Pediatrics Set

Description ~

A successful treatment is unlikely if the PT focusses solely on the child’s motor strengths and needs while neglecting the cultural impact of family and community factors on that child. 

The WHO issued an International Classification of Functioning, Disability and Health (ICF) that is consistent with the APTA guide to PT practice.

ICF - describes the impact of a person’s health condition on body functions and structures, daily activities, and social participation.

Enablement Process and Disablement Process represent the dynamic, interactive relationships a child has within different environmental contexts. 

Enabling Process - 

The PT can advance a child through an enabling process by addressing the body’s structural integrity so that age-appropriate movement and interactive activities can occur.

Classification of Disablement:

Impairment of the body structures and body functions

Characteristics:

• Reflex development

• Joint motion

• Muscle length and strength

• Respiratory status

• Postural stability

Child interaction level.

Activity Limitations

Characteristics:

• Locomotion

• Communication

• Oral motor function

• Social and emotional

Child-daily environment interaction level.

  Participation restriction

Characteristics:

• Community recreation

• School participation

• Employment

• Access to facilities

Child-community and society interaction level.

Impact of Federal Legislation ~

The scope of pediatric specialization within the field of physical therapy is rapidly evolving as a result of a variety of factors that directly affect the care of children:

• Public policy

• Family-centered care

• Practice environments

Education of All Handicapped Children Act (EHCA):

Passed by congress in 1975,  public law 94-142. Its main premise was that all children from ages 6 to 21, regardless of disability, were entitled to free and appropriate public education.

Common Conditions ~

Developmental Delay:

A child who has not attained predictable movement patterns or behaviour associated with children of a similar age.

Caused by a number of factors during fetal development, including:

• Genetic and chromosomal anomalies

• Environmental toxins

• Premature birth

The above may cause impairment in the central/peripheral nervous system that results in immediate or eventual developmental delays.

Affected children generally require some combination of short and long term therapies that continually shift with changes in the child's physical, cognitive, and emotional abilities.

Developmental Disorders:

Pervasive Developmental Disorders (PDDs) -

Characterized by impairments in social interactions with others and communication skills, commonly accompanied by unusual activities and interests such as repetitive behaviors, stereotypes, and poor play skills. Autism diagnosis is often made when symptoms appear before age of 3 years.

Brain-based neurological disorders have multiple origins and can coexist with other developmental disabilities, including intellectual disabilities and attention deficit hyperactivity disorder (ADHD).

They often have associated motor and sensory impairments. E.x: sensory integrative disorders, balance and coordination deficits, and motor development delay. 

The PT’s role is to: 

• provide encouragement 

• maximize opportunities for age-appropriate movement experiences

• address the sensory issues that can interfere with purposeful interactions with people and the environment

Physical Therapists and Occupational Therapists work with other members of the medical and educational team to provide a consistent behavioral program designed for the individual child’s needs.

Otheopaedic Disorders:

Children may be born with or may acquire problems with bones, muscles, fascia, and joints. 

Congenital Muscular Torticollis - 

Associated with in utero constraints… this is the posture of an infant’s head and neck that results from shortening of one sternocleidomastoid muscle, which causes the head to tilt toward and rotate away from the shortened muscle.

Main objective of treatment is to establish full neck movement as soon as possible to stop progression or help reverse the skull deformity.

Juvenile Rheumatoid Arthritis - 

Inflammation of connective tissue manifested as a painful inflamed joint (arthritis). Result of complex genetic factors and environmental exposures. Symptoms include:

• Joint pain

• Swelling

• Decreased motion

• Stiffness

• Muscle atrophy (thinning of muscle mass)

Most lead active lives with medications, therapeutic exercise, and specialized care programs.

Clubfoot -

Foot is turned inwards and slanted upward, shortened muscles cause the foot to remain in a fixed position. Treatment includes progressive and prolonged casting/taping (or both), joint range of motion exercises, and surgical correction.

Scoliosis -

Lateral curvature of the spine, can vary in severity. Can be idiopathic (no known cause), neuromuscular, or congenital. Treatment involves external or internal fixations.

Development Dysplasia of the Hip (DDH) - 

Abnormal development of structures surrounding the hip joint, such that the head of the femur can move into and out of the hip socket. Treatment involves manual or surgical return of the femoral head to the socket and stabilization with splints or casts. Intensive postsurgical exercise protocols are required for full range of joint motion, muscle strength, and function.

Ostgenis Imperfecta -

A severe bone disorder of genetic origin, affects the formation of collagen during bone development, leading to frequent fractures during the fetal or newborn period. Characteristics are

• limb deformities

• dental abnormalities

• stunted growth

• Scoliosis

• loose ligaments

• unusually shaped skull

Treatment of fractures and prevention of deformity through positioning and joint ROM exercises.

Neuromuscular and Genetic Disorders:

These are disorders that cause difficulty moving the body as a result of decreased control between the brain or central nervous system and the muscles of the body. The potential causes include:

• Trauma

• Genetic factors

• Premature birth

• Environmental factors

• A combination of several factors

Duchenne Muscular Dystrophy (DMD) -

Only males have symptoms. Symptom onset occurs between 3-5 years old, presenting as progressive lower extremity muscle weakness and wasting, combined with enlarged yet weak calf muscles and tight heel cords.

Steroid therapy produces improved outcomes, and night time ventilation may increase life span. Emphasis on transition services and prep for college, work, driving, and independent living.

Spinal Muscular Atrophy - Severe muscle weakness in infancy and progressive respiratory failure with decreased lifespan. Requires physical therapy and orthopaedic management.

Neural Tube Defects - failure of the neural tube to close completely during the first month of gestational development.

Spina Bifida: most common neural tube defect, range of symptoms from mild orthopaedic malformations to neurologic malformations.

Spina Bifida Occulta: common impairment of a vertebra that is not associated with disability.

Meningocele: benign herniation of the meninges, does not cause neurologic deficits.

Meningomyelocele: open lesion with minimal to no skin covering deeper nerves. Potential leakage of spinal fluid and infection before surgical intervention and healing. Loss of motor function and sensation of the lower part of the body, problems with bowel and bladder function

Anencephaly: lack of the neural tube closure at the base of the brain, results in fetal death or feath shortly after delivery.

Developmental Coordination Disorder: wide range of dysfunctions, including gross or fine motor coordination problems, and psychosocial problems (like ADHD). Treatment includes comprehensive management of all the child’s areas of difficulty.

Down Syndrome (Trisomy 21): congenital developmental disability due to an extra chromosome 21. Characterized by:

• low muscle tone

• flat facial profile

• upwardly slanted eyes

• short stature

• Varting levels of intellectual disability

• Slowed growth and development 

• Small nose with low nasal bridge

• Congenital heart disease

Cerebral Palsy: a group of conditions from a non-progressive brain lesion. The brain is unable to control nerve and muscle activity. Management emphasis is on attaining optimal growth and development. A variety of specialists may be involved.

Fetal Alcohol Syndrome: presumed history of significant maternal alcohol consumption during pregnancy. Very distinct physical features. May experience developmental delays along with physiological defects.

Prenatal Cocaine Exposure: exposure to cocaine in utero from maternal cocaine use during pregnancy. Evidence is mixed about documented motor problems.

Cystic Fibrosis: pulmonary disorder in which the production of thick mucus causes progressive lung damage. Medications and therapies can help to decrease the side effects of this disease, but no cure has been found.

Principles of Examination ~

Initial information about a child is generally obtained through a review of medical records and discussions with family members. For a child up to 5 years of age, the discussion may take the form of a family assessment, in which the child is treated in the context of the family system.

Assessment measures are generally obtained through standardized testing. Many standardized tests are also norm referenced, meaning that a large number of children have been assessed to create a comparison group for the assessment.

Principles of Eval., Diagnosis, and Prognosis ~

During the evaluation, individualized goals and objectives are developed from the information derived from the examination. The necessary information is contained in an Individualized Family Service Plan (IFSP) or an Individualized Education Program (IEP) developed for each child. 

IFSP describes in detail the total plan of care for the child in the context of the family unit. These plans ae reviewed on a regular basis as the framework for treatment and serve as a baseline by which the progress is monitored.

It is important to remember that the initiation of therapy doe snot signal the end of examination. Examination is an ongoing process that begins with the history and continues throughout each therapy session. It includes assessment of each child’s strengths and needs and evolves as the child, family, and therapist continue to determine appropriate therapeutic activities.

Principles of Procedural Intervention ~

Intervention involves helping the child gain abilities to meet the daily challenges of the most natural environments.

Dynamical Systems Theory:

The internal components of the patient and the external context of the task are equally important and contribute to functional movement. Emphasizes the process of moving rather than the product of a movement. Therapists must work with the interplay of all systems rather than each system in isolation.

Neurodevelopmental Treatment Approach:

Through use of motivating environment and the child’s active participation, the therapist uses manual facilitation and inhibition techniques to present the child with a “normal” sensory experience.

Continued active repetition of normal developmental skills is also theorized to help the child establish more coordinated, efficient movement patterns.

Emphasis is on the movement quality, and training of the parent or provider is stressed to incorporate movement concepts into the child’s functional daily routines.

Sensory Integration Theory:

Based on the theory that poor integration of sensory information prevents the organization of resultant motor behaviour. Assess the child’s sensory systems through reports by the parent and child, clinical observations of limited tolerance for sensory experiences, and tests before initiation of therapy.

Normal Developmental Theory:

Assumes that children with CNS (central nervous system) damage will acquire motor skills in a fashion similar to children with normally developing nervous systems.

Task Oriented Movement Model:

Goal-directed movements include both the investigative and the adaptive behaviors resulting from a child’s interactions with the environment. Orient therapy to focus on child’s impairments, on task reorganization, and on environmental modifications that may improve child outcomes. Therapy is specifc to the environment and task and is designed to promote a child’s development of solutions to movement problems.