L3 Torticollis Flashcards
Family Centered Services and Intervention
- based on family preiorities and needs
- strengths-based
- collaborative
- families involved in decision-making
- PT should be ready to work with family even if/when differing ideas about what is best for child
Content of individualized family service plan
- Statment of infant’s or toddler’s present levels of physical development, cognitive development, communication, social/emtoional, and adaptive involvement
- Family’s resources, priorities, concerns
- Measurable results or outcomes expected to be achieved for the infant or toddler
- Specific early intervention services based on peer reviewed research
- Natural environments in which early intervention services will appropriately be provided, including justification
- Dates for initiation of services and anticipated length, duration, frequency
- Identification of service coordinator
- Support of transition of toddler with disability to preschool or other services
Service coordinator
case manager or service provider that monitors and matches family’s needs
EI Implementation in Natural Environments
settings that are natural or typical for a same-aged infant or toddler without a disability
child acts differently in environments that they are comfortable with
helps to appropriately gauge family resources
PTs may gain most reliable asssessment in these environments
Activity Based Instruction
also known as routines based instruction
should be child directed, activity focused, functional, and include timely feedback
Purposes of early intervention
- minimize developmental delay
- reduce educational costs
- maximize independence of child
- enhance capabilities of family to meet needs of child
- enhance capacity of state to to meet needs of children
ADA
ensured full civil rights to individuals with disabilities. guarantee equal opportunity in employment, public and private accomodataions, transportation, government services, telecommunications
Congenital Muscular Torticollis
asymmetrical cervical posture and positioning. Contracture of the SCM
unclear etiology, potentially intrauterine and perinatal compartment influence
prevalence has increased due to back sleeping to avoid SIDs
Types of Torticollis
Postural
Muscular
SCM Mass
Postural Tort
postural preference, no ROM impairments
Muscular Tort
tightness of SCM, passive ROM impairments
SCM Mass type
SCM fibrosis, ROM impairments
Typical presentation of CMT
- ipsilateral lateral flexion and contralateral rotation, head tilted toward involved side and chin rotated to opposite side
- limited ROM in lateral flexion toward uninvolved side
- limited ROM in rotation toward involved side
- skewed vertical and midline orientation
- participation and activity limitations
Differential Diagnosis for CMT
- neurological conditions like brachial plexus injuries
- developmental dysplasia of hip
- GERD
- eye weakness or disease impairments
- sandifer syndrome (acid reflux)
Treatment for CMT
- Early referral to PT (helps to decrease length of care, muscle thickeness, and improves QOL)
- Initiate within 3-4 months of age
- Strategies include PROM, ARM, environmental adaptations, education
How many children require surgical intervention?
5%
Plagiocephaly
- misshapen head or facial asymmetries
- often accompanies torticollis
- may require helmet therapy, which is more helpful for 6 months yo
treatment for plagiocephaly
head repositioning
prone when awake
education + PT (most helpful)
Rule out with plagiocephaly
craniosynostosis–premature closing of cranial sutures
Brachial Plexus Injuries
-nerve roots stretched, which can be transient, permanent, and cause diminished innervation
-may occur in vaginal delivery
-can be sports or trauma induced
Increased risk of brachial plexus injuries in neonates
shoulder dystocia
gestational diabetes
breech delivery
use of forceps or evacuation pump during delivery
Erb Palsy
C5 and C6 (axillary, suprascapular, radial, muscultaneous, subscap)
GHJ IR and adduction, wrist flexion, finger extension
presents as waiter’s tip position
can easily dislocate due to weak shoulder abductors, flexors, and extensors
Kumpke Palsy
C8, T1 (median, ulnar)
affects muscles of hand, sensation, medial arm. loss of thumb opposition
claw position – MTP ext, DIP/PIP flexion, thumb abduction
Prognosis for Brachial Plexus Injury
erb – very good prognosis with early therapy, should resolve in 6 mo
complete – neurosurgeon required
According to Individuals with disabilities education act, early intervention services means services that…
- provided under public supervision
- provided at no cost (except in certain states)
- designed to meet the developmental needs of infant or toddler with disability
When is early intervention provided?
children within the first three years of their lives
Whose responsibility is it to know when reauthorization/regulations have changed for EI?
PT
Key principles for providing EI services
- Infants and toddlers learn best through everyday experiences and interactions with people they know
- All familities, with necessary supports can enhance children’s learning
- Role of service provider is to work with and support the family members and caregivers in child’s life
- Process must be dynamic and individualized to reflect preferences of family, cultural beliefs, learning styles
- outcomes must be functional and based on kid’s needs
- Family’s needs and priorities are addressed by primary provider
- Interventions have to be based on explicit principles, validated practices, research, laws
State eligibility criteria for EI
varies
Federal description of kids who may receive EI
Infant or toddler with disability
1. individual under 3 years of age
2. Experiencing developmental delays
3. Has diagnosed physical or mental condiition that has a high probability of resulting in developmental delay
4. OR at risk toddlers/infants
Individualized Family Service Plan
comprehensive document that outlines and guides EI services for specific child and family
includes demographics, history, current level of functioning, family’s priorities, EI services, service coordinator, transition plan
Multidisciplinary Team
least active interaction among team members
individually assess and report their findings
not suitable for IDEA part C/EI because EI needs a lot of interaction
Interdisciplinary Team
typically has formal channels of communication established
team may submit combined assessment report
Transdisciplinary Team
-share info across disciplines and with family
-may include role release, a primary therapist will prioritizes what will be best
-assessment and treatment may coincide
-all team members share goals and strategies for child’s optimal development
Optimal Teaming in Intervention
-ongoing communication
-interdisciplinary and transdisciplinary approaches
-coaching
-integrated programing
-cotreatment
-role release
“Coaching”
conversation and self observation to support families and team members learning skills to help the child’s development
Integrated Programing
development of strategies for parent-selected outcomes as a team
holistic perspective
Cotreatment
two or more professionals involved in child’s intervention in a session
Role Release
primary therapist prioritizes what will be best to be repeated most consistently throughout a week
Strategies to Encourage Intervention
Cataloging
Matrix Development
Cataloging
log of child’s daily activities from morning to night
work with family to see when therapeutic intervention
Matrix Development
chart mapping daily activities and outcomes
