Intro to PT Chapter 13 Flashcards
1
Q
US children begin walking
A
10-13 months
2
Q
Some take first step as early as
A
8 months
3
Q
Some take first step as late as
A
18 months
4
Q
PT should design exercise in a way that. (Kids)
A
makes it fun, makes it look like we’re playing
5
Q
Children develop emotionally, cognitively,
socially, and physically
A
through play
6
Q
`
Best place for any physical therapy intervention
A
natural environment
Such as couch, stairs, or laundry baskets
7
Q
A non-progressive condition (children)
A
can present as
progressive due to growth
8
Q
PTs and PTAs work closely with the team (center)
A
keeping the
family at the center
9
Q
Parents and caregivers who are active in therapy
sessions
A
tend to have better carry-over at home, which
improves outcomes
10
Q
Main Pillars of FCC
A
Respect and dignity for family and their values
Family engagement
Information sharing in a reciprocal manner
Collaboration that is ongoing and engages all parties to meet
family’s needs
11
Q
EHCA
A
Education for all Handicapped Children Act - 1975
- All children (6-21) regardless of disability, entitled to free public ediucation
12
Q
IDEA
A
Individuals with Disabilities Education Act 2004
- 2004. Amendments and reauthorizations of EHCA
Entitlements for children, birth to 5 years old
Stipulates family-centered focus and care in “least restrictive” environment
13
Q
Setting Specific Services
Pediatric PTs serve children and families across the continuum of care and across the lifespan
A
Neonatal Intensive Care Unit (NICU)
Acute care, including the pediatric intensive care unit
Inpatient rehabilitation
Clinic-based outpatient services
Home-based early intervention requiring an
Individualized Family Service Plan (IFSP)
School-based services requiring an Individualized Education Plan (IEP)
14
Q
Early Intervention (children)
A
Children 0-3 and within schools 3-21 as part of IDEA program
15
Q
Individualized Family Service Plan
A
0-3
includes support services for the family and any therapeutic services the child may recieve. Specifies the duration, frequency and location of the intervention.
16
Q
Individualized Education Program
A
document governing the provision of services within school setting.
child’s therapeutic goals, as they relate to the educational environment, but also goals for assitive technology to promote independence.
PT- OT-psychologist- family-educator-social worker-speach and language pathologist.
17
Q
Focus of pediatric physical therapy should always be
A
on the child and family as a unit and on using functional and play activities that are meaningful to the child.
18
Q
Common Pediatric Conditions
torticollis
A
Wry kneck - kneck muscles contract abnormally
-Congenital Muscular Torticollis - sternocleidomastoid muscle on one side
-Acquired Torticollis - trauma, inflamation, infection or neurlogic issues
PT= active and passive ROM
Postioning
Environmental adaptations
Surgery
19
Q
Musculoskeletal (MSK) Conditions
May develop in utero
A
(e.g. torticollis) or later into
adolescence (e.g. adolescent idiopathic scoliosis)
20
Q
Musculoskeletal (MSK) Conditions
May lead to secondary impairments
A
in different systems
such as cardiovascular and pulmonary, and
neuromuscular; or even functions such as cognition
21
Q
Musculoskeletal (MSK) Conditions
Developmental Hip Dysplasia (DHD)
A
Bracing or casting helps align the hip joint properly to promote normal development.
Pavlik Harness - common in infants.
Pt- encourage active kicking
position in plavik: prone and sitting; avoid side-lying
avoid baby walkers and bouncers.
22
Q
Musculoskeletal (MSK) Conditions
Adolescent Idiopathic Scoliosis (AIS)
A
Lateral curvature of the spine
PT- Stretching and strengthening of spinal musculature
Breathing and aeromic activities
Pain management
Med- Bracing for angles >24
Surgery for angles >40
23
Q
Musculoskeletal (MSK) Conditions
Arthrogryposis
A
Nonprogressive congenital condition involving multiple joint contractures in two or more regions at birth. Typically symetrical.
PT- Soft tissue mobilization
ROM strengthening
Gait training
Assistive tech
Environmental Mod
Med- Surgery - splinting/bracing
24
Q
Musculoskeletal (MSK) Conditions
Club Foot (Talipes Equinovarus)
A
including forefoot and midfoot adduction, hindfoot varus, and fixed ankle platerflexion.
PT-Positiong in Ponseti brace: prone and supported sitting
ROM
Strengthening
Med: seral casting
ponseti bracing
Surgery
25
# Musculoskeletal (MSK) Conditions
Juvenile Idiopathic Arthritis (JIA)
Autoimune disease - inflammation and stiffness in joints. Periods of exacerbation and remission.
PT- Pain Man
Inflammation man
Joint protection strategies
AROM AAROM PROM
Functional training
Strengthening
Aerobic exercise
Med: NSAID
Corticosteriod
DMARDs
26
# Musculoskeletal (MSK) Conditions
Legg-Calve Perthes Disease (LCPD)
Ischemic Necrosis opf the growing femoral head. deformity. 4-8 year old. decreased range of hip abduction and internal rotation. - limping
PT- Hip active and passive ROM
Hip strengthening
Gait training
Balance exercises.
Med- NSAID
Surgery
27
# Musculoskeletal (MSK) Conditions
Slipped Capital Femoral Epiphysis (SCFE)
Abrupt or gradual slip of femoral head at the epiphysis. 10-16 30-60% bilateral. obesity and edocrine . Decreased hip flexion, internal rotation - limp.
PT- Maintaining ROM
Activity modification
Gait training with crutches
Return to prior level of function PLOF
Med - surgery
28
# Musculoskeletal (MSK) Conditions
common treatments
Some may be addressed with orthotics, casting, and/or surgery in conjunction with PT
29
# Musculoskeletal (MSK) Conditions
Limping is an example of a complex presentation
might be the result of a range of MSK conditions requiring PTs to have astute differential diagnosis skills
30
# Musculoskeletal (MSK) Conditions
Plagiocephally
asymmetric head shape - one of the possible effects of Congenital muscular torticollis.
31
# Neuromuscular Conditions
impact
Primarily impact neural connectivity to some capacity, ultimately impacting motor function
32
# Neuromuscular Conditions
result
May result in an atypical gait pattern, difficulty
with total body movements, or as spasticity, all of which can significantly impact a child’s ability to fully participate with peers
33
# Neuromuscular Conditions
Autism Spectrum Disorder (ASD)
Developmental disorder characterized by early onset deficits in social communication and interaction, repetitive behaviors, obsessive interests, rigid adherence to routines, and altered reactions to ssensory input. Poor balance, cordination, motor imitation, and use of sensory information start at 2.
PT- Deep pressure and sensory input
Play skills and interaction based intervention
Strength, cordination and balance
Body and safety
Med- Pharmacologic intervention
CBT
Applied behavior analysis
34
# Neuromuscular Conditions
Brachial Plexus Birth Palsy
Injury to nerves in the brachial plexus in neonates. Weakness of the ipsilateral UE. Most recover 6-8 weeks after birth. If not in 3 months - permanent.
PT- PROM
Tactile stimulation
Strengthening
Positioning
Med- Pharmacologic
Splinting/bracing
surgery
35
# Neuromuscular Conditions
Cerebral Palsy
Lifelong nonprogressive condition- injury to CNS - abnormal muscle tone, loss of selective muscle control, altered muscle balance, increased reflexes, persistent primitive reflexes, changes in muscle strength, and abnormal gait patters. May include vision and hearing deficits, cognitive disabilities and seizure disorders.
PT - Prevention of secondary comlications (contractures)
Posture and positioning for function
Increasing aerobic capacity
Gait training with or without AD
Pain man
Casting, bracing and orthotics
Med: Surgery (tendon, muscle length)
Pharmacologic interventions.
36
# Neuromuscular Conditions
Cuncussion/Mild Traumatic Brain Injury (mTBI)
impacting brain tissue and causing chemical imbalances in the brain. - blunt trauma - acceleration - deceleration. Alterations in mental state for up to 24 hours.
PT -Monitor rest and recovery period
Balance and cordination
Vestibular rehabilitation
Return-to sport program including graduated strenth and endurance retraining
Med: CBT
Pain and symptom management
37
# Neuromuscular Conditions
Developmental Coordination Disorder (DCD)
affects a child's ability to plan, coordinate, and execute motor tasks. Clumsiness - delays in motor milestones. Writing, dressing playing sports. diag age 5 or later.
PT- task-specific training
Neuromuscular training
Motor imagery training
Teaching motor skills through task analysis
Strengthening
balance
body awareness
Med:
Task oriented CBT
38
# Neuromuscular Conditions
Spina Bifida
Incomplete formation of the spinal cord/meniges - loss of motor function, sensory impairments and bowel and bladder dysfunction. diag in utero.
PT- Age-appropriate gross motor skills
Strengthening
ROM
Gait training w/wo AD
Prevent contracutres
training with mobility devices.
Med - Surgical closure/repair prenatually or postnatally as needed.
Cath - bladder
Man hydrocephalus using a shunt
Orthotic devices.
39
# Neuromuscular Conditions
Gross Motor Function Classification System (GMFCS)
Defines patterns of function in children with CP.
40
# Neuromuscular Conditions
More on Cerebral Palsy
the most common condition
seen by pediatric PTs/PTAs.
It is non-progressive, although growth often results in the worsening of functional impairments
Activity limitations and participation restrictions vary significantly depending on the part of the brain impacted.
41
# Cardiovascular and Pulmonary
Conditions
Affecting a child’s heart and lungs
may be severe enough to require surgery in the first days of life, or mild enough to be monitored; may impact physical activity.
42
# Cardiovascular and Pulmonary
Congenital heart defects:
Cyanotic (insufficient oxygen delivery to the body; blood in the heart shunts right to left) or
Acyanotic (inefficient delivery of blood to the body; blood in the heart shunts left to right).
43
# Cardiovascular and Pulmonary
Asthma
Inflammatory disorder of the airways - wheezing, shortness of breath, chest tightness and coughing
PT- Aerobic conditioning and fitness
Chest PT
Med - Pharmacologic
44
# Cardiovascular and Pulmonary
Cystic Fibrosis (CF)
Genetic disease- lungs, sinuses, exocrine and endocrine bpancreas, small and large intestines, bones, hepatobilary system, glands and vas deferens - increased secretions - obstructive lung disease. chronic lung infections. male infertility. Diag by sweat test, stool studies and genetic testing
PT- Airway clearance tech - percussion, postural drainage, positive expiratory pressure, active cylcle of breathing technique, autogenic drainage
Aerobic conditioning and resistance training
Med- Pharm
Gene therapy
Diet recomendations
Enteral tube feeding
Surgery - lung transplant.
45
# Cardiovascular and Pulmonary
Hypoplastic Left Heart Syndrome (HLHS)
Cyanontic congenital heart defect. Underdeveloped left ventricle. Low systemic circulation. Even though HLHS involves a left-sided heart issue, the cyanosis comes from the mixing of oxygenated and deoxygenated blood Diag - fetal echocardiogrraphy
PT - Development of motor milestones
Early mobility post surgery, including prone positioning as soon as medically appropriate.
Med - Surgical treatment in stages. At birth...4-6 months, 18 months, 3 years old.
Pharm intervention
46
# Cardiovascular and Pulmonary
Ventricular Septal Defect (VSD)
Acyanotic heart defect - opening in the interventricular septum. Blood flows from the higher pressure left ventricle into the lower pressure right ventricle. May cause Shortness of breath, fatigue, poor weight gain Pulmonary hypertension, Heart failure.
PT Aerobic endurance
Participation in sports
Med- Surgical closure of the defect.
Pharm intervention.
47
# Cardiovascular and Pulmonary
A parant's perception of the serverity of child's condition
may play a larger role in developmental outcomes than the disease itself.
48
# Integumentary Conditions
Pediatric patients with burns are NOT just mini-adults
Different body surface area proportions (i.e. a child’s head is larger in proportion to their body vs adults)
Greater fluid loss and risk for hypothermia
Children may experience lifelong decreases in tolerance to physical activity
Children are at increased risk for contractures due to rapid growth
49
# Integumentary Conditions
Pediatric burns - both children and adults enter
hypermetabolic state.
50
# Integumentary Conditions
PTs/PTAs may be involved
with early mobilization, stretching programs, scar management, and exerciseprotocols for these patients
51
# Systemic/Metabolic Conditions
Impact structure and function of many body systems
so
PTs/PTAs are typically part of a large interdisciplinary
team
52
# Systemic/Metabolic Conditions
Diabetes
disorder of insulin production or abnormal response to insulin (type1, type 2)
PT- individualized exercise program
Pain management
Balance and coordination (due to changes in distal sensation)
Management of skin breakdown
Med- Pharm
53
# Systemic/Metabolic Conditions
Fetal Alcohol Syndrome (FAS)
Growth deficits and developmental delays. - diag subjective history and clinical characteristics. Deficits with attention, processing, language, visual-spatial awareness, learning, memory, cognition, and behavior. Mild to severe.
PT- Prone
Min environmental stimuli
Calming techniques
Movement activities
Educating caregivers - recognizing stress cues.
Fine and gross motor coordination.
Med- Pharm
54
# Systemic/Metabolic Conditions
Hemophelia
Inherited disorder with deficiency or lack of Coagulation factor VIII. Bleeding. Bruising.
PT- Aerobic endurance
Weight bearing activities
Encourage noncontact sports
Timing PT intervention and physical activity with prophylaxis management
Med- Bleeding man
Factor replacement
Surgical - prevent joint degeneratyion
Splinting/bracing
55
# Systemic/Metabolic Conditions
Neonatal Abstinence Syndrome (NAS)
Acute withdrawal symptoms in a neonate due to opiod exposure in untero. Irratablility, inability to sleep, high-pitched cry, shakiness, hypertonia, hyperreflexia, seizures, poor feeding, GI issues, fever. Diag: drug testing
PT: Prone positioning
Therapeutic touch
Calming techniques
Movement activities
Minimize environmental stimuli
Educating caregivers on engaging infants and recognizing stress cues
Fine and gross motor control
Med: Decreased stimulation
Adequate nutrition
Pharmacologic intervention
56
# Systemic/Metabolic Conditions
Obesity
Childhood obesity has been increasing in prevalence, and is associated with impaired gross motor development, changes in bony alignment, pain, adult obesity, cardiovascular disease, and Type 2 diabetes
PT: Lifestyle modifications
Weight reduction through aerobic exercise
Med: Dietery considerations
Psychological support
Pharmacologic intervention
57
# Systemic/Metabolic Conditions
Pediatric PTs/PTAs may be involved in
multidisciplinary clinics
with the role of postural analysis, gross motor skill assessment, and the creation of individualized progressive exercise programs to create lifelong healthy habits
58
Genetic Conditions
Result from a spontaneously or inherited change in
normal DNA sequence
Include a wide variety of physical presentations based
on the location and extent of the DNA change
Often affect multiple body systems
59
# Genetic Conditions
Emerging gene modification therapies
changed the outcomes in some patients and PTs/PTAs are in the position to regularly assess and document changes in capacity and rate of change to determine efficacy
60
# Genetic Conditions
Down Syndrom
Extra copy of 21 (trisomy21)
unique facial and physical features. physical and intellectual deficits, including motor, speach, language, cognitive and social delays.
PT- Aerobic exercise and fitness program for wieght control and increasing bone density
Progressive resistance exercises
Balance and cordination
Postural control
Motor skill acquisition.
Med- Lifetime dietary regimen
Orthoses for stability and alignment of the lower extremities
61
# Genetic Conditions
Duchenne Muscular Dystrophy (DMD)
Progressive weakness of theskeletal and heart musculature due to deficient or absent dystrophin protien activity.
diag 2-5 WC by 13 **toe walking ,frequent falls, girth of calf muscles.**
PT: Submaximal exercise - avoid high-impact, high-intensity, eccentric activity
ROM, bracing
Power mobility and standing program
Education on energy conservattion and pacing
Med: pharm intervention
No curative treatment
Ventilation and nutrition support
Minimize effects of long term steroid use
Gene based therapy.
62
# Genetic Conditions
Marfan Syndrom
Inherited connective tissue disorder. gene that makes fibrilin1. cardiovascular, skeletal and ocular manifestations. Joint hypermobility. Hypotonia, scoliosis, pes planus,
PT: Designing low intensity, low impact exercise programs
pt education regarding restricting high-intensity, high-impact competititve activities
Joint protection
Monitoring for scoliosis
Med: pharm intervention
Prophylactic surgical repair of heart abnormalities.
63
# Genetic Conditions
Mitochondrial Disorders
Inherited disorders - mitochondria fail to produce enough energy. May be at birth but can be any age. affect any part of the body.
PT: Energy conservation techniques
Progressive resistance exercieses
Aerobic endurance exercise
Med: Pharm intervention
Stress management
64
# Genetic Conditions
Spinal Muscular Atrophy (SMA)
progressive degeneration of spinal cord and brainstem motor neurons. skeletal muscle atrophy and weakness. symetrical. Begins proximal and moves distal. Death before age 2 without treatment.
PT: Muscular and aerobic endurance
Contracture management
Standing programs
ROM/positioning
Airway clearence techniques
Prescribing assistive devices to maintain function
Med: Orthoses for stability and alignment
Pharmacologic intervention
Ventilation and nutrition support as needed
Gene based therapy SMN1 Gene
65
# Genetic Conditions
Sickle Cell Anemia
Inherited form of anemia - sickle-shaped red blood cells. Get caught in capillaries. Greater risk for stroke.
PT: Pain management
Aerobic endurance - monitor hypoxia
pt education - importance of movement to pain levels
Airway clearance as needed
Med: Pharm intervention
Blood transfusion
Medical management of sickle cell crisis
66
# The ICF Model of Assessment
International Classification of Functioning,
Disability, and Health (ICF) model:
Incorporates concepts of enablement and
disablement processes
Considers impact of disorder or disease on
impairments (in body structure and function), activity limitations, and participation restrictions
67
# The ICF Model of Assessment
Pediatric therapists cannot consider impairments of body structures and function in isolation;
they put them in context with the strengths and needs of the child and family.
68
# The Ecological Model of Assessment
Ecological Systems Theory (child)
important to consider not only child and family but the micro, meso and macro systems the children and families interact with.
69
# The Ecological Model of Assessment
assessement
if we fail to consider the family's cultral beliefs and values, resources, access to care, and ss on, we may be missing a critical pieces of information in our assessment.
70
# Cycle of Assessment
A PT evaluation is not a singular event
it is a cycle requiring continual reassessment
71
# ICF and Ecological model
Body Function and Structure
Characteristics:
Reflex development
Joint motion
Muscle length and strength
Respiratory status
Postural stability
Ecological system level
Child
Microsystem
72
# ICF and Ecological model
Activities
Characteristics:
Locomotion
Communication
Oral motor function
Social and emotional
Ecological system level
Child
Microsystem
73
# ICF and Ecological model
Participation
Characteristics:
Community recreation
School participation
Employment
Access to facilities
Ecological system level
Mesosystem
74
# ICF and Ecological model
Environmental and Personal factors
Characteristic
Housing
Health care access
Race, ethnicity, culture, etc.
Structural or governmental policies
Ecological System Level
Child
Macrosystem
75
# Cycle of Assessment
Nonstandardized assessments
Pt's ability to analyze movement, posture and/or functional skills.
indentify specific impairments impacting activity.
priortize the body systems and impairments requiring intervention.
76
# Cycle of Assessment
Standardized testing
formal tests. - does it meet the needs of the child
Validity, reliability, appropriateness
77
# Cycle of Assessment
screenings
used to determine whether a child needs further evaluation
78
# Cycle of Assessment
Assessments
comprehensive profile of child's physical, cognitive, social, emotional, communication, and/or adaptive abilities to assist in determining their therapeutic needs.
79
# Standardized tests and measures
6-minute walk test
Desc: identify deficits needing further testing
Comp: Impairment screening
ICF level - Impairment
Utilization: Screen for endurance issues in children able to walk.
80
# Standardized tests and measures
Denver II developmental Screening test
Component: Developmental screening
Desc: Identify delays in developmental milestone acquisition.
ICF Level: Activity
Utilization: Screen for developmental milestone delays in language, cognition, fine motor, and gross motor domains.
81
# Standardized tests and measures
Peabody Developmental Motor Scales, ed 2 (PDMS-2)
Comp: Norm-referenced
Desc: Designed to compare a child's performace with the average performance of peers. ften used to determine if a child is eligible for services.
ICF - Activity
Utilization: Compares child's functional abilities with those of age-matched peers on stationalry (balance) skills, locomotion, object manipulation, and fine motor slkills.
82
# Standardized tests and measures
School Function Assessment (SFA)
Comp: Criterion - referenced
Desc: Designed to measure performance against a fixed set of predetermined criteria. Evaluative assessment often used to measure performance or track changes over time.
ICF- participation
Utilization: Measures a child's performance on functional tasks relevant to academic and social aspects of school programming.
83
# Standardized tests and measures
Gross Motor Function Mesure (GMFM)
Comp: predictive assessment
Desc: Designed to categorize individuals based on their expected future status.
ICF: Activity
Utilization: A motor assessment for children with CP, trisomy 21, and TBI. The subsequent GMFM curves have been predictive for age at walking or plateau of skills.
84
# Cycle of Assessment
The cycle of assessment begins when
a family, caregiver, or care provider notes a concern and seeks pediatric PT
85
# Children are NOT Little Adults!
Adults, the focus is on rehabilitation;
| Stark differences exist between treating children and treating adults
children the
focus is on habilitation
86
# Children are NOT Little Adults!
With children, we are dealing with a growing system
| Stark differences exist between treating children and treating adults
so we focus not only on how the child presents today, but how we predict the child might look in 6 months, a year, and even 5 years from now
87
# Children are NOT Little Adults!
We never work with children in isolation
| Stark differences exist between treating children and treating adults
we work with children within the context of their family and social unit
88
# Children are NOT Little Adults!
We work with children (location)
| Stark differences exist between treating children and treating adults
at home, in the childcare center, in school, on the playground, in the community and as they transition to adulthood, at their job site
89
# Children are NOT Little Adults!
With children social roles continually change
| Stark differences exist between treating children and treating adults
so we often engage with children and their families across their entire lifespan
90
# Play and Movement
Play begins with movement and
active movement begins
with play
91
# Play and Movement
Play is critical to a child’s
overall development
92
# Play and Movement
Typically developing children move through stages of
play development
hat parallel and reinforce their cognitive, psychosocial, speech and language, fine motor, and gross motor development
93
# Play and Movement
Through play, children learn
to gain greater control over their bodies, develop self-regulation, and interact effectively with others
94
# Play and Movement
Through play, children develop
physical literacy
95
# Play and Movement
physical literacy
Motor competence, confidence and motivation to engage in physical activity. Underpins lifelong habit of movement and ahealth related fitness and wellness.
96
Moro Reflex (Startle Reflex):
* Stimulus: Sudden head movement or a loud noise.
* Response: Arms extend outward, fingers spread, and then arms return to the body.
* Appears: At birth.
* Disappears: By 4-6 months.
97
Rooting Reflex:
* Stimulus: Stroking the infant's cheek.
* Response: Turns head toward the stimulus and opens mouth.
* Appears: At birth.
* Disappears: By 3-4 months
98
Sucking Reflex
* Stimulus: Placing a finger or nipple in the infant’s mouth.
* Response: Rhythmic sucking.
* Appears: At birth.
* Disappears: By 4 months
99
Palmar Grasp Reflex:
* Stimulus: Pressure on the infant's palm.
* Response: Fingers close around the object.
* Appears: At birth.
* Disappears: By 4-6 months
100
Plantar Grasp Reflex:
* Stimulus: Pressure on the ball of the foot.
* Response: Toes curl down.
* Appears: At birth.
* Disappears: By 9-12 months.
101
Asymmetrical Tonic Neck Reflex (ATNR):
* Stimulus: Turning the infant’s head to one side.
* Response: Arm on the face side extends, and arm on the opposite side flexes.
* Appears: At birth.
* Disappears: By 4-6 months.
102
Babinski Reflex:
* Stimulus: Stroking the sole of the foot.
* Response: Toes fan out and the big toe extends.
* Appears: At birth.
* Disappears: By 12-24 months.
103
Galant Reflex:
* Stimulus: Stroking the side of the infant’s spine.
* Response: Infant curves the trunk toward the stimulated side.
* Appears: At birth.
* Disappears: By 3-6 months.
104
Landau Reflex
* Stimulus: Supporting the infant prone in the air.
* Response: The head lifts, and the back arches in a "superman" position.
* Appears: 3-4 months.
* Disappears: By 12-24 months.
105
Parachute Reflex:
* Stimulus: Holding the infant upright and quickly tilting them forward or downward.
* Response: Extends arms outward as if to protect from falling.
* Appears: 6-8 months.
* Persists: Throughout life.
106
Reflex Significance
* Persistence: If a primitive reflex persists beyond its normal timeframe, it may indicate a neurological problem (e.g., cerebral palsy, brain injury).
* Absence: The absence of expected reflexes can suggest developmental delays or neurologic impairments.
107
Sitting in a W position
sitting posture where a child's buttocks rest on the floor, their knees are bent, and their legs are splayed out to the sides, forming the shape of a "W"
Internal rotation of the hips can place excessive stress on the hip joints, ligaments, and surrounding muscles.
Reduced opportunities to strengthen core and hip muscles can impact balance and motor skill development.
Address in PT if it's the child's primary sitting position.
108
# Evidence Based Practice
Currently, there is no single gold standard
approach to treating children
109
# Evidence Based Practice
Clinical practice guidelines
are emerging
110
# Evidence Based Practice
A focused area of study showing promising
results in the pediatric population
is the
application of motor learning principles
111
# Pediatric motor learning principles that work
Constraint induced movement therapy
treatment that involves a splint or cast on the uninvolved side to encourage forceed use of the impaired UE
112
# Pediatric motor learning principles that work
HABIT - hand-arm bimanual intensive therapy
children with CP or hemiplegia. involves activities purposely designed to encourage and demand use and coordination of both upper extremities.
113
Challenges involved in obtaining high-quality evidence to support a gold standard approach to treatment include
small sample sizes
heterogeneity of clinical presentation
lack of consistent dosing
varying research designs
lack of random sampling
inadequate funding
use of multimodal approaches
inconsistent definitions
insufficient measurement tools
children are continually maturing over time
114
# Motor learning principles
Salience
Meaningful activites:
* Using play
* Involving child in goal setting
* Explaining why activities are important
* Egnaging the child in task-specific activities rather than rote unskilled movement exercise
* Focusing on the use of play and movement that can be embeded into the daily routine.
115
# Motor learning principles
Specificity
use the natural environment and the child's daily routine, including play.
Actual equipment or materials child will need.
Engage parents or school.
116
# motor learning principles
Instructional Strategies
* Concrete and simple verbage
* foster imitation with demonstration
* Observe near-peers
* give specific feedback and let it fade
117
# motor learning principles
Frequency and Practice
Children walk 14,000 steps per day and fall 100 times per day for months to perfect the skill of walking.
Without parents to help, impossible to get enough practice
Embed in daily routine.
Blocked and distributed practice
Random practice
118
# Mobility Devices
Some children may not have the sensorimotor or cognitive ability to move on their own and
engage in their environment
Our role is to engage the family in obtaining
appropriate equipment or other assistive devices to enable the child to interact effectively
119
# Mobility Devices
Splints, taping, and bracing can help
prevent tightness
and asymmetries and potentially increase mobility
120
# Mobility Devices
Positioning devices such as, sidelyers, standers,
adapted chairs
enable children to view the world from
different perspectives and engage with peers on eye level.
121
# Mobility Devices
Mobility devices such as rolling walkers, adapted tricycles, motorized wheelchairs, and powered cars
can provide a sense of movement through space and a way to independently engage with peers and their environment
122
Powered mobility
can improve a child’s cognitive, perceptual, and social-emotional development, as well as speech and language
skills, play skills, upper extremity use, and
overall level of engagement and independence.
123
Powered mobility training
can begin as young as
7 months of age
124
# Role of PTs/PTAs Beyond Direct Intervention
Advocacy:
from the individual level with insurance companies, schools, and physicians to the societal level with government policies impacting children with disabilities.
125
# Role of PTs/PTAs Beyond Direct Intervention
Community Resources and Supports:
identify and evaluate community resources and supports and connect families to those resources and supports.
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# Role of PTs/PTAs Beyond Direct Intervention
Transition planning
from early intervention, to preschool, to school, to work or to some community placement
from hospital to home or to another healthcare facility to provide for the child’s complex medical needs
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# Role of PTs/PTAs Beyond Direct Intervention
Education and Empowerment:
encourage **self-determination** by educating, engaging, and empowering children to take charge of their own health and well-being throughout life
