Pediatric Orthotic Problem solving Flashcards
Typical guidelines for bracing state that we should brace to which one: R1 or R2?
R1, within spasticity free ROM
However, Dr. Bickley states that she braces to R2
When should you evaluate the effects of an AFO?
Wait a week or two for the patient to get used to it
don’t make immediate judgements on how effective it is as soon as they put it on and walk for the first time
What are the 3 ways an AFO can help with non-ambulatory needs
Contracture managment
Wound healing, protection/prevention
positioning
What should we keep in mind about orthotic comfort?
Orthotic MUST be comfortable
especially a night time AFO, it cannot interfere with pt sleep
What are the two methods of making an orthotic more comfortable
Minimize pressure by maximizing area covered
Provide sufficient leverage by increasing the longitudinal segments of the orthotic
the most basic pressure system for an orthotic is the _______
3 point pressure system
how does a surestep SMO compare to a regular SMO?
shorter toe plate and trimlines
designed to promote higher level activities like running and jumping
What issues are associated w/ downsyndrome
Atlantoaxial instability
-Present in 15% of pt with DS
-Take radiographs between 3-5yo
Cardiac issues
Thyroid Issues
Hip Issues
-DHD
-Acetabular Dysplasia
T or F: a SMO w/ a PLS extension is good for crouch gait
F
Idiopathic toe walking and Spastic CP at a GMFCS level II can benefit from what kind of orthotic
SMO with PLS extension
What planes does the SMO with PLS extension control
Controls sagittal plane talocrural issues (with the PLS extension)
Coronal plane Subtalar joint issues (with the SMO)
What kind of orthotic is best for Duchenne’s Ms Dystrophy
GRF AFO
Unless they’re non-ambulatory!
Signs of duchennes muscular dystrophy?
Clumsy, may walk on toes, show motor REGRESSION
GOWERS SIGN!!!!
T or F: Prolonged walking and standing delay the development of scoliosis in Duchenne muscular dystrophy
T
What MSK problem is associated w/ Duchenne’s muscular dystrophy
Scoliosis
What type of medication often improves muscle mass and function in the first 6 months of treatment for Duchenne’s
Corticosteroids
Surgical intervention for scoliosis is typically considered when the curve reaches approximately ______, especially when the child is under ______
30
14
What is the pattern of weakness in Duchenne’s muscular dystrophy
Proximal to distal
not all muscles affected equally
early in neck flexors and abdominal muscles
how do you differentiate duchennes muscular dystrophy from idiopathic toe walking
they just now started walking on toes at 5-6 y/o and are now clumsy
Gait prognosis for Duchenne
gait typically lost by age of 12
What is the most severe classification of Spinal Muscular Atrophy
Type 1- Manifests before age of 6 months
death by 2 years old
most common
What is the mildest form of Spinal Muscular Atrophy
Type 3,
Onset after 18 months
Children may walk independently or with AD into late adolescence and early adulthood
When does each type of Spinal Muscular Atrophy appear?
Type 1- Appears before 6 months
Type 2- Onset between 7 months and 18 months
Type 3- onset after 18 months
What is the prognosis for each type of SMA?
Type 1- Death at age of 2
Type 2- may live into adulthood w/ proper treatment and monitoring of pulmonary function
Type 3- normal life expectancy, may require AD to walk
How are all 3 types of SMA characterized?
Significant limb and trunk weakness
Atrophy pronounced more proximally and in LE
Hypotonia and Areflexia
Progressive musculoskeletal issues
What is the cause of Duchenne?
Progressive neuromuscular disorder
Genetic mutation causes: Absence of dystrophin, a protein normally present in muscles and in the brain –> causes muscle cells to be easily damaged
Duchennes typically affects what gender
males
Differences between duchenne and SMA?
DMD- Later onset, may not have family history, psuedo hypertrophy of calve muscles
SMA- Inhereted, Earlier onset, Affects reflexes( Areflexia), Affects limbs more than DMD
What kind of shoes do we want and not want for orthotic use?
Removable inserts
Extra depth
Laces or velcro
NOT: Canvas shoes or sandals/slip-ons
What are 3 common compensations in gait for children w/ hemiplegia
Hemi-pelvis retraction
increased pushoff w/ unaffected side
early firing of fibularis longus
how do we delay the development of scoliosis in children with DMD?
Prolonged walking and standing
