Paediatric Physiotherapy · Axium Physiotherapy and Rehab
When a child's movement or milestones do not look quite right, an earlier assessment changes what is possible.
Axium's paediatric physiotherapy service works with children with cerebral palsy, developmental delay, torticollis and general concerns about movement or milestones, from first assessment through to an ongoing home programme.
Dr. Deepika Kshirsagar · Paediatric Physiotherapist · Masters in Physiotherapy (UK) · IAP No. L-22275 · HCPC No. PH-96101
Dr. Deepika Kshirsagar working with a child in session (consented)
In short
Paediatric physiotherapy assesses how a child moves, sits, stands and uses their body, and builds a plan around what that specific child needs. At Axium this covers cerebral palsy, developmental delay, torticollis, and general concerns about a child's movement or milestones.
No referral or formal diagnosis is required to book a first assessment.
Why earlier is better
Assessment tends to happen later here than it needs to.
In India, children are typically diagnosed with cerebral palsy at around five to six years of age. Why the gap exists is genuinely debated in the research, family awareness plays a part, but so does how quickly a family gets referred on once a concern is first raised. Both point the same direction: an earlier assessment rarely does harm, and often helps.
Axium Physiotherapy and Rehab · based on pooled epidemiological research across multiple Indian regional studies, cause of the diagnostic-timing gap not settled in the literature
None of the signs below, on their own, mean a child has cerebral palsy or another condition. They are reasons to have a physiotherapist look, not reasons to worry alone. If your child was born prematurely, milestones are usually judged against their corrected age, counted from their original due date rather than their actual birth date, not the calendar age on their birth certificate. A physiotherapist will always account for this, but it is worth knowing before comparing your own child against a general list like this one.
By 4 months
Not able to hold their head steady when upright, or limbs that feel unusually stiff or unusually floppy compared with other babies the same age.
By 9 months
Not sitting even with support, or a strong, consistent hand preference this early, which is unusual before around 12 months.
By 12 months
Not crawling or otherwise moving around independently, or not bearing weight through the legs when held upright.
By 18 months
Not walking independently, persistent toe-walking, or one side of the body used noticeably more than the other.
At any age
A head tilt that does not resolve, or a delay that feels clearly out of step with other children the same age.
Three presentations make up most of the paediatric caseload.
Cerebral palsy
Cerebral palsy describes a group of movement and posture disorders caused by a disturbance that happened in the developing brain, usually before, during or shortly after birth. It does not get worse over time, though how it shows up in a child's movement can change as they grow. It can affect one side of the body, both legs more than the arms, or all four limbs, and it varies a great deal in severity from one child to the next, which is exactly why an individual assessment matters more than a general label.
Physiotherapy cannot reverse the underlying brain difference, and Axium does not claim otherwise. What a structured programme can do is build strength, function, and independence in daily movement, work toward specific goals a family and clinician agree on together, and adjust as a child grows. A child's current level of movement is generally described using the GMFCS scale, explained below.
Many families also hear terms describing how the movement pattern presents, such as spastic (stiff, tight muscles), dyskinetic (movements that are harder to control) or ataxic (affecting balance and coordination). These describe the pattern, not the severity, and a clinician will explain which pattern applies to your child specifically, rather than leaving you to work it out from a general description like this one.
Developmental delay
When a child's gross motor milestones, such as sitting, crawling or walking, lag noticeably behind the typical range, an assessment can identify what is actually happening and whether physiotherapy input would help, rather than waiting to see if a child "catches up" on their own. A delay in gross motor skills specifically does not automatically mean a delay in other areas, such as speech or social development, an assessment is what tells you which is the case for your child, not a general checklist.
Torticollis
Congenital muscular torticollis, a tightness in the neck muscle on one side that tilts or turns a baby's head, is one of the most responsive presentations in paediatric physiotherapy when it is caught and treated early, well before a child reaches walking age. Left unaddressed, it can also contribute to a flattened head shape on one side (positional plagiocephaly), so it is worth an assessment even if the tilt seems mild. Day to day, parents often notice it first as a baby favouring turning their head one way during feeding, or resisting having their head turned toward the tighter side.
If any of the above sounds like your child, an assessment is the next step, not a diagnosis you need to arrive at yourself first.
Physiotherapy cannot cure cerebral palsy, guarantee a specific milestone by a specific date, or promise a child will "catch up completely" to same-age peers. Any provider claiming otherwise is not being straight with you. What a good, individualised programme genuinely does is build strength, coordination and independence in daily movement, one honestly measured goal at a time, and adjust as a child grows and circumstances change.
Progress is reviewed at agreed points, not assumed. If a goal is not being reached the way expected, that gets discussed directly and the plan changes, rather than continuing an approach that is not working.
A term you may hear used
Understanding GMFCS
The Gross Motor Function Classification System (GMFCS) is a widely used five-level scale describing a child's own, self-initiated movement, particularly walking and sitting. It is a description of current function, not a prediction of outcome, and it is one part of an assessment, never the whole picture of a child. Families sometimes find it useful simply because it gives a shared, consistent vocabulary between a physiotherapist, a paediatrician, and a school, rather than each professional describing the same child differently.
I
Walks without limitation, in most settings and situations.
II
Walks with some limitation, for example on uneven ground, in crowds, or using a rail on stairs.
III
Walks using a hand-held mobility device, such as a walker or crutches.
IV
Self-mobility with limitations, may use powered mobility outdoors or in the community.
V
Transported in a manual wheelchair, with limited ability to maintain head and trunk posture against gravity.
Axium's assessment includes noting a child's current level as one part of building a plan, explained in plain language, not just handed over as a label. In very young children, especially under about two years, this classification can settle over time as a child develops, it is treated as a current snapshot to guide the plan, not a fixed label attached to a child for life.
Before your first visit
Bring your child's growth and vaccination record book, if you have one, it often has useful early-milestone notes already written down.
Bring any reports from a paediatrician, health visitor or other specialist already involved, even informal notes help build a fuller picture.
A short list or a phone video of what you have noticed at home is often more useful than trying to describe it from memory in the room.
Dress your child in something easy to move in, assessment usually involves floor play and free movement, not staying seated.
Come with your questions written down. It is easy to forget them once the appointment starts.
The same five stages used across Axium, adapted to a child's pace.
A first assessment involves watching how a child moves and plays, a conversation with parents about what has been noticed at home, and a hands-on assessment appropriate to the child's age. From there, Dr. Deepika explains what she has found before any treatment plan is agreed.
1AssessWatching how your child moves and plays, plus a conversation about what you've noticed at home.
2UnderstandWhat the assessment actually means for your child, explained in plain language before any plan is agreed.
3TreatA plan built around your specific child's needs and pace, not a generic sheet.
4RebuildStrength, coordination and independence in daily movement, one honestly measured goal at a time.
5ReturnProgress reviewed at agreed points, with a home programme so gains continue between visits.
"Understand" is deliberately its own stage, not folded into the assessment. A finding only becomes useful once a family actually understands what it means for their child day to day, not just as a term written on a form.
The home programme is the treatment, not an add-on.
A written, structured home exercise programme with a scheduled clinician follow-up is the part of paediatric physiotherapy with the clearest evidence behind it, more than any particular app or piece of software used to deliver it.
A randomised controlled trial in children with cerebral palsy and other neurodevelopmental disabilities found no significant difference between an app-based and a paper-based home programme (62.8% of prescribed exercises completed via the app, versus 55.8% via paper), with no measurable difference in goal achievement, exercise quality, or how much children enjoyed the exercises. Separately, a triple-blinded trial of a structured, clinician-led home programme in preschool-aged children with cerebral palsy found significant improvements in activity, participation and goal achievement at twelve weeks, against no significant improvement in the usual-care comparison group.
Axium Physiotherapy and Rehab · based on published randomised controlled trial research, not an Axium-specific outcome claim
In practice, this means Axium builds the programme and the follow-up first. A messaging app such as WhatsApp is used as a convenient way to deliver it, not as the treatment itself.
"Goal achievement" in that research is not an abstract measure. It means a specific, agreed target, such as a child pulling to stand unassisted, walking a set distance, or managing stairs with a rail, tracked against where that child started. A structured programme sets targets like these with the family, not generic exercises handed over without context.
Physiotherapy is usually one part of a bigger picture.
Children with cerebral palsy, developmental delay or complex presentations are often also seen by a paediatrician, and sometimes an occupational therapist or speech and language therapist, depending on what the assessment finds. Physiotherapy at Axium focuses specifically on movement, posture and physical function, it does not replace a paediatrician's diagnostic role or another therapist's specific input, and Dr. Deepika will say directly if something outside physiotherapy's scope needs a different specialist.
Led by Dr. Deepika Kshirsagar
Dr. Deepika Kshirsagar — portrait
Dr. Deepika Kshirsagar leads paediatric physiotherapy at Axium. Masters in Physiotherapy (UK) · IAP No. L-22275 · HCPC No. PH-96101.
Axium is a two-clinician practice. Dr. Deepika and Dr. Vinayak Kshirsagar see every patient themselves, there is no rotating roster of junior staff.
Does my child need a formal diagnosis before starting?
No. Physiotherapy can assess and treat a movement concern, developmental delay or torticollis without a prior diagnosis. If something during assessment needs a specialist opinion, that is discussed directly with the family.
A doctor told us to "wait and watch". Should we still get an assessment?
It is reasonable to ask a physiotherapist for a second opinion specifically on movement and motor development, separate from whatever else "wait and watch" was covering. An assessment does not commit you to treatment, and in India the research shows families are typically guided toward assessment later than in some other countries, waiting longer than necessary is a real, documented pattern, not just an individual worry.
What happens at the first assessment?
Dr. Deepika watches how your child moves and plays, talks with you about what you have noticed at home, and carries out a hands-on assessment appropriate to your child's age. She explains what she has found in plain language before agreeing any treatment plan with you.
How long does a course of treatment usually take?
There is no single answer, every plan is built around that specific child. As a reference point, one published study of a structured home programme for preschool-aged children with cerebral palsy measured real gains at twelve weeks, that is a research finding, not a promised timeline for every child at Axium.
My child just seems "a bit behind", with no diagnosis. Is physiotherapy still worth it?
Yes. A gap between where a child's movement sits now and the typical range for their age is a reasonable reason for an assessment on its own, a formal diagnosis is not a precondition.
Do you treat torticollis in very young babies?
Congenital muscular torticollis generally responds best to physiotherapy started early, well before a child begins pulling to stand or walking. Contact the clinic directly with your baby's age and we can tell you whether an assessment makes sense now.
What if my child is anxious or does not cooperate during the assessment?
This is common and expected, not a problem. Much of a paediatric assessment happens through watching a child play and move in their own time, not through asking a young child to follow instructions on demand.
Can grandparents or other caregivers be shown the home programme too?
A home programme is generally more consistent when more than one caregiver knows how to help with it. Ask about this directly, Axium can talk you through what is realistic for your family's situation.
Ask about an assessment
Call, or send an enquiry, and Dr. Deepika's team will get back to you.
