Chan Wing Pui Physiotherapist I Pamela Youde Nethersole Eastern Hospital
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1 Chan Wing Pui Physiotherapist I Pamela Youde Nethersole Eastern Hospital
2 Introduction Roles of physiotherapy Special consideration in paediatric rehabilitation 2
3 Common paediatric upper limb injuries Treatment Complication 3
4 Elbow fractures Supracondylar humerus fracture Lateral condyle fracture Radial neck fracture Medial condyle fracture Forearm fractures Distal forearm fracture 4
5 Types % Mechanism Age Remarks Supracondylar 50-70% of elbow fractures Lateral condylar Medial condylar Radial neck 10-20% of elbow fractures 10% of elbow fractures 6% of elbow fractures Fall with outstretched hand 4-7 ditto 4-10 Fall with outstretched hand with excessive valgus stress Fall with outstretched hand with elbow in extension & valgus % with concurrent elbow dislocation Maybe associated with elbow dislocation E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p
6 Distal forearm fracture 75-84% of forearm fractures Fall with outstretched hand S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p
7 Non-surgical Cast, splint Surgical Pins, screws, wire 7
8 Stiffness Malunion Non-union Neurovascular injury, e.g. neurapraxia 8
9 Physiotherapy during immobilization period Physiotherapy post-immobilization Special physiotherapy for non-union/delayed union 9
10 Maintenance Decrease swelling/pain Advice & home care 10
11 Physical examination Reduce swelling/pain Enhance mobility, including restoration of range of motion strength & endurance joint stability co-ordination according to developmental milestones Advice & home care 11
12 Observation Swelling Muscle wasting Palpation Increase temperature Tenderness Movement Decrease range of motion Decrease muscle strength & endurance Decrease joint stability Impair co-ordination 12
13 Whirlpool Heat therapy (40-42 C) Massage Active mobilization exercise 13
14 Ice therapy After exercise After daily activities at home (home care) 14
15 Active/assisted active mobilization exercise Passive mobilization exercise Accessory mobilization of individual joints 15
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19 Manual Neuromuscular facilitation & inhibition techniques Hold relax Contract relax Self-stretching Incorporate with craniosacral therapy 19
20 Accessory movement Mobilization with movement (Mulligan) 20
21 Muscle Re-education Biofeedback Electrical stimulation Kinesio Taping Mechanical resistance exercise Manual resistance exercise Proprioceptive neuromuscular facilitation (PNF) Functionally based diagonal patterns of movement Neuromuscular facilitation techniques to evoke motor responses & improve neuromuscular control & function C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5 th edition. F.A. Davis Company. Philadelphia. 21
22 Improve neuromuscular control & function 22
23 Biofeedback 23
24 Electrical stimulation Facilitate the contraction of weakened muscle, e.g. neurapraxia 24
25 Kinesio Taping Facilitate muscle contraction Other usage: Inhibit muscle action Facilitate superficial lymphatic drainage 25
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32 Suitable for joint dislocation with fracture 32
33 Eye hand co-ordination Co-ordination skill in simple sports activities Resume sports habit e.g. badminton, table tennis 33
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36 Unwilling to remove the sling/to move Afraid of pain Misunderstanding Afraid of being hurt by others Overprotected parents Too busy to move Focus only on academic activities Not understanding the importance of home programme Moving too much Forget about the fracture while playing vigorously Eager to resume to sports/competition 36
37 Magnetopulse Low Intensity Pulsed Ultrasound (LIPUS) Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24,3 Supplement p
38 Safety Fun Alternatives Relationship with children & parents Understanding Encouragement Environmental factor Well Done! 38
39 1. E. S. Hart, A. Turner, M. Albright et al. (2011) Common Pediatric Elbow Fractures. Orthopaedic Nursing. 30 (1) p S. Carson, D. P. Woolridge, J. Colletti et al. (2006) Pediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, p C. Kisner & L. A. Colby. (2007) Therapeutic Exercise: Foundations and Techniques. 5 th edition. F.A. Davis Company. Philadelphia. 4. M. R. Folio, R. R. Fewell (2000) Peabody Developmental Motor Scales. 2 nd edition. Pro-ed, Inc. Texas. 5. Electrophysical Agents. Contraindications & Precautions: An Evidence-based Approach to Clinical Decision Making in Physical Therapy. Physiotherapy Canada 2010 Special Issue Vol 62 No.5 6. S. Kitchen & S. Bazin (2002) Electrotherapy: Evidence-Based Practice. 11 th edition. Churchill Livingstone. 7. Kinesio Taping Association International. (2011) Course material of KT1: Fundamental Concepts of the Kinesio Taping Method & KT2: Advanced Concepts and Corrective Techniques of the Kinesio Taping Method. 8. M. Y. Boyette & J. A. Herrera-Soto (2012) Treatment of delayed or non-united fractures & Osteotomies with Pulsed Electromagnetic Field in Children & Adolescents. 35 (7) p. e1051-e Y. Watanabe, T. Matsushita, M. Bhandari et al. (2010) Ultrasound for Fracture Healing: Current Evidence. Journal of Orthopaedic Trauma. 24 (3) Supplement p
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