By, Laura Znajda, PT, Manager of Community Based Therapy and Continuing Education
When I went to Physical Therapy school, the entire unit on respiration and the musculature that supports it consisted of a self-study chapter. With so little importance placed on this subject in school, I was surprised to see what an impact treating the rib cage has on my pediatric clients. Learning about the way the rib cage changes in structure and function through normal development, and then what happens when a baby is born prematurely or has poor trunk strength, was a big eye opener for me. Delving into this topic, the most important thing I realized is how rib position could affect not just breathing, but so many other areas of development, including motor skills like sitting, dressing and talking.
If you have put off learning about the rib cage because you think it won’t have a productive impact on your clients’ outcomes, ponder these reasons to add rib cage treatment to your repertoire:
- The ribs are connected to the spine and need to move properly in order for the spine to move in all directions—we all know spinal movement is needed for everything from sitting up straight to swinging a baseball bat.
- The ribcage needs to move downward, usually between 8 and 24 months of age, in order to gain a more efficient breathing pattern. (the newborn pattern uses the diaphragm only; this normally changes over time to include using muscles all around the trunk to expand the ribcage in 3 directions, which allows the lungs to expand fully. When the lungs can expand fully, the child can take deeper breaths and move air in and out more effectively.)
- The rib cage is connected to the shoulder via the collar bones and shoulder blades. The ribs need to move downward after infancy in order to allow the shoulders to work properly for activities such as reaching overhead and dressing.
- Normally, a baby or child can change his breathing pattern when the body needs more stability for difficult tasks or when he needs to breathe faster under stress. If the ribs do not move normally or are not in the right position, the child will only have one breathing pattern and might learn to hold his breath to gain stability.
- The lower ribs need to move inward when lower trunk musculature contracts to produce an effective cough, which clears secretions from the lungs and upper airway. When mucous is not cleared from the lungs, it can become infected and cause a pneumonia.
- When trunk musculature is working properly to contract the rib cage with control, airflow over the vocal folds is controlled in such a way that allows the ability to produce sounds properly for voicing.
Normal development of motor skills that typically occurs from birth until the age of 2 facilitates the muscle lengthening and strengthening that moves the ribcage into its mature position and provides effective breathing patterns for the child. When motor skills develop atypically, muscle lengthening, strengthening, and rib mobility must be provided by a Physical Therapist, Occupational Therapist, or Speech-Language Pathologist trained in this type of therapy. The therapist must also instruct parents in exercises to do at home for the very best result.
The therapy staff at Easter Seals DuPage & Fox Valley are invested in learning more about this frequently overlooked area of treatment and are hosting a continuing education course this month to expand our skill base. Click here to learn more from Rona Alexander, PhD, CCC-SLP, BCS-S, C/NDT.
For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.