PT in Preschool

Question 1

PT in Preschool

Answer 1

Function and participation vary by involvement
Parents may become more aware of magnitude to limitations at this time
Structural limitations decrease participation
Restriction in ROM continues to be problematic secondary to rapid growth
Independent ambulation usually limited due to decreased protective responses in ue

Question 2

Exam

Answer 2

PROM and AROM closely monitored
Proper fit of orthotics and splints
Functional mm strength- helps to determine extent of bracing
MMT more appropriate at this age- improved comprehension of instructions
–important to grade through the arc of motion bc AMC will typically be strong in midrange with increased difficulty near end range–End range = where child needs to work mm to maintain stretch of antagonis mm
Gait assessment
–distance, use of AD , speed, symmetry of step length
gait deviations and mm activity

Mobility with wheelchairs not addressed til school age**

Question 3

Goals

Answer 3

Ability > disability
Assist child through problem solving rather than providing physical assist
Reduce disability, enhance independent mobility with minimal bracing or use of AD
Surgical intervention may be use to improve biomechanical alignment of joints

Question 4

Stretching

Answer 4

Continued need for stretching program
2x/day, shown to adequately maintain ROM
AFO’s and positional splints continue
Independent and functional mobility– want to use minimal AD’s, use supportive bracing
AFO’s use to prevent recurring clubfoot–continued through school age

Question 5

Orthotics

Answer 5

Knee ext contractures require less bracing
Pelvic band for HKAFO used if unable to maintain upright position without hip support
—band encourages neutral rotation and abduction of le’s, band removed when child is able to ambulate with hips unlocked and without jackknifing at hips during stance
Maintain hip strength when band is removed
**Least amt of bracing is optimal
Strong extensors are more functional than a child who needs a brace to substitute weak extensors

Walkers- may need forearms support, walkers may be use for those that have decreased protective responses in standing and walking

Encourage use of head and trunk to stand and balance and then use weight shift to advance limb

Weak quads and knee flexion contracture– amb with locked KAFO, allows for ongoing stretch

Shoes may need wedges to compensate for hip/knee flexion contractures

Manage environment al barriers through family education