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37 Cards in this Set
- Front
- Back
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3 tx types
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TherEx
NDT Sensory integration |
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What must be addressed in concern to "dissociation"?
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We want dissociation btw and within trunk and extermities
ie. Diplegic CP have difficulty fxt with 2 limbs in different positions (ie. half kneel). |
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What must be addressed in terms of alignment and planes?
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Alignment must be considered in all 3 planes!
Often CP kids like to stay in one plane - train in all planes |
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What type of position hiolding should you stay away from?
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Avoid static position holding
Transitions and/or imposed weight shifts are better |
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What must TherEx involve?
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Must involve/address sensory systems (proprioception, visual, tactile,body awareness)
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What type of physical assist may be necessary while child is performing TherEx?
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Assist/support for maintaining alignment, initiating wt shifts, transitional movts, and to dec stiffness
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Who was NDT originally designedfor? What is it?
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Chidlren with CP and adults with hemiplegia
More a philosophy or an understanding of development and mo. control as they pply to xt tasks than a set of techniqes |
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Goal of NDT
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Get the best fxt, carryover to life
Therapist does prep work and may intially fabilitate or guide, but eventually therapist does less and less Child eventually initiates task |
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Who is SI tx used for?
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Sensory Integration - primary tx for children with learning disorders, autism, and ADD.. also used with CP
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What is SI tx and why does it work for CP?
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Povides opportunity for child to experience a variety of controlled sensory input ot encourage prodcution of an adaptive response that include mo. behaviors, social interactions, or cognitive skills
Works with CP b/c often may have problems with processing sensory input and then producing mo. output |
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What is the best way to incorporate SI tx with a CP child?
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Pure SI with CP is problematic due to lack of independent mobility
Use early in tx session as preparation May help child with optimal arousal Promotes purposeful behavior wihtin a meanigful activity Encourages the child to use intrinsic motivation |
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Laundry list of "other tx's"
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BWSTT
Contraint induced therapy Hippotherapy Feldenkrais Craniosacral Myofascial release NMES Therapeutic Estim Conductive education PAtterning Hyperbaric oxygen therapy |
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What is conductive education?
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Rhymes in groups using songs
Little reserach to back it up |
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Tx ideas for hypotonia
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Alignment of trunk and head FIRST
Do not overlengthen mm Use visual, tactile, proprioceptive input to hold alignment Isometric contractions and joint approximations Small weightshift ranges Small rotation with spinal extension Stay away from straigh sagittal planes Narrow BOS |
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Tx ideas for Diplegia
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Work to hold postures that require trunk and hip extensors in combo with ABs
wrk of ABs with trunk in extension is fxt Need to gain connecion between upper and lower trunk Need to be aware of BOS and make sure it is appropriate Be aware of visual impairments - these must be addressed |
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Tx ideas for Quadriplegia
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Look at BOS first, then widen it and work on alignment and joint ROM
Look at head and trunk control with posture and movt, then stiffness Relaxation techniques (vibrations/oscillations) followed by joint approximations Get out of sagittal : ROTATION Splinting, serial casting, night braces as opposed to Stretching |
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Stretching wiht Quads?
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Littel evidence to support it - getting away from it and going to splinting, bracing, serial casting
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Tx ideas for Hemiplegia?
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Work on establishing more correct mildline
Reduce shortening of hemi side, out of rotation on non-hemi side Acive rotation to both sides Elongate hemi side, inhibit holding mm Treat both sides of the body Non-hemi side often excessively mobile, overlengthed and weak Work on approximation and stretching |
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Tx ideas for Athetosis
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Look at inability to separate head, eye, jaw, and arm movts from each other
Center head/eyes and build postural control Help individual to leran how to quiet non functional movts Careful wording - anticipation of instructions brings bursts of non-funcitonal movt |
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Tx ideas for ataxia
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Small uncluttered room, not with other children
Address visual attention Alignment Organization very important Repetitious activity, with few activities Address visual att'n with movt Establish correct midline Deep pressure, firm handling, close to you to dec fear wtih movement away from midline |
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What do ataxic children not use well?
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Do not use sensory system well ot monitor movt
Safety is important for this group especially |
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General tx ideas for ALL
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Fun activities
Activity must have a purpose Give some control to pt Never force an activity Give time to organize and initiate movt sequences |
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How does Therapeutic equipment enhance tx?
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Inhibit undesireable movts
Introduce instability Assist with controlling amt of instability Can control degrees of freedom Therapist creativity with equipment to bring desired outcomes |
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What is Assistive Technology
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Anything that inc's fxt status
Promotes development and/or acquisitoin of skills that are lacking secondary to dx or injury |
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Two types of adaptive equipment professionals?
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Assistive technology practitioner (ATP)
Assistive technology supplier (ATS) |
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Uses of adaptive equipment?
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Allow correct positionng during child's free time
Prevent undesireable positons/movts Promote mo and sensory developmet Can assist with daily household activities (bath, meals) CAn assist with preventing secondary impairemnts Can improve cognitive, percetual, emotional, and social development |
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What must you moniotr when a child has adaptive equipment?
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Monitor to assure that ther goals and family needs being met
Abandonment an issue |
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Precautions for the use of adaptive equipment
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Can be dangerous
Static positioning may not provide env for learning transitions, movts, or exploration If used excessively, can delay mo. development by modifying sensory input and limiting mov MUST educatie caregivers about benefits and precuations |
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What must PT take into consideration when assessing child for adaptive equip?
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Must plan for changing needs of child - growth, fmaily
Predict child's needs in: growth and development, educaiotn, recreation alternatives Must be fmailiar with DME provider, R&R, and alternative funding sources |
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Safety considerations for adaptive equipment
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Educate caregivers on:
Donning/doffing Attention to env (esp mobility devices) |
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What must you examine/eval when about to prescribe adaptive equip?
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ROM of head, neck, hip, knee, ankle
Mm tone, strength, control Sensation and rflexes Perception, cognition, social/emotional factors Fxt sklls |
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What may a powered w/c improve for a child?
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Inc social participation
Enhance development of spatial, cognitive, affective, and social functions Avoid fatigue which can negativley affect academics |
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What type of seaters are available?
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Floo rsitters, feeding seats, sidelyers
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What type of standers are there?
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Supine
Prone Easy stand |
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What type of walkers are there?
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Rollators (2 wheels in front) - b/c hips are in flexion, line of gravity is ANT to feet so ANT trunk lean
Posterior or posture control walker (2 or 4 wheels, more energy efficient) What |
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What do forearm cruthces promote?
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Facilitate rouning of shoulders, forearm pronation, forward trunk lean
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Other equip that may be "issues"
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Swings
Jumpers Exersaucers Infant walker Bumbo seats |
