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Med Screen (Pediatric Cases) (Arthrogryposis Multiplex Congenita (first 5…
Med Screen (Pediatric Cases)
Spinal Muscle Atrophy
4 types (4th is adult onset-rarest)
nervous, respiratory and musculoskeletal systems involved
cognition is normal
sphincter control and sensation is not effected
defect on chromosome 5
advocate for assistive devices, even if they don't need it now, will probably need them later
switch control toys
molded wheelchair to reduce scoliosis...head support is very important
SMA 1 will pass by the age of 3
important to educate parents on proper positioning, especially of their head
Duchenne Muscular Dystrophy
submaximal exercise; slow stretching; planning ahead for next stage, diagnoses is through muscle biopsy,
Gower's sign: do not have strength to get off floor therefore will walk up legs to stand upright, hypertrophy of gastric. because muscle is being replaced by adipose tissue--> go up on toes and compensate with lumbar lordosis
Torticollis
tummy time (84 minutes/day) is VERY important and can decrease the amount of "flat head" and torticollis
educate parents: can't sleep on tummies (SIDS) but should minimize times in "containers" (car seats)
if missed, can cause larger problems down the chain as they grow up (scoliosis, etc.)
recommend developmental consult to be conscious
stretch contralateral side
educate parents to stretch every diaper change
very common, usually treated for a few treatments and then are fine
more common in multiples (twins, triplets, etc.)
Cerebral Palsy
educate parent in position so they can feed themselves
drowning or head injury early in life
most common is around birth... there was difficulty at birth and reduced oxygen
can happen in utero
speech can be affected (depends on part of the brain involved)
adaptive ambulatory devices, adjusted bikes.. to help you get to the next goal
1/1000 kids; very common
movement and posture analysis as well as developmental exams
also different body involvements
don't worry about levels just know mild, moderate and severe CP
Erb-duchenne palsy
if have weak arm: keep eye on hand growth and arm length; work on weight bearing to stimulate bone growth
more common in large babies, difficult deliveries and multiples (twins, etc)
diagnosed typically before the bay returns home and sent to PT early
if complete tear due to a surgical repair
Primary: Neuromuscular. Secondary: musculoskeletal system
protect shoulder, supported prone position, sensory stimulation
if identified early, can do well and get full return; see steady progression in PT
train parents in proper positioning and exercises
Scoliosis
between 20-40º, prescribed a body jacket
less than 20º, referred to PT
leg length discrepancy is not "true" --> due to pelvic symmetry
idiopathic is most common usually noticed around puberty
convex side you want to strengthen, concave you want to stretch
primary system: musculoskeletal. Secondary: respiratory
can have an S (primary curve above, secondary below) curve or a C curve
Osteogenesis Imperfecta
may be referred to PT due to post fx.
no contact sports
NO PROM
1/4 will live normal life
skeletal system is primary, CV is secondary
1/20,000 kids but will be tested if in family history
don't need to know the types
less fx. after age of 5, especially if PT has been used before age 5
aka. Brittle bone disease
have kids take a note that they have OI if they travel (less dealing with social work suspicion)
Down Syndrome
ligament laxity big consideration as they grow up and are seen in ortho PT setting
watch knee- hypotonia, foot pronation (may need orthotics by age of 4)
odontoid ligament in neck is large precaution: keep neck stable, educate parents to be mindful of horseplay and roughhousing
monitor cardiac and respiratory issues in exercise program
special education but can talk, walk, very social
walk at 2.6 years (later than normal)
all systems except integumentary
very common 1/700. increases to 1/40 if mom is 45 yrs or older
mothers over 35
trisomy 21 (extra chromosome)
Arthrogryposis Multiplex Congenita
first 5 years they will have many surgeries to release tension on tendons
teach them compensations
visible disorder: contractures, under developed muscles
1/3,000 kids
be careful of overstitching and joint capsule
motor unit deficit
neuromuscular
build relationships with surgeons
99% of kids will walk
regular education- bright and can go to college
can end up with joint issues due to wear and tear, will see in OP ortho as they grow up
Osgood-schlatter disease
those parents canoe a problem; coaches
get the film to help you plan the treatment
will see this in girls earlier because of puberty
appropriate stretching and strengthening
musculoskeletal system
more common in boys but girls are catching up due to increase in participation in sports