Pediatric physical therapy / [edited by] Jan S. Tecklin. — Fifth edition. p. ; cm. Includes bibliographical references and index. ISBN ( hardback). Trove: Find and get Australian resources. Books, images, historic newspapers, maps, archives and more. This books (Pediatric Physical Therapy [PDF]) Made by Jan Stephen Tecklin About Books none To Download Please Click.
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Download Pediatric Physical Therapy PDF File; 2. Book Details Author: Jan S. Tecklin Pages: Binding: Hardcover Brand: imusti ISBN. Professor, Pediatrics, Physical Medicine and Rehabilitation. Sidney Kimmel particular our understanding of proper treatment and drug therapy. The authors. The textbook Pediatric Physical Therapy by Jan Tecklin provides phys- ical therapists with an evidence-based approach to the assessment, evalua- tion, and .
There- nancy 1 a 25 percent chance of the offspring having fore, the respiratory complications of chronic neuro- the disease, 2 a 50 percent chance of it being a muscular disease in children are largely due to respi- carrier, and 3 a 25 percent chance of it being free of ratory muscle weakness and dysfunction. The basic the CF gene. There is currently neither an accepted pathologic process will often determine the nature of heterozygote carrier test nor a prenatal homozygote the respiratory complications: mild and temporary or disease test.
The clinical course of the disorder, like its onset, is Diffuse pathologic conditions of the CNS caused extremely variable. Although CF is still considered a by disease, trauma, or perinatal anoxia may result in fatal disease, the survival rates have continued to acute respiratory failure, chronic respiratory insuffi- improve slowly for the past 25 years. Recent reports ciency, or complications associated with poor secre- of large numbers of adults with CF haveappeared.
Children It must be noted that CF is one of the few diseases with severe problems in motor control or cerebral among young people in which there seems to be a palsy often have perinatal anoxia as the etiologic female disadvantage. Altered reflex and neural control mecha- Pulmonary involvement in CF, which results in the nisms may change the physiologic response to chem- greatest mortality, begins when thick voluminous mu- ical and mechanical stimuli within the lung, brain- cous secreted by goblet cells and mucous glands is stem, major vessels, blood, and cerebrospinal fluid.
These secretions These altered mechanisms are often found in children provide a culture medium for bacterial pathogens, with familial dysautonomia, sleep apnea, and obesity- notably Staphylococcus aureus and Pseudomonas hypoventilation syndrome. Spinal cord injury can aeruginosa, with the resultant infection producing still result in numerous respiratory complications, which more mucous.
A vicious cycle of mucous obstruction have been described elsewhere in this special issue.
In mon respiratory complications that often lead to the addition to the destructive process, the goblet cell and mortality associated with these disorders. The progression of pul- portion of lung. When a child has a rapid respiratory monary disease and efficacy of treatment appear to rate, breaths are more shallow and a larger percentage play a major role in determining survival for children of the minute volume ventilates only the anatomical with CF. The pulmonary complications of CF include dead space.
In this inefficient pattern of breathing, pneumothorax, hemoptysis, lobar or segmental atel- decreased air movement to the distal portions of the ectasis, pulmonary artery hypertension, and cor pul- lower lobes is common. The therapist may teach the monale. The pulmonary aspect of CF has been fully child to slow the rate and increase the volume of each described previously. The therapist must take care to directed toward controlling the pulmonary infection.
Appropriate choice of medi- may be lost. Currently there is no effective oral prepa- with neuromuscular disease. When the child is acutely sive nutritional support, physical rehabilitation, and ill, the use of accessory muscles of inspiration and early psychosocial and emotional counseling are all expiration to augment ventilation is physiologically made available through a national network of CF and mechanically appropriate.
The physical therapist must train the all become important issues in caring for individuals child to discontinue this inefficient type of breathing. No objective data exist, however, to support the TREATMENT notion that short-term changes achieved during treat- ment have a residual effect on the muscular pattern Physical therapy evaluation of children with of breathing.
The respiratory evaluation should examine the pattern of breathing, strength of the respiratory Evaluation of inspiratory muscle strength and en- musculature, mobility of the thorax and shoulders, durance as well as development of a strengthening and ability to clear secretions.
The nonrespiratory program when appropriate are important facets of evaluation should determine overall strength, range physical therapy for children with chronic lung dis- of motion, endurance, and response to physical activ- ease.
Based upon an objective evaluation, the thera- ity. Merrick and Axen recently described objec- Pattern of Breathing tive expressions of inspiratory muscle shortening, maximal velocity of shortening, and strength by using By examining the child's breathing pattern, the spirometry, flow rates, and maximal inspiratory pres- therapist can answer two major questions: Is the sures, respectively. Is an economical muscular pattern used for whether increased strength or endurance is the spe- breathing?
Improved respiratory muscle function may Auscultation to determine air entry and measure- be beneficial when an increase in ventilation is nec- ment of minute volume respiratory rate times tidal essary during periods of increased physical activity or volume provide an objective answer to the first ques- during acute exacerbations of the child's chronic res- tion.
If an area of lung served by a patient's bronchial piratory illness.
Chest radio- spiration. Older improve volumes, and using a rapid, deep breathing children, when questioned, can identify areas of their maneuver called the maximal sustainable ventilatory lungs in which they are congested. Necessary ance in the accessory muscles may augment inspir- components for an effective cough include a large atory reserve for periods of ventilatory stress. These three events will cause a marked increase in intrathoracic Regardless of disease, the child whose thorax or pressure that is released, as a cough, by a sudden shoulder girdle lacks full range of motion will have opening of the glottis.
The therapist must assess the increased work to maintain adequate ventilation. Range of motion and config- raise sputum. These produced.
A child with asthma will have intermittent active efforts may be augmented by use of incentive production of secretions that is more prevalent follow- spirometers or, in the presence of inspiratory muscle ing an exacerbation of the asthma or a respiratory weakness, by use of intermittent positive pressure infection.
Secretions in the child with neuromuscular devices. A child, whose thorax is normally more disease vary widely. A youngster with muscular dys- compliant than that of an adult, should respond well trophy may have no secretion retention until very late to these techniques.
Improved range of motion in the in the progression of his disease, yet a child with shoulder joints will also help improve thoracic mo- cerebral palsy who has poor swallowing function and bility. Specific treatment techniques have been dis- chronically aspirates food may have large amounts of cussed by others. The youth with CF who has significant pulmonary involvement will need daily secretion clearance.
Bronchial Hygiene Modalities of treatment to clear sputum, that also must be taught to parents, include positioning for Secretion clearance, a major concern for physical gravity-assisted bronchial drainage; manual tech- therapists who work with children having acute res- niques including percussion, vibration, and chest-wall piratory illnesses, remains a great concern for children shaking; and secretion evacuation including cough- with chronic lung disease.
Because of the small cross- ing, huffing, and, if necessary, endotracheal aspira- sectional area of a child's airway, the predisposition tion. These techniques have all been described else- exists for small amounts of mucous to occlude ab- where in this issue.
When a large percentage of airways is occluded by secretions, Physical Rehabilitation chronic respiratory dysfunction can rapidly deterio- rate into acute respiratory failure. A critical portion In addition to the respiratory evaluation, the child's of the physical therapy assessment, therefore, is eval- overall physical strength, exercise tolerance, and pos- uation for secretions and determination of the child's ture must be assessed.
In a recent review of pulmonary ability to clear those secretions actively. Auscultation of the lungs is a useful testing for major muscle groups can be performed method for identifying airways occluded by mucous.
Evaluation of posture may take note secretions. Decreased or absent breath sounds different forms, but a commonly used method in- may indicate atelectasis that is often accompanied by cludes a grid system as described by Kendall and mucous obstruction of an airway. Palpation of the Boynton. A useful and simple index a pattern of rapid, shallow respiration may be more of fitness is the heart rate achieved during a standard efficient for the child in respiratory distress than the work load and the time necessary for heart rate to supposedly improved pattern of slow, deep breath- return to the preexercise resting level.
A treadmill, ing. Also, the ing deep expiration. Therefore, the use of unusually child with neuromuscular dysfunction should be eval- deep respiratory efforts in children with asthma must uated, if appropriate, for coordination, ability to per- be cautiously initiated because of the possibility of form activities of daily living, developmental level of increased airways resistance.
A physical rehabilitation program based upon the Respiratory Muscle Function strength and exercise tolerance assessment should be developed for the child. Standard methods of muscle Based on the results of several recent projects, the concept of specific strength and endurance training strengthening may include progressive resistive exer- for the respiratory muscles appears to be justified for cise, isometric exercise, and use of isokinetic devices.
Merrick and Axen Training methods to improve exercise tolerance may state that the diaphragm, like other skeletal muscle, include running on a treadmill, riding a bicycle er- can adapt to training because its fiber composition gometer, free-running, jogging, or swimming.
In chil- and oxidative capacity are modified in response to dren with advanced lung disease, arterial blood gas functional demands.
This lack onstrated for patients with quadriplegia improve res- of objective data is most apparent for breathing re- piratory muscle strength and endurance. Clinicians commonly muscle endurance training was reported by Keens refer to studies performed using adult subjects with and associates, in , using patients with CF as chronic lung disease and infer that the benefits of subjects and physical therapists as controls.
However, the sig- subjects were assigned to one of two groups—venti- nificant difference between adult and pediatric res- latory muscle training or general physical activity. The groups speculative at best. The Pattern of Breathing latter group was engaged daily in vigorous physical activity such as rowing and basketball.
After a four- There have been no studies evaluating attempts to week period of daily MSVC training, the ventilatory alter patterns of ventilation in children by changing training group had a statistically significant improve- the pattern of respiratory muscle use.
Nor have in- ment in MSVC of 52 percent. After an identical vestigators justified the claim that children will be MSVC training program, the control group showed spared physical work by changing their breathing an improvement in MSVC of 26 percent. The re- pattern from that of shallow breathing with accessory markable finding in this study was the 57 percent muscle predominance to a pattern increasing tidal improvement in MSVC for the physical training volume and decreasing respiratory rate.
One author group after four weeks of daily activity. The authors has suggested that because of the increased inspir- postulated that the normal ventilatory response to atory work needed to achieve large lung volumes by vigorous physical activity served as a training tool to overcoming elastic recoil of the lung and chest wall, increase endurance of the ventilatory muscles.
Two studies have compared the efficacy of me- Most of these studies had as subjects patients with chanical devices and manual techniques for chest CF, but at least one author confined his investigation percussion and vibration. The experimental efforts can treated using gravity-assisted bronchial drainage and be divided based upon dependent variables. A num- both manual and mechanical percussion and vibra- ber of authors have examined the effects on pulmo- tion.
Both treatments produced improvement in ex- nary function of bronchial hygiene, and others have piratory flow rates, indicating improved airway status, relied upon changes in sputum transport or removal. Secretion removal is greatly measurable sputum. With the addition of percussion enhanced and large and small airways obstruction, and vibration, 22 of the 23 subjects produced sputum denoted by pulmonary function tests, is decreased.
Lorin and Denning found an increased amount of sputum per cough and per treatment session with 20 Physical and Breathing Exercises minutes of gravity drainage as well as percussion and vibration when compared to a control test of five Physical reconditioning to improve cardiovascular voluntary coughing attempts. Wong and colleagues examined the effects upon Because swimming appears to provoke fewer symp- mucociliary tracheal transport rates of gravity drain- toms of exercise-induced asthma, several investigators age in subjects with CF.
No change , found improvement in test results of both large was observed for either group for pulmonary function and small airway function. This improvement was of or personality traits but the swimming group had a the greatest magnitude at 45 minutes after treatment. The number of wheezing pulmonary function values after a treatment that days for the control group increased during the con- consisted of only two drainage positions.
Levison and God- capacity at heart rate of , a quantitative drug frey employed only two drainage positions—hardly score, FEVi, and response to an exercise challenge. By studying Children in the treatment group had a statistically mildly involved patients, Schwenk and associates did significant improvement for all values except FEV1, not have the most important indication for treat- and the parents spontaneously reported improved ment—large amounts of secretion.
The bronchospastic re- Huber and co-workers treated one of two groups sponse to a standardized exercise challenge remained of children having moderately severe bronchial unchanged. The exercise program included eight tion programs for children with Duchenne muscular activities whose sequence was varied during the eight dystrophy MD , and a recent study examined the weeks of the training project.
The FVC and FEV1 benefits to children with cerebral palsy of a similar were measured at the beginning and end of the eight- pulmonary program. Although the results of each week exercise schedule. The results showed a mean study appeared promising, factors inherent in the increase in FVC of 0.
The control group subjects and lack of statistical analysis, prohibit gen- had no change in FVC. The FEV1 was within normal eralizations regarding the usefulness to improve pul- limits for both groups and did not change with the monary function of exercises in children with chronic exercise program.
Major studies of physical reconditioning for chil- Hobermann, in , studied seven subjects with dren with CF have not been reported. Several authors MD whose vital capacities were below 75 percent of have examined the responses of children with CF to the predicted value. Larson and Souhrada studied the took part for four months in an intensive rehabilita- pulmonary responses to exercise in 12 children with tion program that included breathing exercises.
Im- CF of mild or moderate severity. These changes with MD matched for age and functional level. The normal children and 20 children with CF. Subjects with severe CF had significant dim- ance, and forced expiratory flow games used three inution of all values. The authors concluded that days each week. At the end of the program no statis- limitation of physical activity was unnecessary for tically significant differences between the treatment children with mild or moderate CF, but in those with and control groups were found for pulmonary func- severe involvement mild exertion could elicit signifi- tion.
No statistical analysis of the data lung disease. Physical Therapy Modalities. WB P ] RJ P5P43 However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication.
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