Pediatric Orthotic Problem solving

Question 1

Typical guidelines for bracing state that we should brace to which one: R1 or R2?

Answer 1

R1, within spasticity free ROM

However, Dr. Bickley states that she braces to R2

Question 2

When should you evaluate the effects of an AFO?

Answer 2

Wait a week or two for the patient to get used to it

don’t make immediate judgements on how effective it is as soon as they put it on and walk for the first time

Question 3

What are the 3 ways an AFO can help with non-ambulatory needs

Answer 3

Contracture managment

Wound healing, protection/prevention

positioning

Question 4

What should we keep in mind about orthotic comfort?

Answer 4

Orthotic MUST be comfortable

especially a night time AFO, it cannot interfere with pt sleep

Question 5

What are the two methods of making an orthotic more comfortable

Answer 5

Minimize pressure by maximizing area covered

Provide sufficient leverage by increasing the longitudinal segments of the orthotic

Question 6

the most basic pressure system for an orthotic is the _______

Answer 6

3 point pressure system

Question 7

how does a surestep SMO compare to a regular SMO?

Answer 7

shorter toe plate and trimlines

designed to promote higher level activities like running and jumping

Question 8

What issues are associated w/ downsyndrome

Answer 8

Atlantoaxial instability
-Present in 15% of pt with DS
-Take radiographs between 3-5yo

Cardiac issues

Thyroid Issues

Hip Issues
-DHD
-Acetabular Dysplasia

Question 9

T or F: a SMO w/ a PLS extension is good for crouch gait

Answer 9

F

Question 10

Idiopathic toe walking and Spastic CP at a GMFCS level II can benefit from what kind of orthotic

Answer 10

SMO with PLS extension

Question 11

What planes does the SMO with PLS extension control

Answer 11

Controls sagittal plane talocrural issues (with the PLS extension)

Coronal plane Subtalar joint issues (with the SMO)

Question 12

What kind of orthotic is best for Duchenne’s Ms Dystrophy

Answer 12

GRF AFO

Unless they’re non-ambulatory!

Question 13

Signs of duchennes muscular dystrophy?

Answer 13

Clumsy, may walk on toes, show motor REGRESSION

GOWERS SIGN!!!!

Question 14

T or F: Prolonged walking and standing delay the development of scoliosis in Duchenne muscular dystrophy

Answer 14

T

Question 15

What MSK problem is associated w/ Duchenne’s muscular dystrophy

Answer 15

Scoliosis

Question 16

What type of medication often improves muscle mass and function in the first 6 months of treatment for Duchenne’s

Answer 16

Corticosteroids

Question 17

Surgical intervention for scoliosis is typically considered when the curve reaches approximately ______, especially when the child is under ______

Answer 17

30

14

Question 18

What is the pattern of weakness in Duchenne’s muscular dystrophy

Answer 18

Proximal to distal

not all muscles affected equally

early in neck flexors and abdominal muscles

Question 19

how do you differentiate duchennes muscular dystrophy from idiopathic toe walking

Answer 19

they just now started walking on toes at 5-6 y/o and are now clumsy

Question 20

Gait prognosis for Duchenne

Answer 20

gait typically lost by age of 12

Question 21

What is the most severe classification of Spinal Muscular Atrophy

Answer 21

Type 1- Manifests before age of 6 months

death by 2 years old

most common

Question 22

What is the mildest form of Spinal Muscular Atrophy

Answer 22

Type 3,

Onset after 18 months

Children may walk independently or with AD into late adolescence and early adulthood

Question 23

When does each type of Spinal Muscular Atrophy appear?

Answer 23

Type 1- Appears before 6 months

Type 2- Onset between 7 months and 18 months

Type 3- onset after 18 months

Question 24

What is the prognosis for each type of SMA?

Answer 24

Type 1- Death at age of 2

Type 2- may live into adulthood w/ proper treatment and monitoring of pulmonary function

Type 3- normal life expectancy, may require AD to walk

Question 25

How are all 3 types of SMA characterized?

Answer 25

**Significant limb and trunk weakness** Atrophy *pronounced more proximally* and in LE Hypotonia and Areflexia Progressive musculoskeletal issues

Question 26

What is the cause of Duchenne?

Answer 26

Progressive neuromuscular disorder Genetic mutation causes: Absence of dystrophin, a protein normally present in muscles and in the brain --> causes muscle cells to be easily damaged

Question 27

Duchennes typically affects what gender

Answer 27

males

Question 28

Differences between duchenne and SMA?

Answer 28

DMD- Later onset, may not have family history, psuedo hypertrophy of calve muscles SMA- Inhereted, Earlier onset, Affects reflexes( Areflexia), Affects limbs more than DMD

Question 29

What kind of shoes do we want and not want for orthotic use?

Answer 29

Removable inserts Extra depth Laces or velcro NOT: Canvas shoes or sandals/slip-ons

Question 30

What are 3 common compensations in gait for children w/ hemiplegia

Answer 30

Hemi-pelvis retraction increased pushoff w/ unaffected side early firing of fibularis longus

Question 31

how do we delay the development of scoliosis in children with DMD?

Answer 31

Prolonged walking and standing