Ilija Dimitrovosk

Parents of Children with CP Receive Practical Training

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SZ CP 1A free lecture event for parents of children with cerebral palsy was recently hosted by LIH Olivia Place’s Shenzhen and Shenzhen Angelland Disabled Children Caring Center. Parents attended with great learning enthusiasm despite the summer heat. Lead physical therapy consultant Ilija Dmitrovosk presented a three-and-a-half hour feast of rehabilitation expertise.

Through demonstration, Ilija vividly introduced the principles and approaches of physical therapy for treating children with cerebral palsy. Bearing in mind that each child is unique, he patiently instructed parents one by one how to properly care for their children at home.

SZ CP 2Ilija elaborated on the concepts of physical therapy in simple language to increase parents’ understanding. Quite a number of parents had some knowledge of physical therapy, but through this event, they learned myriad approaches of physical therapy such as 24-hour postural therapy and water therapy, to name but a few. In addition, Ilija introduced how to use the various equipment and special considerations for them. Many parents discovered that they had been using their child’s assistive equipment improperly.
During practical training, Ilija patiently explained appropriate exercises. He noted repeatedly that parents need to help their children exercise to fulfill their potential. According to the situation of each child, parents can use common and simple equipment to help children do rehabilitation exercises properly. But these simple exercises have many points that need to be carefully considered, therefore parents need to closely pay attention to their child and actively interact with and encourage them while they exercise.

Encouraged by her mother, a little girl sitting in wheelchair began to respond actively, positions that she had been unable to do before. All the people present burst into cheers and her parents were greatly inspired.SZ CP 4

During a break, parents said that they planned on signing up for more courses and the vivid descriptions and practical training brought benefits to them. Despite a duration of more than 3 hours, many found the event too short. After the lecture concluded, parents gathered around Ilija, continuing to search for professional instruction.SZ CP 5

Ilija Dimitrovosk, Lead Physical Therapy Consultant at Shenzhen LIH Olivia’s Place, has 15 years of experience in physical therapy early intervention for newborns and premature infants, children’s growth and development, children’s physical therapy, and sports and rehabilitation medicine.

Winter Nutrition and Maintaining a Healthy Weight

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place

baked-potatoIn the winter months, there is a smaller selection of fresh foods, we more frequently eat foods which are cooked, and the food we choose in the winter tends to be higher in energy value (calories) than at other times of the year. Most of us also decrease our physical activity during the winter, which means that it is easy to gain weight. This leads to two questions: How does this extra weight affect our health? Is it normal to gain weight in the winter?


mhrf-cpmh-110691f10If during the whole winter a person gains one to two kilograms, it usually does not pose a health risk. However, complication arise when a person gains this amount of weight every winter and retains it over the year. Most often, weight gain is the result of poor nutritional habits, consuming large quantities of food, and reduced physical activity. A diet that is not varied, skipping meals, and alternating between over and under eating are sure ways to quickly gain weight.


How do we avoid a larger increase in body weight and prevent health risks that can arise because of this? First, do not give up on the recommended basic principles of proper nutrition, which are, let us remember: moderation, variety, and regular meals. These are important recommendations for all ages in every season.


1z-16789Some additional guidelines can help families to avoid weight gain in winter:
• Eat frequent, smaller meals
• Eat a variety of foods
• Avoid or decrease frying
• Cook meals with seasonal ingredients
• Chew each mouthful of food well
• Do not link your nutrition to emotional states (joy, sadness, happiness, boredom, anxiety, etc.


No less important is daily physical activity. Walking, light exercises at home, organized sport/recreation activities, and clearing snow or leaves are some other possibilities, but always keep your current level of fitness in mind.

Reference: Serbian Institute for Public Health

What is “Flatfoot” and How Does it Affect Children?

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place

Pediatric flatfoot refers to a structural deformity that occurs in children, which involves the lack of a developed arch of the foot. This can further be classified as symptomatic or asymptomatic. In the latter, the child exhibits no symptoms. This condition is sometimes called “pronated foot” by doctors and therapists.

Symptomatic flatfoot in children is characterized by pain or tenderness in the foot or leg. There may be an alteration in the child’s walking patterns, with a valgus heel (rearfoot turned outward) and difficulty wearing shoes. The child may also tire easily, seeming to lack energy to participate in physical activities.

flatfoot 1It is important to note that all children start out with little to no arch when they first start walking. As they mature, the medial midfoot plantar fat pad in the foot starts decreasing, leading to the development of a clearly identifiable medial longitudinal arch.

flatfoot 2In some children, however, the force of certain movements (pathomechanical) acts on the foot to cause a host of compensatory movements which affect the child’s gait function. There is noted fatigue of the lower extremity and the child may constantly want to be carried.

One possible reason for abnormal functioning of feet in children is a genetic predisposition to develop the condition. Biomechanical factors can contribute to the progression of flatfeet in children, like torsional problems in the transverse plane such as an adduction of the metatarsus (forefoot pointed to medial line – inside) or femoral (thigh) and tibial (shin-low leg) rotation.

Excessive internal hip rotation, rearfoot and forefoot varus (inversion- inward turning), limitations of dorsiflexion, equinus (foot pointed down- ”horse’’ foot) or pseudo torsion (Rotation) at the knee can also lead to acquired deformities of the foot.

A careful musculoskeletal assessment is required to spot anatomical compensations that signal the presence of an abnormal foot position. The foot needs to be evaluated in both weight bearing and non-weight bearing positions. Apart from a thorough gait analysis, the physical examination must include a detailed inspection for tenderness, severity of the deformity, range of motion, muscle strength, and spasticity. Any family history of foot deformities and medical conditions such as neurological disorders also need to be taken into consideration.

flatfoot 4Based on the results of such a foot evaluation, an appropriate treatment modality can be constructed. Orthotics provide early arthrokinematic (joint motion) care to children to prevent latent disability in adulthood. If not looked into at a young age, the loss of posterior tibialis function can trigger the development of a host of foot conditions as the child grows up. By supporting the child’s foot in its optimal position, orthotics ensure that mechanical instabilities are treated at an early stage, while improving posture and balance.flatfoot 3 This also promotes proper growth and development. Compensatory motions are eliminated and full functionality is restored to the medial arch height while maintaining the optimal structural integrity of the foot. This encourages healthy supination (inversion-inward turn) and functional pronation (eversion-outward turn) of the foot throughout daily activities; orthotics provide for the constant postural adjustments and readjustments the body undertakes on different terrain during the day. There is also less expenditure of energy due to the optimal alignment of the muscles, tendons and ligaments; the child is able to engage in physical activities without the constant feeling of lethargy.

Russell G. Volpe (2012) Pediatric Flatfoot: When Do You Treat It? Podiatry Today: January 2012, Vol. 25, No. 1.
Michelle L. Butterworth (2010) A Systematic Approach To Pediatric Flatfoot: What to Do and When to Do It. Retrieved from:

LIH Olivia’s Place: Supporting Schools

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supporting-schools-1Staff at LIH Olivia’s Place are always delighted to be asked to support partner schools. We were recently invited to speak to parents at Wellington Bilingual School as part of the events leading up to the Festival of Education in Shanghai.

Jamie Fanelli, Learning and Behavior Support Lead, spoke to parents on the topic of Understanding the Connection Between Learning, Child Behavior, and the Power of Positive Reinforcement. She introduced some learning principles that are essential to understanding a child’s behavior and strategies to promote positive behaviors.


Our physical therapist, Ilija Dimitrovosk spoke with the parents on the importance of physical activity for children in the early years age group. He provided theory behind the growth and development of young children as well as encouraging parents to participate when giving some exercise examples.


During the Festival of Education, leading experts from across the globe came together to discuss alternative approaches to teaching, as well as share their insights in educational thinking. Parents and educators were invited to join two days of talks, workshops and panel discussions in such areas as wellbeing, the relationship between Chinese and British education, Early Years, and classroom practice. LIH Olivia’s Place has a long history of supporting children, families, and schools and were honored to be involved in this initiative through sponsorship and opportunities for dialogue with educators, parents, and community members.


Our psychology team has continued to work very closely with the community at Dulwich High School. We are supporting their “Parent Academy” initiative by speaking on topics such as executive functioning and building relationships with teenagers. We regularly support the school staff by supporting career and professional development events and via professional supervision.

Physical Therapy Team Trains Therapists in Kunshan

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Physical Therapists Ilija Dimitrovski and ZiLi Wang recently trained therapy staff at Kunshan’s Jiajie Rehabilitation Center. The center is affiliated with the China Disabled Persons’ Federation and serves as an important resource for children needing rehabilitation, especially children with cerebral palsy or autism. Staff at the facility include physical and occupational therapists as well as speech therapists and learning support. The training provided by the LIH Olivia’s Place team focused on improving the staff’s ability to plan treatment and introduced new standardized assessment tools, as well as teaching specific techniques for children with cerebral palsy. Feedback from the course was positive, with the center’s president, Dr. Shao Ping, looking for continued partnership with LIH Olivia’s Place, including receiving occupational therapy and speech therapy experts for additional training in the future.


Stand Up for Healthier Sitting

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place Shenzhen

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place Shenzhen

Nowadays our way of living is more passive than ever. There are lot professions which use various electronic devices to help and get the job done properly. This trend impacts even children in the classroom. But that also has a, negative influence’’ on our health condition. One of the most affected body parts with this so called, modern age disease’’ is the back. Sitting is the most common culprit. Long and incorrect sitting can create weakness in our muscles (back, abdominal, gluteal and leg muscles), poor peripheral blood circulation, poor lungs ventilation, … Less physical activities can certainly influence our body weight, and increased body weight leads to worsening symptoms. So people who are required to sit for long periods of time or in incorrect seating are more exposed to these problems.

When talking about children, we need to mention increased use of computers and tablets for school work, in their spare time, and during recreational activities. Parents should be aware that excessive time spent in incorrect body positions can be harmful for children. Long periods of sitting daily can cause decreased heart and brain function (slow circulation), improper lung ventilation, slow digestion, and obesity. Children who are sedentary for too long can experience posture problems like neck and shoulder strain and back problems including pain and weak muscles (scoliosis, kyphosis, loose abdominal muscles, low back pain). Parents should look at the posture of their children and if they notice some changes, consult a healthcare practitioner or PE teacher for advice. These problems are not harmless or irrelevant and can negatively influence a children’s growth and development. Spinal deformities, weak muscles, and childhood obesity can all be linked to a sedentary lifestyle that features too much time sitting.

We all should encourage our children to take breaks during long sitting periods and do some movement. Established advice is 30 to 60 minutes per day of some physical activity. That could be activities like walking, riding a bike, slow running, stretching exercises, walking up and down stairs, climbing up a slide instead of sliding down, swinging, crab walking, jumping jacks, skipping rope, etc. Swimming is also highly recommended. One great free resource for movement breaks at home or in the classroom is Go Noodle ( Your child can also exercise while seated (stretching and breathing exercises).
Always check that your child is seated in the correct position, which means:
• Elevate feet from the floor at less than a 20° angle (books or cushions can be used for elevation)
• Lean back on the chair’s backrest
• Do not fold legs under bottom
• Do not hook shins and feet under the chair on which they are seated.

Adults often complain about back problems, which are typically neck or low back pain problems. With time, symptoms can worsen and pain can radiate all the way through a person’s arms and legs. That level of severity certainly reduces effectiveness in the workplace and quality of life in general. All around the world, employers and employees try to find the best models to organize their workplaces and activities to decrease that negative health influences’. There are two steps we can take to achieve that.

One is to adjust work environment and the other is to do a few exercises during worktime. If you are sitting a long time at work you should consider adjusting the height of your desk, the position and angle of your computer or other electronic device, and use accessories such as wrist or arm supports if it is necessary. When seated, lean your back fully on the backrest of the chair (back support part of the chair). Do not position your shins under the chair or sit on your bent legs; try to put your feet on a platform at a 15-20° angle with the floor, and wear comfortable clothing and shoes.

Stand Up 1

Next are exercises. Performing physical exercises during the day helps to decrease symptoms, improve physical abilities, prevent possible future problems, and increase work efficiency. They can be performed in a chair at your desk, at the chair using it as a support, or simply stand up and do your exercises in a free space. Stretching is a main component of these exercises, then comes strength and endurance. You can stretch your upper or lower limbs, use some weight accessories for strength, and do as many repetitions as you can for endurance. Start with short duration, no/low weight, and fewer repetitions for start and then increase over time to avoid muscle inflammation, muscles spasms (higher muscle tone), fatigue, and pain.
We all should have regular physical activity, especially those of us who are sitting too long or in an inadequate way. In order to prevent pain, deformities, weakness, and poor work efficiency we can adjust our work space and exercise at work. However, before beginning any exercise at work, consider your present health condition. If you are currently experiencing pain or other symptoms, have a medical condition that could affect your physical abilities, or are just not “in shape, “ask for advice from a qualified healthcare professional or physical trainer first.

Taking Action to Prevent Sports Injuries

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Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia's Place Shenzhen

Ilija Dimitrovsk, Lead Physical Therapist, LIH Olivia’s Place Shenzhen

During the summer school break most children have  more time for activities beyond studying. Among them certainly are sport-related physical activities, which have many proven benefits. Nevertheless, there are some risks and injuries are not uncommon. Therefore, children, parents, and coaches need to pay attention to injury prevention.

sports injuries figure 1

Experience shows to us that some things can be done to prevent unpleasant moments (injuries). First of all, young people, particluarly those over the age of 10, who are considering participation in sports activities need to do some self-evaluation. This means that he/she needs to check their present fitness condition;  a short running test (2 minutes running at regular speed) or climbing up and down stairs (30-40 stairs), several squats, jumps or similar will be enough to show present state. If a child cannot complete these basic tests than he/she need to improve him/her self before beginning sport-related activities. If those test show to you that you are in good shape, you are going to the next phase.

Before the sport activity:

Warming up is very important. A lot of sports experts around the world highlight the necessity of both warm up and cool down activities. Before every physical activity your body need some preparation. This preparation actually improves body functions (not only loco-motor but cardio, pulmonary ) and trains it for further physical activity. We can divide warm up into two types, static and dynamic.  If a child chooses a static warm-up, the streching, proprioception  ( routines including strength, balance, agility, coordination) and balance warm up should be done in one position with small movements.  Dynamic warm-ups include streching, proprioception , balance and plyometrics (designed for explosiveness, strength, and speed) with the certain amplitude of movements.

Plyometrics (“plyo” for short) used to be called “jump training.” It’s a technique that you can use in many different ways. For instance, you can do plyometrics to help train for basketball, volleyball, tennis, or any other activity that uses explosive movements. You’ll do a series of jumps and hops, like jump squats or one-leg hops. You might jump up and onto a box or bench, or jump over cones. Some moves will be faster than others. Proprioceptive training exercise routines  are designed to increase strength, balance, agility, coordination, and prevent sports injuries. Examples of good exercises are: streching hamstrings quadriceps, and pectoral muscles, standing on toes and heels alternately, semi-flexed knee balancing, standing on one leg, changing directions, and jumping on or over objects.

Iliija 6 Ilija 1 Ilija 2 Ilija 4 Ilija 5 Ilija 7 Ilija 3

During the Sport activity:

Now you can start the game. During  sport activities, if a child notices pain in the limbs, back, or chest,  or feeling of weakness, dizziness, or similiar, stop the activity and take a break. With sudden increased intensity of sport, some muscle imbalance may become evident. Strain on the growth plates can also lead to Osgood-Schlatter disease,  which can cause a painful lump below the kneecap in children and adolescents experiencing growth spurts during puberty. Osgood-Schlatter disease occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet. While Osgood-Schlatter disease is more common in boys, the gender gap is narrowing as more girls become involved with sports.  If you child experiences pain or other symptoms, consult with a physical therapy or orthopedic physician. It is important to remember that hydration of the body is neccessary, especially in this summer months.

After Sport activities:

After sport play/game, cool down is next (not many people like it and do it). Experience shows that cool down helps the body to relax, calm down to the pre-activity level more easily, and certainly helps recovery after activities (fatigue, muscle inflammation, joint irritation). Exercises and duration are the same as in warm up, although there can be differences related to inflammation or pain and should be performed more carefully and slowly. Hydration and supplementation of the electrolytes needs to be done in the following hour to avoid dehydration.