Chapter 27: Flashcards
Activity Modification, Joint Protection, and Energy Conservation
Strategies are often used with children who have pain that limits functional use, ROM deficit, strength impairments, or fine motor impairments in their UEs.
Activity Modifications
Adaptations made to an activity or tool to increase the child’s ability to perform the activity or use the tool independently
OT completes a task analysis to identify the most appropriate activity modification for the task in question.
Examples
Modified sports equipment or instruments, adapted writing utensils, assistive technology, and adaptive devices such as buttonhooks or pediatric-sized sock aids.
Joint Protection Strategies
-Techniques used to decrease pain caused by the amount of strain placed on a joint during a task or the amount of work a muscle group must perform to complete the task
OT explains the purpose and importance, conducts interview to determine which activities trigger joint pain, then reviews the child’s day and pattern of symptoms to identify the most beneficial techniques.
OT often demonstrates the strategy and then has the child and/or family perform the strategies in the clinic setting to ensure correct application.
Energy Conservation Technique
Benefits children experiencing fatigue limiting their function (systemic conditions such as juvenile idiopathic arthritis or Duchene muscular dystrophy)
OT identifies the child’s activity demands, observes how the child performs specific activities identified as difficult or contributing to fatigue, then educates the family and child on strategies and develops a plan for applying the strategies.
Congenital Differences
(of the hand) are a common feature of some childhood syndromes, such as VACTERL, which stands for “vertebral defects, anal atresia, cardiac defects, trachea-esophageal fistula, renal abnormalities, and limb abnormalities,” and Fanconi anemia
OT should screen the child’s overall health status, developmental milestones, and fine motor skills
Cryotherapy
Most commonly used when acute inflammation is present to relieve pain and tissue inflammation.
Contraindications
Children with Raynaud’s disease, open wounds, acute vessel or nerve reconstruction, or sensory impairment
Results in the tissue contracting and the patient experiencing stiffness following application of the modality.
Usually applied after the therapy session to alleviate or minimize tissue inflammation and pain.
Ice Packs (can be replicated at home)
Ice Massage (particularly effective for tendonitis)
Desensitization and Sensory Reeducation
Two interventions OTs use for children experiencing sensory impairments following peripheral injuries or trauma.
Desensitization
reduce pain from touch and facilitate the child’s use of the affected arm in everyday functional activitie
Sensory Reeducation
Used when a child is experiencing sensory return after a nerve injury.
OT exposes the UE to a variety of sensory activities to improve sensory discrimination
Appropriate to begin when a child has a Semmes-Weinstein grade of monofilament 6.65 or better
Dynamic Orthoses
with moveable components that apply a force to a specific joint(s) for moving that joint.
Include components that apply a dynamic force to a joint.
Often assist a child with a motion that is absent or very weak or to apply light sustained force to increase joint mobility at a joint that is limited in active motion secondary to joint tightness.
Can be fabricated by the OTt or can be prefabricated.
Static Progressive Orthoses
Orthotics that are serially modified to increase the joint angle
Static orthotics with serial adjustments to reposition the orthotic to change the joint angle.
Used when mobility is limited by joint tightness with a soft end feel (ex., mild to mod resistance to passive motion in the direction of ROM limitation).
Children typically wear when sleeping to allow for AROM and functional use of the affected arm when awake.
Hand therapist routinely readjusts the orthotic to increase the angle of elbow extension over time.
Joint Tightness
Child may have if they present with similar measurements for AROM and PROM in the movement plane for the joint
Kinesiology Tape
Can be used to facilitate or inhibit specific muscles or muscle groups to decrease pain, improve ROM, enhance muscle activation, and/or relax specific muscles.
An elastic, waterproof tape that was first used in sports therapy and has more recently been applied in the practice of pediatric hand therapy.
Cn enhance lymphatic drainage and improve blood flow to decrease inflammation, improve joint biomechanics, improve shoulder kinematics, neuromuscular conditions, improve postural control, UE function and provide stability and joint alignment, and improve the activation and strength of the weaker muscle groups
Mirror Therapy
A novel therapeutic intervention was first introduced by Ramachandran to decrease phantom limb pain (PLP) in individuals with amputations.
Effective in decreasing pain, restoring function in individuals with complex regional pain syndrome, improving motor and sensory function in adults with hemiparesis after CVA, and may improve motor control and function in children with hemiparesis.
Physical Agent Modalities
Employ a physical property, such as temperature, sound, or electricity, to achieve a specific therapeutic benefit
Infrequently used in peds hand therapy as compared with adults. However, when used, superficial thermal agents and electrical modalities are the most commonly applied.
Ultrasound
A PAM that relies on the conversion of sound to produce a deep thermal heat, is not advised in children who are skeletally immature because it may harm growth plates in the bone
Serial Cast
Used to increase joint mobility and tissue extensibility for improved ROM in the child’s affected UE typically when the child presents with joint tightness.
like static progressive orthotics in that a series of casts are applied, with each cast increasing the angle of the affected joint(s) to obtain the desired arc of movement.
Typically applied permanently until the child returns for the next cast to be applied
Xan be formed as a bivalve cast that is removable in cases in which the child may require some time out of the cast
Increases mobility following Botox or phenol injections and to decrease muscle spasticity in children who have movement limitations (.
Tendon Tightness
The available AROM and PROM at a joint vary depending on the position of joints that are more proximal to the joints being tested
May occur in the intrinsic or extrinsic muscles of the hand or both.
