Peadiatrics physical rehabilitation

1. ZULEKHA NASAR

3.  Congenital deficiencies
 the first trimester is the most crucial trimester for the genesis of limb
production. Congenital limb deficiency occurs as a result of failure of
formation of part or all of the limb bud.
 maternal diabetes, and gestational diabetes.
 Acquired deficiencies
 the most common causes of acquired amputations are trauma and
disease
 Osteogenic sarcoma, Ewing’s sarcoma, and the rare rhabdomyosarcoma
are responsible for the majority of tumors resulting in amputation.

6.  Digital Deficiencies
 Moebius syndrome often affects the sixth and seventh cranial nerves,
which compromises the child’s ability to visually follow objects, swallow,
and communicate.
 Poland syndrome involves a partial absence of the ipsilateral pectoralis
muscle and hypoplastic chest.
 polydactyly and syndactyly.

7.  Amputation with more proximal residual limb.
 tend to be more easily fit with a prosthesis.
 Amputation with less proximal residual limb.
 the amount of length available for contact with the prosthesis is limited.
 If prosthetic intervention is not attempted or accepted, bimanual tasks will be
performed via grasping of objects in the cubital fold, between one’s legs, in the
axilla region, or under the chin.

8.  the child has fewer options to assist in pre-positioning the distal limb in space and
experience more limited pronation and supination for functional tasks of the
prosthesis.
 the child relies solely on the muscles and ROM of the shoulder complex.
 Transhumeral Deficiencies lead to a shorter limb that potentially is less functional
and amendable to prosthetic fitting.

9.  It becomes increasingly difficult to restore the functions of the anatomic
arm as the level of deficiency reaches the shoulder and higher with
current technology.
 the axilla will be used to assist these individuals to grasp and manipulate
objects.
 If the child has unilateral limb deficiency, the contralateral non-involved
limb will be or become the dominant side.*
 When the child has bilateral deficiencies at the shoulder level, the child
will be strongly encouraged to use the feet to grasp and manipulate
objects.

10.  In general, the higher the limb absence, the less likely it is that a child will find a
prosthesis useful enough to wear it regularly.
 Prostheses are generally considered around 3 to 6 months of age.
 the age chosen because it was the time the child was expected to have achieved
sitting balance and to begin to engage in bimanual tasks.

11. Transradial
myoelectric
prosthesis.
Transhumeral passive “banana
arm” prosthesis
infant
foam-filled
passive
hand.

12.  Longitudinal Deficiency of the Fibula
 a completely absent fibula
 a foreshortened tibial section
 Syme amputation,
Amputation takes place when the child is beginning to pull to
stand and cruise with the assist of furniture or toys to time.
Boyd amputation, serves to centralize the heel pad
more effectively.

13.  Angular deformity

14.  If the amount of lengthening necessary is unattainable, the limb lengthening
may be performed in conjunction with appropriately timed epiphysiodesis of the
contralateral leg to equalize leg lengths at full maturity.
 All of the limbs present with some degree of hip flexion, abduction, and external
rotation.

17.  When there is a complete absence of the tibia, the treatment of choice is
disarticulation at the knee.
 If the tibial segment is short, the surgeon creates a synostosis with the
intact fibula in conjunction with amputation of the foot.
 If the heel pad is retained, this procedure will create a walking surface for
the child, providing stability without a prosthesis.

18.  Parental and child understanding of the proper utilization of these
devices.
 It is difficult to instruct the young active child in specific exercises and
positioning due to limited comprehension and attention span.
 Play is the primary motivation for desired movements and activities.

19.  The goal of physical therapy is to develop a normal pattern of gait, including
stride length, step length, and velocity.
 The prosthesis should incorporate these same features in order to allow for
normal gait development.

20. 20 months the normal child can stand on one foot
with help.
3 years on one foot momentarily
4 years for several seconds
 The normal child does not establish heel-to toe gait until about 2 years of age.
at 5 years for longer period

21.  Strengthening both agonists and antagonist muscles about the joint is
important.
 As long as children have arms with which to balance, they should be
expected to walk independently.
 Prone positioning is important for encouraging trunk extension and
mobility.

22.  The aim is to increase the child’s awareness of the affected side, including the
prosthetic device.
 The child should also be encouraged to use the prosthesis for transitional
movements, such as sitting to crawling, and leaning on the prosthesis for weight-
bearing while reaching with the dominant hand.

23.  The child with an isolated limb deficiency or amputation is capable of
achieving age-level academic skills.
 The philosophy promoted for children with physical disability is that of
“participation, not observation.”