
Can be used to provide initial support to inhibit excessive stiffness, maintain alignment, initiate a weight shift, support a movement, or aid smooth transitions of movement.
Should be altered intermittently at first to provide the child with an opportunity to practice the movement independently.
Move the support from a proximal point (trunk, shoulder, or pelvis) to a more distal point along the limb → child will assume a greater degree of control over the movement at the unsupported joints.

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Examples of Activities in Therapeutic Session
Child side-lying, head supported on small pillow or towel; therapist's hands on child's abdominal muscles; lower extremities dissociated or symmetrically flexed; toy placed in front of child at chest level

Maintains head in line with trunk; sensory input to abdominal muscles; will encourage downward gaze, flexion of neck, and shoulder flexion in gravity-eliminated position; will provide a midline orientation of the body

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From side-lying, backward weight shift into supine with buttocks maintained elevated off the support with hips and knees flexed; lower extremities just outside lateral dimensions of trunk


Activation of axial flexors and antigravity movement of upper extremities; elongation of axial and hip extensors.

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Some book might be of help!

REQUIRED AND RECOMMENDED TEXTBOOKS AND READINGS:
• Campbell, S., Vander Linden, D.W., Palisano, R.J. (2005) Physical Therapy for children. Third edition, W .B. Saunders Company, Philadelphia.
• Campbell, S . (1999) Decision Making in Pediatric Neurological Physical Therapy. Churchill Livingstone, New York.
• Tecklin, J. (2007) Pediatric Physical Therapy. Fourth edition, Lippincott Williams