,
, PEDIATRIC
PHYSICAL THERAPY
F IF T H E D I T I O N
,
, PEDIATRIC
PHYSICAL THERAPY
F IF TH E D ITIO N
Jan Stephen Tecklin, PT, MS
Professor
Department of Physical Therapy
Arcadia University
Glenside, Pennsylvania
,Sr. Acquisitions Editor: Emily Lupash
Product Development Editor: John Larkin
Production Project Manager: Marian A. Bellus
Marketing Manager: Leah Thomson
Manufacturing Manager: Margie Orzech
Designer: Stephen Druding
Compositor: S4Carlisle Publishing Services
Fifth Edition
Copyright © 2015, 2008, 1999 Lippincott Williams & Wilkins, a Wolters Kluwer business
351 West Camden Street Two Commerce Square
Baltimore, MD 21201 2001 Market Street
Philadelphia, PA 19103
Printed in China
NOTICE TO READER: This publication contains information relating to general principles of medical
care that should not be construed as specific instructions for individual patients. Manufacturers’
product information and package inserts should be reviewed for current information, including
contraindications, dosages, and precautions. It remains the responsibility of the practitioner to evaluate
the appropriateness of a particular opinion or therapy in the context of the actual clinical situation and
with due consideration of any new developments in the field and current drug information.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from
the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103,
via email at , or via website at lww.com (products and services).
987654321
Library of Congress Cataloging-in-Publication Data
Pediatric physical therapy / [edited by] Jan S. Tecklin. — Fifth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-7345-1 (hardback)
I. Tecklin, Jan Stephen, editor of compilation.
[DNLM: 1. Physical Therapy Modalities. 2. Child. 3. Infant. WB 460]
RJ53.P5
615.8’20832—dc23
2013041121
Disclaimer
Care has been taken to confirm the accuracy of the information present and to describe generally
accepted practices. However, the authors, editors, and publisher are not responsible for errors or
omissions or for any consequences from application of the information in this book and make no
warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents
of the publication. Application of this information in a particular situation remains the professional
responsibility of the practitioner; the clinical treatments described and recommended may not be
considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accordance with the current recommendations and practice at the
time of publication. However, in view of ongoing research, changes in government regulations, and
the constant flow of information relating to drug therapy and drug reactions, the reader is urged
to check the package insert for each drug for any change in indications and dosage and for added
warnings and precautions. This is particularly important when the recommended agent is a new or
infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration
(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care
provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at (800) 638-3030 or
fax orders to (301) 223-2320. International customers should call (301) 223-2300.
Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams
& Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST.
, With deep love, affection, respect and thanks to my
wife who has loved and supported me through almost fifty years of our lives
I love you Randee Lynn
and
in memory of my dear friend
Stephen Schecter
,
, CONTRIBUTORS
Heather Atkinson, PT, DPT, NCS Michael DiIenno, PT, DPT, CSCS
Clinical Specialist Site Manager
Physical Therapy Department The Children’s Hospital of Philadelphia
Children’s Hospital of Philadelphia Care Network, Primary Care
Philadelphia, Pennsylvania Nicholas and Athena Karabots Pediatric Care Center
Philadelphia, Pennsylvania
Emilie J. Aubert, PT, DPT, MA
Associate Professor Jean M. Flickinger, MPT, PCS
Department of Physical Therapy Clinical Specialist
Marquette University Physical Therapy Department
Milwaukee, Wisconsin Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Jason Beaman, MPT, PCS
Staff Physical Therapist Rita F. Geddes, PT, MEd, DPT
Therapeutic and Rehabilitative Services Bucks County Intermediate Unit #22
Nemours/duPont Hospital for Children Doylestown, Pennsylvania
Wilmington, Delaware
Alan M. Glanzman, PT, DPT, PCS, ATP
Dolores B. Bertoti, PT, MS, PCS Clinical Specialist
Dean of Center for Academic Advancement Physical Therapy Department
Associate Professor The Children’s Hospital of Philadelphia
Alvernia College Philadelphia, Pennsylvania
Reading, Pennsylvania
Elliot M. Greenberg, PT, DPT, OCS, CSCS
Anjana Bhat, PT, PhD Board Certified Specialist in Orthopaedic
Assistant Professor in Kinesiology Physical Therapy
Physical Therapy Program Sports Medicine & Performance Center
University of Connecticut The Children’s Hospital of Philadelphia
Storrs, Connecticut Care Network
Pediatric & Adolescent Specialty Care, King
Amy Both, PT, MHS, ACCE of Prussia East
Assistant Professor and ACCE Philadelphia, Pennsylvania
Department of Physical Therapy
Health Science Campus Eric T. Greenberg, PT, DPT, SCS, CSCS
University of Toledo Board Certified Specialist in Sports Physical Therapy
Toledo, Ohio Clinical Assistant Professor
Doctorate of Physical Therapy Program
Deborah Bubela, PT, PhD Stony Brook University
Assistant Professor in Residence in Kinesiology Stony Brook, New York
Physical Therapy Program
University of Connecticut Heather Hanson, PT, DPT, PCS
Storrs, Connecticut Physical Therapist III
The Children’s Hospital of Philadelphia
Kathy Coultes, MSPT, PCS Philadelphia, PA
Pediatric Clinical Specialist in Physical Therapy Current position:
Coordinator of Mercy Kids 4 Fitness Program Physical Therapist
Mercy Fitzgerald Hospital Step by Step Developmental Services
Darby, Pennsylvania Rochester, New York
vii
, viii Contributors
Faithe R. Kalisperis, MPT, DPT, C/NDT Kathleen Miller-Skomorucha, OTR/L, C/NDT
Staff Therapist Staff Occupational Therapist
Therapeutic and Rehabilitative Services Therapeutic and Rehabilitative Services
Nemours/duPont Hospital for Children Nemours/duPont Hospital for Children
Wilmington, Delaware Wilmington, Delaware
Susan E. Klepper, PhD, PT
Mary B. Schreiner, EdD
Assistant Professor of Clinical Rehabilitation &
Chair of Education
Regeneration Medicine
Associate Professor
Columbia University, College of Physicians
Alvernia University
and Surgeons (CUMC)
Reading, Pennsylvania
Program in Physical Therapy
New York, New York
Elena McKeogh Spearing, MA, DPT, PCS
Rebecca Landa, CCC-SLP, PhD Contract Physical Therapist
Professor in Psychiatry Dynamic Physical Therapy Solutions, Inc
Johns Hopkins School of Medicine Former Physical Therapy Manager
Director, Hugo Moser Center for Autism and Related Disorders Children’s Hospital of Philadelphia
Kennedy Krieger Institute Philadelphia, Pennsylvania
Baltimore, Maryland
Elena Tappit-Emas, PT, MHS
Karen Yundt Lunnen, PT, EdD
Staff Therapist, School District of Philadelphia
Associate Professor and Head
Former Senior Therapist
Department of Physical Therapy
Myelomeningocele Clinic
Western Carolina University
Children’s Memorial Hospital, Chicago, Illinois
Cullowhee, North Carolina
Private practice, Philadelphia, Pennsylvania
Kirsten Hawkins Malerba, PT, DPT, PCS
Board Certified Specialist in Pediatric Physical Therapy Jan Stephen Tecklin, PT, MS
Department of Rehabilitation Services Professor
Children’s Healthcare of Atlanta Department of Physical Therapy
Atlanta, Georgia Arcadia University
Glenside, Pennsylvania
Victoria Gocha Marchese, PT, PhD
Assistant Professor
Diane Versaw-Barnes, PT, MS, PCS
Physical Therapy Department
Clinical Specialist-NICU
Lebanon Valley College
The Children’s Hospital of Philadelphia
Annville, Pennsylvania
Philadelphia, Pennsylvania
Suzanne F. Migliore, PT, DPT, MS, PCS
Clinical Practice Coordinator Audrey Wood, PT, MS
Physical Therapy Department OT/PT Clinical Specialist
The Children’s Hospital of Philadelphia Ken-Crest Services
Philadelphia, Pennsylvania Philadelphia, Pennsylvania
, PEDIATRIC
PHYSICAL THERAPY
F IF T H E D I T I O N
,
, PEDIATRIC
PHYSICAL THERAPY
F IF TH E D ITIO N
Jan Stephen Tecklin, PT, MS
Professor
Department of Physical Therapy
Arcadia University
Glenside, Pennsylvania
,Sr. Acquisitions Editor: Emily Lupash
Product Development Editor: John Larkin
Production Project Manager: Marian A. Bellus
Marketing Manager: Leah Thomson
Manufacturing Manager: Margie Orzech
Designer: Stephen Druding
Compositor: S4Carlisle Publishing Services
Fifth Edition
Copyright © 2015, 2008, 1999 Lippincott Williams & Wilkins, a Wolters Kluwer business
351 West Camden Street Two Commerce Square
Baltimore, MD 21201 2001 Market Street
Philadelphia, PA 19103
Printed in China
NOTICE TO READER: This publication contains information relating to general principles of medical
care that should not be construed as specific instructions for individual patients. Manufacturers’
product information and package inserts should be reviewed for current information, including
contraindications, dosages, and precautions. It remains the responsibility of the practitioner to evaluate
the appropriateness of a particular opinion or therapy in the context of the actual clinical situation and
with due consideration of any new developments in the field and current drug information.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from
the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103,
via email at , or via website at lww.com (products and services).
987654321
Library of Congress Cataloging-in-Publication Data
Pediatric physical therapy / [edited by] Jan S. Tecklin. — Fifth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-7345-1 (hardback)
I. Tecklin, Jan Stephen, editor of compilation.
[DNLM: 1. Physical Therapy Modalities. 2. Child. 3. Infant. WB 460]
RJ53.P5
615.8’20832—dc23
2013041121
Disclaimer
Care has been taken to confirm the accuracy of the information present and to describe generally
accepted practices. However, the authors, editors, and publisher are not responsible for errors or
omissions or for any consequences from application of the information in this book and make no
warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents
of the publication. Application of this information in a particular situation remains the professional
responsibility of the practitioner; the clinical treatments described and recommended may not be
considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accordance with the current recommendations and practice at the
time of publication. However, in view of ongoing research, changes in government regulations, and
the constant flow of information relating to drug therapy and drug reactions, the reader is urged
to check the package insert for each drug for any change in indications and dosage and for added
warnings and precautions. This is particularly important when the recommended agent is a new or
infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration
(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care
provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at (800) 638-3030 or
fax orders to (301) 223-2320. International customers should call (301) 223-2300.
Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams
& Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST.
, With deep love, affection, respect and thanks to my
wife who has loved and supported me through almost fifty years of our lives
I love you Randee Lynn
and
in memory of my dear friend
Stephen Schecter
,
, CONTRIBUTORS
Heather Atkinson, PT, DPT, NCS Michael DiIenno, PT, DPT, CSCS
Clinical Specialist Site Manager
Physical Therapy Department The Children’s Hospital of Philadelphia
Children’s Hospital of Philadelphia Care Network, Primary Care
Philadelphia, Pennsylvania Nicholas and Athena Karabots Pediatric Care Center
Philadelphia, Pennsylvania
Emilie J. Aubert, PT, DPT, MA
Associate Professor Jean M. Flickinger, MPT, PCS
Department of Physical Therapy Clinical Specialist
Marquette University Physical Therapy Department
Milwaukee, Wisconsin Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Jason Beaman, MPT, PCS
Staff Physical Therapist Rita F. Geddes, PT, MEd, DPT
Therapeutic and Rehabilitative Services Bucks County Intermediate Unit #22
Nemours/duPont Hospital for Children Doylestown, Pennsylvania
Wilmington, Delaware
Alan M. Glanzman, PT, DPT, PCS, ATP
Dolores B. Bertoti, PT, MS, PCS Clinical Specialist
Dean of Center for Academic Advancement Physical Therapy Department
Associate Professor The Children’s Hospital of Philadelphia
Alvernia College Philadelphia, Pennsylvania
Reading, Pennsylvania
Elliot M. Greenberg, PT, DPT, OCS, CSCS
Anjana Bhat, PT, PhD Board Certified Specialist in Orthopaedic
Assistant Professor in Kinesiology Physical Therapy
Physical Therapy Program Sports Medicine & Performance Center
University of Connecticut The Children’s Hospital of Philadelphia
Storrs, Connecticut Care Network
Pediatric & Adolescent Specialty Care, King
Amy Both, PT, MHS, ACCE of Prussia East
Assistant Professor and ACCE Philadelphia, Pennsylvania
Department of Physical Therapy
Health Science Campus Eric T. Greenberg, PT, DPT, SCS, CSCS
University of Toledo Board Certified Specialist in Sports Physical Therapy
Toledo, Ohio Clinical Assistant Professor
Doctorate of Physical Therapy Program
Deborah Bubela, PT, PhD Stony Brook University
Assistant Professor in Residence in Kinesiology Stony Brook, New York
Physical Therapy Program
University of Connecticut Heather Hanson, PT, DPT, PCS
Storrs, Connecticut Physical Therapist III
The Children’s Hospital of Philadelphia
Kathy Coultes, MSPT, PCS Philadelphia, PA
Pediatric Clinical Specialist in Physical Therapy Current position:
Coordinator of Mercy Kids 4 Fitness Program Physical Therapist
Mercy Fitzgerald Hospital Step by Step Developmental Services
Darby, Pennsylvania Rochester, New York
vii
, viii Contributors
Faithe R. Kalisperis, MPT, DPT, C/NDT Kathleen Miller-Skomorucha, OTR/L, C/NDT
Staff Therapist Staff Occupational Therapist
Therapeutic and Rehabilitative Services Therapeutic and Rehabilitative Services
Nemours/duPont Hospital for Children Nemours/duPont Hospital for Children
Wilmington, Delaware Wilmington, Delaware
Susan E. Klepper, PhD, PT
Mary B. Schreiner, EdD
Assistant Professor of Clinical Rehabilitation &
Chair of Education
Regeneration Medicine
Associate Professor
Columbia University, College of Physicians
Alvernia University
and Surgeons (CUMC)
Reading, Pennsylvania
Program in Physical Therapy
New York, New York
Elena McKeogh Spearing, MA, DPT, PCS
Rebecca Landa, CCC-SLP, PhD Contract Physical Therapist
Professor in Psychiatry Dynamic Physical Therapy Solutions, Inc
Johns Hopkins School of Medicine Former Physical Therapy Manager
Director, Hugo Moser Center for Autism and Related Disorders Children’s Hospital of Philadelphia
Kennedy Krieger Institute Philadelphia, Pennsylvania
Baltimore, Maryland
Elena Tappit-Emas, PT, MHS
Karen Yundt Lunnen, PT, EdD
Staff Therapist, School District of Philadelphia
Associate Professor and Head
Former Senior Therapist
Department of Physical Therapy
Myelomeningocele Clinic
Western Carolina University
Children’s Memorial Hospital, Chicago, Illinois
Cullowhee, North Carolina
Private practice, Philadelphia, Pennsylvania
Kirsten Hawkins Malerba, PT, DPT, PCS
Board Certified Specialist in Pediatric Physical Therapy Jan Stephen Tecklin, PT, MS
Department of Rehabilitation Services Professor
Children’s Healthcare of Atlanta Department of Physical Therapy
Atlanta, Georgia Arcadia University
Glenside, Pennsylvania
Victoria Gocha Marchese, PT, PhD
Assistant Professor
Diane Versaw-Barnes, PT, MS, PCS
Physical Therapy Department
Clinical Specialist-NICU
Lebanon Valley College
The Children’s Hospital of Philadelphia
Annville, Pennsylvania
Philadelphia, Pennsylvania
Suzanne F. Migliore, PT, DPT, MS, PCS
Clinical Practice Coordinator Audrey Wood, PT, MS
Physical Therapy Department OT/PT Clinical Specialist
The Children’s Hospital of Philadelphia Ken-Crest Services
Philadelphia, Pennsylvania Philadelphia, Pennsylvania
