individualized family service plan
statement of present levels of development based on cognitive, communication, physical, social, emotional, adaptive criteria, family resources, priorities, and concerns related to enhancing development, statement of measurable outcomes expected with criteria, procedures, and timelines, etc.
reviewed every 6 months
Hydrocephalus is excessive accumulation of cerebrospinal fluid in the ventricles of the brain. It is treated with a shunt to move fluid from lateral ventricles to the peritoneal space so that the CSF may get reabsorbed. Signs of malfunction are changes in speech, fever and malaise, recurring headache, decreased activity level, decreased school performance, onset of or increased strabismus, changes in appetite and weight, incontinence begins or worsens, onset or worsening of scoliosis, onset of or increased spasticity, personality change/irritability, decreased or static grip strength, difficult to arouse in the morning, decreased visuomotor coordination, decreased visual acuity or diplopia, decreased visuoperceptual coordination, and onset or increased frequency of seizures. CMT is the posture of the head and neck from unilateral shortening of sternocleidomastoid causing the head to tilt toward and rotate away from the affected SCM muscle, may exhibit asymmetric neck extension and a forward head posture because of upper cervical extension, named for side of involved SCM
Common findings include: ipsilateral mandibular asymmetry, ear displacement, plagiocephaly, scoliosis, pelvic asymmetry, congenital dislocated hip, and foot deformity.
Risk factors are: large birth weight, male gender, breech position, multiple birth, primiparous mother, difficult labor and delivery, use of vacuum or forceps, nuchal cord, and maternal uterine abnormalities.
Other areas affected by CP are strength, selective control, postural control, motor learning, and pain.
These impact activity and participation levels because they typically decline due to these other areas of impairment.
They recommend examining and evaluating spasticity, ROM, bony deformity, strength, selective control, gait, stability and balance, weight transfer, speed and control, symmetry, and use of assistive devices.
The PT goals should focus on the promotion of participation in their specific personal and environmental contexts by maximizing the activity allowed by impairments and compensating for activity limitations when necessary.
Achieving these goals involves the PT providing support, guidance, and education for children, families, communities, in addition to direct treatment.
Concepts important to consider in this process are: family centered care, honesty, commitment to the child, and the belief that the PT is making a difference, science based approach, dynamic systems theory, and neuronal group selection theory.
Vary greatly depending on extent of initial pathology, neurologic regeneration, and residual impairments but usually inability to reach, grasp, and perform tasks requiring bilateral manual abilities, ADLs that require bilateral UE use, ROM limitations, typical developmental activities may be compromised, neglect of involved limb, self abusive behavior may occur, shoulder pain and neuritis in adults. Facilitation of normal movement patterns while inhibiting substitutions during reaching and weight bearing activities, careful attention to scapulohumeral rhythm, manually guiding extremity through movements to accomplish task, hand to mouth, transfer objects, weight shift on propped UE in prone, quadruped, sitting with hands in front or back, creeping, reaching for toys at various heights and angles, sidelying on uninvolved arm, gravity for strengthening, tactile stimulation. a. Flexed and dislocated hips, extended knees, clubfeet, internally rotated shoulders, flexed elbows, and flexed ulnarly deviated wrists.
b. Abducted and externally rotated hips, flexed knees, clubfeet, internally rotated shoulder, extended elbows, and flexed ulnarly deviated wrists.
Primary impairment is: muscle weakness.
Type 1: weakness, contractures, respiratory distress, scoliosis, cranial nerve involvement, within first 4 months
Type 2: within first year, significant weakness, occasional contractures
Type 3: typically later in first decade, weakness, postural compensations, contractures, scoliosis,
Goals: mobilize secretions, increase aeration, and increase general mobility
Techniques: yawn maneuver, incentive spirometry, segmental expansion techniques, percussion and vibration techniques, suctioning, counter-rotation technique to alter respiratory rate in neurologically impaired children, early mobilization, position changes, early ambulation.
Postural pain: frequent turning, positioning, PROM, elongation of trunk
Neuropathic pain: splinting of distal extremities and desensitization
Behavior modification techniques (guided imagery, muscle relaxation, meditative breathing)
Modalities: ultrasound, phonophoresis, e-stim, TENS, biofeedback, temperature biofeedback, hydrotherapy, therex
Fabrication of equipment
Use of developmental activities to promote mobility and function
Incorporation of fine motor, social, and cognitive activities with gross motor activities
Education of family, school, etc.
Facilitation of postural reactions
Facilitation of normal motor patterns for attainment of
Prevention of deformities and contractures: positioning,
handling, carrying, splinting or casting, adaptive equipment
Facilitation of motor control/functional movement skills: mobility, reaching, grasping, manipulation of objects, normalization of sensation, perception, play skills
Facilitation of feeding: oral motor control, sucking, swallowing, breathing coordination, food textures,
Maintenance of respiratory status: breathing pattern,
congestion status, energy expenditure, oxygen saturation
Maintenance of health status: coordination with physicians,especially in presence of drug therapies
Once a referral has been made, the steps followed by the AT team are similar to the elements of patient/client management in the Guide to Physical Therapist Practice3:
Step 1: Examination. Examination is the process of obtaining a history, performing systems reviews, and selecting and administering tests and measures to obtain relevant client information. The process begins with an interview to identify child/family goals and how they relate to AT. The team records relevant history and social information. The examination includes assessments and measurements of myotome and dermatome, skin, range of motion (ROM), muscle strength, and motor function, including sitting, transfer, and mobility.
Step 2: Evaluation. The team makes clinical judgments based on data gathered during the
examination. Keeping in mind the information gathered in Step 1, the team considers options
Step 3: Diagnosis. The team makes a decision on the child's needs for AT.
Step 4: Prognosis. The team estimates the level of improvement that might be attained through AT and the amount of instruction and training required.
Step 5: Intervention. The child and family try out options for AT. The team selects the AT system and services to implement a system that will provide maximal independence based on the child's diagnosis and prognosis. Funding is secured. The team may be responsible for gathering prescriptions and writing letters of medical need. The system is ordered, delivered, and fit to the user.
Step 6: Outcomes. Documentation of changes associated with the AT, including activity and participation.
Step 7: Follow-up and reevaluation. The process described is usually only one of many
repetitions of a cycle. Mechanical and electronic equipment wear out and break down,
making repairs and replacement necessary. The child's problems and needs change with age, development of new skills, and change of environments. As technologies continue to
improve or be introduced, new solutions become available.
consideration of the seating system, the child's lifestyle, and the physical features of the environments in which the system will be used.
Many factors affect the ability to manually propel a wheelchair, including physiologic capacities, such as strength and endurance, which are dependent on the user's diagnosis, age, sex, lifestyle, and build. The position of the individual within the wheelchair, particularly in relation to the hand rims or other propulsion method, determines the mechanical advantage of the user to propel the chair. Wheelchair factors that affect mobility are rolling resistance, control, maneuverability, stability, and movement dynamics. These factors are dependent on the quality and construction of the wheelchair, such as weight, rigidity of the frame, wheel alignment, mass distribution, and suspension.