pediatric rehabilitation fi
DESCRIPTION
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PEDIATRIC REHABILITATIONPEDIATRIC REHABILITATION, AFIRM
REHABILITATION
Definition– Process of helping a person– Fullest potential– Consistent with person’s impairment and
desires
PEDIATRIC REHABILITATION
A subspecialty
Different from adult rehabilitation
Everything is changing
PEDIATRIC REHABILITATION
Utilizes interdisciplinary approachCongenital and child-hood onset physical
impairmentRehabilitation of children requires
– Identification– Selection– Understanding
INTERDISCIPLINARY TEAM
PATIENT
REHAB SPECIALIST
OCCUPATIONAL THERAPIST
PHYSICAL THERAPIST
PSYCHOLOGIST
SPEECH THERAPIST
PEDIATRIC REHABILITATION
Team members include– Pediatric physiatrist– Occupational therapist– Physical therapist– Rehabilitation nurse– Prosthetist-orthotist – Psychologist– Speech-language pathologist– Case manager– Dietician– Therapeutic recreation specialist– Spiritual care
TEAM MEMBERS
Pediatric Rehab Specialist– Oversee medical care team– Prescribe treatments– Coordinate with other specialists– Educate patient
OCCUPATIONAL THERAPIST
TEAM MEMBERS
Occupational therapist– Provide training
• Activities of daily living• To compensate• Upper extremity prosthesis
– Recommend equipment– Fabricate splint– Suggest home modifications– Educate patient’s family– Manage dysphagia
TEAM MEMBERS
Physical therapist– Evaluate
• Muscle length• Muscle strength• Muscle tone
– Therapeutic exercises– Normalize muscle tone– Joint handling techniques– Improve balance– Training adaptive devices and lower limb prosthesis– Perform auscultation to lung fields– Physical therapy modalities– Assess body posture
FOR BALANCE AND STRETCHING
GAIT TRAINING
TEAM MEMBERS
Rehabilitation nurse– Direct personal care– Determine goal– Assesses and addresses
• Hygienic factors• Bowel and bladder programs• Intervention related to skin integrity• Use of equipment• Minimize effects of inactivity• Medication management• Help manage time
TEAM MEMBERS
Psychologist– Neurophysiological testing
• Personality style• Psychological status• Testing of intelligence, memory
– Ways to deal with stress– Counseling
• Adjustment to body changes• Problem solving skills• Death and dying
TEAM MEMBERS
Speech-language pathologist– Detailed assessment– Evaluation of swallowing– Pragmatic and cognitive based disorders– Motor speech– Augmentative and alternative approaches
• Talking tracheostomy tubes• Electro larynx
TEAM MEMBERS
Prosthetist-orthotist– Evaluation, design and fabrication– Instructions in care and use– Follow up maintenance and repair
PEDIATRIC REHABILITATION
Common disabling conditionsTRANSIENT STATIC PROGRESSIVECONGENITALBrachial plexus injury
AQUIREDGuillain-Barre syndrome
Cerebral palsySpina bifidaRetardation
Spinal cord injuryTraumatic brain injuryTraumatic limb amputationpolio
Muscular dystrophySpinal muscular atrophyCystic fibrosis
Juvenile rheumatoid arthritisCollagen vascular disease
CERBRAL PALSY
Definition– Disorder of movement and posture– Injury to immature brain– Ages involved
CERBRAL PALSY
ClassificationBy tone abnormalities By body parts involved
SpasticDyskinetic Athetoid Choreiform Ballistic AtaxicHypotonicMixed
DiplegiaQuadriplegiaTriplegiaHemiplegia
CERBRAL PALSY
Goals of rehabilitation
– Decrease complications
– Enhance or improve new skills
EVALUATION
Objectives– Type and etiology of disability
– Child’s potential for rehabilitation
EVALUATION
Screening test for development– Bailey scale of infant development– Denver developmental screening test
Quantitative analysis of motor performance– Physical parameters– Physiological parameters
Jebson Taylor Hand Function Test
EVALUATION
Functional assessment– Wee FIM scale
– Gross Motor Functional Measure
– The Pediatric Evaluation of Disability Inventory
EARLY INTERVENTION
Decreases the impact of brain injury on the development of CP
For infants and toddlers ( 0 to 3 years old)
The rationale of early intervention
Neurodevelopmental technique (Bobaths)
Sensorimotor Approach to Treatment (Rood)
Sensory Integration Approach ( Ayres)
CNS model Hierarchical Hierarchical Hierarchical
Goals of treatment 1. To normalize tone2. To inhibit primitive
reflexes3. To facilitate
automatic reactions and normal movement pattern
1. To activate postural responses
2. To activate movement once atability is achieved
1. To improve efficacy of neural processing
2. To better organize adaptive responses
Primary sensory systems utilized to effect a motor response
1. Kinesthetic2. Proprioceptive3. tactile
1. tactile2. Proprioceptive3. Kinesthetic
1. Vestibular 2. Tactile3. kinesthetic
NEUROMOTOR THERAPY APPROACHES
Neurodevelopmental technique (Bobaths
Sensorimotor Approach to Treatment (Rood)
Sensory Integration Approach ( Ayres
Emphasis of treatment activities
1. Positioning and handling
2. Facilitation of active movement
1. Sensory stimulation to activate motor response
1. Therapists guides but child controls sensory input to get adaptive purposeful response
Intended clinical population
CP childrenAdult post CVA
Children with CPAdults post CVA
Children with learning disabilitiesautism
Emphasis on treating infants
yes no No
Emphasis on family involvement
yes no no
NEUROMOTOR THERAPY APPROACHES
HANDLING TECHNIQUES
Lifting and carrying
POSITIONING
SUPINE
Lying
PRONE
SIDE LYING
POSITIONING
SITTING
Long sitting W Sitting Cross legged Sitting
POSITIONING
– Standing
MOVEMENT BETWEEN POSITIONS
Movement between positions– Rolling– Lying to sitting
MOVEMENT BETWEEN POSITIONS
Sitting to standing
MOVEMENT BETWEEN POSITIONS
Exercises for sitting to standing
MOVEMENT BETWEEN POSITIONS
Walking
TREATMENT TECHNIQUES
Mobilization activities
TREATMENT TECHNIQUES
Activities to facilitate postural abilities
Activities to challenge postural abilities
Activities to improve the child’s ability to move
AIDS AND APPLIANCES
STANDER
PRONE MOBILE STANDER
STANDER
SUPINE STANDER
AIDS FOR ADLS
WEIGHTED UTENSILS HAND STRAP
AIDS FOR ADLS
CURVED UTENSILS SUCTION BOWL
AIDS FOR ADLS
ZIP GRIPS SOFT TOUCH SPRING ACTION SCISSORS
WHEEL CHAIR
Strap for trunk support
Head rest
Wedge
CP CHAIR
ANKLE FOOT ORTHOSIS
Supramaleolar orthosis Hinged ankle foot orthosis
Solid ankle foot orthosis
Posterior leaf spring AFO
KNEE ANKLE FOOT ORTHOSIS
•
HIP-KNEE-ANKLE-FOOT ORTHOSIS
MEDICATIONS FOR SPASTICITY
Drugs in use– Baclofen ( lioresal)
• 2.5-5 mg twice daily– Diazepam
• 1-2 mg twice daily– Dantrium
• 0.5 mg/kg/day– Clonidin
• 0.05 to0.1 mg twice daily Intrathecal Baclofen infusion
INJECTION THERAPY
Botulinum toxin A– 12 to 14 U/kg
Local injections– Phenol– Alcohol
Nerve blocks– Obturator– Sciatic– Tibial– Femoral– Musculocutaneous
SURGICAL PROCEDURES
SURGERY IN CEREBRAL PALSY
Foot and ankle– Tendoachilles lengthening for ankle equinus– Split anterior tibialis transfer for inversion and
dorsiflexion– Split posterior tibialis transfer for inversion
and plantiflexion– Subtalar arthodesis for calcaneovalgus
SURGERY IN CEREBRAL PALSY
Knee– Hamstring lengthening for crouch and internal
rotated gait– Rectus transfer (to semitendinosis or sartorius)
to balance hamstring weakness and prevent recurvatum
– Tibial derotation osteotomy for internal rotation
SURGERY IN CEREBRAL PALSY
Hip– Psoas lengthening ( intramuscular over the
pelvic brim for hip flexion– Adductor tenotomy for scissored gait or early
hip subluxation– Varus derotational osteoyomy for hip
subluxation– Pelvic shelf procedure for subluxation with
severe acetabular dysplasia
SURGERY IN CEREBRAL PALSY
Neurosurgical procedure– Selective posterior rhizotomy
FUNCTIONAL PROGNOSIS
Independent Ambulation– Spastic CP 75%– Diplegia 85%– Quadriplegia 70%– Hemiplegia– Ataxic CP– Hypotonic CP
Independent sittingPersistence of primitive reflexes
PEDIATRIC REHABILITATION
Indoor – Physical therapy gym– Occupational therapy gym– One-way mirrored observation room– Sound proof one-way mirrored speech therapy room– Regular speech therapy room– Psychological assessment and therapy room– Special education classroom
Outdoor– Sensory integration playground– Functional activities playground
PHYSICAL THERAPY GYM
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