Physical Therapy Protocols Edited by Janet Bezner

PEDIATRICS Newborn Spina Bifida Protocol Treatment/Goals I. Frequency. One time per day, less if family involvement and nursing follow-through is good. II. Treatment techniques and goals A. Treatment: 1. Range of motion exercises should be done using short lever arms with good joint stabilization to prevent fractures or joint damage. 2. Contractures will occur due to muscle imbalances (innervated hip flexors and adductors without counter balancing by innervated hip extensors and abductors) and due to prolonged positioning (hip flexion, abduction, external rotation con­ tractures due to repeated supine positioning). Range of motion exercises should be prescribed with this in mind. 3. Positioning and splinting may supplement range of motion exercises. Goal: Maintain or increase range of motion as appropriate to minimize deformity. B. Treatment: Assist nurses and parents with proper varied positioning to maintain skin integrity, as well as to facilitate developmental skills and assist with range of motion goals. Goal: Prevent skin breakdown. C. Treatment: Educate parents in home program. Goals: Parental independence with home program; parents win understand sensory precautions, proper handling and positioning techniques for facilitating developmen­ tal skills, and will recognize shunt malformations. III. Equipment. Provide equipment as needed for positioning and maintaining range of motion (for example, adduction strap for tight iliotibial bands). Discharge I. Evaluation. Discharge patient when goals have been met. Document hospital course, including family involvement and referrals made. II. Follow-up plan/referral. Refer to infant stimulation program or outpatient physical therapy services as necessary. III. Home program. Provide written program of developmental activities, range of motion exercises, and positioning as needed; review signs and symptoms of shunt malfunction. Patient Example Patient is a one-week-old male with myelomeningocele at the thoracic level. Patient exhibits decreased tone in both lower extremities. Parents express anxiety over handling infant. Goal: (1 week) Parents will demonstrate proper techniques for range of motion, positioning, and handling infant as outlined in the home pro­ gram in order to promote infant-family bonding. 154 Copyright © 1991 by Therapy Skill, Builders, a division of The Psychological C()(poration IAll rights reserved I 1-800-228-07521 ISBN 07616681280

Nonorganilc Failure to Thrive Protocol Objectives I. Establish social skins appropriate for age of patient. II. Improve gross motor skills and muscle tone of patient. III. Educate family regarding interactive skills. IV Investigate home situation and coordinate discharge planning with other disciplines. Admission/Evaluation I. Areas to evaluate A. General impression. Note infant's affect, past weight gains, parental presence, and social history. B. Range of motion. Note asymmetry and possible hypermobility or hypomobility. C. Strength. Posturing against gravity may indicate strength even when infant appears hypotonic. D. Functional ability 1. Give particular attention to the social skills of smiling, eye contact, and tracking. These skills may be best observed at a distance of several feet. 2. Assess interactive communication. Language may be delayed or absent. 3. Gross and fine motor skills a. Fine motor skills are frequently at higher levels than gross motor skills. b. Infant may tolerate supine position better than prone position and may have very poor prone and transitional skills. c. Infant may appear unmotivated to move. E. Gait 1. Evaluate if gait is appropriate for age and developmental level of child. 2. There are no known clusters of abnormalities with walking. F. Neurological 1. Asymmetry and imbalance of muscle tone are common. Tone may appear either higher or lower than normal, but tendon reflexes are rarely hyperactive. 2. Reflexes. Frequently, infant may have good reflexes but seem too weak to perform corresponding gross motor skills. (For example, head righting reflexes are intact, but head control in prone position is poor.) G. Cardiorespiratory. Respiration is rarely affected. Copyright © 1991 by Therapy Skill Builders, a division of The PsyctxJlogical COfporation / All rights reserved /1-800-228{)752/ISBN 07616681280 155