6 Pediatrics

Orthopedic Pediatrics

• Acute - Injuries, etc.

• Congenital - From birth

Torticollis

• Congenitally short cervical mm

• Plagiocephaly (slanted head)

• Rx: Gentle PROM, MFT, AROM, orthotics, football hold, rotational stretches

• Precautions: vertebral anomalies, location of vessels/nerves

Osteogenesis Imperfecta

• Congenital lack of collagen type 1 ability to form bones

• Fractures easily

• Rx: aquatics, restoring func and strength, family ed.

Arthrogryposis Multiplex Congenita

Congenital jt contractures form mm fibrosis

• Rx: maximize function, adaptive mobility, family ed.

Brain development by age (important?)

• 1 mo: neural tube development

• 2 mo: cerebral cortex (outer layer)

• 3 mo: reflexes and reactions

• 5 mo: controlled movmt

• 6 mo: development of separate hemispheres

• 7-9: inc motor control and sensory processing, memory

• Birth to age 3: 80% fo basic brain architecture complete - 90% by age 5

Cerebral Palsy

• PVL, Hydrocephalus, IVH, Agenesis of the corpus collosum

• Hallmarks of CP:

  • hypotonicity to spasticity

  • Hemiplegia to diplegia to quadriplegia

  • Reflex dominance then asymmetry

Spina Bifida

• Mixed ortho/neuro: SCI, chirai malformation

• Common precaution: latex allergy

• Maximize early gait and mobility

• Orthotics/ADs

Types of Cognitive impairment

• PDD/Autism

• ADHD/sensory processing

• Other: Core weakness, delay coordination, delayed milestones, sensory defensiveness

AIMS (Alberta Infant Motor Scale)

• A tool used to assess gross motor skills birth to 18 mo

• Uses 4 positions: prone, supine, sitting, and standing to track development of head control, rolling, sitting, and standing

Treatment goals for pediatric

• Max/restore function does NOT equal making more normal

• Minimize compensations/establish mvmt/bone shape

• Have a session goal

Minimizing compensations by…

• Accessory mvmts (elbow flex, hip IR, etc.)

• Compensatory strategies (learned non-use)

• Fixing/over-recruitment dec need for distal/proximal stabilizing

What are good strategies for treatment in Peds?

• High# of repetitions

• Motivation = play/exploration

• Just right challenge

Just Right Challenge

• Sensory input for motor input

• Auto level of integration /learning

• Start with what they have then move into new mvmt

Prone (developmental mobility)

• The first protective reflex: to clear the airway

• Cephalo-caudal wt shift

• Hip ext/add development

Supine

• Abdominal development

• Hand-eye coordination

• Cephalo-caudal development

• Crossing midline

Sitting

• Hands-supporting

• Hands-free

• Transitions to/from

• Predictive of gat by 2 yrs old

Standing

• Transitions to/from

• Learning balance (gravity ex)

Pt #1

• 4 yr old withspastic diplegic CP

• Wears bilat AFOs

• Requires UE assit x 1 for standing balance

• Goal: Ind standing balance

• Create activity for inc standing balance and LE strength

  How can you make it easier? More challenging

Fill this out and the other pt scenarios when Mrs. Leighman goes over it in class