The PIMT Concept

Pediatric Integrative Manual Therapy (PIMT) is a concept for the assessment and treatment in physical therapy of musculoskeletal and developmental disorders. It is not intended as a methodology or a technique. Its aim is to act as a conceptual framework to understand the relationship between structure and function in the development of infants and children. It is, in a way, a model that integrates pediatric manual therapy and developmental physical therapy.

PIMT is clearly an element in a biopsychosocial model that focuses on the families.

Manual therapy has shown over the last years a notable increase of evidence-based results through many scientific publications that have proven its benefits for many dysfunctions in the musculoskeletal symptoms. Although its results have been shown more often on adults than on children, some of its benefits, such as the increased joint range of motion or some effects on inflammation and pain can also be applied to the pediatric population. PIMT tries to develop mechanisms of assessment and treatment for newborns and children whose anatomical conditions require a methodological adaptation of the classical systems of assessment and treatment in manual therapy. Pediatric manual therapy is necessary in the treatment of different pathologies of children, such as congenital torticollis, and in areas as varied as traumatology, pediatric neurology, or sports medicine.

For its part, pediatric physical therapy also has supporting studies that endorse its assessment and treatment systems. There are reliable scales to observe the neurodevelopment of children, both in the population with neurological disorders and in children without any specific condition. There has also been an increased incidence of developmental disorders and attention and learning disorders in the pediatric population, which show sensorial and motor dysfunctions without any observable neurological damage in the imaging tests. In these children, a possible suboptimal neurological maturation is suspected, which leads to difficulties regarding coordination, balance, ocular motricity or vestibular balance, among others.

PIMT puts forward an intervention strategy in pediatric physical therapy based on sensorial stimulation, an improved motor control through motor and postural ontogenetic patterns, and the stimulation of automatismsthat are the basis of the optimal function of the nervous system. Of course, there is also a firm commitment to prevention and education for the familiesso as to create an enriching and stimulating environment for infants and children.

The practice of PIMT skillfully integrates manual therapy and developmental pediatric physical therapy. In other words, it is conceptually based on a relationship between structure and function which, albeit essential, was not developed in the field of pediatric physical therapy until now. This can be applied to musculoskeletal, traumatological, neurological or respiratory pathologies.

PIMT training provides physical therapists with the necessary skills to assess and treat different musculoskeletal disorders in infants and childrenthat may affect their health and their development; or could lead to future problems regarding attention and learning. Unlike pediatric osteopathy, the approach to the neurodevelopment of children and infants is an essential aspect, as well as the integration of families as part of the treatment, with properly motivated and protocolized work at home in which the children can obtain the best results.

Courses of pediatric physical therapy as part of the PIMT concept provide training on clinical reasoning for physical therapists, helping them to establish the different biopsychosocial factors that may affect the health of infants and children, and leading to a hypothesis, a prognosis, and an evidence-based therapeutic proposal within the conceptual framework of the ICF-CY, and taking personal and environmental factors, which are essential in pediatric care, into account. This training offers physical therapists a set of materials (brochures, infographics, videos, etc.) for the families, which enhances the value of their professional service. Apart from that, PIMT offers specific training on communicative abilities to present a treatment plan, adapt the objectives, motivate the families, and even give conferences on pediatric health.

In addition, PIMT offers advanced courses of intervention in neurodevelopment, vision during development or respiratory physical therapy, among others.

PIMT training provides physical therapists with the skills and abilities to assess and treat musculoskeletal alterations and developmental disorders in newborns and infants.

In the case of musculoskeletal alterations such as congenital torticollis, hip disorders or cranial malformations, PIMT training makes it possible to conduct an accurate joint, tissue, or cranial assessment, and it offers different objective measurement systems for these disorders.

In case of developmental disorders, PIMT training prepares specialists for an accurate neuromotor, postural and sensorial assessment through clinical criteria and reliable and valid international scales and screening methods. PIMT makes it possible to successfully manage infant colic, congenital torticollis, irritability, digestive disorders, cranial malformations, plagiocephaly, etc.with mild, safe, and extremely effective pediatric manual therapy.

As part of the integrative approach of PIMT, it is essential to help the parents to stimulate the motor and sensorial patterns that the infant requires at each stage. Therefore, the intervention becomes balanced between the effectiveness of the manual treatment, the neuro-sensory-motor stimulation and family training. This is a combination with outstanding results.

PIMT training provides physical therapists with the skills and abilities for the assessment and treatment of musculoskeletal disorders and developmental disorders in children with a typical or atypical development.

It is possible to acquire the skills required to assess disorders in the joint, tissue or cranium that may interfere with the development of the children and their function.

In neurodevelopmental disorders, PIMT training prepares specialists for an accurate neuromotor and sensorial assessment of the child through clinical criteria and reliable and valid international scales and screening methods.Clinical assessment procedures include aspects such as coordination, ocular motricity, balance, cerebellar function, or automatisms of the CNS, such as the vestibular and vestibulo-ocular reflexes. This is all integrated with the assessment of potential joint, muscle or neuromeningeal defects that may be related to it.

PIMT provides physical therapists with a global clinical reasoning that includes structural and functional aspects, with a multifaceted view and from a biopsychosocial perspective.

Treatment proposals in PIMT include mild and safe techniques for the musculoskeletal system and, on the other hand, programs of neuro-sensory-motor stimulation, with an interdisciplinary approach and focused on families.