Transcript Length Strength Kiddy-Up Kit or Nadia Seat www.specialkidszone.com

Adaptive Exercise for Individuals
Living with Spina Bifida
39th SBA National Conference
Gearing Up
For the Future
Indianapolis, IN
June 28 –July 1, 2012
Liz Kelly, PT
Penn State Hershey Children’s Hospital
The Pennsylvania State University College of Medicine
Hershey, Pennsylvania
Mobile: 717 919 0208
EMAIL: [email protected] or [email protected]
Vital Components of a Physical/Occupational
Therapy Program
•
•
•
•
•
•
•
Proper positioning in sitting and sleeping
Stretching (Muscle Length)
Strengthening
Pressure relief and joint protection
Mobility for short and long distances
Transfers and activities of daily living
Self-care
•
From Hinderer KA, Hinderer SR, Shurtleff DB, Myelodysplasia. In Campbell SK, Palisano RJ, Vander Linden DW (eds), Physical Therapy for
Children, 2nd edition. Philadelphia, WB Saunders, 2000, pp 621-670.
Matt Scott
appears in
the Nike
“No
Excuses”
Commercial
UWWhitewater
wheelchair
Basketball
player
EXCUSES
I’m too weak, too slow, too big
I ate too much for breakfast, I’ve got a headache, My dog is sick
It’s raining, I can’t right now, I’m not inspired Makes me smell bad,
I’m allergic to stuff, I’m fat, I’m thin, It’s too hot, I’m not right, I’ve
got shin splints, I’ve got a headache, I’m exerting myself too much,
Love to, but I can’t: just can’t, My favorite TV show is on, I’ve got a
case of the Mondays, the Tuesdays, the Wednesdays
I don’t want to do this. I want to do something else
After New Years, next week, I might make a mistake, I’ve got
homework, I feel bloated, I’ve got gas, I’ve got a hot date,
The coach hates me, My mom won’t let me, I bruise easily, It’s too
dark, too cold, my blister hurts, This is dangerous, I don’t have a
bike, I didn’t get enough sleep, my tummy hurts…
and my feet hurt
Learn Your Anatomy –
Your healthcare team
can be the teachers
Motor (movement) & Sensory Loss
The level is named for the spine bone or
vertebra. Below this vertebra the nerve
or lesion is the same number.
The outgoing motor nerve system
ends in the muscles of the legs and
the bowel and bladder.
This break/loss with the brain will
cause loss of voluntary control.
The ingoing sensory system
that responds to the
sensations of pain,
temperature and
touch are lost.
www.childrensmemorial.org
NATIONAL SPINA BIFIDA
PATIENT REGISTRY DIAGNOSIS
TYPE OF LESION
FUNCTIONAL LEVEL OF LESION
Thoracic (T) Flaccid LE’s
High Lumbar (L2 Ilipsoas)
Middle Lumbar (L3 Quadiceps)
Low Lumbar (L4 Tibialis Anterior)
Sacral (S1 2/5 Gastrocnemius/Soleus)
(S2 3/5 Gastrocnemius/Soleus)
Sacral (S2, 3 and 4 Bowel and Bladder)
Determine Myelomeningocele Level
• Motor function below that
level is absent or impaired
• Higher levels (thoracic) less
functional
• Problems specific to each level
Dr. Romness
• Often defined as lowest level
of normal sensation
Left and right sides often different
Skipped Lesions
PREVENTION OF CONTRACTURES
• Many muscles work in pairs to keep bones in line + balance the
movement of joints
• SB often causes one muscle of a pair to have full function while the
other is partially or completely paralyzed.
• This imbalance can lead to a variety of problems including dislocated
hips, bowed legs, foot deformities and curvature of the spine.
• Conditions can be present at birth, others develop over time.
• Some contractures and deformities can be prevented
• Contractures can limit the use of bracing or mobility aides
• Contractures can complicate dressing and transfers
• Poor sitting posture can compromise sitting stability, alignment of
spine, the function of internal organs and general health
• Children’s National Medical Center Washington D.C. Spina Bifida Program Guide
Muscle Length,
Length Measurements, and
Muscle Extensibility
Know your baseline and your goal
Human muscle length measurements are, with few
exceptions, measurements of joint angles.
It may not be possible to determine what degree the
joint itself and its capsular structures (as well as skin,
connective tissue, muscles, and neurovascular
structures) contribute to extensibility limitations and
passive resistance.
Learn pelvic mobility/stability
maintain length/strength of low back
and abdominal muscles
Lordosis
Pelvic Tilt
Keep Pelvis Stable + Low Back Stable
when working on hip flexor
length and strength
STABLE SPINE
Flatten lower back by using lower abdominals to pull pelvis up
Keep it Simple
Encourage lower body awareness: putting on socks, shoes. Washing feet
and toes in the tub. By age 2 children can put on simple clothing items.
EXECUTIVE FUNCTIONING starts early, TRANSITION
Take Care of Your Bones
Diminished Bone Mineral Density
• Either osteopenia or osteoporosis, is a
significant medical problem that must be
considered when treating patients with
myelomeningocele. The measurement of
bone mineral density may help identify those
patients at risk for sustaining multiple
pathologic fractures. Single photon
absorptiometry to measure BMD is readily
available, inexpensive, and has been shown
to be accurate and reproducible.
•
Bone Mineral Density (BMD) in Myelomeningocele Lee S. Segal, MD
Dr. Lee Segal and Nurse Cindy Hulse
Know your orthopedic doc and nurse coordinator
All questions are good questions!
Orthopedic Warning Signs
• Weight bearing and muscle contractions
are essential to the growth of normal
bones. The child with spina bifida may lack
some of this stimulus. The bones are
normally strong but after mobilization is
lost or after prolonged time in bed, the
bones lose calcium and become brittle and
are quite prone to fractures.
• Swelling, deformity, local heat or redness,
and fever are warning signals of a fracture.
An Introduction to Spina Bifida by David G. McLone, M.D., Ph.D
Sit on your ischial tuberosities,
extend/straighten your back
Proper Position of Pelvis is Crucial to Proper Posture
Kiddy-Up Kit or Nadia Seat www.specialkidszone.com
Comfort Stretch TM
A simple to use, in-home therapeutic tool that augments physical therapy.
The unique design targets muscles while they are relaxed.
Take care of your feet
Pampered Toes
Gyms are more accessible
Balance Gym, Mobility Fitness, Total Access (Stage 2 IFI Inclusive Fitness Initiative)
Good Core Strength
• Joseph H. Pilates (1880-1967)
He worked with war casualties by adding springs to beds to
provide resistance and stretching training to help develop
their muscular strength and flexibility
• Devised a core strengthening program (centering)
• Focus on proper posture and technique
• Overall muscle length and strength
• Pelvic control requires the balance of back and abdominal
musculature
• Arms and legs are more efficient when core is strong
• If you are walking poorly, you tend to overuse all of your
muscles and joints.
Joseph Pilates
(1880 – 1967)
Pelvic Control Requires Balance of Back and
Abdominal Muscles
Benefits of Pilates
(and programs for length and strength)
•Improve strength, flexibility and balance
•Tone and build long, lean muscles
•Challenge deep abdominal muscles to support the core
•Engage the mind and enhance body awareness
•Create efficient movement patterns making the body less
prone to pain and injury
•Reduce stress, relieve tension and boost energy
•Restore postural alignment
•Create a strong, flexible spine
•Increase joint range of motion
•Improve circulation
•Heighten neuromuscular coordination
Shoulder Stability
is critical to doing Pilates exercises safely and effectively.
Beyond the studio or gym, once you train yourself to
stabilize the shoulder area through well-aligned
exercise, you take that knowledge into everyday
movement, thereby protecting your back and neck, and
increasing movement efficiency. Shoulder stability is
one of the many functional fitness aspects of Pilates.
When we talk about shoulder stability, the term scapular
stability is often used. Your scapula are the wing-like
bones on your upper back, the shoulder blades.
Relax your shoulders, draw your shoulder blades down or
settle your scapula on your back.
By increasing your awareness of the placement of your
scapula, you will stabilize movement and promote a
• Be aware of shoulder alignment
(thumb up)
• Brains over Brawn (sensible, proper technique)
• Be aware of position of shoulder
blade
Length, Strength, Balance, Stability,
Talk to your doctor
Mobility…
before you start.
Statue of liberty standing
to lengthen trunk,
strengthen gluteus
medius for stepping
Work with your therapist to
set your goals.
Always work both sides, left
and right.
Pelvis, back and hips are
important for stability
Pilates
Benefits of Pilates
(and many programs for length and strength)
•Improve strength, flexibility and balance
•Tone and build long, lean muscles
•Challenge deep abdominal muscles to support the core
•Engage the mind and enhance body awareness
•Create efficient movement patterns making the body less prone to
pain and injury
•Reduce stress, relieve tension and boost energy
•Restore postural alignment
•Create a strong, flexible spine
•Increase joint range of motion
•Improve circulation
•Heighten neuromuscular coordination
Hands and Knees Position
is the best for learning
stable/neutral spine position
Keep your chin up
Slow and steady
Wins the race
Monument Circle
many views on a single subject
Enjoy the conference and Indianapolis + Stretch = Arms Up