Pediatric Rehabilitation

Pediatric Rehab Basics - Tiny Titans, Big Steps

• Core Principles:
  • Family-centered care: Involves family in goals & therapy.
  • Play-based therapy: Uses play for therapeutic goals.
  • Early intervention: Crucial for optimal developmental outcomes.
  • Multidisciplinary team: PT, OT, SLP, physiatrist.
• Assessment Focus:
  • Developmental screening (e.g., Denver II, ASQ).
  • Functional assessments (e.g., WeeFIM, PEDI-CAT).
  • Goal Attainment Scaling (GAS) for progress.
• Key Intervention Areas:
  • Gross & fine motor skills.
  • Cognitive & communication development.
  • Activities of Daily Living (ADLs).
  • Social participation.
• Developmental Milestones: Guide assessment & intervention planning.

⭐ Early identification and intervention for developmental delays significantly improve long-term functional outcomes and quality of life in children.

Cerebral Palsy - Brainy Movement Paths

• Non-progressive neuromotor disorder from injury to the developing brain (prenatal to 2 years).
• Etiology: Hypoxia-ischemia, prematurity, infections (TORCH), trauma, kernicterus.
• Classification (based on motor abnormality & topography):
  • Spastic (~75%): UMN lesion (motor cortex/pyramidal tracts). Hypertonia, pathological reflexes.
    • Diplegia (legs > arms), Hemiplegia (one side), Quadriplegia (all limbs).
  • Dyskinetic: Basal ganglia lesion. Involuntary movements (athetosis, chorea, dystonia).
  • Ataxic: Cerebellar lesion. Impaired balance, coordination, gait.
  • Mixed: Combination of types.
• Key Signs: Delayed motor milestones, abnormal muscle tone, persistent primitive reflexes, feeding issues.
• Management: Multidisciplinary team. Physiotherapy, occupational therapy, speech therapy, orthotics, medications (e.g., Baclofen, Botulinum toxin for spasticity), orthopedic surgery.

⭐ Spastic diplegia is the most common form of CP in preterm infants, often associated with periventricular leukomalacia (PVL).

Neuro & MSK Challenges - Twists, Turns, Wins

• Torticollis (Wry Neck):
  • SCM contracture; head tilt, chin opposite.
  • Rx: Stretching; surgery if >1 yr.
• Scoliosis:
  • Lateral curve > 10° (Cobb). Adam's test.
  • Brace: 25-45° (growing). Surgery: >45-50°.
• Clubfoot (CTEV):
  • CAVE deformity. Ponseti: casting, tenotomy.
  • Foot abduction brace.
• Developmental Dysplasia of Hip (DDH):
  • Barlow/Ortolani. Galeazzi sign.
  • Rx: Pavlik harness (<6m), reduction.
• Brachial Plexus Palsy:
  • Erb's (C5-C6): Waiter's tip. Klumpke's (C8-T1): Claw hand.
  • PT; surgery if no recovery 3-6 mo.

⭐ DDH: Pavlik harness most effective early; aims for hip flexion & abduction.

Ortho & Aids - Bones, Braces, Boosts

• Bones & Rehab:
  • Fractures: Phased rehab (Immobilize → Mobilize → Strengthen).
  • Osteogenesis Imperfecta (OI): Low-impact exercise, protect bones.
  • Rickets: Vit D, Ca, corrective orthoses.
• Braces (Orthotics):
  • Scoliosis: Milwaukee (CTLSO), Boston (TLSO) for curves 25-45° (skeletally immature).
  • Clubfoot (CTEV): Ponseti method (casting/tenotomy) + Foot Abduction Brace (FAB) 2-4 yrs.
  • DDH: Pavlik harness (<6 months); abduction brace/spica cast (>6 months).
• Boosts (Aids & Therapy):
  • Goals: ↑Function, ↑Independence, ↑ROM, ↑Strength, ↓Pain.
  • Interventions: PT (Physical Therapy), OT (Occupational Therapy), adaptive equipment.
  • Aids: Crutches, walkers, wheelchairs.

⭐ Pavlik harness for DDH: dynamic splint for infants <6 months, maintains hip flexion & abduction. Avoid if teratologic or child >6-8 months.

High‑Yield Points - ⚡ Biggest Takeaways

• Cerebral Palsy: Prioritize spasticity control, functional independence, and multidisciplinary team approach.
• DDH: Early screening (Ortolani/Barlow) and Pavlik harness (<6 months) are critical for outcomes.
• Clubfoot (CTEV): Ponseti method (casting, tenotomy, bracing) is the gold standard treatment.
• DMD: Recognize Gower's sign; focus on maintaining mobility and respiratory care.
• Spina Bifida: Demands comprehensive, lifelong management of orthopedic, neurological, and urological complications.
• Brachial Plexus Birth Palsy: Early physiotherapy is crucial; monitor for surgical indications_._