Transcript Mutual areas of concern

OT & Podiatry in Paediatrics
Mutual areas of concern
Caryn Mincherton OT
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When to refer to OT
How do we assess?
Occupational
Therapy
What do we look for?
Tips for parents
Pearls to take back to your practice
PAEDS
Outline
Podiatry
Still basket weaving??
How do we work together?
We know podiatrists don’t just look at feet.
Similarly, OT’s don’t just look at hands
Co-Morbid Issues
• The child with low muscle tone
– Flat and pronated feet
– Poor postural control
– Difficulty sitting for fine motor tasks
– Feeding issues
…and further
• Hands need arches too
In hand manipulation and
Speed and dexterity
Building blocks for development and
learning
Sensory
Processing
• Body Awareness
• Sensory Modulation
Social – Play
Skills
Motor Skills
• Co-ordination
• Bilateral Integration
• Gross Motor
• Fine Motor
Visual Skills
Emotional
Regulation
• Visual Perception
• Where we come in…
– Assess
– Skills training
– Strategies
– Adaptations
– Building skills
First step, assessment
• Informal (Clinical Observations)
• Formal (Standardised Assessments)
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Gross and fine motor movement
Sensory processing
Visual perceptual and visual motor
Developmental assessments
Handwriting
Treatment
• Where?
• How?
• What?
Benign Joint Hypermobility Syndrome
(BJH)
BJH
Poor
Coordination
Issues with
participation in
PE
48%
Clumsy
14%
Speech and
language issues
40%
Handwriting
difficulties
36%
48%
BJH – Joint Involvement
Ankles
Elbows
92%
Knees
79%
Fingers/MCP
82%
Wrists
75%
87%
BJH
• 84% of children with BJH have motor skill
difficulties.
• 14% correlation with speech and language
concerns.
Quick checks
• Ask the child to fully extend
elbows
– Greater than 180°?
• Gently see if their fingers
bend back at the MCP’s
– Greater than 90°?
• If BJH present, but no
functional limitation  NO OT
What works to improve strength
Activities/Exercises
• Increase strength
• Increase stability
especially in the midrange (Co-contraction)
• Heavy work
Joints?
• Provide stability
– Use splints, lycra or
neoprene
• Conserve joints
– Decrease load/weight
– Alternate methods to
complete a task
What do we use
• Adapted equipment
• Adapt the environment
High school years
• Handwriting
– Legibility
– Speed
• Exams
• Curriculum Council process
Toe Walkers
• Co-morbidity
• Ideopathic
toe walkers
• Non-ideopathic
toe walkers
Toe walkers and sensory processing
• Proprioceptive seekers
• Tactile Avoiders on
different surfaces.
Sensory Processing
We all do it, every day.
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Tactile
Proprioceptive
Vestibular/Movement
Oral
Auditory
Visual
Olfactory
Sensory Seekers and Avoiders
This is the child that
you have bouncing off
the walls in your clinic
This is the child that you
see that is unusually
tentative or avoidant of
touch/movement
Motor Skills
• Assessment
• Treatment
– Top-down
– Bottom-up
Motor Skills
• Vestibular- children need good quality
efficient movement skills and tactile skills for
motor planning
• DCD/orthotics link
Red Flags
• At any age, the child who is
– Too busy
– Too quiet (defensive/anxious)
– Low tone (fatigues)
More …. Red Flags
At Three
• Arms in high guard when walking
• Drooling
• Can’t hold their own bodyweight on monkey bars
At Four
• Can’t cup their hand
• Can’t imitate simple finger actions like Twinkle Twinkle
• Can’t balance on one leg for 2-7 seconds
At Five
• Hand dominance not well developed – sometimes swaps
• Can’t heel toe walk along a 2 metre line
• Cant complete 10 hops on preferred foot.
At Six
• Thumb collapses with circle thumb-finger test
• Cannot Skip- 85% can skip well.
• Cant hop on one leg for 3 mtrs (first left then test right).
Pearls…
• Physical activity
– Increase good quality
movement, decrease
screen time
• Heavy work
– Can calm a deregulated
child
– Stimulates muscle strength
in the hypotonic child
– Improves proprioception
in poorly coordinated
children
Top 3 fine motor activity pearls
Theraputty / super strengthening kit
from Skillbuilders
Tricky Fingers Game
Highly motivating writing tools e.g.
crayon rocks , overwriters , silkies
Top 3 gross motor activity pearls
Animal walks
Scooter boards
Space Hoppers
Take away points
Toe
walking
OT is a highly engaging,
motivating process
helping children meet
their goals.
Warts
BJHS
Flat
feet
Questions for you???
• What are your thoughts on trampoline use
and toe walking?
• When should children have their orthotics on
and off?
– During our therapy sessions?
– At the beach?
– On trampolines?
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