0 Item(s)
Orthotic Management of the Pediatric Hip (module 4)
Certificate Program for Professional Development Module
Keyword(s)
Pediatrics, Cerebral Palsy, SCI, CVA, TBI, Arthrogryposis
There are several pathologies that can adversely affect the structural integrity of the pediatric hip: cerebral palsy, tone, or spasticity secondary to spinal cord injury, cerebral vascular accident, traumatic brain injury, congenital or developmental hip displasia, arthrogryposis, and Legg Calve Perthes disease. Each presents with distinctive deficiencies due to ligament laxity, muscular imbalance, degenerative bony changes, and subluxation or dislocation. Management of these patients poses a unique challenge to every member of allied health team. This course describes several ways to manage the pediatric hip.
Author(s)
Garry Ogilvie, CO, FAAOP
Description
There are several pathologies that can adversely affect the structural integrity of the pediatric hip: cerebral palsy, tone, or spasticity secondary to spinal cord injury, cerebral vascular accident, traumatic brain injury, congenital or developmental hip displasia, arthrogryposis, and Legg Calve Perthes disease. Each presents with distinctive deficiencies due to ligament laxity, muscular imbalance, degenerative bony changes, and subluxation or dislocation. Management of these patients poses a unique challenge to every member of allied health team. It is common to divide management into two categories: pre-operative and post-operative. Pre-operative intervention focuses on preservation of anatomical structures, reduction of contractures, ambulation, sitting balance, and early integration of ADLs. To achieve these goals, orthotic applications are designed to stabilize and protect soft tissue from contractures, align the hip to achieve maximum bony congruency, aid in proper development, reduce subluxation or dislocation and prolong operative management that allows maximum bony growth to occur. These designs are often thought of as ambulatory, however they also provide significant stability in sitting and may have a positive effect on reducing upper limb spasticity/tone. The objective of post-operative orthotic intervention is to preserve stabilization techniques, range of motion, and aid in rehabilitation, ambulation, and to relative ADLs. Traditionally, stabilization was done through the use of hip spica casts. These have been very successful in maintaining proper bony and soft tissue alignment but had significant drawbacks relative to skin care, wound site inspection, and toileting complications. To address these deficiencies, orthoses were designed to be removable, washable, and provide adequate stabilization techniques. In addition, these orthoses can be adjusted to provide various range of motion, allowing for safe and controlled ambulation during the rehabilitation process. The introduction of these designs throughout the past three years has given way to many successes and reported failures. To address the discrepancy in results, the presentation will explore the application of each style of orthoses, appropriate pre- and post-operative applications in addition to investigating perceived expectations and outcomes of the caregiver, therapists, and orthotist. Orthoses to be included: Allard—SWASH, Becker Orthopedic—Maple Leaf, Fillauer Inc.—anti-adduction orthoses, Orthomerica—Newport Jr.