Lin Arthur, Physiotherapist

My life is filled with love and laughter thanks to the amazing people I get to hang out with. As well as being awesome, they’re creative, talented, generous, and fun! I thought you might like to meet them so I’ve asked them to come and give us a behind-the-scenes look at what they’re passionate about. I have to warn you though – creativity is contagious!

My guest today is Lin Arthur, compassionate and caring pediatric physiotherapist! Lin’s dedication and extensive experience are invaluable to children and families coping with developmental disabilities.

smudge chalk girlsLin, how did you become interested in working with children in the field of physiotherapy? L: When I was a physiotherapy student, I did a summer internship at Sick Kids in Toronto on the neurosurgical unit. I loved working with the kids and part of that work included outpatient treatment for children diagnosed with cerebral palsy, spina bifida and muscular dystrophy. I really enjoyed that population and after graduation, decided to focus my career on treatment for children with developmental disabilities. Working with infants is my favourite!

I always find it so interesting how a placement or volunteer experience can influence what we choose to do. What does your work entail? L: Physiotherapy for children involves treatment of the child (birth to teens) as well as education and support for the family and/or other care providers. Although I chose to concentrate on developmental disabilities, physiotherapy for children is similar to that needed by adults with a little extra twist of family issues and growth and developmental milestones to consider. We look at the physical challenges – gross motor development, posture, balance, range of motion, muscle tone, respiratory status, cardiovascular status; a child’s progress relative to typical development and how any challenges might impact function. The family and I decide what our shared focus will be and create a pathway to achieve our goals. Perhaps an example would be helpful.

Ivy was sent to me at 5 months of age. There were concerns about her development. She was an irritable infant who was unable to do things a child of her age should do such as rolling over, sitting with support, getting her hands together to play with a toy, or propping on her arms from lying on her belly. She had trouble swallowing properly, was fussy, arched and frequently choked during feeding. Her mother was upset and very worried about how to nurture this little one.

I started my first session by playing with Ivy on her mother’s lap, building her and her mother’s trust in me. I watched how Ivy moved while chatting with her mom and playing with the baby. It was clear that Ivy lacked the robust quality, variety and fluidity of movement normally seen at 5 months. Babies are rarely still and Ivy was very limited in her spontaneous leg movement. Eventually, Ivy allowed me to touch her legs and as she cooperated, I checked her range of motion and muscle tone. There were limitations about her hips and ankles. Her muscle tone was high in her legs but not throughout her body. She also had difficulty holding her head up as she sat on her mom’s lap.

On her belly, she couldn’t raise her head or get her hands underneath to help her move. On her back, she couldn’t kick her legs off the supporting surface and didn’t explore her body as 5 month olds do – finding their bellies, touching their hands and mouths, reaching for their hips and knees. She had difficulty reaching for a toy. Without a strong core to stabilize her, Ivy couldn’t demonstrate age-appropriate gross motor skills.

Her mom and I talked about what was most important to her. The number one concern was for Ivy to take her feeds easily and effectively, so that became our focus.

In order to swallow, the head and neck must be properly aligned. In babies who have weak cores, it’s common for them to compensate: raise the shoulder girdles, extend the neck and rest the head on the raised shoulders. It is very difficult to swallow with the neck in an extended position as the airway is opened and children choke easily. No wonder Ivy was irritable, arched away from her mother and fed poorly! We used a variety of different ways to position Ivy, support her head in better alignment and found some options that worked for her mom while she fed her.

I remained concerned about the tightness in Ivy’s legs and feet so I taught her mom different ways to hold Ivy, move her joints, and position Ivy so that we could increase her range of motion and improve her mobility. To give her mom some alternatives, we used a variety of adapted equipment. By improving her alignment and giving her support, it decreased the tone in her legs and activated her trunk muscles. She could hold her head up and she could play with less frustration. Ivy was a happier baby!

Her mom had some great questions about appropriate toys. We decided to involve Early Intervention home educators now that we had equipment and strategies in place to help with Ivy’s play time. The home teachers are a wonderful community resource for children who have identified delays. They are experts in the development of play, have positioning equipment to lend and have a toy lending library. The teachers make regular home visits and upgrade equipment and toys as needed at no cost to families.

As Ivy grew, I continued my involvement and adapted her treatment to her and the family’s needs. Ivy progressed though development slowly but eventually used a supportive walker, wore braces to align her feet and had a wheelchair for distance mobility.

In summary, physiotherapy for children requires a working knowledge of several systems: typical and atypical development, the musculoskeletal system, the neurological system, an understanding how children play at different ages and an empathetic understanding of basic parenting – dressing, feeding, cleaning and moving children. The best outcomes happen when therapists, collaborating with occupational therapists, speech therapists, dieticians, educators, and medical practitioners, support the family.

happy stick girlWow – so much to consider, especially when they can’t tell you what’s wrong. Do you have any advice for parents? L: Play is very important and should be a priority in the day. Fun is important. Make therapy fun. Let your baby play on his or her stomach. Crying is a part of baby’s communication with us and there are different cries that tell us what a child needs – hunger cry, tired cry, scared cry, pain cry and discomfort (cold, frustration etc). In my opinion, crying need not be a regular occurrence in good physiotherapy treatment. There are times when crying is unavoidable such as following surgery or during casting however, crying during regular therapy should be the exception and not the rule.

Play is good for adults too! (Hopefully no crying though) If someone is interested in a career in physiotherapy, what’s involved? L: PT is a post-graduate university degree in Canada and the U.S. at a Master’s or Doctorate level. The best idea is to contact the various schools and see what they require. The requirements can be quite different. In addition to academic requirements, most also require community service and first-hand experience with the field such as being a volunteer or being a recipient of therapy, in order to apply.

balloon-boyMake sure it’s what you thought it would be! You obviously have a tremendous passion for your work. What do you love most about it? L: I love that I have to use all of myself at work- my scientific brain as well as my creative-intuitive brain; my body because I am constantly moving or moving others; use my sense of humour and sense of play. A good pediatric therapist is able to put everything together with a song and a smile. Best of all, I got to laugh every day!

Art and science together J What would you pick as your superpower? L:I would want to be able to manipulate time and space. Wouldn’t it be cool to travel anywhere at any period in time? It’s a marvellous world to explore!

It is! Lin thank you so much for sharing your insight into the world of pediatric physiotherapy. It’s a fascinating field and I imagine with each patient you have to approach what you do and how you interact completely differently. That would make for an interesting variety! And you heard what she said, everyone, get out there and play!