Typical development gives a child opportunities to move in many different ways, they develop lots of different combinations of movement, which is the basis to future progression.

Variety is present from utero and continues as an infant develops.Ĭhildren who have developed typically have many combinations of movement.īabies love to explore with sounds they make, their movement and their interaction. Studies looking at baby’s general movements born term and pre-term, describe that a typical baby is born with a variety of movement in their trunk, arms and legs (2). We know that typical development starts with a baby moving inside the mother’s womb.

Typical development is the exploration of movement, movement for movement sake. So, children learn to move by exploration, they move and something happens, they repeat the movement, “….it feels different to move my leg that way”, “….o oh…I’m falling….…,I’m closer to that toy now – a ha!!”, “what happens if I try that again?”. To understand why children with a brain injury, for example a child with Cerebral Palsy, benefits from a “hands-on” therapy approach, it is helpful to understand a bit more about typical development.

So, when does a child benefit from “hands-on” therapy? Parents can be given advice on activities to encourage the child to move in different ways, to improve confidence and balance and off the child goes! You will see quick improvement when this is the case. They may have been a child who was not so motor driven, or a child with less opportunities to develop those skills. It supports learning new skills by way of repetition and practice.Īnother example is a child who is delayed walking, and examination reveals good quality of movement, a good repertoire and variety of movements, demonstrating the building blocks for continued typical development – there are no concerns around this being a neurological difficulty. Typical development relates to a typical brain that enables us to move in a co-ordinated and effortless way. They are also likely to be able to understand and follow instructions. They can maintain their sitting or standing position whilst isolating movement in their limb. Intact sensory pathways are present, so they know where the limb is in space and they know where it is in relation to their body, their balance, visual and auditory feedback all provide information to support each other to build an overall understanding of their experience. The child will have access to a wide variety of movements that have already been established. There may be weakness, but essentially the brain has already developed ways of moving which are not affected – the child has a typical brain. For example, a child with a fracture or sprain – there is a localised injury in one area of the body. For me, this is when the condition is simple and it is easy for the child and parent to follow the instructed programme of exercises. There are many examples of where hands-off therapy is absolutely indicated. Hands-off therapy, is typically review appointments with advice to parents on activities they can encourage their child to do. Hands-on physiotherapy is a treatment session where the therapists handling helps guide the child’s movements in order to encourage and assist the child to move in new ways. Well, in the context of Children’s Physiotherapy a simple explanation of hands-off, is where the predominant input is through review appointments and provision of a programme of exercises for parents to do with their child, or where a therapist provides activities where the child can practice a functional activity. So, what do we mean by “Hands-on vs Hands-off”

They summarise that a combination of hands on, and hands off therapy is best – sounds sensible! Gwendoline Jul and Ann Moore wrote about this in the context of musculoskeletal physiotherapy in 2012 (1) and referred to the changes being related to socioeconomic factors, societal needs and desires (what do we want), as well as an increase in knowledge and evidence base.

I have worked as a Children’s Physiotherapist in many different settings, in specialist children’s hospitals, smaller general hospitals, in the community and now as an Independent Physiotherapist and have seen trends come and go, as they do in all areas of business, fashion and life.

Hands on vs hands off parenting