ot & podiatry in paediatrics mutual areas of concern caryn mincherton ot
TRANSCRIPT
OT & Podiatry in Paediatrics Mutual areas of concern
Caryn Mincherton OT
Outline• When to refer to OT• How do we assess?• What do we look for?• Tips for parents• Pearls to take back to your practice
Occupational Therapy Podiatry
PAED
S
Still basket weaving??
How do we work together?We know podiatrists don’t just look at feet.
Similarly, OT’s don’t just look at hands
Co-Morbid Issues
• The child with low muscle tone– Flat and pronated feet– Poor postural control– Difficulty sitting for fine motor tasks– Feeding issues
…and further
• Hands need arches too In hand manipulation and
Speed and dexterity
Building blocks for development and learning
Emotional Regulation
Social – Play Skills
Sensory Processing• Body Awareness• Sensory Modulation Motor Skills
• Co-ordination• Bilateral Integration• Gross Motor• Fine Motor
Visual Skills• Visual Perception
• Where we come in…– Assess– Skills training – Strategies– Adaptations– Building skills
First step, assessment
• Informal (Clinical Observations)• Formal (Standardised Assessments)
– Gross and fine motor movement– Sensory processing– Visual perceptual and visual motor– Developmental assessments– Handwriting
Treatment
• Where?• How?• What?
Benign Joint Hypermobility Syndrome (BJH)
BJH48% Clumsy
36%Poor Coordination
14% Speech and language issues
48%Issues with
participation in PE
40% Handwriting difficulties
BJH – Joint Involvement
92% Knees
75%Ankles
79% Fingers/MCP
87%Elbows
82% Wrists
BJH
• 84% of children with BJH have motor skill difficulties.
• 14% correlation with speech and language concerns.
Quick checks
• Ask the child to fully extend elbows– Greater than 180°?
• Gently see if their fingers bend back at the MCP’s– Greater than 90°?
• If BJH present, but no functional limitation NO OT
What works to improve strength
Activities/Exercises• Increase strength• Increase stability
especially in the mid-range (Co-contraction)
• Heavy work
Joints?
• Provide stability– Use splints, lycra or
neoprene• Conserve joints
– Decrease load/weight– Alternate methods to
complete a task
What do we use
• Adapted equipment• Adapt the environment
High school years
• Handwriting– Legibility– Speed
• Exams• Curriculum Council process
Toe Walkers
• Co-morbidity• Ideopathic
toe walkers• Non-ideopathic
toe walkers
Toe walkers and sensory processing
• Proprioceptive seekers• Tactile Avoiders on
different surfaces.
Sensory Processing
We all do it, every day.
• Tactile• Proprioceptive• Vestibular/Movement• Oral• Auditory• Visual• Olfactory
Sensory Seekers and AvoidersThis is the child that you have bouncing off the walls in your clinic
This is the child that you see that is unusually tentative or avoidant of touch/movement
Motor Skills
• Assessment• Treatment
– Top-down– Bottom-up
Motor Skills
• Vestibular- children need good quality efficient movement skills and tactile skills for motor planning
• DCD/orthotics link
Red Flags• At any age, the child who is
– Too busy– Too quiet (defensive/anxious)– Low tone (fatigues)
More …. Red FlagsAt Three
• Arms in high guard when walking• Drooling• Can’t hold their own bodyweight on monkey bars
At Four
• Can’t cup their hand• Can’t imitate simple finger actions like Twinkle Twinkle• Can’t balance on one leg for 2-7 seconds
At Five
• Hand dominance not well developed – sometimes swaps• Can’t heel toe walk along a 2 metre line• Cant complete 10 hops on preferred foot.
At Six
• Thumb collapses with circle thumb-finger test• Cannot Skip- 85% can skip well.• Cant hop on one leg for 3 mtrs (first left then test right).
Pearls…
• Physical activity– Increase good quality
movement, decrease screen time
• Heavy work– Can calm a deregulated child– Stimulates muscle strength
in the hypotonic child– Improves proprioception in
poorly coordinated children
Top 3 fine motor activity pearls
Theraputty / super strengthening kit from Skillbuilders
Tricky Fingers Game
Highly motivating writing tools e.g. crayon rocks , overwriters , silkies
Top 3 gross motor activity pearls
Animal walks
Scooter boards
Space Hoppers
Take away points
Toe walking
BJHS
Flat feet
Warts OT is a highly engaging,
motivating process helping children meet
their goals.
Questions for you???
• What are your thoughts on trampoline use and toe walking?
• When should children have their orthotics on and off?– During our therapy sessions?– At the beach?– On trampolines?
