Postural Therapy Update 12:45-1:30 Thursday Dec 6, Ginny Paleg, PT, DScPT Montgomery County Infants and Toddlers Program

Transcription

1 Postural Therapy Update 12:45-1:30 Thursday Dec 6, 2018 Ginny Paleg, PT, DScPT Montgomery County Infants and Toddlers Program

2 Children with contractures and deformities have pain Let s not let this happen (photo from Facebook)

3 Sitting Standing Lying This is a new addition to an old concept Activity/Exercise

4 Children at GMFCS levels IV and V. Lay 16 hrs/day Active 30 min/day Sedentary % Photos from Google

5 <8 hrs/day total sitting Ensure sitting is symmetrical Stand minutes/day with abduction (30 degrees?) Lying <8 hrs in supine (use other positions too), support symmetry, prevent windswept deformity Activity >2 hrs/day standing counts

6 Gmelig Meyling, Seven of 8 studies reported positive effects on hip migration after postural management interventions. However, level of evidence and quality of the articles were low. Miller, There is currently insufficient evidence to support or refute the use of the identified interventions to prevent hip displacement or dislocation in children and young people with CP.

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8 Postural Management Consensus Statement A postural management program is a planned approach encompassing all activities and interventions which impact on an individual s posture and function. Programs are tailored specifically for each child and may include special seating, night-time support, standing supports, active exercise, orthotics, surgical interventions, and individual therapy sessions. Children should start 24-hour postural management programs in lying as soon as appropriate after birth, in sitting from 6 months, and in standing from 12 months Gericke DMCN 2006, 48:

9 These photos are NOT from Chailey, just used to make a point - abduction 9

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11 102 with CP age range years GMFCS levels I to II, head and trunk asymmetries were most common GMFCS levels III to V postural asymmetries varied with position. Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position.

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13 In the control group, 12 of 68 children (18 %) developed Windswept deformity. In the study group of 139 children, 13 (9 %) developed Windswept deformity (p = 0.071). Of all 25 children with Windswept deformity, 21 also developed scoliosis and 5 developed a hip dislocation. Early inclusion in a hip surveillance program and early treatment of contractures, reduced the frequency of windswept deformity

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15 Cross-sectional data of 714 adults with CP, years, GMFCS level I-V, reported to CPUP. Of adults at GMFCS level V, 22% had asymmetrical limited hip flexion (<90 ). The odds of having an oblique pelvis, an asymmetrical trunk, scoliosis and windswept hip distortion were higher for adults with asymmetrical limited hip flexion compared with those with bilateral hip flexion>90. Asymmetrical limited hip flexion affects the seating posture and is associated with scoliosis and windswept hip distortion.

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17 830 adults with a diagnosis of CP, years, Adults who are immobile in the lying position have higher odds of both scoliosis and windswept hips. Spending more than 8 h daily in the same lying position, increased the odds of having scoliosis, while lying solely in a supine position, resulted in higher odds of windswept hips. One in four adults with cerebral palsy use only one position when in bed. The results indicate the need for early introduction of appropriate posture control in individuals unable to change position.

18 Erika Cloodt, PT, PhD

19 3,045 children with CP Knee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture.

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22 GMFCS II Radiograph at 2 and 6 years, if RI <33 % and no deterioration GMFCS III-V Radiograph at earliest suspicion of CP, and yearly until 8 years, then individually J Bone Joint Surg 2005;87B:95-101

23 30 Contractures 30 Surgery Windswept 12 Scoliosis J Pediatric Orthop B 2005;14: ; Spine 2012;37:1-6

24 Slide used with permission of Dr. Rodby-Bousquet Pain Acta Pædiatrica :

25 Posture and Posture Ability Scale PPAS

26 Posture and Postural Ability Scale Quality, frontal (score 1=yes, 0=no) Head midline Trunk symmetrical Pelvis neutral Legs separated and straight relative to pelvis Arms resting by side Weight evenly distributed Total score

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31 Children with SMA are living longer continue to develop contractures are at high risk for hip subluxation need postural management!

32 What About the Older Kids? Is It Ever Too Late? Sometimes Try anyway Just a little change over a long period of time is better than nothing Be mindful and kindful

33 Fromhttps://

34 The Recipe Early identification of CP with GMA and HINE Hip surveillance at 1 year (follow published guidelines) Start proactive strategies BEFORE deformity and contracture set in Spasticity Management Support families who are offered early (age 5 years) preventative surgeries

35 Children with contractures and deformities have pain Let s not let this happen (photo from Facebook)

36 Doing nothing is bad To get great results you have to do the whole program Can we just do a little and get by? Let s try! Photo from google

37 Thank-you Ginnypaleg.com