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Cerebral Palsy Clinic: Your Child’s Care and What To Expect

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

by | Oct 3, 2025 | Neurology

At Scottish Rite for Children, our experts provide care to the whole child – body, mind and spirit. The Neurology and Rehabilitation Medicine department sees children with orthopedic issues who also have related neurological disorders and neuromuscular diseases. One of the most common conditions seen by this team is cerebral palsy (CP).

Like all conditions, the severity of cerebral palsy can vary depending on the child and requires a multidisciplinary team to determine the best treatment options. With several factors that play into this diagnosis, we understand that as a parent or caregiver it can be challenging to navigate through the care plan for a child with cerebral palsy. Below is what you need to know about our specialized cerebral palsy clinic at Scottish Rite.

Who is part of the CP team?

  • Orthopedics: A pediatric orthopedic surgeon focuses on evaluating and monitoring for operative interventions to address function and pain
  • Pediatric Rehabilitation Medicine (PRM): PRM focuses on evaluating and monitoring the child for nonoperative interventions, including bracing, casting, tone medications, botulinum injections, equipment and therapies with the goal of optimizing function and reducing pain.
  • Neurology: This team treats the active neurological conditions such as seizures.
  • Advanced practice providers (APPs): The APPs work with both the neurologists and pediatric rehabilitation specialists to provide holistic care.
  • Nursing: This team coordinates and organizes each of the multidisciplinary teams and ensures that education is tailored to the needs of each patient.
  • Orthotics: A team of orthotists work with the teams to evaluate, fit and fabricate braces used to help your child’s mobility.
  • Physical therapy (PT): PT works with the child to improve functional mobility, with or without their needed equipment.
  • Occupational therapy (OT): OT focuses on activities of daily living, upper extremity function and the use of equipment needed to help your child function.
  • Therapeutic recreation (TR): TR works with the patient to promote activities and participation through peer interactions and relationships, such as adaptive sports, games and more.
  • Psychology: Our team of pediatric psychologists manage the psychological well-being of the child and helps them with strategies to overcome barriers to the treatment plan.
  • Developmental and Behavioral Pediatrics: This team optimizes nutrition, feeding and medical comorbidities and manages behavioral differences.

    What can a patient family expect when come to the CP clinic?

    First, the child will see a motor control nurse who will go over medications and safety questions. One of the neurology/rehabilitation medicine APPs will continue the visit. A video recording will be conducted of the child for their gait to be analyzed, so the team can compare any changes that occur throughout time. Then, the pediatric rehabilitation medicine specialist and the APPs will complete the visit and explain the plan to the patient family.

    Depending on the clinic and specific needs, the patient may also be seen by a pediatric orthopedic surgeon, orthotist, physical and/or occupational therapist, pediatric psychologist or a recreational therapist. When appropriate, referrals are also made to the other CP experts.

    How often are clinic appointments?

    • Children younger than 5 are typically seen every three to four months. Since this is a period of rapid growth and development, our team of experts want to make sure that they are monitoring the patient’s growth closely and intervening in any way needed to promote healthy and happy development.
    • Children between ages 6 to 12 are seen about every six months but may require visits more often if they are in the middle of a growth spurt.
    • After a child has completed their growth spurt, the team typically sees them between every six months to a year.

    Pediatric rehabilitation medicine physician Fabiola I. Reyes, M.D., works closely with this patient population. “I am honored to have the opportunity to provide care to these kids,” Reyes says. “In the CP clinic, we pride ourselves in making sure that both the child and parent/guardian understand and feel comfortable with every step of the treatment plan. Although your child may have several specialists caring for them, which can be overwhelming, our team is here to walk you through the process – making sure the patient remains our priority.”

    Learn more about the Neurology and Rehabilitation Medicine department.

    5 Common Types of Scoliosis: Which Form Does Your Child Have?

    5 Common Types of Scoliosis: Which Form Does Your Child Have?

    by | Jun 4, 2025 | Scoliosis & Spine

    Scoliosis is a common orthopedic condition that affects between 2% to 3% of the population. This abnormal sideways curvature of the spine can range from mild to severe, with varying health impacts. Scoliosis must be monitored until children stop growing, and moderate to severe curves will need corrective treatment. However, different types of scoliosis have different prognoses and may require different types of treatment.

    What Is Scoliosis?

    Prior to learning about the different forms of scoliosis, it helps to first understand what this condition is and how any form of the disease can affect a child.

    Scoliosis happens when a child’s spine curves sideways. Normally, the spine is straight or has a slight S-curve when you look at it from the side — the top of a child’s back may curve out a little bit, and their lower back may curve in slightly. In children with scoliosis, the spine curves or twists in an S- or C-shape.

    Mild cases may only limit a child’s flexibility, but severe cases can cause deformities and serious health problems, such as:

    • Arthritis
    • Back pain
    • Breathing problems or other lung issues
    • Heart problems
    • Paralysis
    • Problems walking, standing or doing other physical activities

    Whether mild or severe, the form of scoliosis your child has can also play a role in its long-term impacts. Below are five common types of scoliosis.

    Idiopathic Scoliosis

    Idiopathic scoliosis, also called adolescent idiopathic scoliosis, is the most common type of scoliosis. It affects around 80% of children with scoliosis. It typically shows up at age 10 or later and has no known cause, although there is a genetic connection. About 30% of children with idiopathic scoliosis have a family history of scoliosis. Despite what many parents or kids may think, carrying a heavy backpack or slouching will not cause scoliosis.

    Treatment for this type of scoliosis depends on the severity of your child’s spinal curve, defined as:

    • Mild, less than 20 degrees
    • Moderate, between 25 degrees and 40 degrees
    • Severe, greater than 50 degrees

    Regardless of severity, many children with scoliosis benefit from physical therapy (PT). PT helps reduce pain and improve breathing, while also preventing a curve from getting worse.

    Children with mild curves may simply need monitoring every six to 12 months to ensure a curve is not getting worse. Moderate curves may require a child to wear an orthotic back brace daily for months or even years.

    Braces are usually successful in stopping the curve from progressing to a point of needing surgery. Severe curves or moderate curves that do not get better with bracing may require spinal surgery. Spinal fusion is the most common type of surgery for severe adolescent idiopathic scoliosis, but some patients may benefit from a newer technique, vertebral body tethering (VBT).

    Congenital Scoliosis

    Congenital scoliosis is a form of the condition that exists when a child is born. A rare birth defect, congenital scoliosis occurs in only 1 in 10,000 children. There are several different types of congenital scoliosis, each affecting how the spine curves abnormally in different ways. All can cause serious problems in children’s growth.

    Many children with congenital scoliosis are not diagnosed until the problem becomes noticeable later in childhood or during the teenage years. Unlike idiopathic scoliosis, congenital scoliosis usually cannot be helped by bracing. Children with mild curves will still likely only need monitoring, but those with moderate to severe curves may need surgery.

    Neuromuscular Scoliosis

    Neuromuscular scoliosis is caused by medical conditions that impact the muscular or neurological systems. These conditions can affect a child’s muscle balance or how the body controls the muscles that support the spine.

    Common neuromuscular conditions that lead to scoliosis include:

    • Cerebral palsy
    • Friedreich ataxia
    • Muscular dystrophy, especially Duchenne
    • Myelodysplasia
    • Spina bifida
    • Spinal muscle atrophy
    • Spinal trauma, especially that causing paralysis

    These conditions may require children with scoliosis to be in wheelchairs. For those children, wheelchair seats can be modified to improve balance.

    Bracing may also help many patients with neuromuscular scoliosis, but it will not stop the progression of curves. Surgery may be an option, depending on the underlying medical condition and other factors.

    Early-Onset Scoliosis

    Early-onset scoliosis develops before age 10. In most cases, early-onset scoliosis is idiopathic. Treatment is crucial for preventing breathing problems or deformities later in life.

    Infants and children younger than age 2 who have early-onset scoliosis may need to wear a cast for two to three months at a time. In children this young, casting is often easier than bracing.

    If a very young child’s scoliosis is severe, they may need a special type of surgery that involves attaching a magnetic rod to the spine. The rod can be lengthened as the child gets older, at which point they usually have spinal fusion surgery.

    Syndromic Scoliosis

    This type of scoliosis is very rare and develops as part of another condition, such as:

    • A connective tissue disorder, such as Marfan or Ehlers-Danlos syndrome
    • Beale’s syndrome
    • Down syndrome
    • Prader-Willi syndrome
    • Rett syndrome

    Treatment options for syndromic scoliosis depend on the severity and the other health conditions involved.

    Could Your Child Have Scoliosis?

    Children are usually screened for scoliosis during their annual wellness exams, and they may be screened at other times, such as during school health screenings.

    However, children grow quickly, so it’s important for parents to know the symptoms of scoliosis. Be on the lookout for signs such as:

    • Back pain
    • One shoulder blade that sticks out more than the other
    • One shoulder, hip bone or rib cage that seems higher than the other
    • Rounded shoulders
    • The sense that your child’s head is no longer directly centered above the pelvis
    • A sunken chest

    Call your child’s pediatrician if your child experiences any of these symptoms or if you notice an unusual spinal curve when your child bends forward to touch their toes. Getting treatment early, no matter which type of scoliosis your child has, often leads to more successful outcomes.

    If your child has been diagnosed with scoliosis, the Scottish Rite Center for Excellence in Spine is here to help. Schedule an appointment to discuss scoliosis care.

    Sports Physicals – Don’t Rush This Important Process For Your Young and Growing Athlete

    Sports Physicals – Don’t Rush This Important Process For Your Young and Growing Athlete

    by | Feb 6, 2025 | Research & Innovation

    Although schools and sports organizations often require physicals annually, it is frequently overlooked until the last minute. Shane M. Miller, M.D., FAAP, sports medicine physician and the Section Director of Medical Sports Medicine at Scottish Rite for Children, shares his thoughts on the pre-participation evaluation (PPE) in the following article.

    Dr. Miller suggests to follow the recommendations of the American Academy of Pediatrics, urging families to schedule an appointment with the child’s primary care provider at least six weeks before the season. To prepare for this apppointment, families can discuss the following topics prior to the visit:

    • Family and child medical and heart-related history and cardiac health
    • Muscle, joint, or bone pain or injuries and pain
    • Eating habits and any desires to gain or lose weight
    • Menstrual cycle frequency and any concerns
    • Use or contemplation of using supplements
    • Changes in sleep, mood, or interest in sports or friends

    Learn more about Sports Medicine at Scottish Rite for Children here.

    A Parent’s Guide to Contact Sports for Kids

    A Parent’s Guide to Contact Sports for Kids

    by | Nov 18, 2024 | Sports Medicine

    Contact sports can be exciting for young athletes and parents alike. They also introduce an element of danger into the exercise equation. 

    Any time a person participates in a physical activity, there’s a risk of injury. However, engaging in contact sports magnifies that risk. If your child participates in this type of athletic activity, following the proper safety precautions is critical.

    What’s Considered a Contact Sport?

    In a contact sport, players come into physical contact with each other or an object as part of the competition. There’s a risk of contact in nearly all sports, but the risk is higher in some than others. 

    In basketball and soccer, for example, children are likely to knock into others athlete as they jockey for the ball. When they’re rebounding, taking a shot or defending on the basketball court, they’re in close contact with others and can accidentally (or otherwise) touch them lightly or with force.

    Other sports have an even higher risk of contact. Some sports, such as ice hockey, football and lacrosse, involve techniques that have kids actively running into or making contact with an opponent. Making contact is not incidental in these sports. It is intentional. For that reason, this sports category is sometimes called “collision sports.”

    While most contact sports are team sports, some contact is involved in solo activities, such as gymnastics. In that case, an athlete makes contact with the floor or an apparatus rather than a person.

    How to Keep Your Child Safe in Contact Sports

    To protect your young athlete on the court or field, begin with these basics, which can reduce the risk of sports injuries:

    ●      Get a sports physical. This specialized medical checkup helps ensure your child is healthy enough to participate in a sports activity. It’s a good idea to have your child have a sports physical before each season, even if their school or team does not require one.

    ●      Buy the proper protective gear. Every sport has specific equipment, so check with your child’s coaches to see what’s required and recommended. Depending on the sport, this may include a helmet, knee pads, shin guards, padding or a mouthguard.

    ●      Be sure your child learns the correct technique. Many sports injuries in contact sports occur because somebody incorrectly performed a move. Emphasize that your child should use proper form and follow the rules of the sport.

    ●      Mix things up. Overuse injuries are common among athletes, particularly young athletes who are still growing and developing. Encourage your child to participate in multiple sports or physical activities that use different parts of the body, which will lower the risk of overusing a specific muscle or joint. Overuse injuries can reduce your child’s range of motion and limit their ability to play at their best.

    In addition to these tips, talk with the coaches or even the athletic trainer about other steps you can take to keep your child safe while playing contact sports. There is some risk, but you can also do many things to mitigate that risk.

    The Scottish Rite for Children sports medicine team is committed to keeping kids healthy and in the game. Call 469-515-7100 to schedule an appointment with one of our sports medicine specialists.

    Get To Know Our Staff: Timothy Nuckols, Therapy Services

    Get To Know Our Staff: Timothy Nuckols, Therapy Services

    by | Nov 13, 2024 | Spotlight

    What is your job title/your role at Scottish Rite?
    I supervise therapy technicians, assist physical therapists with daily exercises selected for their patients and help ensure that patients are using proper technique in therapy.

    What is the most fulfilling part of your job?
    I enjoy hanging out with the many cool and amazing patients that we have and hearing their life stories.

    What makes Scottish Rite a special place to you?
    When you walk around town in your Scottish Rite t-shirt, people immediately stop you to show gratitude and compassion for what we do for the pediatric community. I also appreciate the amazing staff and love the kids we see.

    What made you choose a career in health care?
    I was inspired by my dad, who is a psychiatric physical therapist at Texas Health Presbyterian Hospital Dallas.

    What is something unique you get to do in your position?
    I create challenges for the kids so that they can do different exercises. It becomes a competition to see who can win!

     

    What’s your favorite thing to do outside of work?
    I like to hang out with my girlfriend and family. I also like to play soccer, work on cars and watch the Kansas City Chiefs win their games.

     

    Do you have any hidden talents?
    I can drift a car on a racetrack.

     

    Where are you from and what brought you to DFW?
    My family is originally from Missouri, but then we moved to Frisco.

     

    If you could travel to anywhere in the world, where would you go and why?
    I want to visit Tokyo! It is a modern city that has a lot to offer and is a completely different culture. I love learning new things, so it would be a lot of fun!

     

    If you had to pick one meal to eat for the rest of your life, what would it be and why?
    It would have to be lasagna. It has been my favorite meal to eat since I was a kid, and no other food gets more joy out of me than eating lasagna.

     

    What movie do you think everyone should watch at least once?
    Interstellar.

    What was the first concert you attended?
    I saw Beyonce.

     

    Favorite DFW hidden gem?
    Egg Roll Hut in South Dallas.

     

    If you were to have a movie based on your life, which actress/actor would you choose to play your character?
    Will Smith.

     

    What is some advice you would give your younger self OR what’s the best piece of advice you’ve received?
    I would tell my younger self to invest in cryptocurrency early. I would also say to keep striving for the large things in life early, take the opportunities when they are in front of you and don’t wait.