14: Using manipulative techniques on children is unethical Flashcards
(19 cards)
Affirmative opening statement
• Manipulative therapy uses quick manual techniques (like spinal joint “cracking”) to treat issues such as:
- musculoskeletal problems
- posture
- sciatica
- sports injuries
- repetitive strain injury (RSI).
• It’s performed by licensed professionals including physiotherapists, chiropractors, doctors, and osteopaths.
Affirmative arguments
- Manual techniques carry potential for harm
- Unproven or poorly supported techniques are used
- Children cannot give true informed consent
What supported the affirmative argument “Manual techniques carry potential for harm” ?
• Children are more vulnerable anatomically; still developing
• Even small/rare risks break “do no harm” when real harms like nerve injury have been reported.
• A meta-analysis found serious adverse events with pediatric spinal manipulation, including neurological events, hemorrhage, and delayed diagnosis.
What supported the affirmative argument “Unproven or poorly supported techniques are used” ?
• These methods lack strong evidence and may harm growing children, violating the “Do No Harm” principle.
• Children deserve protection based on science, not guessing.
What supported the affirmative argument “Children cannot give true informed consent” ?
Children cannot give true informed consent, which is essential for ethical care and respecting their dignity and rights.
Opposition opening statement
Physical therapy supports function, pain relief, and independence in children.
Manual techniques are essential tools; calling them “unethical” misrepresents their value in care.
Opposition arguments
• Evidence based and clinically effective.
• Support natural healing.
• Specifically adapted and safe.
What supported the opposition argument “Evidence based and clinically effective.” ?
APTA states manual therapy, including manipulation and mobilization, is evidence-based when used appropriately in pediatric populations by trained clinicians
What supported the opposition argument “Support natural healing.” ?
• Manual therapy offers a gentle, non-invasive first-line treatment that supports natural healing, especially important for children.
• A 2019 study found spinal manipulation safely reduces pain and improves mobility in pediatric patients with few mild side effects.
What supported the opposition argument “Specifically adapted and safe” ?
• Pediatric manual therapy uses gentle, low-force, clinically modified techniques.
• A 2019 review (Manual therapy for pediatric population) found that when properly indicated and modified, these interventions are safe and beneficial for children.
Affirmative Rebuttal to “Evidence based and clinically effective”
• Evidence for manual therapy in children is limited, low in quality, and inconsistent.
• Many pediatric studies lack strong methodology.
• Vohra et al. (2007) concluded there is insufficient evidence for efficacy and some documented harm exists.
• Using weak evidence in vulnerable groups like children goes against ethical standards.
Affirmative Rebuttal to “Support natural healing.”
This is a false dichotomy. The choice is not just between manipulation vs surgery/medication.
Many non-invasive evidence based alternatives exist, such as:
• therapeutic exercises
• Active movement-based play
• Parent education
• Stretching techniques
Manual therapy in children lacks the same level of high-quality evidence as active therapies.
Ethically, clinicians must use the least harmful and most effective treatment. Manual therapy is not always the safest or the most effective.
Affirmative Rebuttal to “Specifically adapted and safe”
• Modifying manual therapy for children doesn’t remove risk or resolve ethical concerns.
• A 2015 review found poor safety reporting in pediatric studies.
• Without solid data, “safe and beneficial” claims are premature.
• Even gentle techniques can harm developing bones, plates, and ligaments.
Affirmative closing statement
Manipulation in children is unsafe and unethical; therapists must prioritize safety and avoid unnecessary harm to ensure the best outcomes.
Opposition rebuttal to “ Manual techniques carry potential for harm “
• No intervention is risk-free, but manual therapy is extremely safe when done by trained professionals.
• Serious adverse effects are very rare; minor effects like soreness are mild and temporary.
• Risk is reduced by professional standards, gentle pediatric techniques, and clinical judgment.
Opposition rebuttal to “ Unproven or poorly supported techniques are used “
• APTA and IFOMPT officially support manual therapy for pediatric patients.
• Support is based on clear clinical guidelines, showing the practice is safe, ethical, and professionally accepted.
Opposition rebuttal to “ Children cannot give true informed consent”
• Children can’t give legal consent, but substituted consent by informed parents or guardians is valid and ethical.
• Pediatric care involves child assent, making the process collaborative, protective, and professional.
• According to Article 11, if the patient is under 18, consent must come from a parent or legal guardian, reinforcing ethical and legal standards.
Which article was used by the opposition team to rebuttal “ Children cannot give true informed consent” ?
Article 11
Opposition closing statement
• Using manipulative techniques in pediatric care is ethical and appropriate when done by trained professionals.
• These methods are safe, well-studied, and commonly used.
• They provide a gentle, drug-free way to support children’s healing, prioritizing safety, comfort, and well-being.
