|
T6-9
|
Upper trunk (abdominals)
No LE function
|
Kyphoscoliosis,
Lumbar hyperlordosis
Coxa valga–hip dislocation
Decreased bone density
Fractures
Contractures:
Hip: abduction, flexion,
external rotation
Knee: flexion, extension
Foot: heelcord, clubfoot
|
TLSO
Night splints: body, hip
abduction, KAF, AF
Early: Parapodium, (10
months of age and up to 2
years)
Later: stander, RGO, HKAFO, KAFO
Caution: Preserve UE function with level transfers, stable seated posture.
Maintain strength + flexibility of shoulders/ arms.
|
Community: Wheelchair/
wheelchair cushion,
transfer board
Home: Walker/Crutches
(for household or exercise
walking), Raised, padded
commode seat.
Bath bench
Mirror for skin checks
Stander: 1 hour/day minimum starting at 10-12 months of age.
Driving with hand controls
Learn public transportation
|
Executive function impairments
can impact educational, social and
self help skills.
Cognitive function can vary with
the degree of hydrocephalus
number of shunt infections, and
the involvement of the nervous
system. Function may not be
related to level of lesion or ability
to walk. Support early assessment
of attention difficulties,
sensorimotor integration, visual
perception, visual motor ability,
psychosocial development in
addition to fine/gross motor +
communication ability.
Independent living: Occupational
Therapy Goals: Basic activities of
daily living (BADLs) or bathing,
dressing, grooming, bowel/
bladder program, skin care,
moving/transportation in your
home/community. Instrumental
activities of daily living (IADLs).
Shopping, meal preparation,
use of home appliances. Early
learning/practice of all ADLs is
vital.
Physical/ Occupational Therapy/
Gross Motor Goals:
- Achieve/maintain full ROM.
- Achieve/maintain full strength
in intact muscles for ADL's and
mobility.
- Locomotion activities including
ambulation skills (falling down,
getting up), walk on various
terrains, transfer to various
surfaces (chair, car, bed).
- Achieve maximal sitting
tolerance with skin intact.
- Attain cardiovascular endurance
for function.
- Ability to perform or direct care
including care + maintenance of
orthotics + equipment.
- Obtain recommendations re:
home modifications.
- Document medical appts,
follow up, surgical history.
Transition to adult self care begins
at birth.
|
|
L2
|
Hip flexors 3/5
Hip adductors
|
Scoliosis, Overuse of UE's
Lumbar hyperlordosis
Hip subluxation
Coxa valga–hip dislocation
Decreased bone density
Fractures
Contractures:
Hip: flexion
Knee: flexion, extension
Foot: Heelcord, clubfoot
|
Night hip abduction splint
Early: Parapodium (10
months of age up to 2
years)
Later: Stander, RGO, HKAFO, KAFO (if quads are less than 3/5 strength)
L3-5 May be temporarily addressed by twister cables or derotations straps
|
Community: wheelchair +
cushion
Home: Stander: 1 hour/ day
minimum
Early: may use walker or
crutches
Later: wheelchair in home
|
|
L4
|
Medial knee flexors 3/5
Ankle dorsiflexor 3/5
|
Lumbar hyperlordosis
Coxa valga
Contractures:
Hip: flexion
Knee: flexion (avoid crouch gait)
Foot: Progressive calcaneus
(tight heelcord)
Calcaneovalgus
Equinovarus—Clubfoot
Paralytic Vertical Talus
|
Night hip abduction splint
Early: Parapodium
Later: RGO, HKAFO, KAFO, AFO (L3-L4 CCAFO)
L4-5 Toeing in gait and weak gluteals may be
temporarily addressed by twister cables and/or
rotation straps
Consider shunt malfunction and/or tethered cord
|
Community: wheelchair,
walker, crutches, cane
Strong medial hamstring needed for community gait
Home: early on may need no support
Later: may require UE support
|
|
S1
|
Hip abductors 3/5
Hip extensors (weak) 2/5
Plantar flexors (weak) 2/5
|
Monitor hips closely
Contractures:
Foot: Calcaneus (tight
heelcord)
Calcaneovalgus
Pes Cavus,
Clubfoot
Toe clawing (flexion)
Heel/foot ulcers
|
AFO, SMO (supra malleolar orthotics), shoe inserts or no orthotics
S1-2 Toeing out gait
Use of crutches may decrease the valgus forces
at the knee and also improve endurance
|
Community: walking with walker, crutches, cane.
Gluteus lurch/ Trendelenburg gait aided by cane or crutches.
Long distance alternative:
lite weight wheelchair, bike, scooter
Home: May need no support.
|
