1- Foreword

Children rehabilitation is a permanent challenge for the physiotherapist that requires a multidisciplinary team to integrate a high quality attention program, that involves efficacy, efficiency and welcome reception to the patients and their families.

Inside this rehabilitation program (RHB) it is vital the participation of the patient and their families, in general the share responsibilities secure better results as it becomes specific for each patient.

Physiotherapy objective in the management of pain has to be directed to the creation of routines of movement adapted to the possibilities of each child to obtain an improve in health quality not only physically but emotionally. Pain becomes a common pain in children and teenagers, so it would be a mistake not to treat it as a first line treatment during rehabilitation.

2-What about pain in rehabilitation exercises?

Pain definition is an uncomfortable  emotional end sensorial experience very personal, multifactorial and not associated to real or potential tissue damage.

It is the most important reason that requires doctor’s advisory, pain is consider a complex and multidimensional symptoms with no objectives measurements.

Pain has been like a problem only when associated to suffering, so the children personality will influence in a strong way the answer to pain.

We must try to obtain as much information as possible about the different factors that affect pain perception by children and parents, to be able to break the cycle of fear to the movement.

To evaluate the pain, we require the full history, we need a progressive patient valuation to be able to modify the treatments.

A detail full history will have three questions: Intensity, localization and physiopathology.

From the anatomical point of view its known that between 24 and 29 pregnancy week all the pain pathways are really finished, over the 30 week the mielinization of cerebral cortex and thalamus are finished, so it will be an error to think that children perceive the pain with less intensity.

The attitude towards pain during the rehabilitation has to be approach to answer these questions:

Is there any movement you do that does not make you feel pain?
Whith which movement pain appears or change its intensity?
Could you describe the pain as the same along all movement range?
Are you scared about moving if pain appears or increases?
Since when you live with pain?
Could you identify which is the movement that generated the pain?
How does this pain affects your school activities? And at home?
Which movements could you realice without been afraid that pain appears?

3-How PT could help to improve the pain?

An inclusive society is based in human rights that promotes the social justice and equal opportunities. So why children with motor difficulties, spinal atrophy, or any special need  can´t play sports or artistic disciplines as the resto of children with no difficulties?

PT, Somatic education, classic dance, yoga, try to prosecute the movement control from a holistic point of view, where body, mind is not separated from each other. Why not to adapt these lessons to children with pain?

Pain that appears in children as a consequence of pathology, generates frighten feelings to the movement, frustrations and catastrophizing. Day by day, children that suffer pain see how the participation in social and family related activities is reduced so they confront challenges obtaining level of activities in comparison to the general population.

A ludic PT characterized by a progressive series of movements in a musical surround (as it has to be precise), adapted to the pain characteristics of each children allowing sensory-motor changes and becoming a motivating and gratifying activity.