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PEDIATRIC REHABILITATION

PEDIATRIC REHABILITATION. Prof.Dr. Şafak Sahir Karamehmetoğlu İstanbul University Cerrahpaşa Medical Faculty Physical Medicine and Rehabilitation Department. HISTORY (1). Prenatal: Age of the mother Previous diseases Coincident diseases Habits Unusual weight gain or loss. HISTORY (2).

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PEDIATRIC REHABILITATION

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  1. PEDIATRIC REHABILITATION Prof.Dr. Şafak Sahir Karamehmetoğlu İstanbul University Cerrahpaşa Medical Faculty Physical Medicine and Rehabilitation Department

  2. HISTORY (1) • Prenatal: • Age of the mother • Previous diseases • Coincident diseases • Habits • Unusual weight gain or loss

  3. HISTORY (2) Prenatal: 6. Drugs 7. Radiation 8. Trauma 9. Rh factor discrepancy 10.Genetic disease

  4. HISTORY (3) • Perinatal: • Delivery duration • Prematurity • Anesthesia • Drugs (induction) • Trauma

  5. HISTORY (4) ÖYKÜ (4) Perinatal: 6. Low birth weight 7. Low Apgar scores 8. Incubator 9. Intensive care 10.Sucking reflex

  6. HISTORY (5) ÖYKÜ (5) • Postnatal: • Trauma • Infection • Metabolic diseases • Vascular anomaly • Oxygen deficiency

  7. HISTORY (6) • School age: • Previous diseases • Coincident diseases • Allergy • Drugs • Epileptic seizure

  8. HISTORY (7) School age: 6. Surgical intervention 7. Trauma 8. Blood pressure 9. Pulse rate 10.Nutrition

  9. DEVELOPMENT - 1 • Heihgt • Weight • Head circumference • Growing • Follow-up

  10. DEVELOPMENT - 2

  11. DEVELOPMENT - 3

  12. DEVELOPMENT - 4

  13. GENERAL HEALTH GENEL DURUM • Fever • Blood pressure • Pulse rate • Posture • Discoloration • Edema

  14. PHYSICAL EXAMINATION-1 • Inspection (most informative) • Reaction to separation from the parents • Apparent visual and auditory awareness • Temperament (calm/hyperactive, compliant/difficult) • Spontaneous exploration and interest in toys, games, or books in the room

  15. PHYSICAL EXAMINATION-2 Inspection (most informative) 5.Style, concentration, attention span, or distractibility during play 6.Level and manner of motor activities 7.Attempts to engages the parents and examiner in conversation, vocabulary, complexity of language, and quality of speech 8. Interaction with parents and examiner (appropriate, shy, demanding)

  16. PHYSICAL EXAMINATION-3 • Blue sclerae (osteogenesis imperfecta) • Asymmetric face (facial palsy) • Café-au-lait spots (neurofibromatozis) • Scoliosis (idiopathic) • Foot deformities (spina bifida)

  17. PHYSICAL EXAMINATION-4 • Palpation: • Fontanelles • Skin (fever, sweating, coldness) • Noduls (rheumatic diseases) • Muscles (tonus, fibrosis, hypertrophy) • Joints (swelling, redness, tenderness)

  18. PHYSICAL EXAMINATION-5 Neurologic examinationReflexes (Moro, palmar, plantar)Tonus (normotoni, hypertoni, hypotoni)Active motionMuscle strenght (0-5)Coordination (proprioception)Sensation

  19. PHYSICAL EXAMINATION-6 • ROM • Prone • Supine • Side-lying • Standing • Walking

  20. PHYSICAL EXAMINATION-7 ROM • Elbow extension (- 25°) • Hip extension (- 30°)

  21. PHYSICAL EXAMINATION-8 • Walking disorders • Asymmetric step width • Toe walking • Crossing • Trendelenburg • Stepping • Ataxia

  22. SENSATION • Abdominal T6 – T 12 • Kremaster L1 – L2 • Anal S4 – S5

  23. OTHER ORGANS • Heart (anomaly, myopathy, collagen disease, sci, Guillain Barré, polio, drug) • Lung (myopathy, trauma, scoliosis, polio, cp) • Urinary bladder (spina bifida, sci) • Bowels (spina bifida, sci)

  24. FUNCTIONAL EVALUATION • Sight • Hearing • Speech • Gross motor • Fine motor • Social behavior

  25. MAJOR DISEASES • CP • SB • TBI • SCI • NMD • Amputations • Rheumatic diseases • Trauma Torakal instabilite kriterleri-2

  26. CP • Brain injury • Non-progressive • Persistent • Modifiable • Motion, tonus, coordination and posture are affected

  27. Rehabilitation • Education • Team work • Participation of the family

  28. Head • Body • Extremities • Epilepsy • Sight • Hearing • Speech • Perception • Behavioral changes • Mental retardation

  29. TYPES 1. Spastic 2. Flaccid 3. Atetoid 4. Ataxic 5. Mixt

  30. SPASTIC 1.      Hemiplegic 2.      Diplegic 3. Quadriplegic

  31. PHYSICAL EXAMINATION • Muscle tonus  • DTR • Primitive reflexes (+) • Postural changes (+) • Motor development  • Abnormal motion (+)

  32. Grading % 5/5 Normal 100 4/5 Good 75 3/5 Fair 50 2/5 Poor 25 1/5 Trace 10 0/5 Zero 0 Muscle Testing

  33. Ashworth 0: Normal tonus 1: Minimal 2: Moderate 3: Severe 4: Very severe

  34. REHABILITATION TEAM • Physiatrist • Pediatrist • Physiotherapist • Nurse • Social worker • Psychologist • Occupational therapist • Speech therapist • Special education teacher • Child development specialist • Child educator • Family

  35. General aims in CPrehabilitation • Reach an understandable speech • Near normal use of the upper extremities • Functional use of lower extremities in walking • Near normal appearence

  36. Management of Spasticity • ROM exercise • Positioning • Stretching exercises • Strenghtening exercises • Local cold applications • Electrical stimulation • EMG biofeedback • Stretching splints • Baclofen, diazepam • Local injections (botulinum toxin A) • Tendon transfers, myotomy, tenotomy • Orthoses and assistif devices

  37. Rehabilitation is a process, including medical, economical, vocational and social aspects.

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