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Physical Therapy For Children: Paediatric Physical Therapy

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Physical Therapy For Children: Paediatric Physical Therapy Question: Describe about the Physical Therapy for Children of Paediatric Physical Therapy?   Answer: The Essential Components Of The Examination And Evaluation For The Patient Are As Follows: Developmental and birth history- The patient would be asked questions about the developmental and the stages she has through from the time of birth to understand the complications present in relation to mobility. General health questions- The questions asked would be the duration of illness, the last visit to the physician, the eating habits and medicines taken, the diet followed, the level of energy present and any fatigue and general weakness experienced. Others may include allergies to medications, depression and mental health and appetite. Parental concerns- The parents must be questioned about the concerns of the patient. Their worries and their observations hold much value of for the examination and evaluation of the patient. Physical examination- The physical examination would include the height, weight, movement patterns, hand-on assessment of muscle tone, strength and flexibility. The coordination and balance of the child would also be tested. Motor development tests- Specific tests would be performed for determining the child’s motor development. The use of hand, intellect, language skills and other areas of development would be assessed. Proper monitoring of motor functioning in the lower extremities is very much needed. Serial orthopaedic examination, including joint range of motion (ROM) assessment and muscle strength, are to be conducted for detecting changes required in the intervention (Campbell & Palisano, 2006). The concerns regarding the signs and symptoms of Ashley would be the left hip pain, inability to remain comfortable in the wheelchair, calcium loss and gain of weight. Left hip pain- The left hip pain may be due to scoliosis. Myelomeningocele is characterised by several complications and one of those are scoliosis. Even if one or more operations are carried out, some disability may remain with the patient. In many cases the operations are not successful. The common problems are with the hips. It must be noted that the patient has a history of two fractures in her lower extremities during the past four years (Ieorio et a., 2015). Uncomfortness in using wheelchair- Uncomfortness in using wheelchair is due to the chronic pain and need of seating in the same posture at a stretch. The pain and uncomfortness is an inevitable consequence using a wheelchair on a full-time basis. The pain that the patient feels is due to the constant posture maintained by the patient. In such cases, the patients find comfort in only lying down.   Calcium loss- Patients with myelomeningocele have difficulty with ambulation, and thus secondary loss of bone mineral density. This leads to loss of calcium from the body of the patient. Moreover, patients with non-ambulatory myelomeningocele may be suffering from  urinary calcium losses. Such calcium losses make the body more weak (Flynn & Ordorica, 2016). Gain of weight- the patient has been gaining more weight as she is is a permanent user of a wheelchair. People who use a wheelchair find it difficult to lose weight since they do not have the option of losing calorie by taking up physical activities. A healthy body weight is not achieved. The metabolism also may be hampered due to the constant posture of sitting on a wheelchair. A decrease in the mobility is the main cause. Any medical disorder may also affect the mobility. Medications have a chance of making an influence on the appetite. The patient may also not have adequate knowledge of nutrition and weight management (Williams et al., 2014). The goal of the physical therapy would be directed towards at contractures of the hips of the patient and would include the strengthening and range-of-motion exercises. This is due to the muscle imbalance experienced by the patient. Different factors affects the ability of the patients with myelomeningocele to ambulate. The most significant factor that forms the basis for judgment is location of the malformation. Patients with higher lesion in the upper lumber spine and thoracic spine have more chances of being in the wheelchair (Wheelson, 2012). The same is the case of the patient Ashley. The decision taken on whether to begin physical therapy or refer Ashley to the physician would depend on the monitoring of the alignment of the joint, muscle contractions, muscle imbalance, body posture and the signs of increasing neurological deficits. If the condition of the patient is severe, surgery may be required and physical therapy may not be of much use (Molina, 2013).   References Campbell, S. K., & Palisano, R. J. (2006). Physical Therapy For Children (p. 564). Elsevier Saunders. Flynn, K., & Ordorica, J. (2016). Commentary on “Bone Mineral Content in Infants With Myelomeningocele, With and Without Treadmill Stepping Practice”. Pediatric Physical Therapy, 28(1), 32. Iorio, J. A., Jakoi, A. M., Steiner, C. D., Cahill, P. J., Samdani, A., Betz, R. R., & Singla, A. (2015). Minimally Invasive Lateral Interbody Fusion in the Treatment of Scoliosis Associated with Myelomeningocele. Surgical technology international, 26, 371-375. Molina, J. E. (2013). Physiotherapy. In New Techniques for Thoracic Outlet Syndromes (pp. 13-14). Springer New York.     Williams, G. J., Georgiou, P. A., Cocker, D. M., Bonanomi, G., Smellie, J., & Efthimiou, E. (2014). The safety and efficacy of bariatric surgery for obese, wheelchair bound patients. The Annals of The Royal College of Surgeons of England, 96(5), 373-376. Wilson, F. (2015). Grieve’s Modern Musculoskeletal Physiotherapy.

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