Pediatric Note Taking Guide PDF

Environmental Adaptations to the infant’s environment can be incorporated by adaptation -Alternating position in crib & changing table promotes head turn in desired direction -Adapting car seat to promote symmetry & minimize time in car seat and infant carrier...

Environmental Adaptations to the infant’s environment can be incorporated by adaptation -Alternating position in crib & changing table promotes head turn in desired direction -Adapting car seat to promote symmetry & minimize time in car seat and infant carrier -Placing toys on affected side for infant to turn head toward tighter side Parent and -Integrated into infant’s daily routines caregiver Tummy time at least one cumulative hour daily education Positioning and handling for symmetry Minimize time in equipment Alternate feeding side to side -Adherence to HEP monitored through verbal report and parent demo -Frequency can be adjusted based on compliance Intervention: Key Interventions for CMT Limitation PT Intervention Decreased cervical Manual stretching of tight musculature, active cervical rotation toward rotation nonpreferred side, strengthening of cervical musculature, passive positioning to stretch tight tissues Head tilt Manual stretching of tight musculature, active cervical lateral flexion away from head tilt, strengthening of cervical musculature, passive positioning to stretch tight tissues Positional preference Active movement & strengthening opposite of preferred side or asymmetry and/or trunk asymmetry Prone position Increase use of prone positioning to strengthen capital muscles and facilitate intolerance symmetrical trunk and head alignment Asymmetrical postures Active movement and strengthening opposite of the asymmetry Developmental delay Facilitate equal use of all extremities and head turning to both directions during daily activities and play Intervention: Key Interventions for CD Limitation PT Intervention Brachycephaly -Increase prone positioning to relieve pressure on occiput to allow for reshaping. -Refer severe cases for cranial orthotic assessment at 4 months of age and moderate cases for cranial orthotic assessment at 6 months of age  Novak Article from study in the slides Interventions - Below line is not worth - Stay in green range, usually Effective for Motor: “Do It” - Can move into yellow too CIMT Partial Body Weight Support Treadmill Training- for speed Mobility Training Treadmill Training Strength Training- for muscle strength Goal Directed Training Task specific training HEP Environment enrichment Motor: “Probably Do It” Partial Body Weight Support Treadmill Training- for endurance PA Mobility training Virtual Reality + Gaming Acupuncture Animal assisted therapy Strength Training: for gross motor skills , UE strength, function Fitness training AFOs Botox+ PT: for gross motor skills & walking: Botox: results in decreased spasticity for 3–6 months following injections Botox+ resistance: for muscle strength Modified sports Yoga Selective Dorsal Rhizotomy: cut of some nerve endings responsible for spasticity Intrathecal Baclofen: Pump inserted under skin of abdomen, catheter tube to SC Hippotherapy Mirror therapy Hydrotherapy Casting Coaching Biofeedback Effective for Tone: “Do It” Botox Selective Dorsal Rhizotomy Intrathecal Baclofen Diazepam Effective for Contracture & Alignment: “Do It” BoTox +Casting  Hip surveillance Scoliosis Surgery LE casting Orthopedic Interventions for CP: Spinal fusions: Mostly posterior PTs are critical for positioning post-op Hips Night splinting in hip abduction, flexion, and ER Typically, surgery is not done unless they are painful (even if dislocated) —even for a child who is Wbing Derotational osteotomy Percutaneous hip adductor lengthening Knee  Soft knee immobilizers—usually as night splints or during standing program  Hamstring lengthening— tenotomy or percutaneous  Ankle and Foot o Stretching or splinting o Heelcord lengthening; typically percutaneous o Serial casting—stretching with casts over a period of 2-6 weeks Orthotic Intervention for CP; Driven by PTs: Determine What is goal of orthotic? What is minimal level of support given by orthotic which can aid in goal being reached? – support w/out limiting mobility Orthotic concepts Shoe inserts for arch support Supramalleolar Orthotics (SMOs) for medial-lateral support, while allowing free DF/PF Ankle Foot Orthotics (AFOs) typically limits PF and may resist DF to an extent Solid Articulating/hinged Dynamic Ankle Foot Orthotics (DAFOs) Articulating AFO – free DF w/ PF stop, good for people with some DF control Floor/ground reaction AFO (aka GRAFOs) – decrease crouching/increased DF during gait Goals and Functional Outcomes Overall outcome pf PT: optimize independence and, or, participation with functional activities Goals: Measurable, Functional, Obtainable and realistic Use: Gross Motor Function Measure (GMFM), GMFCS, or standardized testing PT: meant for times of change; not all the time Person’s entire life must be considered when planning interventions & HEP Slide Deck 3.14: Myelomeningocele (MM): PT Management Examination: MM: Systems Review Body function and structure Pain - FLACC, Faces Pain Scale, Numerical Orthopedic deformity Integument, especially skin under orthoses Bowel and bladder function Activity and mobility Developmental gross and fine motor skills Feeding and positioning in the newborn Fitness levels and body mass index or weight Cognitive deficits, learning differences or disabilities Participation Use of local recreational activities Physical access or barriers in key community areas Examination: MM: Tests and Measures Body Function and Structure Impairments Pain numerical pain scales; 0-10; older kids Faces Pain Scale-Revised, FPS-R, for kids > 3 y.o. Face, Legs, Activity, Cry, Consolability (FLACC) scale Range of motion with goniometer Manual muscle testing 0-5 scale: 5 and older functional strength testing hand-held dynamometry: 5 and older Infants: : 5-point MMT scale to observe movements & get baseline muscle function Spasticity Sensation testing for sharp and dull sensation within a dermatomal pattern Proprioception Standing and seated posture and alignment Standing and seated balance Activity Limitations Functional mobility and endurance; floor, bed, transfers, wheelchair Gait Classification of MM by Ambulation Status Normal ambulation. independent, unrestricted Community ambulation. independent outdoor; braces, or assistive devices; may use WC for longer distances Household ambulation. braces or assistive devices indoor; WC for outdoor mobility Nonfunctional ambulation. walks in therapeutic settings Nonambulation. WC dependent Functional Mobility Scale: independent mobility & AD use at 5, 50, 500 meters 6-Minute Walk Test, 2 Minute Walk Test  Gross motor skills: Norm-referenced tests: Alberta Infant Motor Scales (AIMS): 0-18 mo Bayley Scales of Infant/Toddler Development: 0-42 mo Peabody Developmental Motor Scales: 0-72 mo Bruininks-Oseretsky Test of Motor Proficiency: 4-21 yp Independence with self-care skills Pediatric Evaluation of Disability Inventory (PEDI): 6 mo-7 yo Wee-FIM (Functional Independence Measure): 6 mo-7 yo Fit and appropriateness of current equipment Participation Restrictions Family and home School and employment School Function Assessment: kindergarten through 6th grade Community accessibility Participation across settings; eg, home, school, place of worship, community activities, sports, dance The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC): 6-21 yo Participation and Environment Measure for Children and Youth (PEM-CY) Canadian Occupational Performance Measure (COPM) Self report, parent proxy if needed Pediatric Quality of Life Inventory (PedsQL): 2-18 yo: QOL in physical, emotional, social, and school functioning Child Health Questionnaire (CHQ): 5-18 yo: QOL re: global health, physical functioning, family activities Prognosis: MM; Expected Level of Function and Equipment Use Effected by Lesion level and functional motor level Presence of shunt and Chiari malformation type II Cognitive level Family and social resources and involvement Access to care Level of lesion has an impact on the extent of paralysis, muscle weakness, sensation Prognosis: MM; Expected Level of Function and Equipment Use: 5 Functional Motor Levels Interventions: MM: Newborns and Infants: Interventions for Newborns Interventions for Infants Prior to surgery: wound protection, promoting prone or Positioning and PROM exercises sidelying positioning to avoid sac rupture, and or stretching to address & prevent maintaining a latex free environment contractures of hips, knees, ankles, trunk After surgical repair, which usually happens within 24-48 hrs of birth, positioning and handling that protect Positioning and play to optimize muscle the surgical site but also optimize good musculoskeletal development & attainment of antigravity alignment, keeping in mind typical development strength Interventions: MM: Overall: Function Positioning Bracing Orthotics Exercise Gait Training Interventions: MM Positioning: essential to effectively perform functional tasks Symmetric alignment : minimize joint stress and deforming forces and to permit muscles to function at the optimal length  Typical postural problems include forward head, rounded shoulders, kyphosis, scoliosis, excessive lordosis, anterior pelvic tilt, rotational deformities of the hip or tibia, flexed hips and knees, and pronated feet Static and dynamic balance: observe in sitting, four-point positioning, kneeling, half-kneeling, and standing, as well as during transitions between these positions Standing frame: from 1-2 yo: decrease osteoporosis , limit hip, knee, ankle contractures Parapodium: ages 3 to 12 years: allows erect posture  greater experience standing and manipulating work with UEs at a table or desk Bracing: prevent contractures, allow function at maximum level Ensures a normal developmental progression Allows for appropriate age-related activities Goal of ambulation Orthotics: aid in minimizing energy expenditure to maintain mobility levels Knee-ankle-foot orthosis (KAFO) may be helpful in allowing ambulation Hip-knee-ankle-foot orthoses (HKAFO) mostly used in PT, not practical for long-term use Exercise Brief PROM exercises 2-3 times each day Stretching to correct muscle imbalances Gait Training Independent ambulation: have intact quads with good or excellent plus strength levels Without adequate quads: may need bilateral Lofstrand crutches or primary use of WC Functional ambulation is described by the Classification of MM by Ambulation Status Slide Deck 3.15: Duchenne Muscular Dystrophy: PT Management Examination: DMD Body Functions and Body Structures Goniometry Handheld dynamometry Manual muscle testing Pulmonary function testing Activity: 6-minute or 2 minute walk test Timed up/down 4 steps Timed Gowers’ Timed 10-m run/walk TUG Timed Up from Floor Activity: Multiple Items Northstar ambulatory assessment Performance Upper Limb Module for DMD  Motor function measure Vignos Scale (classification): 1-10 Functional Rating Scale for DMD 1. Walks and climbs stairs without assistance 2. Walks and climbs stairs with aid of railing Independent to Dependent 3. Walks & climbs stairs slowly with aid of rail, > 25 seconds for 8 standard steps 4. Walks, but cannot climb stairs 5. Walks assisted, but cannot climb stairs or get out of chair 6. Walks only with assistance or with braces 7. In WC: Sits erect & can roll chair & perform bed and wheelchair ADLs 8. In WC: Sits erect & unable to perform bed & WC ADLs without assistance 9. In WC: Sits erect only with support and is able to do only minimal ADLs 10. In bed: Can do no ADLs without assistance Participation: Multiple Items Pediatric Evaluation of Disability Index PEDS QL Egen Klassifikation Scale Health Utilities Index Questionnaire Interventions: DMD Body Functions and Body Structures Stretching Night splinting at end range Concentric endurance exercise; pool, bike, non–weight bearing Inspiratory muscle training Cough assist/BiPAP with respiratory insufficiency; per pulmonary Percussion and postural drainage; with upper respiratory infection Activity Standing program prior to or at cessation of ambulation Mobile arm support with feeding difficulty or prior to spinal fusion Participation Power mobility Environmental modification Ramps Bathroom adaptation or equipment Van with lift/tie down Assistive tech for computer access; onscreen keyboard dictation programs etc. Adapted gym/sport activity Slide Deck 3.16: Spinal Muscular Atrophy: PT Management Examination: SMA Very similar to Duchenne’s Body Functions and Body Structures Goniometry Handheld dynamometry Manual muscle testing Quantitative muscle testing (for SMA) - Functionally active motion  Pulmonary function testing Activity: Single Task 6-minute walk test Timed testing Timed up/down 4 steps Timed Gowers’ Timed 10-meter run/walk TUG Timed up from floor Activity: Multiple Items Northstar ambulatory assessment Revised upper limb module for SMA Motor function measure The Expanded Hammersmith Functional Motor Scale (type 2 or 3) Participation: Multiple Items Pediatric Evaluation of Disability Index PEDS QL Health Utilities Index Questionnaire Egen Klassifikation Scale Interventions: SMA Body Functions and Body Structures Stretching Night splinting at end range Concentric endurance and strength training exercise Inspiratory muscle training with respiratory insufficiency Cough assist/BiPAP with respiratory insufficiency (per pulmonary) Percussion & postural drainage (with upper respiratory infection) Activity Standing program at cessation of ambulation or if non-ambulatory Mobile arm support (or slings and springs) with feeding difficulty or for function/play Participation Power mobility Environmental modification Ramps Bathroom adaptation or equipment Van with lift/tie down Assistive tech and switch toys Adapted gym/sport activity  DPT 0619 Management Across the Lifespan: Pediatric Patient W4 Note Taking Guide for Lecture Slide Deck 4.1: ICF Model: for all practice settings: -Focuses on function not disability -Captures how people with a health condition function in their daily life rather than focusing on their diagnosis or presence or absence of disease -Activities and Participation -consider setting -Assessing children with disabilities: What is the child capable of doing at their best? -we want them to perform at their -Natural environment -school, home best level -Barriers -*Note differences in activity and participation levels of same age peers ie: entire school environment, students routine, performance, identify factors that are influencing Activities and Participation: Focus on: Performance: Learning and applying knowledge-school/program General tasks and demands Communication -language, short sentences, visuals Mobility Self-care Domestic Life -home Interpersonal interactions and relationships -fam, friends, classmates Major Life Areas -worship, play ground Community, social and civic life ICF: pt with CP Use the ICF Model to: Select and use appropriate tests and measures for: -fxnal limitations -Body Structure and Body Function -fitness -tests and measures -Activity -fxn -goal setting (SMART goals) -interventions -Participation -friends -environmental factors - family -personal factors - fun ICF: Body Structure and Body Function: Tests and Measures Pain Structural integrity Strength Anthropometrics Endurance ROM Cardiopulmonary Sensory Processing Fitness Reflexes Balance Spasticity Coordination Visual Motor/Perception Posture ICF: Activity: Developmental Screening Play Fine Motor Gross motor Gait/walking Multiple domain activity tools ICF: Participation: objective data Multiple domain measures Health Status Quality of Life Strategies for Selecting the Appropriate Tests and Measures Age, Clinical Presentation, Setting, Parent and child values and interests Assess the actual and perceived ability to carry out activities o i.e. mobility in an environment, personal care, participation in work/home/school Write goals for functional improvement o instead of considering traditionally measured impairments in body function, i.e. ROM, strength, consider child/family values, points of view and preferences for daily activities and life participation Summary: Use appropriate tests and measures for each child in relation to Child and family needs Child and family values Setting  Slide 4.2: Organizing Pediatric Tests and Measures by the Domains of the ICF Model Summary: *i added her charts at the bottom for your reference. we dont need to know them!! Organizing tests and measures by domains of the ICF Model can assist with: ease of use comprehensive, focused evaluations goal writing tracking progress Slide 4.3: Goal Focused Ecological Assessment in Pediatric PT Goal Focused Ecological Assessment: Focuses on ICF’s Participation tests and measures: participation A child’s participation is best conducted in environments in which child actually participates -plan Natural environment: increasingly advocated to support enablement model for all children with disabilities -want generalization of skills Episodic Examination: Because children function in multiple environments, episodic examination to address use systematic chart to participation deficits or needs within a specific context may be necessary analyze tasks Challenges are best addressed via examination of both task AND environment task occurs An ecologic assessment: helpful to examine participation within context of an identified goal Examination: Family and child goals of participation: Participation Tests and Measures 1. question= goal? 2 Recreation and leisure activities outside of school Children’s Assessment of Participation and Enjoyment (CAPE)- ages 6-21 Measures diversity, intensity, enjoyment, and context of the activities Preferences for Activities of Children (PAC)- ages 6-21 Measures preferences for involvement in activities 3 Functional Tasks Caregiver Assistance Scale of the Pediatric Evaluation of Disability Inventory (PEDI) Measures participation related to mobility, self-care, and social function in the home environment School Function Assessment (SFA) Measures participation, activities, & necessary task supports in school environment for K- 6th gr 4. ecologic assessment of a specific task Summary Participation is key Use Participation Tests and Measures for recreation and leisure and functional tasks Challenges are best addressed via examination of both task and environment where task occurs An ecologic assessment: helpful way to examine participation within context of an identified goal Use a systematic chart format to analyze task