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Normal knee anatomy Symptoms and pathology of juvenile rheumatoid arthritis Pain management

Normal knee anatomy Symptoms and pathology of juvenile rheumatoid arthritis Pain management Stages of development and psychosocial issues Multidisciplinary approach. Anatomy of the knee. Synovial joint components. What is juvenile rheumatoid arthritis ?. Joint contracture

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Normal knee anatomy Symptoms and pathology of juvenile rheumatoid arthritis Pain management

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  1. Normal knee anatomy • Symptoms and pathology of juvenile rheumatoid arthritis • Pain management • Stages of development and psychosocial issues • Multidisciplinary approach

  2. Anatomy of the knee

  3. Synovial joint components

  4. What is juvenile rheumatoid arthritis? • Joint contracture • Joint inflammation • Joint damage • Alteration or change in growth

  5. Juvenile idiopathic arthritis • Polyarticular JRA - typically affects 5 or more joints • Systemic onset JRA - high spiking fevers and rash • Oligoarticular JRA - typically affects 4 or fewer joints • Pauciarticular JRA - may cause eye inflammation

  6. Diagnosis • Joint swelling • Joint tenderness • Loss of movement • Joint malalignment • Rash

  7. Pain management • Medication • TENS • Ice

  8. Jean Piaget (1896-1980) • Piaget developed four stages to his theory of cognitive development: • Sensori-Motor Stage • Pre-Operational Stage • Concrete Operational Stage • Formal Operational Stage

  9. Pre-operational stage • The child’s thoughts become more symbolic and they represent their world through images and words • However they do not have the skill of ‘reversibility’ • They do not understand quantity, volume and number have not changed despite a change in its appearance

  10. Concrete Operational Stage • Children acquire internally consistent (adult) logic but only in concrete situations such as problem solving • Children in this stage are able to conserve and decentrate, they may also be able to use reversibility

  11. Piaget’s theory has had an enormous impact on our understanding of cognitive development CBT further developed in the 1970’s by Beck Cognitive - Thinking and beliefs Behavioural – Behaviours and actions (CBT) is tuning into emotions, challenging, negative automatic thoughts, and unlearning unhelpful habits of thinking that can leave us at the mercy of unwanted emotions

  12. How does this relate to Tilly or her close family members? • When therapists elicit and gracefully deal with deeply felt emotional issues, treatment takes off • Effective CBT reveals and deals with the tragedies of young patients lives (Leahy 2007) • Since CBT is so flexible it may be applied in a variety of formats including individual, family and groups • The International Association of Study of Pain describe pain as “An unpleasant sensory and emotional experience which is due to actual or potential tissue damage, or which is expressed in terms of such damage”

  13. Lev Vygotsky (1896-1934) • Vygotsky felt the acquisition of knowledge was active and socially constructed rather than a passive conditioning • He believed that social interaction played a vital role in cognitive development firstly on a social level (between child and the world) and then on a individual level (internally)

  14. Culture teaches children both what and how to think, through the acquisition of knowledge via intellectual tools • Since much of what children learn is through interaction, Vygotsky believed isolation was inappropriate...guidance by a another is usually most beneficial • Woods et al described this process as scaffolding i.e. The support given by a significant other, e.g. teacher, parent or even peer

  15. The stages of scaffolding • RECRUITMENT - gaining the child’s interest • REDUCTION OF DEGREES OF FREEDOM – breaking the task down into manageable steps • DIRECTION MAINTENANCE – encouraging and motivating the child until they have become self-motivating • MARKING CRITICAL FEATURES – drawing attention to aspects of the problem that will help further progress • DEMONSTRATION - the tutor (parent) finishes the task off so that the learner can imitate this back in a better form

  16. Applying the theory • Learning as collaboration- Learning together rather than individuals...promotes critical thinking & interest • Zone of proximal Development (ZPD)-MKO (more knowledgeable other) i.e. teacher or friend. ZPD encompasses the tasks that learners cannot perform on their own but can with help from the MKO • Scaffolding- Begin with full support, gradually remove support as abilities and confidence increase

  17. Physical management programme • Orthoses • Referral to other health professionals • Family members

  18. Multidisciplinary team • GP • Consultant paediatric rheumatologist • Paediatric rheumatology nurse • Paediatric physiotherapist • Occupational therapist • Play therapist • Podiatrist • Pharmacist • Paediatric pain service

  19. The children's chronic arthritis association • Regular newsletter • Active support network • Annual family weekend • Outings for the children

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