Arthrogryposis describes congenital joint contractures in two or more areas of the body. Children born with one or more joint contractures have abnormal fibrosis of the muscle tissue causing muscle shortening, and therefore have limited range of motion in the affected joint or joints.

The primary long-term goals of therapy are increasing joint mobility, muscle strength and the development of adaptive use patterns that allow for walking and independence with activities of daily living.

References: Arthrogryposis Multiplex Congenita

This is how the child responds to auditory information. It includesauditory attention (ability to focus on spoken information); auditory sequencing (ability of the brain to correctly comprehend the order ofsentences or lists of words); and auditory memory for words, sentences and instructions (the ability of the child to remember spoken information), following instructions and recalling details.

Autism Spectrum Disorders (ASDs) are disorders of brain development affecting a child’s communication skills, social skills and in their play and behaviour (Autism Research Training Program, 2010). The disorder presents differently in each child with respect to severity and symptoms.

ASD’s are characterized by three main difficulties:

  • Impairment in social interaction
  • Impairment in verbal and nonverbal communication
  • Restricted repetitive and stereotyped behaviours

Difficulties in sensory processing, emotional regulation and motor skills may also be demonstrated (DSM-IV). The characteristics of autism may change as a child grows older, however the difficulties in socialization, communication, and interests continue in adulthood.

References: KT Slide Deck 2010, CIHR Autism Research Training Program;

Brachial plexus injury is a loss of movement or weakness of the arm that occurs when the collection of nerves around the shoulder are damaged during birth. This bundle of nerves is called the brachial plexus.

The nerves of the brachial plexus can be injured during a difficult birth from:

  • The infant’s head and neck pulling toward the side as the shoulders pass through the birth canal.
  • Pulling on the infant’s shoulders during a head-first delivery.
  • Pressure on the baby’s raised arms during a breech (feet-first) delivery.

Gentle massage of the arm, positioning and range-of-motion exercises are recommended for mild cases. In more severe cases, or those that do not begin to improve in the first few weeks of life, an evaluation by a medical specialist is recommended.

References: Pham CB, Kratz JR, Jelin Ac, Gelfand AA. Child neurology: brachial plexus birth injury: what every neurologist needs to know. Neurology. 2011. 77:695-697.

Cerebral palsy (CP) refers to a group of disorders in the development of motor control and posture, occurring as a result of a non-progressive impairment of the developing central nervous system. The motor disorders of cerebral palsy can be accompanied by disturbances of sensation, cognition, communication, perception, and/or seizure disorder (Rosenbaum, 2007).

The three types of CP are:

  • Spastic cerebral palsy — causes stiffness and movement difficulties
  • Athetoid/Dyskinetic cerebral palsy — leads to fluctuating muscle tone and uncontrolled movements
  • Ataxic cerebral palsy — causes a disturbed sense of balance, postural control and depth perception

There is no single cause of cerebral palsy. For the majority of babies born with cerebral palsy, the cause remains unknown. Researchers now know that only a very small percentage of cases of cerebral palsy are due to complications at birth (e.g. lack of oxygen). Cerebral palsy usually arises from a series of events that when combined can cause injury to the developing brain.

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. These birth defects commonly are called “orofacial clefts”. These birth defects happen early during pregnancy. A baby can have a cleft lip, a cleft palate, or both a cleft lip and cleft palate.

Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and speaking clearly. They may also have hearing problems and problems with their teeth. Services and treatment for children with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes or other birth defects.

Congenital muscular torticollis (CMT), also called twisted neck or wryneck, is a condition in which an infant holds his or her head tilted to one side and has difficulty turning the head. CMT is present at birth or develops soon after. It is usually discovered in the first 6 to 8 weeks of life, when a newborn begins to gain more control over the head and neck.

In congenital torticollis, the muscle that extends down the side of the neck – the sternocleidomastoid muscle — is tight and shortened. For most babies, stretching exercises and simple changes in how the infant is held or positioned will gradually lengthen the muscle and correct the problem.

CMT is commonly accompanied by asymmetrical positioning of the trunk and pelvis, affecting movement of the head and trunk into the mid-line and arm and leg use on the affected side. This asymmetry will effect a child’s ability to weight shift using postural reactions. These skills include turning the head properly and using the eyes equally, weight shifting of the trunk, rolling, propping up on elbows, crawling, sitting and an assortment of transitional movements between different postures.

References: AAOS – American Academy of Orthopaedic Surgeons

Down syndrome is a genetic disorder, associated with the presence of an extra chromosome 21. Some symptoms include some degree of mental retardation, characteristic facial features and visual and hearing impairment. Coordination is often lacking due to low muscle tone, and the voice can be boisterous. These children will learn to do the things other babies will do, but it will take them longer to reach development milestones.

Down syndrome is the most common genetic chromosomal disorder and cause of learning disabilities in children. Early interventions can greatly increase the quality of life for children and adults with this disorder and help them live fulfilling lives.


  • Medline Plus: Health Topics – Down Syndrome
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Dyspraxia is the partial loss of the ability to co-ordinate and perform skilled, purposeful movements and gestures with accuracy. Apraxia is the complete loss of this ability. Dyspraxia/apraxia may be acquired (e.g. a head injury), or associated with delay of normal neurological development.

The following areas may be affected:

  • Gross and fine motor skills
  • Motor planning and the organization of movement (planning what to do and how to do it)
  • Speech and languagePresentation is variable in terms of severity from child to child.
  • Difficulties may be identified first by parents or at school.
  • Intelligence is usually not affected but learning ability is.

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. DMD is caused by an absence of dystrophin, a protein that helps keep muscle cells intact. Symptom onset is in early childhood, usually between ages 3 and 5. The disease primarily affects boys, but in rare cases it can affect girls.

Signs and symptoms typically first surface when the child begins to walk and may include:

  • Frequent falls.
  • Difficulty getting up from a lying or sitting position.
  • Trouble running and jumping.
  • Waddling gait.
  • Large calf muscles.
  • Learning disabilities.

A genetic disorder is an illness caused by one or more abnormalities in the genome/ DNA. Genetic disorders may or may not be inherited. In non-heritable genetic disorders, defects may be caused by new changes to the DNA.

A syndrome is a disease or disorder that has more than one identifying feature or symptom. Each particular genetic syndrome will have many typical features, depending on which aspects of development are affected by the abnormal genes or chromosomes. A child might be born with obvious body deformities, abnormal organ function, or neurological problems (for example, when a baby’s body is floppy or the baby is unable to nurse or bottle feed). However, many of the genetic syndromes start to take effect only once the baby has been born and is starting to feed and grow. These babies may look and act normal at birth, but then develop problems later on in life.

The child is first evaluated by a therapist, and treatment will usually dependent on identification of the overall pattern of delay or abnormality.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994 as cited in Mandich et al., 2003) describes children with DCD as having marked impairment in the development of motor coordination that is not explained by mental retardation nor by a known physical disorder, that significantly interferes with academic achievement or activities of daily living.

At the London Consensus, DCD was described as a chronic and usually permanent condition characterised by impairment of motor performance that is sufficient to produce functional motor performance deficits that are not explicable by the child’s age or intellect, or by other diagnosable neurological or spatial-temporal organisational problems (Missiuna et al., 2003; Dewey & Wilson, 2001).

Child development refers to the process in which children go through changes in skill development during predictable time periods, called developmental milestones. Developmental delay occurs when children have not reached these milestones by the expected time period. For example, if the normal range for learning to walk is between 9 and 15 months, and a 18-month-old child is still not walking, this would be considered a developmental delay.

Developmental delays can occur in all five areas of development or may just happen in one or more of those areas. Additionally, growth in each area of development is related to growth in the other areas. So if there is a difficulty in one area (e.g., speech and language), it is likely to influence development in other areas (e.g., social and emotional).

Dysphagia is a condition in which swallowing is difficult or painful. Causes of dysphagia vary from neuromuscular diseases, neurological disorders, prematurity or the presence of a cleft lip or palate. Some children have difficulty with swallowing due to sensory discomfort with how food feels in their mouth.

Gastric reflux my also contribute to dysphagia. All speech pathologists at TherapyWorx are experts in the area of dysphagia and swallowing disorders. Oral Motor/ Feeding therapy will address the specific issues impacting each child’s feeding disorder.

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), is the most common type of arthritis in children under the age of 16. JRA is an autoimmune, non- infective, inflammatory joint disease of more than 3 months duration, and causes persistent joint pain, swelling and stiffness.

Some children may experience symptoms for only a few months, while others have symptoms for the rest of their lives.Treatment of juvenile rheumatoid arthritis focuses on controlling pain, improving function and preventing joint damage.

References: “Juvenile Idiopathic Arthritis (JIA): Joint Disorders: Merck Manual Professional”.

Oral-motor feeding is the coordination, timing and movement of the feeding system. Children who have difficulty with oral feeding may exhibit this disorder. Meal times can become exhausting, and eating and drinking may be dangerous, stressful and awkward.

The speech pathologist understands the biomechanical interrelationship of the head, neck and trunk and recognizes the impact of abnormal muscle tone, compensatory body posturing and patterns of movement that influence oral motor functioning and respiration. Specific goals in oral motor therapy include the handling of food in the mouth in coordination with swallowing and breathing to eliminate choking, gagging and aspiration.

This is the ability of the child to consciously reflect on sounds within words. It includes skills such as the ability to identify first, last and middle sounds; rhyming; the ability to break sentences into words and words into syllables; and the ability to join words, syllables and sounds to form new words. It includes the foundation skills that will be needed to learn to read and spell phonetic (sound) words, such as “plop”.

A premature infant is a baby who is born too early, before 37 weeks. Premature babies may have more health problems and may need to stay in the hospital longer than babies born later. They may also have long-term health problems that can lead into adulthood. Finding and treating health problems as early as possible can help babies lead longer, healthier, and more independent lives.

The earlier in pregnancy a baby is born, the more likely he/she is to have health problems. Some premature babies have to spend time in a hospital’s neonatal intensive care unit (also called NICU).

Premature birth can lead to long-term intellectual and developmental disabilities. These are problems with how the brain works.

Sensory processing (sometimes called “sensory integration” or SI) is a term that refers to the way the brain receives messages from the senses and turns them into appropriate motor and behavioral responses. For example, when you are riding a bicycle, reading a book, or drawing a picture, your successful completion of the activity requires processing sensation or “sensory integration.”

Sensory Processing Disorder (SPD, formerly known as “sensory integration dysfunction”) is a condition that exists when sensory signals don’t get organized into appropriate responses. It is like a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.

Speech: Refers to articulation, or the movement of the lips, tongue, cheeks and soft palate, to produce sounds and combinations of sounds. Usually, by 6 months, a child is using a variety of sounds in vocal play. By 12 months, a child is usually combining sounds into a few words or word-like appointments. By the age of 2 years, most speech is intelligible but usually not precise. Accuracy of sounds continues to improve as the child grows. A child with a speech disorder would have difficulty creating or forming speech.

Language: Refers to the areas that control understanding information, processing information and forming words or gestures. The ability to follow directions, vocabulary, grammar, understanding of concepts and emotions are all part of language. A child with a language disorder would have difficulty understanding (receptive language disorder) and/or communicating (expressive language disorder) with other people.

Spina bifida is an abnormality in the development of the spine and spinal cord which leaves a gap in the spine. During the first month of life, an embryo (developing baby) grows a structure called the neural tube that will eventually form the spine and nervous system. In cases of spina bifida, something goes wrong and the spinal column (the bone that surrounds and protects the nerves) does not fully close. In most cases, surgery can be carried out to close the defect.

However, damage to the nervous system will usually already have taken place, resulting in a range of symptoms, including:

  • partial or total paralysis of the lower limbs
  • bowel incontinence and urinary incontinence
  • loss of skin sensation

Stuttering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.

Children as young as age three may be treated for stuttering. If warranted by severity, early remediation is often the best option. The major goals of speech therapy will be the improvement of fluency and overall communication.

References: Irwin, M (2006). Au-Yeung, J; Leahy, MM, eds. Terminology –How Should Stuttering be Defined? and Why? Research, Treatment, and Self-Help in Fluency Disorders: New Horizons. The International Fluency Association. pp. 41–45.