Pediatric Presentations (Supported Treadmill Training, Suit Therapy, Pelvic Floor + Incontinence, Aquatic Therapy, Hippotherapy + Virtual Reality)

what is SUPPORTED TREADMILL TRAINING

use of overhead harness system to support part of child's body weight during treadmill-based gait training

for MORE INVOLVED CHILDREN, what may SUPPORTED TREADMILL TRAINING also include

PTs manually guiding child's LEs through gait pattern

what is the RESULT of SUPPORTING some of CHILD'S BODYWEIGHT

reciprocal steps can be taken with improve gait mechanics + endurance

what does SUPPORTED TREADMILL TRAINING provide

a safe environment to work on strength, balance + coordination

what is the TARGETED + PRIMARY TARGETED POPULATION for SUPPORTED TREADMILL TRAINING

Targeted Population: 9 months to 21 years old

Primary Targeted Population: children 2-16 years old

what are 8 CONDITIONS that SUPPORTED TREADMILL TRAINING is used for

1. cerebral palsy (generalized + spastic)

2. down syndrome

3. prematurity

4. developmental delays

5. genetic syndromes

6. infantile spasms

7. temporal astrocytoma

8. cytomegalovirus

what are the 3 TYPES of SUPPORT with SUPPORTED TREADMILL TRAINING

1. harness system

2. parent/caregiver handheld assist

3. utilization of bilateral/unilateral handrails

what is the PURPOSE of a child utilizing HANDRAILS (bilateral/unilateral) at SPECIFIED INTERVALS

to improve coordination + balance while providing support during walking

what are the 3 TYPES of HARNESS SYSTEMS used with SUPPORTED TREADMILL TRAINING

1. BWSTT (body weight supported treadmill training)

2. PBWSTT (partial body weight supported treadmill training)

3. LTT (loaded treadmill training)

what was the FREQUENCY RANGE for the TREADMILL TRAINING PROGRAMS

biweekly sessions to up to 6 days/wk

- most programs: 2-3 sessions/wk

how LONG did the TREADMILL TRAINING PROGRAMS last for

2 weeks to a year

what are 3 REASONS for why ANKLE WEIGHTS are utilized in some TREADMILL TRAINING SESSIONS

1. to reduce excessive or uncontrolled movements

2. to increased proprioceptive input

3. to increase demand + intensity without increasing speed

regarding INTENSITY of SUPPORTED TREADMILL TRAINING, what can be GRADUALLY REDUCED as the child progresses through the program

amount of support provided by harness system

what is the HIGHEST AMOUNT of SUPPORT that can be given for SUPPORTED TREADMILL TRAINING

50% of child's body weight

what is the LOWEST AMOUNT of SUPPORT that can be given for SUPPORTED TREADMILL TRAINING

handrails

what is the TYPICAL TIME RANGE for SUPPORTED TREADMILL TRAINING

15-45 minutes

what are 6 THINGS does SUPPORTED TREADMILL TRAINING IMPROVE with CEREBRAL PALSY

IMPROVES:

1. walking capacity

2. functional mobility

3. walking speed

4. endurance

5. trunk control

6. energy expenditure

how is SUPPORTED TREADMILL TRAINING EFFECTIVE for DOWN SYNDROME

effective with advancing development of independent walking + proper gait mechanics

what is SUPPORTED TREADMILL TRAINING EFFECTIVE for with DEVELOPMENTAL DEALYS

effective for walking speed, gross motor skills + gait mechanics

overall, what can SUPPORTED TREADMILL TRAINING show improvements in (3)

1. walking capacity

2. gait mechanics

3. speed

what are 2 RECOMMENDATIONS to CONSIDER when DETERMINING COURSE OF TREATMENT + INTENSITY for SUPPORTED TREADMILL TRAINING

1. what the child is telling you

2. signs that the child's body is giving

what is THERASUIT

is a modernized, FDA-registered evolution of the Adeli-suit designed for intensive physical therapy that uses adjustable elastic bands to provide structural alignment + targeted resistance

what CONDITION is the THERASUIT primarily used for

cerebral palsy

regarding CEREBRAL PALSY, what is the RECOMMENDED FREQUENCY/INTENSITY for the THERASUIT

1. 5 days/wk

2. 4 hrs/day for 3 consecutive weeks (15 sessions)

regarding CEREBRAL PALSY, what is the STANDARD PROTOCAL TIME FRAME for the THERASUIT

10-30 minutes

1. 10-15 minutes: heat

2. 15-20 minutes: manual therapy

3. 15-30 minutes: strengthening using pulleys (UEU system)

for CEREBRAL PALSY, is SUIT DONNING + ADAPTATIONS considered CUSTOMIZABLE/NOT CUSTOMIZABLE

customizable

what TYPE of FUNCTIONAL EXERCISES are administered during a THERASUIT SESSION with CEREBRAL PALSY

UEU upright exercises for:

1. balance

2. sensorimotor

3. fine motor

4. balance + coordination

5. gross motor skills

6. endurance

what are 2 RESULTS on the EFFECTIVENESS of INTENSIVE THERAPY PROTOCOLS for THERASUIT with CEREBRAL PALSY

1. minimal increases in cadence, increased hip extension + pelvic symmetry

2. slight improvements in gross motor function + mobility

regarding THERASUIT THERAPY with CEREBRAL PALSY, what is PROTOCOL TIMING tailored to

patient goals

what is the ADELI SUIT

is the original Soviet-derived prototype that uses a high-tension system of elastic bungees to load the body + "re-teach" the brain how to perceive movement by stimulating gravitational pressure

what is the RECOMMENDED FREQUENCY/INTENSITY for ADELI SUIT

1. 30 minutes - 2 hrs

2. 5 days/wk for 4-6 weeks

what are 3 INTERVENTIONS with the ADELI SUIT

1. used alone

2. used in combination with NDT

3. modified AST

what is the purpose of using the ADELI SUIT alone

for gait training + functional activity training

what 2 INTERVENTIONS can be carried out when using MODIFIED AST

1. passive stretching

2. functional activities

regarding EFFECTIVENESS, what are 2 RESULTS of USING ADELI SUIT ALONE

1. increased GMFM scores

2. improved FAPS scores

regarding EFFECTIVENESS, what is the RESULT of USING ADELI SUIT in COMBINATION with NDT

significant improvement with spatiotemporal parameters of gait

why is MODIFIED ASTS suggested to be effective

improved long term retention skills

what is an EXOSKELETON

a battery-powered, rigid external frame equipped with motors that actively provide the mechanical force necessary to move or stabilize a user's limbs

what 3 CONDITIONS can the EXOSKELETON be used with

1. cerebral palsy

2. spinal muscular atrophy

3. generalized gait impairments

what is the RECOMMENDED AGE RANGE for using an EXOSKELETON with CEREBRAL PALSY

2-25 years old

what is the RECOMMENDED FREQUENCY/INTENSITY for using an EXOSKELETON with CEREBRAL PALSY

1. 6-28 sessions

2. 30 minutes - 4 hours

3. over 6-12 weeks

what are 5 EXOSKELETON TYPES for CEREBRAL PALSY

1. unilateral/bilateral hip, knee + ankle joint

2. unilateral knee joint

3. attachments to orthotics

4. added trunk support

5. moonwalkers

regarding EFFECTIVENESS, what are 5 OUTCOMES of using EXOSKELETONS with CEREBRAL PALSY

1. improve gait mechanics

- better hip + knee extension and ankle DF

- symmetry

- upright posture

- reduced step width

2. reduced spasticity

3. improved strength

4. variable difference in gait speed + endurance

5. improvements in motor function + balance

in CEREBRAL PALSY, what is the purpose of the EXOSKELETONS

to increased total steps + gait training time outside of clinic

in CEREBRAL PALSY PATIENTS, what can EXOSKELETONS improve

engagement in therapy sessions

what is the RECOMMENDED AGE RANGE for using an EXOSKELETON with SPINAL MUSCULAR ATROPHY

3-12 years old

what is the RECOMMENDED FREQUENCY/INTENSITY for using an EXOSKELETON with SPINAL MUSCULAR ATROPHY

1. 60 minute sessions

2. 8-30 sessions total

what is ONE TYPE of EXOSKELETON for SPINAL MUSCULAR ATROPHY

ATLAS 2030 (bilateral hip, knee, ankle + trunk)

regarding EFFECTIVENESS, what are 4 OUTCOMES of using EXOSKELETONS with SPINAL MUSCULAR ATROPHY

1. improves maximal isometric strength

- hip flexion, extension + abduction

- knee flexion + extension

- ankle DF + PF

2. improves joint contractures + PROM

3. improves duration of activity + number of steps achievable

4. small improvements in functional assessments

with SPINAL MUSCULAR ATROPHY, what is an INDICATION that an SMA PATIENT is tolerating the EXOSKELETON well

stable vital signs

with SPINAL MUSCULAR ATROPHY, is the EXOSKELETON able to USED OUTSIDE CLINIC/JUST IN THE CLINIC

used outside clinic

what are 2 TYPES of EXOSKELETONS for GENERALIZED GAIT IMPAIRMENTS

1. unilateral knee joint

2. bilateral knee joint

what are 2 WAYS an EXOSKELETON can help crouched gait in GENERALIZED GAIT IMPAIRMENTS

1. improving peak knee extension

2. improving knee ROM during swing

what are 2 WAYS an EXOSKELETON can help genu recurvatum in GENERALIZED GAIT IMPAIRMENTS

1. decreasing hyperextension during stance

2. improving knee flexion during swing

what is a NEUROSUIT

a brand-specific dynamic soft orthotic that utilizes a unique configuration of attachment points + bands to provide the deep proprioceptive input needed to improve posture + most control

what is PEDIATRIC URINARY INCONTINENCE

is involuntary leakage of urine in children paste the age of which bladder control is expected

what CAUSES PEDIATRIC URINARY INCONTINENCE to occur

impaired control of:

1. bladder

2. urethral sphincters

3. pelvic floor muscles

when can PEDIATRIC URINARY INCONTINENCE occur

during daytime/nighttime

is it MORE COMMON for BOYS to have NOCTURNAL/DAYTIME INCONTINENCE

nocturnal incontinence

is it MORE COMMON for GIRLS to have NOCTURNAL/DAYTIME INCONTINENCE

daytime incontinence

what AGE RANGE is PEDIATRIC URINARY INCONTINENCE commonly found in

children 5-10 years old

does the PREVALENCE of PEDIATRIC URINARY INCONTINENCE DECREASED/INCREASED with AGE

prevalence decreases with age

what are 5 PROBLEMS associated with PEDIATRIC URINARY INCONTINENCE

1. social embarrassment

2. low self-esteem

3. participation restrictions

4. UTIs

5. underlying developmental issues

what are 2 TYPES of PEDIATRIC INCONTINENCE

1. urinary incontinence

2. fecal incontinence

what are 4 TYPES of URINARY CONTINENCE

1. diurnal

2. nocturnal/bedwetting

3. primary

4. secondary

what is the MOST COMMON TYPE of PEDIATRIC URINARY INCONTINENCE

nocturnal/bedwetting

when does PRIMARY PEDIATRIC URINARY INCONTINENCE occur

when toilet training has not been mastered

what is SECONDARY PEDIATRIC URINARY INCONTINENCE

a period of dryness followed by periods of wetting

what are 3 TYPES of FECAL INCONTINENCE

1. urge

2. passive

3. pseudoincontinence/encopresis

what is URGE FECAL INCONTINENCE

sudden strong need to have a bowel movement

what is PASSIVE FECAL INCONTINENCE

when child has stool leaking without knowing due to not being able to sense when their rectum is full

when does PSEUDOINCONTINENCE/ENCOPRESIS occur

in children who are toilet trained but have severe chronic constipation causing soft/liquid stool to leak out of their rectum

what is the GOAL a PT EVALUATION for PEDIATRIC INCONTINENCE

to identify contributing factors (underlying movement impairments, posture, strength + pelvic floor muscle coordination)

what are 2 KEY COMPONENTS for a PT EVALUATION for PEDIATRIC INCONTINENCE

1. assessment of abdominal, LE + trunk strength

2. considerations that may influence continence, include child's:

- diet

- sleep patterns

- physical activity level

- behavioral factor

what are 4 EFFECTIVE TREATMENTS for TREATING PEDIATRIC INCONTINENCE + PELVIC FLOOR DYSFUNCTION

1. biofeedback assisted training

2. TENS therapy

3. functional magnetic stimulation (FMS)

4. pelvic floor PT

what does BIOFEEDBACK ASSISTED TRAINING involve

electrodes placed around pelvic floor musculatures (either internally or externally) + are hooked up to a display providing real-time feedback of pelvic floor muscle activation

what are 2 RESULTS on the EFFECTIVENESS of BIOFEEDBACK ASSISTED TRAINING

1. improved voiding patterns in patients

2. achieve completely normal urine flow

what is the RESULT of BIOFEEDBACK COMBINED with PELVIC FLOOR PT

complete reduction of urinary incontinence episodes

what are 4 POSSIBLE ELECTRODE PLACEMENTS for TENS THERAPY

1. bilaterally over S2-S3

2. over pubic symphysis + ischial tuberosity

3. posterior tibial nerve

4. internally via intrarectal probe (to stimulate pudendal nerve)

regarding TENS THERAPY, what can ELECTRICAL STIMULATION of PELVIC FLOOR MUSCULATURE help (3)

1. regulate an overactive bladder

2. reduce symptoms of urgency

3. reduce urinary frequency

what are 4 RESULTS on the EFFECTIVENESS of TENS THERAPY

1. improvements in nighttime incontinence

2. improvements in post-void residual volume

3. improvements in urinary flow rate

4. improvements in bladder capacity

what is FUNCTIONAL MAGNETIC STIMULATION (FMS)

is electromagnetic stimulation that does not require electrode placement + involves pulsed magnetic fields that generate an induced electric field at the pelvic floor musculature + sacral nerve three

regarding FUNCTIONAL MAGNETIC STIMULATION (FMS), what does PROPAGATION of NERVE IMPULSES to the MUSCLES INITIATE

contraction

regarding FUNCTIONAL MAGNETIC STIMULATION (FMS), what is the RESULT of muscle contraction initiated by propagation of nerve impulses

improve muscle strength + endurance

what is the PULSE FREQUENCY SET AT with FUNCTIONAL MAGNETIC STIMULATION (FMS)

15Hz (with 5s pulses for contraction + relaxation for 20 minutes)

what are 2 RESULTS of a 2 WEEK FUNCTIONAL MAGNETIC STIMULATION TREATMENT in children with OAB (overactive bowel)

1. reduction of unstable bladder contraction

2. improved bladder stability

regarding URINARY INCONTINENCE, what are 3 POSITIONS that PELVIC FLOOR EXERCISES can be prescribed in

1. supine with hip + knee flexion

2. on exercise ball

3. in gravity dependent positions

regarding PELVIC FLOOR PT in PEDIATRIC PATIENTS with URINARY INCONTINENCE, what can be used to AID VISUALIZATION

biofeedback

regarding PELVIC FLOOR PT in PEDIATRIC PATIENTS with CONSTIPATION/FECAL INCONTINENCE, what did the PHYSICAL THERAPY SESSIONS INCLUDE (3)

1. pelvic floor therapy working on coordination + proprioception

2. manual therapy

3. postural + breathing exercises

what are 4 POSITIVE OUTCOMES of PELVIC FLOOR PT for CONSTIPATION/FECAL INCONTINENCE

1. reduction in pain with defecation

2. less pharmacological intervention

3. constipation reduction in 5-12 therapy sessions

4. reduced defecation frequency

what are 7 CONDITIONS that can benefit from AQUATIC THERAPY

1. cerebral palsy (spastic diplegic/quadriplegic)

2. autism

3. down syndrome

4. ADHD

5. duchenne muscular dystrophy

6. developmental coordination disorder

7. neuromuscular disorders

what is the RECOMMENDED AGE RANGE for AQUATIC THERAPY with CEREBRAL PALSY

1-23 years

for CEREBRAL PALSY, what is the RECOMMENDED FREQUENCY/INTENSITY for AQUATIC THERAPY

1. 2-5 sessions a week for 4-16 weeks

2. 30-65 minutes a day

3. water temperature: 28-36 degrees C (82.4-96.8 degrees F)

for CEREBRAL PALSY, what are 4 INTERVENTIONS to include in AQUATIC THERAPY

1. balance activation exercises

2. manual passive stretching

3. functional training

4. halliwick concept/aquatic motor learning

regarding AQUATIC THERAPY for CEREBRAL PALSY, what are BALANCE ACTIVATION EXERCISES used for (6)

1. DF muscles

2. knee muscles

3. hip extensor muscles

4. lower limb weight bearing

5. gait

6. postural stability

regarding AQUATIC THERAPY for CEREBRAL PALSY, what does MANUAL PASSIVE STRETCHING involve

stretching spastic muscles + holding for 60 seconds x5

regarding AQUATIC THERAPY for CEREBRAL PALSY, what are 8 TYPES of FUNCTIONAL TRAINING that can be included in aquatic therapy

1. 2-point kneeling

2. sitting control

3. standing

4. walking with + without flotation devices

5. core stability

6. STS transfers in shallow pools

7. reaching + grasping movements while supported in water

8. walking/stepping patterns against water resistance

regarding AQUATIC THERAPY in CEREBRAL PALSY, what is the HALLIWICK CONCEPT/AQUATIC MOTOR LEARNING

is a structured aquatic program emphasizing balance, trunk control + swimming skills

what does the HALLIWICK CONCEPT/AQUATIC MOTOR LEARNING include (3)

1. rotational control in water

2. breathing + posture

3. independence in water movements

what are 10 IMPROVEMENTS seen with AQUATIC THERAPY with CEREBRAL PALSY

IMPROVEMENTS in:

1. muscle strength

2. motor control in trunk + extremities

3. circulation

4. breathing

5. static + dynamic balance for gait patterns

6. postural stability

7. lying + rolling

8. sitting

9. crawling

10. kneeling