Acquired pediatric conditions are those that are developed after birth and do not have a link to genetic abnormalities.
Legg-calve perthes disease
Legg-calves perthes disease is a cause when there is a temporary interruption in blood flow to the femoral head causing femoral head death and eventual collapse of the femoral joint. The interruption of blood flow can be due to trauma or blood clots. Medical confirmation is performed through physical examination, MRI, x-ray. Most common in children under 10 years old.
Phases of Legg-calve perthes:
1.) Necrosis -part of the femoral head has died,
2.) Fragmentation - the body attempts to clean-up the broken pieces of bone from area
3.) Re-ossification - blood flow restored to femoral head and bone begins to re-grow,
4.) Remodeling - new bone is new in place.
Each phase can last from months to years but indicates the body has the potential to heal itself once temporary blood flow is restored.
Symptoms include:
Antalgic gait
Pain/stiffness in thigh/groin
Leg length discrepancy
Limitations in range of motion- abduction, flexion, and internal rotation
Physical therapy interventions and legg-calve perthes disease
Activity modifications
Bracing/splinting to keep femoral head in contact acetabulum
Strengthening and range of motions activities of hip
Medical management of legg-calves perthes disease
Use of anti-inflammatory medications
Surgical interventions to correct blood flow- not indicated for children under 6
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Slipped-capital epiphysis
Slipped-capital epiphysis is a condition in which the femoral head slips from the femoral plate at the growth place. Etiology can be due to hormonal changes during puberty, growth spurt, obesity, weakening of the growth place, family history. The most common age of injury is between 10-16 years of age.
Symptoms
Inability to bear weight on extremity
Pain in groin/thigh
Leg length discrepancy
Limitations in range of motion- flexion, internal rotation, and abduction
Medical management and slipped-capital epiphysis
Surgery is indicated once confirmed through physical examination and x-ray imaging. Delay in intervention can cause serious damage such as avascular necrosis, arthritis, or deformity of hip joint. Surgery entails the implementation of a metal screw to maintain the position of the femoral neck through the growth plate.
Physical therapy intervention and slipped-capital epiphysis
Physical therapy interventions are dependent upon the surgeon’s protocol post-op and will gauge the progression of activities until return to full weight bearing.
Osgood-schlatter
Osgood-schlatter is a condition in which an individual experiences knee pain and swelling at the tibial tuberosity due to increased pulling by quadriceps of patellar tendon. Common causes are repetitive movements, excessive growth during puberty, and participation in sports that require increased running and jumping. Age of onset is typically after age 12 during the time of puberty. Confirmation of diagnosis is through physical examination and x-ray.
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https://upload.wikimedia.org/wikipedia/commons/5/51/Radiograph_of_human_knee_with_Osgood%E2%80%93Schlatter_disease.png
Symptoms
Palpable swelling at tibial tuberosity
Pain at anterior knee
Increased pain during running, jumping activity with relief of pain during rest
Physical therapy interventions and Osgood-Schlatter
Strengthening of lower extremity muscles to create even pull of muscles
Dynamic balance activities to mimic times of exacerbation
Postural re-education when performing running, jumping activities
Scoliosis
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Scoliosis is an increased curvature of the spine. Scoliosis may develop due to cerebral palsy, muscular dystrophy, birth defects, trauma, infections to the spine, or can be idiopathic. Most idiopathic cases are diagnosed during the time of adolescence. Diagnosis is confirmed through physical examination and x-ray imaging. Severity of scoliosis is defined by degree of curve- this also guides interventions that may be performed
Cobb angle (severity of scoliosis):
Mild scoliosis: Cobb angle less than 10 degrees
No intervention or conservative management
Moderate scoliosis: Cobb angle between 10 and 25 degrees
Bracing and physical therapy may be indicated
Severe scoliosis : Cobb angle greater than 25 degrees
Surgical intervention to correct curve as curve >25 degrees could compromise respiratory system
Symptoms
Uneven shoulders
One shoulder blade that appears more prominent than the other
Uneven waist
One hip higher than the other
One side of the rib cage jutting forward
Physical therapy interventions and scoliosis
Address muscle imbalances that may be present due to curvature
Provide shoe inserts to correct leg length discrepancy
Prescribe durable medical equipment as necessary
Autism spectrum disorder
Autism is a developmental disorder that causes difficulties in verbal and nonverbal communication, social interaction, gross motor development, and atypical play skills. Etiology is unknown but some link to genetic predisposition and/or diet. Diagnosis is made through observation, use of outcome measures, interview with parents and child, and diagnostic criteria. Reliable diagnosis can be done at age 2.
Symptoms
Sensory integration dysfunction
Hyposensitive (sensory seeking) or hypersensitivity (sensory avoidant)
Difficulty with verbal and non-verbal communication
Impaired coordination
Balance deficits
Occasional strength and range of motion deficits
Developmental delay
Physical therapy and autism spectrum disorder
Address developmental delay
Improve strength
Improve balance and coordination
Sensory integration activities
Be aware that new people and situations can cause either withdrawal behavior or increased aggression
Brachial plexus injuries
Brachial plexus injuries are compression or traction injuries that occur during birth that lead to dysfunction of one or both upper extremities. Common causes of brachial plexus injuries can be breech birth causing use of assisted birth techniques (forceps or vacuum), increased birth weight, twins or more, or gestational diabetes. Diagnosis of brachial plexus injuries is performed via physical examination (movement of upper extremity and/or testing of primitive reflexes), x-ray, and MRI if needed.
Severity of brachial plexus injuries are as follows:
Traction
Stretching of nerve with spontaneous recovery
Rupture
Nerve is torn but remains attached to spinal cord; may require surgical intervention
Avulsion
Nerve is completely torn from spinal cord; permanent disability may result after surgical intervention
Common brachial plexus injuries
Erb’s palsy
Involves C5-C6 nerve roots- upper arm paralysis involving rhomboids, serratus anterior, levator scapula, deltoid, infraspinatus, supraspinatus, biceps
Immobility of shoulder girdle leading to subluxation of shoulder
Only use of hand muscles
Klumpke’s palsy
Involve s C8-T1 nerve roots- lower arm paralysis involving intrinsic muscles of hand, finger flexors, and finger extensors
Contractures of hand may result
Functional use of shoulder and elbow; deficits in use of wrist and hand
Global palsy
Involves C5-T1- total arm paralysis
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Physical therapy interventions and brachial plexus injuries
Partial immobilization for 1-2 weeks of injured extremity
Constraint induced therapy of non-injured arm
Range of motion to avoid contractures
Age appropriate movements to decreased likelihood of of developmental delay
Parent education on positioning and handling of infant
Tortocolis
Tortocolis is a condition in which an infant’s neck bends and rotates due to tightness in neck muscles. The muscle that is tight or contracted is the sternocleidomastoid which is responsible for cervical lateral flexion to the same side and cervical rotation to the opposite side. Tortocolis can be caused by difficulties at birth, large infant weight, breach birth, or improper positioning after birth. Diagnosis is confirmed via physical examination.
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Symptoms:
Persistent head tilt to one side
Difficulty turning the head to the opposite side
A lump or knot may be felt in the tight neck muscle
Facial asymmetry may develop over time
Flat head on side of muscle tightness may present (plagiocephaly)
Physical therapy interventions and torticollis
Stretching of contracted sternocleiodomastoid muscle
Positioning to allow for prolonged stretched
Addressing any developmental delay issues
