Scoliosis, autism, and birth injuries

Most idiopathic cases are diagnosed during adolescence. Diagnosis is confirmed through physical examination and X-ray imaging. The severity of scoliosis is defined by the degree of curve - this also guides which interventions may be performed.

Cobb angle (severity of scoliosis)

• Mild scoliosis: Cobb angle less than 20 degrees
  • No intervention or conservative management
• Moderate scoliosis: Cobb angle between 20 and 40 degrees
  • Bracing and physical therapy may be indicated
• Severe scoliosis: Cobb angle greater than 40 degrees
  • Surgical intervention to correct the curve; large curves, generally greater than 50 degrees, can begin to compromise the respiratory system

Symptoms

• Uneven shoulders
• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip is higher than the other
• One side of the rib cage jutting forward

Physical therapy interventions for scoliosis

• Address muscle imbalances that may be present due to curvature, per the plan of care
• Apply and reinforce use of prescribed shoe inserts to correct leg length discrepancy
• Reinforce use of prescribed durable medical equipment and report changes in fit or tolerance to the supervising PT

Autism spectrum disorder

Etiology is unknown, but there is a strong genetic predisposition, along with some prenatal or perinatal environmental factors that may contribute. Diagnosis is made through observation, use of outcome measures, an interview with the parents and child, and diagnostic criteria. A reliable diagnosis can be made at age 2.

Symptoms

• Sensory integration dysfunction
  • Hyposensitivity (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 interventions for 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

Common causes of brachial plexus injuries include breech birth (causing the use of assisted birth techniques such as forceps or vacuum), increased birth weight, multiple birth (twins or more), or gestational diabetes. Diagnosis is performed via physical examination (movement of the upper extremity and/or testing of primitive reflexes), x-ray, and MRI if needed.

Severity of brachial plexus injuries

• Traction
  • Stretching of the nerve with spontaneous recovery
• Rupture
  • Nerve is torn but remains attached to the spinal cord; may require surgical intervention
• Avulsion
  • Nerve is completely torn from the 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 deltoid, supraspinatus, infraspinatus, biceps brachii, brachialis, and brachioradialis
    • Immobility of the shoulder girdle leading to subluxation of the shoulder
  • Only use of hand muscles
• Klumpke’s palsy
  • Involves C8-T1 nerve roots - lower arm paralysis involving intrinsic muscles of the hand, finger flexors, and finger extensors
    • Contractures of the hand may result
  • Functional use of the shoulder and elbow; deficits in the use of the wrist and hand
• Global palsy
  • Involves C5-T1 - total arm paralysis