Rehab/habilitation Flashcards
Rehab
Timely referral to rehab and comprehensive team show best results
Goals are set according to usual expectations for age
Include parents as active team members throughout rehab process
PT Exam/Intervention
tailor assessments on child’s chronologic and developmental age
Determine motor and sensory levels
MMT unreliable in children under 5–obtain info through observation of mvmt
Sessions/interventions focused around play
Sitting balance = major goal of PT
- may need orthosis
Strengthen all innervated musculature, maintain full ROM, contracture prevention
- maintain tenodesis grasp for those with tetraplegia
C1-3 need mechanical vent
Children must be instructed on how to instruct others in their care if needed
Bed Mobility/Transfer Training
Similar to those use for adults
Head hips relationship= move your head/upper trunk in the opposite direction you are moving, and looking away from where you are moving in order to unweight the pelvis for transfers and mat mobility– not intuitive to children–need lots of practice
C6 and below- initial slide board training, push up blocks,
Transfer should include level and not level surfaces, w/c to floor and floor to w/c, vehicle transfers
C5 and above- dependent in mobility and transfers
Wheeled Mobility
Used when community ambulation is not an expected outcome
At C6 or above = power chair
Lower C levels or high T levels = may be able to propel manual chair for limited distances on level surfaces
18-24 mo may be trained in power mobility but must have parent supervision
For family convenience may want manual and power chair to accommodate home and for easy transportation of device
Must be aware the overuse injuries can occur in shoulders and wrists as a result of manual w/c
Seating prescribed with skin protection and spinal alignment in mind– level pelvis = decreased pressure on ischial tubes, solid seat and back are preferred in children
Ambulation
Frequently ambulation does not replace use of w/c d/t energy/time consumption
Swing through gait pattern in efficient, RGO or KAFO may be used for standing or during exercise
T1 and below- amb achieved through different kinds of bracing
- HKAFO or RGO- for those with absent/limited hip flexion, must have 3/5 strength in quads
Lower level injuries- amb with AFOs
Initiate gait training in parallel bars or with ue AD
Standing frames used for static standing or mobile standers
Locomotor training- activity based therapy used to stimulate central pattern generators through repetitive mvmt
- body weight support treadmill training, followed by overground body weight support
Functional E-stim Cycling
Cycles are FDA approved for children 4 yrs or older
Protocol: 30-60 min 3-5x/week with cadence of 40-50 revolutions per minute
Improved CV health, bone mineral density, mm volume, O2 uptake
Maximize activity and participation
Community/school reentry activities- combined responsibility of all therapists involved in treatment team
- navigation of different environmental barriers (curbs, doors, shelves, etc.)
- caregiver training regarding amt of assistance to provide
Encourage teens to problem solve
D/c planning— mobility issues in multiple environments- home school community
Home eval- home modifications
Accessibility in school
Safe Transportation- w/c tie downs, car transfers
- teens- must be independent in transfers and loading/unloading w/c before returning to driving
C1-4
Dependent in bed mobility and transfers
Independent in power chair with head, chin, mouth or tongue control
Dependent for pressure relief in bed or in MWC, Independent in power tilt chair
Unable to drive, need van with lift
C5
Assist for bed mobility
dependent for transfers
independent with power chair- hand control with splint
Dependent for pressure relief in bed or in MWC, Independent in power tilt chair
Transportation independent with ue controls
C6
independent in bed mobility and transfers- may use sliding board
w/c- independent in manual with adapted rims, likely to use power chair in community
Independent in pressure relief
Transportation- I with hand controls, Assist for load chair
C7-T1
I- bed mobility/transfers, may use sliding board
C7-T1
I- bed mobility/transfers, may use sliding board
I- mobility with manual chair
I- pressure relief
I- driving with hand controls and loading chair
T2-10
I in manual w/c at home and community
Amb- SBA, exercise only, KAFO or RGO with crutches or walker (not practical for T2-6)
Diving- hand control I with loading
T11-L2
I in manual chair at home and community
Amb- I indoors with KAFO/RGO and lofstrand, some can do stairs
Driving independent
L3-S2
May not need MCS except long distances/recreation
Amb- I at home and in community may need lofstrand or cane
Driving- can drive automatic transmission, may prefer hand controls
