We posted a clinical case study a few weeks ago and had some great responses. We wanted to share one comment from our distinguished faculty member; Barbara Hypes
DEAR ERI COMMUNITY: Hello! I am a pediatric physical therapist (Early Intervention) currently struggling with a little girl (19 months old); significant hypotonia, NO head control, dislocating joints (elbows, shoulders, hips and knees), joint contractures in lower extremities, minimal movement, can roll to her side, no other gross developmental milestones met, bright girl, tracking, babbling and responding to her name and to simple verbal requests with vision and limited upper extremity movements in a supine position or supported in her xpanda chair. Has seen multiple specialists on the east coast and all are scratching their heads. MD has been ruled out, SMA ruled out. Is feeding via g-tube but has nice oral motor munching patterns and drinks from a straw. Thoughts on activities for promoting more head control or muscle activation. Cannot stress this enough, NO head control at this point. Have used a Hensinger, Miami J, and DMO suit to supplement supported sitting activities.
Thanks for any input.
The biggest mistake I observe is that people try to promote head lifting without attending to shoulder girdle stability and alignment in the shoulders and neck. In therapy I would attend to alignment and promote activity in the upper trunk and shoulder girdles. In regards to head lifting, I encourage therapist and parents to think about “making the child’s head weigh less”. When the head is supported there is no “traction” or pulling, instead the weight of the head is partially supported by the adult helping the child activate what they can without being overwhelmed by the mass of the inactive head. This can lead to active assisted recruiting and the therapist needs to observe what responses the child can elicit and build on his/her control by tweaking the provided support.
I also support the idea of bracing and am encouraged to discover how open you are to adaptive equipment. But, this won’t necessarily lead to control and might lead to greater compensations so my overall goal is MAXIMUM FUNCTION WITH MINIMAL PATHOLOGY THROUGHOUT LIFE.
I too would strongly encourage parents to continue to pursue a diagnosis. Have mitochondrial issues been explored? Genetic testing?
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