PT in Infancy

Question 1

PT in Infancy

Answer 1

Most significant involvement occurs during the new born period–critical time in which stretching and splinting can have greatest impact
Feeding issues possible due to abnormalities of jaw and tongue

Breech presentation results in: club feet, hip flexion contracture, knee extension contractures, shoulder tightness (IR), elbow/wrist flexion contractures

Amyoplasia- typically has posturing of hips in abduction, flex, ER, flexed knees, club feet, IR shoulders, extended and pronated elbows, and flexed wrists

Asymmetrical posturing of extremities can result in dislocation (i.e. hip) require surgery

Question 2

Examination

Answer 2

PROM, AROM–recc re-eval of ROM monthly
Document strength based on infants movements and palpation of mm cxn
Developmental tools used occasionally but usually reflect poorly due to contractures and decreased strength
Delayed motor milestones = activity limitations and participation restrictions
Motor milestones often delayed or skipped
Mobility*** more important to evaluate than a developmental score
PT: rolling, sitting, prone tolerance, scooting, creeping, crawling, transitional mvmts , standing tolerance and upright mobility–assess fit and need for AD or other supportive devices, track club foot alignment
OT: feeding, ADLs, object manipulation

Question 3

Tests that may be used

Answer 3

Bayley, AIMS, PDMS2, WeeFIM

Question 4

PT Goals in Infancy

Answer 4

Maximize strength
Improve ROM
Enhance sensorimotor development
Education for family: positioning, stretching, avoidance of activities that can increased deformity

Question 5

Intervention Strategies

Answer 5

Focus on improving alignment to maximize the biomechanical advantage for strengthening
- reduction of joint contractures through stretching, serial casting, foot abduction, thermoplastic serial splinting, and positioning devices

Address developmental skills, teaching compensatory strategies (ADL’s, alternative mobility, maximize participation in age-appropriate activity)

Question 6

Development, Strength, and Mobility

Answer 6

First Type AMC: limited positioning d/t hip flex contractures—prone positioning encouraged for stretching of contracture

• -learn to roll and scoot on bottom as primary floor mobility (do not want to reinforce increased hip flexion with quadruped positioning)
• -delayed in sitting occurs at 15 mo
• -able to stand when placed in position
• -walking at 18 mo with AD or orthotics
• -independent ambulation by 2 y/o

Amyoplasia: more positioning options d/t hip/knee flex contractures

• -difficulty in prone d/t elbow ext contractures (limits comfortable propping, use towel roll under chest)
• -encourage positioning of hips in neutral rotation and abduction
• -slower developmentally- slow at achieving rolling, faster at achieving sitting and scooting
• -sitting and scooting more energy efficient than creeping, however are able to attain creeping
• -may never achieve floor to stand independently
• -ambulation in 2nd year, need increased bracing

Question 7

Strengthening in fist 2-3 years

Answer 7

dynamic strengthening through developmental facilitation and play
Trunk rotation
Aquatics

Question 8

Self Care, feeding, and object manipulation

Answer 8

Dependent on hand function and elbow flexibility
May use mouth or feet to assist in manipulation of objects when hands have decreased strength
May need adaptive equipment if unable to achieve hand to mouth
With bilateral elbow contractures–common to cross over hands to achieve grasp on object

Question 9

Standing

Answer 9

Important in first 1-2 years
Begin standing at 6 months, completed in completely upright position to encourage biomechanical alignment needed to stand without support
Standing frames&raquo_space; independent static standing in frame
By 1 y/o should tolerate standing for 2 hrs in frame
Avoid prone standers as they do not encourage dynamic trunk control
Standing encourages self stretching
Incorporate dynamic activities when standing (ball games, etc.)

Question 10

Stretching and Splinting

Answer 10

3-5 sets/day with 3-5 reps/set, hold for 20-30 sec–must be performed daily
Incorporate into daily routine
Stretching most critical in first 2 years of life due to growth

Thermoplastic splints- maintains positioning for prolonged stretch, want to be in comfortable position of stretch because if placed in maximum stretch can lead to skin break down or decreased tolerance to splinting

AFO’s- cast calcaneus in neutral, hindfoot and forefoot in neutral to prevent rocker bottom foot–should be worn for 22 hours per day

Knee contractures:

• -first 3-4 months anterior knee flexion splints for knee extension contractures or posterior knee extension contractures for knee flexion contractures–should be worn 20 hours per day
• -older infant should not where knee flexion splint for sleeping that is greater than 50d bc encourage hip flexion contractures
• • should wear flexion splints when performing activities that require flexion (sitting in car seat or high chair, prone, quadruped)
• -knee extension splints = 18 hours per day esp during sleep, at 6 mo of age can be used for standing, should be off for 6 hours per day to allow for floor mobility

Wrist splints: cock ups splints
Hand splints not worn until 3 mo old (want to allow for physiological flexion, integration of palmar reflex)
Day: posterior wrist cock up, fingers free
Night: dorsal cock-up with pan for finders

Elbow:

• • Ext splints worn while sleeping (elbow
• -Flex splints best worn during day because encourage functional ue movement

Question 11

Key to successful intervention

Answer 11

FAMILY EDUCATION