HeartSpacePT

HeartSpacePT Shelley Mannell PT has over 25 years experience in pediatric Physical Therapy.

HeartSpace provides Physical Therapy clinic services to babies, children and adolescents with motor and sensory challenges at our Kids Therapy Circle location. Shelley has been a clinical faculty member at McMaster University and has developed HeartSpace Yoga and Meditation for children with special needs. She has co-created Dynamic Core for Kids, an approach to treating core strategy in children

with challenges. As well as clinical work, Shelley teaches continuing education courses for pediatric therapists internationally. HeartSpace has Michelle Duncanson PT who provides home-based services in Niagara and Kristyn Watters PT who serves children at home in the Hamilton area.

08/18/2026

A 2026 article raises significant concerns regarding UE botox injections in pediatric unilateral CP.
"Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary
retrospective 5-year follow-up case-control study".
This study followed 11 children with unilateral CP over 5 years. 5 children received a single UE Botox in conjunction with PT and 6 who received only PT.
Clinical takeaways:
*All 5 children had one Botox injection but showed deterioration in UE function.
*All 6 children who received PT showed preserved or improved UE function.
*The paper includes excellent discussions of both possible mechanisms and clinical implications.
*Children with MACS (=Manual Ability Classification System) level 1 may be particularly at risk of long-term functional deterioration.
What I'm thinking about:
*Despite the small sample size, the consistency of the outcomes merits serious consideration. These results warrant serious ongoing evaluation of the risk-benefit profile of botox injections in the paediatric CP population.
Article link: https://pubmed.ncbi.nlm.nih.gov/42602096/
Link to MACS outcome measure: https://canchild.ca/shop/macs/

08/13/2026

A 2026 article entitled "Can slow and (un)steady still win the race? A narrative review
of developmental gait characteristics and clinical implications in children born preterm" had some interesting findings for all of us who see children born preterm during childhood.
Clinical takeaways:
*A 1-2 month delay in independent walking is consistent, even after correction for gestational age (GA).
*Greater delays are seen for children born with lower GA or with very low birth weight (BW).
*Gait differences persist into preschool years - shorter step length, wider BOS, prolonged double support, increased temporal variability, reduced complexity.
*Subtle differences persist into school age, particularly in more demanding situations such as dual-task walking.
*Secondary data analysis revealed a vulnerable subgroup - those at risk for DCD - who demonstrated significantly more difficulty with dual-task walking at 4-5 years old. (At risk for DCD = MABC 80 on WPPSI and no diagnosis of CP).
What I'm thinking about:
*Paying attention to qualitative movement characteristics is as important as checking off motor milestones.
*We can view gait as the foundation for more complex movement skills, rather than an endpoint for monitoring/intervention.
https://pubmed.ncbi.nlm.nih.gov/42474821/

08/07/2026

As a PT who is both NDT and SI trained, I am excited about this 2026 article "Rewiring the Senses: The Impact of Sensory IntegrationTherapy on Balance and Cognition in Cerebral Palsy". The study examined the use of sensory integration on various outcomes for children with CP GMFCS Level I and II. The control group (11 children) participated in balance and coordination activities. The study group (11 children) participated in sensory integration therapy as well as the same balance and coordination activities.
Clinical takeaways:
*The conclusion states sensory integration therapy combined with balance and coordination exercises was associated with improvements in balance, functional mobility, independence, sensory processing and cognitive function.
*BUT this is a stronger claim than the analysis actually supports since primary outcomes (balance, Timed Up and Go) showed no significant between-group difference.
Things I'm still thinking about:
*Sensory integration framework was not designed for children with neuromotor differences. Evaluating whether the differences in motor output originate in the sensory systems or the motor system or both is a complex conversation.
*Supporting children with CP requires therapists to understand the complexity, nuance and interaction between the sensory and motor systems, acknowledging the motor control issues of spasticity's impact on range of motion, alignment's impact on central stability and base of support and the paucity/latency of movement.
https://pubmed.ncbi.nlm.nih.gov/42267458/

07/29/2026

A 2026 study entitled "The effects of exercise intervention on children with
developmental coordination disorder: a systematic review and network meta-analysis of randomized controlled trials" yielded some interesting results. The authors do recommend further study due to limitations of study design.
The study examined 3 kinds of motor intervention:
Task-oriented training (TOT): Practice is organized around a functional goal and the therapist manipulates the environment.
Process-oriented training (POT): Focuses on the underlying components thought to be necessary for movement — postural control, sensory processing, specific motor patterns.
Integrated training (IT): Combines both using process-level work within the context of meaningful, task-specific practice.
Clinical takeaways:
*All 3 interventions significantly improved motor function.
*TOT showed largest effect on overall motor function.
*IT was best for balance and manual dexterity functions.
*Aiming and catching was most improved with IT and POT. TOT did not have significant effect on these skills.
Things I'm thinking about:
*Many therapists practice integrated training. Our clients are a homeogenous group with varying sensory and motor differences. They are best served by therapists with multiple skill sets and the clinical reasoning to combine them to support them.
https://pubmed.ncbi.nlm.nih.gov/42483389/

07/22/2026

This 2026 commentary in Autism Research is an excellent call to action. "Motor Disorders in Autism: From Comorbidity to Core Criterion" addresses the very real probability that motor differences are fundamental in ASD - something I've been discussing for 2 decades.
Clinical takeaways:
*There is a growing body of evidence suggests that motor differences precede emergence of core autistic traits.
*Motor differences are observed during early infancy and toddler years.
*Motor differences are not incidental; they are the earliest observable indicators of altered neurodevelopment trajectory.
*Movement differences are core characteristics of ASD.
*Movement differences include: delayed milestones, disruptions in gait, toe walking and patterns of upper limb movement.
*Embodied cognition teaches us that differences in sensorimotor development can amplify cognitive differences.
Things I'm thinking about:
*Last month I posted an article indicating the position of the pelvis at 3 months is a strong predictor of further motor development. However early movement assessment takes a good deal of skill and training.
*The article recommends paediatricians complete developmental screenings. I absolutely disagree. Paediatric PTs and OTs with expertise in early movement analysis are the most appropriate choice for movement screening.
Please share this article with every professional you know who is providing support to autistic children and their families.
https://pubmed.ncbi.nlm.nih.gov/42297632/p

07/21/2026

This autumn and I are excited to teach our hybrid course Paediatric Pelvic Health: Dynamic Core for Kids - Day One online and Day Two in-person in Montréal QC. We've spent years developing our model of trauma-informed, systems-based paediatric pelvic health, and it's exciting to see support for this model now emerging in the literature. Whether you’re a paediatric therapist looking to build pelvic health skills, or a pelvic health therapist looking to build paediatric skills, this course is for you.
Follow the link for more information: https://bit.ly/4aYiJqb

07/16/2026

New course alert! I am very excited to announce this spring workshop with my OT colleague Donna Legge-Nevitt ().
Two days. One whole-child approach to feeding.
Day 1: The developmental foundation — sensory processing, postural control, and motor skills, and how neurodiversity may impact the developmental picture.
Day 2: The clinical application — assessment, co-regulation, whole body preparation and practical strategies for real feeding success.
Video analysis, handling labs, client demonstrations and collaborative clinical reasoning - to help you translate your learning from classroom to clinic.
http://bit.ly/3RDQu9F

07/15/2026

I have encountered many children/adolescents/adults with CP who have pain. This 2026 open access paper "The impact of pain in children and adolescents with cerebral palsy: A daily diary study" explored this topic in 45 individuals with CP, aged 7 to 18, representing GMFCS levels I to V (but the majority being level I and II).
Clinical takeaways:
*Pain is the most prevalent secondary condition in youth with CP
*Pain can be caused by muscle spasticity, contractures, and skeletal
and gait abnormalities
*40% of respondents had chronic pain (double that of the general population)
*Daily pain intensity was significantly associated with same-day and next day interference with activities
*higher pain intensity and pain interference was significantly associated with heightened mental health symptoms (anxiety and depression) and a reduced quality of Life
Things I'm thinking about:
*How well we are identifying and managing pain for children and youth with CP?
*Given the neurodiversity, how do we apply our knowledge of chronic pain in support of this population?
https://pubmed.ncbi.nlm.nih.gov/42365702/

07/08/2026

I've known several children over the years who have used intrathecal baclofen (ITB) pumps. Most have been successful but one or two have had mixed results. The 2026 article "Intrathecal Baclofen in Children with Cerebral Palsy: A Critical Review of Selection Criteria, Rehabilitation Goals, Outcomes and Complications" is an excellent overview.
Clinical takeaways:
*Multi-disciplinary teams should be involved in this process
*Indications and contraindications for ITB and patient selection are clearly outlined
*A decision making pathway is clearly outlined
*Clinical outcomes are discussed
*ITB is compared with other invasive treatment options
Things I'm thinking about:
*We have learned over time which children are the best candidates for ITB and why. Having clear discussions around what ITB can offer could support parents in their decision making.
https://pubmed.ncbi.nlm.nih.gov/42278952/

07/01/2026

My IT meltdown has passed, just in time for Canada Day! I am celebrating the multi-cultural mosaic of our country today, reflecting on its beauty and its imperfections.

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http://www.heartspacept.com/

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