Pediatric and Geriatric Physiotherapy
What is tested
Age-specific norms and adaptations: developmental milestones and paediatric conditions on one side, physiological ageing, falls and frailty on the other.
Core rules
- Milestones. Head control around 3 months, rolling 4–6 months, sitting 6–8 months, crawling 8–9 months, pulling to stand 9–10 months, walking 12–15 months, two-word phrases 18–24 months. Use corrected age for preterm infants until about 2 years.
- Primitive reflexes. Moro, ATNR, palmar grasp and rooting should integrate by 4–6 months; persistence suggests neurological involvement.
- Cerebral palsy. GMFCS I–V describes gross motor function, not cognition; spastic diplegia is common in children born preterm.
- Down syndrome. Hypotonia and joint laxity; screen for atlantoaxial instability and avoid deep neck flexion and collision sport until cleared.
- Erb's palsy. C5–C6, "waiter's tip" posture; support the shoulder and avoid forced early elevation.
- Ageing. Sarcopenia, reduced vestibular and proprioceptive acuity, lower maximum heart rate, polypharmacy (sedatives increase falls), osteoporosis.
- Falls. Multifactorial: strength, balance, vision, footwear, home hazards, medication. Berg Balance Scale below 45 and TUG over 12 seconds flag risk.
Worked example
A 78-year-old reports two falls in 6 months, takes a benzodiazepine and an antihypertensive, and has a TUG of 16 seconds. Reasoning: this is not "just ageing". Assess strength, balance, gait, vision, feet, cognition, continence and the home environment, and request a medication review. Prescribe progressive balance and strength training three times weekly plus a home-hazard check, and document the falls risk and actions taken.
Traps
Treating children as small adults (different proportions, open growth plates, play-based dosing); over-protecting a child with cerebral palsy so practice is prevented; attributing falls to age alone; ignoring cognitive impairment when setting goals.