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Peds Disorders3

DCD, Plagiocephaly, Torticollis, BPI, DDH, Club Foot, Osteogenesis Imperfecta

Developmental Coordination Disorder (DCD) 'clumsy child' & developmental apraxia. motor coordination - not due to a general medical condition
Developmental Coordination Disorder (DCD) clinical presentation poor gross & fine motor skills (unable to skip, diff w/crossing midline, poor handwriting, unable to tie shoes) muscle weakness & low tone, requires verbal & visual cues
DCD task performance re-learning a task each time attempted
Plagiocephaly 'a flattened head' incidence (back to sleep campaign), positional; plagio, brachy, scapho. Crainiosynostosis - sutures fused together wrong
Plagiocephaly PT intervention prone positioning!! helmet in severe cases. see by 2 months, 10-12 months too late
Torticollis presentation asymmetrical posturing of head & neck, sidebend to ipsilateral side w/rotation to contralateral side (named for direction of tilt - 75% right)
Torticollis types sternomastoid tumor, muscular, post-postural
Torticollis clinical presentation Right - shortening of R upper trap & L splenius capitus. Significan trunk tightness, decreased symmetrical upper & lower body rotation & lateral flexion
Torticollis secondary complications developmental delay, shoulder elevation, decreased midline control & ROM during growth spurts, fussiness, irritability w/poor self-calming, decreased tolerance to movement, pain.
Torticollis PT intervention cargiver education!! positioning, stretching, developmental motor skills, facilitation of 'opposing' musculature
Brachial Plexus Injury (BPI) Incidence 1/1000 births, Paralysis or weakness of the UE due to trauma to C5-T1 spinal nerve roots
Types of Brachial Plexus Injury (BPI) Erb's Palsy (C5-C6 - waiter's tip), Klumpke's Palsy (C8-T1 - claw hand, don't have elbow ext, int rot & finger ext), Erb/Klumpke - entire UE involved
Causes of Brachial Plexus Injury (BPI) difficult labor, large baby, hypotonic infant, (traction on should during delivery in breech position or head & neck during vertex delivery
Symptoms of OPBI facial involvement, clavicular/humeral fx, subluxation of shld, torticollis, partial paralysis to diaphram (C4)
BPI PT intervention E-stim, Botox, position/active movement promotion, modified constraint-induced protocols
BPI surgical intervention neurosurgery between 6-12m, before 12m ideal, effectiveness is ?. Ortho surgery for contractures/postural problems
Developmental Dysplasia of the Hip (DDH)/Congential Hips Dysplasia (CHD) - Treatment up to 6m - positioning in hip flex & abd. up to 12m - closed reduction, spica cast. over 1yr - surgical osteotomy (pavlik harness/casting)
Club Foot plantarflexion, inversion - varus (rearfoot), midfoot/forefoot add & supination. 1/1,000 births, 2:1 males. bilateral approx 30-50% of cases
Clubfoot Classification Category 1 postural cluvfoot, flexible deformity, medial & plantar deviation of had/neck of talus, foot size equal no atrophy
Clubfoot Classification Category 2 true club feet, fixed deformity, involves talonavicular & midtarsal jts, navicular & entrie forefoot add & supinated, soft tissues of calf & foot are contracted & underdeveloped
Clubfoot Classification Category 3 sever, fixed deformity, usually associated w/myelodysplasia, may have other severe neuromusculoskeletal problems
Clubfoot Interventions correct deformity early (prior to 1yr) and completely. Maintain corrected position until foot stops growing (ponseti serial casting & Dennis Brown Splint). Mild cases mixed in surgical outcome
Osteogenesis Imperfecta Brittle bone disease. Inherited disorder of connective tissue resulting in gfragile bones & recurrent fractures, muscle weakness & ligmentous laxity w/blue sclera
Osteogenesis Imperfecta Incidence & severity 1/200,000 birth. Mild - forms classified differently. Severe - multiple fractures at birth 7 infants do not usually survive.
Osteogenesis Imperfecta Management Bisphosphonate, bone marrow transplant or surgical -intermedullary rods in long bones.
Osteogenesis Imperfecta PT Management Family education & SUPPORT/COUNSELING. ROM & strengthening program-usually aquatic, reduce injury, splinting, casting, assistive devices (prevent deformities)
Legg Calve Perthes Disease Boys 4:1, 4-12yrs. Disease of the hip initiated by avascular necrosis of femoral head
Legg Calve Perthes Disease Presentation limp w/pain referred to groin, thigh & knee. Hip ROM limitation in IR, abd & flex
Legg Calve Perthes Disease Medical Intervention orthotic use to maintain hip approximation, surgery.
Legg Calve Perthes Disease PT Intervention strengthening & ROM pre/post orthotic or surgical management. Maintain pain-free ROM & non-weight bearing during progressive stage
Slipped Capital Femoral Epiphysis Boys, 11-15, obesity factor. Femoral head slips or is displaced from normal alignment w/femoral neck.
Slipped Capital Femoral Epiphysis Clinical Presentation pain-groin, medial thigh or knee, limp, ER of LE, limited hip flex, abd & IR
Slipped Capital Femoral Epiphysis Medical Intervention stabilize growth plate through bedrest, traction or surgical pinning
Slipped Capital Femoral Epiphysis PT Intervention NWB, gain training
Autism behavior conditions existing on continuum involving: socialization, communication, repetitive behavior
Autism Clinical signs evident before 3 yrs old. poor eye contact, koesn't know how to play w/toys, excessively lines up toys or objects, overly attached to one particular toy/object, doesn't smile, appear hearing impaired
Autism PT Presentation 60-80% demonstrate motor signs, poor muscle tone (hypotonia), poor motor planning, toe walking, sensory impairments (hypo/hyper)
Autism PT Intervention sensory integration, coordination activities, motor patterning /planning, low tone, focus on safety, benefit from increased structure or consistent plan, decreased verbal interaction (communication w/pictures/visual aids)
Created by: jklincoln