Work Type



Fall 2018

Faculty Advisor

Holly Roberts, PT, DPT, GCS, NCS




Purpose: The purpose of this project is to:

  • describe the history and etiology of the Zika virus as well as relationship of gestational Zika infection to incidence of microcephaly.
  • describe clinical manifestations and useful physical therapy treatments of microcephaly.


  • Lit Review: A systematic literature review was performed in PubMed and CINAHL. Two researchers reviewed the sources screening in articles with relevance for evaluation and treatment of infants and children with microcephaly. Articles relevant to the link between Zika and microcephaly were also included in the review.
  • Case Studies: During 03/11/18 - 03/16/18 in the Zacapa region of Guatemala, three children with microcephaly were seen for a single visit each. Cases included two infants and one adolescent, two males and one female, all of whom presented with symptoms including abnormal tone and impaired motor control. Each child was evaluated and treated by at least one of the authors and a licensed physical therapist. Treatments were individualized to the needs of the child and included the following: passive range of motion, stretching, tone reduction techniques, and sensory stimulation. Medical confirmation of gestational Zika infection was not possible due to the nature of Zika testing, medical resources in the region and study design.

Summary of Use

  • Guatemala reported rates of Zika infection in the Zacapa region at 106 per 100,000 people in 2016, making it an area of interest for further discussion due to suspected sequela of Zika infection which includes microcephaly and Guillain-Barre Syndrome. Rates of Zika infection are difficult to quantify due to poor understanding of virus etiology, methods of testing, lack of healthcare resources, and mildness of symptoms.
  • The relationship between gestational Zika infection and microcephaly is substantial and is corroborated by multiple studies.

Importance to Members

  • Infants with microcephaly should be evaluated and treated by a multidisciplinary team. PT evaluation and treatment of microcephaly should be based on the biopsychosocial model including activity, participation and environmental factors as opposed to the prior style of biomedical assessment. Early evaluation and intervention, within the first 6 months of infancy, leads to better outcomes with babies with microcephaly due to high brain plasticity in infancy. Physical therapists who provide short- or long-term services in regions affected by Zika should screen at-risk children for developmental delays and assist with providing appropriate intervention.
  • There is a link between degree of microcephaly and physical disability. Children with microcephaly may present with spasticity, hyperreflexia, poor motor control, irritability, tremors, and dysphagia. Other problems include seizures and visual and auditory deficits.
  • Due to the recent increase in Zika virus infection rates and the lack of literature on treatment of infants exposed in utero, there is a need for future research.


University of Puget Sound