Examination, Eval, and Intervention Flashcards
Infancy
Most serious fx: ribs and skull
Possible cardiopulmonary compromise– increased time in NICU
Increased parental anxiety- fear of holding child- can lead to minimal contact with infant
PT: important to educated regarding handling, positioning, and playing, goal is to minimize fractures,
- When handling important not to put force along long bones, head and trunk should be supported with arms and legs draped across supporting arm, may use standard pillow to carry child
- Dress with loose clothing or those with snaps or velcro, avoid overdressing due to excessive sweating
- Diapering- never lift from ankles- support bottom and legs
- infant carriers provide supportive seating system
- Encourage s/l with towel rolls along extremities and spine
- prone should start with baby on caregiver
- -Supine need support for arms, hips neutral, towel roll under knees
- Unsupported sitting should begin on pillow or in parents lap when child has appropriate head control
- Change position frequently
- Encourage sensorimotor development through appropriate toys
Pull to sit from wrists = contraindicated, should perform transition with support at shoulders
Parents should avoid devices that play baby in upright standing bc places extra stress on bones
Infant may be normal size at birth but then growth becomes stunted
Assess pn using FLACC (face, legs, activity, cry, and consolability)
Assess AROM only—passive stretching is contraindicated
MM strength assessed through observation and palpation of mm contraction
GM assessment: PDMS-2, Brief assessment of motor function
Preschool
Secondary impairments develop: atrophy and osteoporosis develop as result of fx immobilization
Recurrent fx = have started biphosphonates
MM weakness and delayed GM skills
Cognition should be age appropriate
Microfractures d/t repetitive trauma at growth plates = decreased growth, may lead to LLD, popcorn appearance
Walking without support results in increased bowing of bones- bowing occurs in anterolateral direction in femur and anteriorly in tibia
Those who do not walk = increased osteoporosis
Emphasize protected WB, encourage child to actively participate in transfers and ADLs, continue active exercise through developmental play, aquatics
Examine mobility and need for adapted equipment
Can use PDMS-1, PEDI
Assess pn
Safety in independent mobility- want to prevent activity limitations
In moderate to severe OI, may need to use braces or splints to begin standing activities
School age and adolescence
Limited participation in peer related activities due to reduced mobility and decreased independence
Social skill development may be hampered d/t parents being overprotective
Scoliosis and Kyphosis or both present– increased risk of compression fx, osteoporosis and lig laxity
Patellofemoral joint usually dislocates d/t bowing of bones = increase risk for falls and fx
May develop elbow deformities or contractures
**Frequency of fx decreases after puberty– often see an increase in participation of activities around this time
PT: coordinate with other team members, increased independence, weight mgmt and physical activity important, management of scoliosis, energy conservation in positioning and mobility, ambulation, endurance, strength
Use of AD for community ambulation–usually w/c for community, and AD or no AD for household distance
Encourage child to be an active family member
