PEDIATRIC

REHABILITATION

PEDIATRIC
REHABILITATION, AFIRM
REHABILITATION
Definition
Process of helping a person
Fullest potential
Consistent with persons impairment and
desires
PEDIATRIC REHABILITATION
A subspecialty

Different from adult rehabilitation

Everything is changing
PEDIATRIC REHABILITATION
Utilizes interdisciplinary approach
Congenital and child-hood onset physical
impairment
Rehabilitation 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 patients 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 conditions
TRANSIENT STATIC PROGRESSIVE
CONGENITAL
Brachial plexus
injury



AQUIRED
Guillain-Barre
syndrome

Cerebral palsy
Spina bifida
Retardation


Spinal cord injury
Traumatic brain injury
Traumatic limb
amputation
polio

Muscular dystrophy
Spinal muscular atrophy
Cystic fibrosis


Juvenile rheumatoid
arthritis
Collagen vascular
disease


CERBRAL PALSY
Definition
Disorder of movement and posture
Injury to immature brain
Ages involved

CERBRAL PALSY
Classification

By tone abnormalities By body parts involved
Spastic
Dyskinetic
Athetoid
Choreiform
Ballistic
Ataxic
Hypotonic
Mixed


Diplegia
Quadriplegia
Triplegia
Hemiplegia
CERBRAL PALSY
Goals of rehabilitation

Decrease complications

Enhance or improve new skills

EVALUATION
Objectives
Type and etiology of disability

Childs 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 tone
2. To inhibit primitive
reflexes
3. 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. Kinesthetic
2. Proprioceptive
3. tactile


1. tactile
2. Proprioceptive
3. Kinesthetic

1. Vestibular
2. Tactile
3. 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 children
Adult post CVA
Children with CP
Adults post CVA
Children with learning
disabilities
autism
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 childs ability to
move
AIDS AND APPLIANCES
STANDER

PRONE MOBILE
STANDER
STANDER
SUPINE STANDER
WALKER

PLATFORM WALKER
WALKER
STANDING SEATED WALKER
WALKER
NON-FOLDING
WALKER
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 sitting
Persistence 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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