PT management of lifelong conditions Flashcards
Not a single disease; Encompasses all forms of arthritis that demonstrate onset prior to 16 years of age, last longer than 6 weeks, and have an unknown origin; Diagnosis is based on clinical presentation
Juvenile idiopathic arthritis (JIA)
What is the pathogenesis of JIA?
Pathogenesis is not well understood; however, likely:
- Autoimmune inflammatory condition
- Activated by an external trigger
- In a genetically pre-disposed individual
What is the most common type of JIA?
Oligoarthritis
- low-grade inflammation in four or fewer joints, most commonly affects the knee; early childhood onset peaks 2-4 years
What are the types of JIA?
- Systemic arthritis - throughout childhood; F=M
- Oligoarthritis - early childhood, peaks 2-4 years; F»>M
- Rh (+) polyarthritis - late childhood or adolescence; F»M
- Rh (-) polyarthritis - peaks 2-4 and 6-12 years; F»M
- Enthesitis-related arthritis - peaks late childhood or adolescence; M»F
- Psoriatic arthritis - peaks 2-4 and 9-11 years; F»M
- undifferentiated arthritis
What are the S and S of JIA?
- Joint swelling, pain, stiffness
- Morning stiffness** - Indicates active disease; Hallmark sign
- Muscle atrophy; weakness; poor muscle endurance
- Acute or chronic iridocyclitis (typically in oligoarticular): asymptomatic inflammation of the eye that may lead to functional blindness. Treated with corticosteroids; Need to make sure child is seeing opthamologist
- Systemic manifestations - Severe in systemic JIA; Mild to moderate in polyarticula
- Decreased joint ROM secondary to soft tissue contracture
- Fatigue
- Decreased aerobic capacity; impaired exercise tolerance
- Growth abnormalities
- Osteopenia or osteoporosis- Increased with long term corticosteroid use
- Gait Impairments
- Difficulty with ADLs
- Activity & Participation Restrictions
What is the PT management of JIA?
- Control inflammation
- Preserve joint structure and function - Prevent secondary impairments at the joint
- Promote participation
- Educate the family and child
What is the instrument commonly used to assess JIA?
CHAQ
- looks at all 3 levels of ICF model
- .143 indicates clinically important change from PT
What pain rating scales are good for assessing pain in children with JIA?
- Oucher scale
- Faces
- Rating scale
- poker chip tool
What does PT intervention include?
- Address ROM (AROM, no stretching)
- Increase strength (isometric strengthening)
- Improve cardiovascular fitness - Decrease fatigue
- Promote appropriate gross motor skill
- Educate the family on the benefits of maintaining ROM and participating in aerobic activity as well as signs of systemic disease
- Provide family-centered care
- Use of modalities to control pain and maximize ROM
- Educate on the benefits of sleep
- Guided imagery for relaxation, distraction
What surgical procedures are used in JIA?
- Soft Tissue Release - Common sites: hip flexor, ITB, hamstrings; Role of PT: preserve gained ROM through functional activities, splinting and ROM exercises
- Supracondylar osteotomy
Arthrodesis - Epiphysiodesis to prevent/correct leg length discrepencies
- Post-Operative PT: Increase strength, ROM; Gait training; Educate on postoperative precautions set by physician
What are the prognostic indicators for JIA?
- Overall, improving functional outcomes over the past decade
- Negative:
1. Hip involvement and polyjoint involvement in systemic and oligo JIA within the first year of disease presence
2. Rheumatoid Factor (+) - Positive:
1. Oligo JIA has best prognosis for joint preservation and function
2. Onset of symptoms >9 years of age in males
3. Early and effective treatment
Nonprogressive disorder characterized by multiple joint contractures and muscle weakness or imbalance; Incidence: 1 in 3000 to 4000; Suspected cause is a suspension of movement during the fetal periods of development, which results in contractures; Etiology is not well understood, but likely a genetic link; Association with other disease processes where the motor unit, including the anterior horn cells, is impaired.
Arthrogryposis Multiplex Congenita (AMC)
What are the characteristics of AMC?
- Cylindric-shaped joints that lack creases
- Rigid joints, significant contractures
- Joint dislocation, especially at the hips
- Atrophy or absence of entire muscle groups
- Intact sensation, though deep tendon reflexes (DTRs) may be diminished or absent
- Symmetric presentation
What is typical presentation of AMC?
- Shoulder internal rotation
- Elbow flexion or extension
- Wrist flexion with ulnar deviation
- Hip flexion with internal rotation or a frog-legged posture
- Knee flexion or extension
- Equinovarus at the feet
What is the appropriate PT management of AMC?
- Passive stretching - NOT forceful– could result in joint damage; Maintain range with splints
- Positioning
- Serial casting and splinting
- Strengthening
- Promote development of motor skills - Mobility (Usually through power mobility)
- Post-operative rehabilitation
- Adaptive Equipment prescription
What are the goals of PT intervention of AMC?
- Maintain range of motion
- Increase strength
- Promote participation through providing a primary mobility means
Congenital Disorder of the Type I collagen synthesis that affects all of the connective tissues in the body; Incidence: 1 in 15,000 to 1 in 100,000
Osteogenesis imperfecta (OI)
What are the characteristics of OI?
- Systemic Osteoporosis
- Excessive fractures at birth
- Bowing of the long bones
- Spinal Deformities
- Muscle weakness
- Ligamentous laxity -Subluxation or dislocation of joints
- also associated with blue sclera of eyes, dentinogensis imperfecta, hearing loss, growth deficiency, cardiopulm abnormalities, easy bruising, excessive sweating
What is the PT intervention of OI?
- Education on safe handling techniques
- Positioning
- Standing programs to promote bone mineral density
- Active strengthening programs
- Aquatic therapy!
- Emphasis on development of head control - Kids with OI generally have large heads
- Development of appropriate gross motor abilities
- Gait training should occur with an assistive device
- Prevent secondary comorbidities - Hip flexion contractures common
- Provide independent mobility - Manual or power wheelchair
- Whole Body Vibration - Assists with improving bone mineral density
What are the goals of PT treatment of OI?
- Prevent deformity
- Maximize cardiorespiratory status
- Maximize child’s ability to engage in safe mobility and physical activity
What are the most common childhood cancers?
- Leukemia
- Brain tumor
- Lymphoma
- Wilms tumor
- Neuroblastoma
- Retinoblastoma
- Rhabdomyosarcoma
- Osteosarcoma
- Ewing sarcoma
Leukemia:
- Accounts for 25% of cancers in children under 15
– Classified by type of cancerous cell: ____ or ____
- Classified by how quickly the neoplasm replicates: ___ (Fast) or ____ (Slow)
Example: Acute Lympoblastic Leukemia (72% of all leukemias)
Lymphoid; Myeloid; Acute; Chronic
CNS tumors:
- Accounts for 25% of cancers in children under 10
- Treatment = Surgery, radiation, chemotherapy
List the 6 Types (most frequent to least frequent)
- Astrocytoma
- Primitive Neuroectodermal tumors
- Medulloblastoma
- Brainstem glioma
- Ependymoma
- Craniopharyngioma
Develop from the primordial neural crest cells; Responsible for 50% of infant malignancies; 2/3 of kids diagnosed with neuroblastoma are under 5 - Improved survival rates in those diagnosed younger; Generally recognized as a palpable, fixed, hard mass in the neck or abdomen; Common sites: adrenal glands, sympathetic nervous system, abdominal ganglia, sympathetic ganglia of the chest or neck; Medical Treatment: surgery, chemotherapy, radiation
neuroblastic tumors
Of mesenchymal origin- Meschyme gives rise to skeletal muscle, smooth muscle, fat, fibrous tissue, bone and cartilage; Medical Treatment: neoadjuvant chemotherapy (pre-surgical), adjuvant chemotherapy (post-surgical), surgery, radiati
Sarcomas
Name the types of sarcomas
- Osteosarcoma: bone tumor, most common in the long bones; teenagers at greatest risk
- Ewing sarcoma: bone tumor originating from neural crest cells; commonly effects the vertebral column, pelvis, ribs, and long bones
- Rhabdomyosarcoma: soft tissue sarcoma; commonly effects the head and neck, urinary and reproductive organs, extremities and trunk
Name the benefit of exercise in children with cancer
- Improved hemoglobin
- Reduced duration of neutropenia and thrombocytopenia
- Reduced severity of diarrhea and pain
- Reduced duration of hospitalization
- Reduced reports of nausea
- Decreased emotional stress
- Improved lean body weight
- Improved physical performance
- Improved functional capacity
- Improved quality of life index
- Improved flexibility
- Decreased fatigue
- Improved concentration (attention)
- Increased skeletal mass
