Symptom Management
Orthopedics
Common Orthopedic Problems
Most of the orthopedic problems that affect our children are those that result from high tone
(muscle tension) and lack of weight bearing (standing).
Hip subluxation (partially out of the hip socket), which can lead to dislocation, can occur at an early age. This problem is generally identified during an infant physical examination. To treat this condition, the child is positioned with the legs spread apart or “abducted”. This can be accomplished either manually by proper holding techniques (e.g., holding the child with your arm between the legs to keep them apart), by pillows wedged between the legs, or by the use of a special brace. Dealing with special problems like these has prompted several parents to explore unique and creative solutions.
“My child was given a brace called a Pavlik Harness® at six months of age for his subluxed hip. It strapped over the shoulders, attaching to the thighs to hold them in abduction. The straps dug into his shoulders, causing discomfort and abrasions. He cried constantly while in it. My mother and I designed a “vest” that attached to the thighs in a much more comfortable way for my child.”
Parents should not feel inhibited about designing any equipment that may make their child more comfortable and make life easier. Should you find a helpful and creative solution to a problem, please share your experience with NTSAD so that other parents can benefit from this information.
If your child's hip problem progresses to dislocation, and your child is not walking or standing, it may not be a problem. In the absence of weight bearing, there is usually no discomfort from a dislocated hip.
Another common orthopedic problem is contractures. With this condition, the joints remain slightly flexed (bent) and eventually are no longer able to completely return to their normal position. This condition inevitably occurs over time. The best way to prevent or limit contractures is to continue a regular physical therapy program which includes exercising the joints, ligaments and muscles with passive exercise techniques. Some of the common contractures are: wrist drop and foot drop, as well as contractures of the knees.
Various splints can be worn during parts of the day or during the night to help prevent the progression of contractures. Ankle-foot orthotics (AFO Splints) can be used to prevent foot drop. These splints generally are made from a thin plastic material, extend over the heel and foot up to the mid calf and keep the foot at a 90 degree angle. They are worn over a sock, but you can put a sock and shoe over it as well. Surgery can also be done to correct tight heel cords that can cause the foot to point downward. Hand splints can be worn to help keep the thumbs abducted (spread apart). Neoprene® Sof-Splints allow for normal thumb movement and help to prevent cortical thumb (when the thumb crosses in over the palm).
Curvature of the spine (scoliosis) can also be attributed to high tone, which gradually causes the spine to curve towards the area of greater tone. If the curve becomes severe, it can cause discomfort as the hip and lower rib cage begin to meet and the internal structures become compressed. A body jacket is the one answer to help stall the progression of scoliosis and give the child relief from discomfort.
“A body jacket was just one more intervention that I could not deal with. I couldn't imagine him being comfortable in that hard plastic. I also had trouble with the idea of the plastic coming between our bodies while we were snuggling. But he was clearly becoming uncomfortable as the scoliosis progressed. The body jacket definitely helped. His scoliosis actually improved and he is now more comfortable. I just take it off when I want to snuggle with him.”
The ongoing involvement of a physical therapist in your child's care is very helpful in preventing various problems and in monitoring existing ones. Early intervention programs may provide this service. In some states, supportive services such as physical therapy are included within the scope of special education under Entitlement Law 94-142. Check your state or local programs to determine what services are available in your region.