Term
| PT initial evaluation in children with SB |
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Definition
• determine baseline
• help determine level of lesion and muscle function that is present
• determined by the last intact level found
• determine asymmetries and ID muscle imbalances at each joint to prevent deformity and contractures
• assist in determining need for bracing and surgery
• PT may begin 24-48 hours following surgical closure of the spinal defect |
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Term
| Grading scale used to assess strength for infants and young children with SB |
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Definition
• Strength should be re-assessed 10 days postop, at 6 months of age, 12 months, and then yearly
• PT cannot use verbal commands to MMT, instead use multisensory stimuli to encourage general
movement in the infant
• Not graded 0-5
• X - movement is present and strong
• 0 - no movement at joint
• T - trace (can palpate contraction but see no movement)
• R - reflexive movement |
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Term
| Discuss how to assess ROM in children with SB |
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Definition
ROM
• may have increased physiological flexion from normal
• ROM can begin 1-2 days post op
• use gentle stretching - do not be aggressive with long lever arms, hand should be proximal to joint
• PROM should be brief and performed 2-3x/day
• child may need support in prone secondary to risk of osteoporosis |
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Term
| Discuss how to assess sensation in children with SB |
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Definition
• Sensation
• best to use light touch or tickle - does infant move, reach out, turn head, withdraw
• around age 6-7 y/o PT can perform more accurate testing (2pt discrimination and proprioception) |
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Term
| Relate important topics of parental education |
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Definition
• skin care - monitor skin where sensation is lacking, especially when splints/orthotics are used
• positioning - to prevent LE contractures and deformities - use pillows or towel rolls to prevent hip flexion,
abduction, ER, knee flexion, PF (frog leg position)
• ROM - teach efficient exercises incorporating full patterns
• handling - teach parents to reduce support when holding infant to encourage development of head
control, provide opportunities for movement in upright positioning, not to overuse total support devices,
not to over-protect child
• allergies - possible latex sensitivity |
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Term
| Describe the developmental delays common in children with SB |
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Definition
• head control delayed due to decreased tone
• rolling and weight shifting in prone delayed due to overuse of UE to support in prone
• independent sitting delayed
• transitioning out of sitting initiated by throwing head to one side and collapsing to floor or leaning forward
over the legs to crawl out of sitting
• treatment should focus on development of head and neck control, righting reactions, sitting posture,
transitions and mobility |
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Term
| Discuss the importance of standing and ambulation in children with SB |
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Definition
• WB is required to promote LE growth and alignment and to develop the acetabulum
• assists with B&B function
• promote upright with devices such as parapodium or prone stander |
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Term
| Describe the progression of ambulation training in children with SB |
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Definition
| • generally begin gait training in parallel bars > progress to assistive devices > walkers > FA crutches |
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Term
| 3 basic types of standing frames/ambulation devices and how each works |
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Definition
• parapodium/swivel plate walker - base secures foot placement and provides swivel motion (may also be
fixed); AFOs are frequently worn with it for ankle stability
• reciprocating gate orthosis (RGO) - cables attached to hip joints provide mechanical drive for walking,
disengaging the cables allows sitting
• HKAFO - will use a swing through or swing to gait pattern with a walker or FA crutches
• use of an assistive device depends on child’s motivation and cognitive level, as well as level of lesion |
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Term
| Describe basic treatment issues for children with SB |
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Definition
• children need frequent monitoring and adjustment of braces and ambulatory devices
• energy demands of ambulation increase as child grows
• PT should focus on endurance activities
• many individuals who use orthotics and assistive devices in childhood may choose to use
wheelchairs as adults due to high energy demand of continued ambulation
• school-age children tend to have more surgery for fixed deformities
• PT involved in pre & post op stretching and strengthening |
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Term
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Definition
Impairments
• lower trunk musculature weakness
with decreased sitting balance and
possible decreased respiratory
function
• if T12 motor intact will have strong
trunk musculature
• total paralysis of LE
• often have higher degree of
cognitive deficits
Assistive Devices/Independence
• sliding board
• wheelchair
• may attempt to ambulate with
parapodium if T12 level motor
function intact
• most independent in self-care and
mobility, but require supervised
living thru life |
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Term
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Definition
Impairments
• weak hip flexion with L1 motor
function
• L2 - hip flexion, adductors and
rotators are 3/5 or better
• no hip extensors - risk for
contracture
• at risk for hip dislocation
Assistive Devices/Independence
• KAFOs or RGOs
• most adults use wheelchair for
functional community ambulation
• about 50% live independently but
will not be employed |
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Term
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Definition
Impairments
• no hip extensors - at risk for hip
flexion contractures
• will have weak hip rotation and at
least antigravity knee extension
Assistive Devices/Independence
• KAFOs for FA crutches for
household and short community
ambulation
• w/c for long community ambulation
•about 60% live independently,
about 20% employed |
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Term
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Definition
Impairments
• have at lease antigravity knee
flexion
• ankle DF - at risk for DF
contracture
Assistive Devices/Independence
• may ambulate with AFOs and FA
crutches
• about 60% live independently,
about 20% employed |
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Term
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Definition
Impairments
• still at risk for DF contractures
Assistive Devices/Independence
• may ambulate without orthotics,
but may need them to correct foot
position
• majority will be community
ambulators with UE support
• about 80% live independently,
30% employed |
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Term
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Definition
Impairments
• less risk for contractures
Assistive Devices/Independence
• most have AFOs or foot orthotics
to improve alignment |
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Term
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Definition
Impairments
• residual foot deformities due to
intrinsic weakness
Assistive Devices/Independence
• community ambulators with fairly
normal gait |
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