Pediatrics - Week 7 Flashcards
Developmental considerations
- Structural and developments
- Emotional/psychological
- Cognitive
- Communication
- Motivation
- Parent/care givers
- Constantly changing
Adolescent growth spurt
- Large changes in skeletal and muscle mass
- Trunk > extremities
- Muscles’ spurt 3 months after bone
- Bone demineralization prior to spurt
Endochondrial ossification
How bone develops - where cartilage is being replaced by ossified bone tissue
Physis, epiphyseal plate cartilage
Growth plate
Diaphysis
Shaft, primary ossification center
Epiphysis
The ends, secondary ossification center
Metaphysis
In between the epi- and dia - physes, part of growth plate (more central side)
Apophysis
Secondary ossification center
Growth plate attachment of a muscle
Why are adolescence at an inherent risk for overuse injuries?
Because of the point they’re at with skeletal maturity
What factors interact with each other to produce an overuse injury?
Adolescent growth spurt
Growth related disorders
Repeated microtrauma
Overuse injury
- Repetitive submaximal loading of the MS system; stress injuries
- Rest is not adequate to follow for structural adaptation to take place
Overuse injury sites
- Muscle-tendon junction
- Bone
- Articular cartilage
- Physis stress injury
- Bursa
- Neurovascular structures
- Diminished metaphysical perfusion - less perfusion —> less bone growth —> injury to those tissues
Characteristics of growth cartilage in adolescent (physes, apophyses, articular surfaces)
- Less resistant to tensile, shear and compressive forces
- Most vulnerable stage
Characteristics of adolescent bone
- Decrease in bone mineral density and strength
Characteristics of rapid changes in limb length and body mass in an adolescent
- Imbalances between growth and strength
- Changes in moments of inertia that demand greater force generation
Characteristics of longitudinal growth of extremities in an adolescent
- Change in length, mass and stress forces on bone-tendon and muscle-tendon junctions, growth cartilage and ligaments
Other risk factors for overuse injury
- Previous injury
- History of amenorrhea
- High training volume
Prevention - moderate evidence
- Limits on participation and scheduled rest
- Monitor training closely
- Pre-season conditioning
- Pre-practice neuromuscular training
Prevention - low level evidence
- Training modifications made on individual basis
- Proper fitting of equipment
Considerations for manual therapy
- Physical, psychological and emotional response more variable than with adults
- Structures —> less rigid/more flexible, susceptible to microtrauma
- joint mobility changes with age and conditions
- Ability to gauge response
- Parental facilitators
- Neuro impairments can be more involved than orthopedic impairments
Indications for manual therapy
- Improve joint mobility
- Improve neurophysiology to gain better response to exercise
- Address pain and stiffness
- Some conditions improve mobility vs cure disorder
Precautions to manual therapy
- Skeletal maturity of patient
- Muscular and ligamentous support
- Patient size
- Systemic problems
- May be exaggerated risk of stroke in young children w/ cervical manipulation/manual therapy
Symptoms of stroke in infants
Seizures
Symptoms of stroke in kids
- Headaches
- Trouble moving
- Paralysis on one side
- Slurred speech
- Loss of vision
- Confusion
Absolute contraindications to manual therapy
- Malignancy
- TB
- Osteomyelitis
- OA
- Fracture
- Ligament rupture
- Disc prolapse w/ nerve root compression
- Influenza
Regional contraindications for manual therapy
- Vertebral artery syndrome
- C1 ligament trauma
- Cauda equina syndrome
- Suspect spinal aneurism
- Post op - depending on phase
- Cervical RA
- Hemarthorosis
- Long term corticosteroid use
- Clotting disorder
Common uses for manual therapy
- Post sports injury - regain motion and function
- Scoliosis or hyperkyphoisis
- Juvenile RA
- Hip dysplasia
- LBP
- Brachial plexus injury, torticollis
