The Significance of Touch in Pediatric Physiotherapy

Abstract

Change in theoretical framework over the last decades and recent research in pediatric physiotherapy, has created a debate surrounding therapeutic touch. What is the role of or is there a need for handling and hands-on facilitated guidance (facilitation)? Does it limit and/or interfere with children's learning and development? It is frequently argued that therapeutic touch represents a passive and/or static approach that restricts disabled children's participation during interaction and activity in clinical encounters leading to decreased home, school and community participation. Touch may even appear as coercive and controlling. In this context, therapeutic touch is largely associated with physical hands-on activities. However, therapeutic touch can also be understood as an intersubjective phenomenon that arises from a deep connection between movement, perception, and action. We believe the significance of therapeutic touch and its impact on physiotherapy for children has not been considered from this broader, holistic perspective. In this theoretical paper, we will apply enactive concepts of embodiment, sensory-motor agency, coordination, and emergence to explore the concept and importance of touch in physiotherapists‘ clinical face-to face encounters with children. We will frame the discussion within the context of the typical sensorimotor development of children from the fetal stage to birth on and into adulthood. Moreover, we will rely on biological, physiological, and phenomenological insights to provide an extended understanding of the importance of touch and the significance of touch in clinical practice.

Enactive explorations of children's sensory-motor play and therapeutic handling in physical therapy

“…Bodily interactions, i.e., interaction of any part of the body with a person, objects, or the environment, are essential to us as humans and a natural part of how children learn to move. Across cultural settings, children interact with their environments, including caregivers, to understand and develop their own movement capacities ( 1 ). As part of these interactions, caregivers find ways to facilitate a child's motor skills and learning by providing support, guiding the direction of movement, and moving along with the child as he or she discovers and problem-solves new motor tasks.…”

“…We want to explore if these activities can also include hands-on approaches ( 4 ). Moreover, building on the view that therapeutic handling can be part of the child's learning through a bodily dialog between the physical therapist (PT) and child ( 1 ), we question if the child's playful learning opportunities can even be diminished if pediatric PTs abandon the use of hands-on approaches, thus reducing the children's natural movement learning as an interaction with other moving bodies. We approached this qualitative study as an in-depth exploration of the role of therapeutic handling in connection to children's sensory-motor play and performance during physical therapy.…”

“…The PT must attend to the child's signs of intention, attention, and motivation so that therapeutic actions such as handling, choices of toys, and changes to the task or environment become “part of the play,” not a disturbance to it. This entails the incorporation of bodily know-how into the PT's clinical reasoning ( 1 , 14 ), i.e., being sensitive to the child's bodily signals and accepting the child as an initiator and active agent of movement. As part of this concept, therapeutic handling can be a means by which children discover and explore new sensory-motor movement and play possibilities.…”

“…The nervous system is a continuous sub-system within a brain–body entity that perceives and acts upon its environment both simultaneously and holistically. Experience then molds us as individuals and is the foundational source of learning within this brain–body–environment system ( 1 , 20 ). It is a transformational force through which we develop and refine new skills in interaction with the world.…”

“…It is important to note that these are theoretical distinctions that in real-life interactions will usually fluctuate between unidirectional and mutual incorporation, or between coordination to and with, and with the agents taking turns being the active or the receptive part. Finally, we also want to highlight the term sense-of-agency ( 1 , 23 ). This phenomenological term pinpoints the bodily perception of being the one who performs a movement or action, as opposed to being moved by something or somebody else (or being unaware of the moving agent).…”