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Baclofen is a skeletal muscle relaxant used to decrease spasticity. It can be given orally or intrathecally into the spinal cord after a device which is known as the Baclofen Pump is surgically implanted in the patient's abdomen. Baclofen is used in the case of severe spasticity. It can be used to decrease spasticity to increase independent function in a child, or it can decrease spasticity to assist in positioning a child as well. At PTA we treat children who receive varying levels of Baclofen, and we are skilled at recommending whether or not a child would benefit from the use of the drug. We also refer patients to doctors who specialize in the prescription and management of Baclofen as a vital supplement to the therapy received in our offices.
Botox injections are used in children to affect the nerve-muscle junction in spastic muscles. It is injected into muscles that have spasticity that interferes with a child's function and into muscles that are prone to contractures. The effects of Botox are not permanent, though they can last up to 4 months. During this time after injection, passive and active range of motion and functional exercises are of utmost importance so that muscle length and strength can be gained now that spasticity has been removed. These injections are sometimes also combined with serial casting or other orthotic fabrication to ensure that the increased range of motion or musculoskeletal alignment that was achieved via the injections is not lost in an excessively rapid manner. We work daily with children whose spasticity is managed with Botox, and we are skilled at recommending which muscle groups would benefit the most from injections, as well as referring to doctors who specialize in the use and administration of the drug.
Genetic and Chromosomal Syndromes
Genetic disorders are carried in the genetic code of each individual and are inherited in either autosomal dominant / recessive or sex-linked dominant / recessive patterns from the parents. Sometimes there is a mutation of the gene. Here the child is affected with the disorder, but the parents are not carriers of that gene. Some examples of genetic disorders are Muscular Dystrophy, Rett Syndrome and Hemophilia.
In chromosomal disorders an entire chromosome or a large segment of one is missing, duplicated, or altered. Examples of these disorders are Down's Syndrome, Wolf-Hirshorn Syndrome, DiGeorge Syndrome, Fragile X Syndrome, Cri-DuChat Syndrome, 1p36 Deletion Syndrome, Turner's Syndrome, Triple X Syndrome, Williams Syndrome, Angelman's Syndrome, Klinefelter's Syndrome, Cornilia DeLange Syndrome, Noonan's Syndrome and Smith Magenis Syndrome.
Our staff has extensive experience in meeting the physical therapy, occupational therapy and speech therapy needs of children diagnosed with genetic and chromosomal disorders. In addition to providing needed therapy, we assist parents in finding support through parent groups, literature, and interaction with other parents at the office.
Intensive therapy gives the child the chance to get the practice and the boost that they need to move ahead. Specifically, intensive therapy is physical therapy, occupational therapy &/or speech therapy on a concentrated basis in order to meet the desired goals of the child and family. Children are treated 3-4 hours per day for a period of one to three weeks. At PTA every child is unique and so treatment is tailored to the particular needs of each child. Motor learning principles and the latest information from movement science is incorporated. Parents are given an extensive report and home program instructions so that the work and progress may continue after the intensive program. The family will receive a video or photos during the intensive to ensure the ability to take the information home. This is the child's opportunity to go beyond the traditional approach of 30 minutes to, at most, a few hours of therapy a week. This is the opportunity that you have been looking for, for your child!
Partial Weight Bearing (PWB) Treadmill Training (also called PWB Gait Therapy) is a new form of treatment based on research. According to www.litegait.com "PWB Gait Therapy relies on a combination of two elements: 1. A postural control device that reduces the amount of weight borne by the patient; and 2. A treadmill operated at slow speed to retrain proper patterns of walking. Researchers in Canada, Germany, and the United States have clinically tested and established the usefulness of this gait retraining program." This type of training has also been found to be effective with individuals who are currently working on sitting and other balance goals, even head control. The suspension system is also used without the treadmill for balance and coordination training in sitting and standing, allowing the child to move without fear of falling. The suspension supports the upright posture while the child builds strength, endurance and postural control.
Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, that have medical problems or other health-related conditions that limit their abilities to move and perform functional activities. At Pediatric Therapy Associates our PTs examine each child and develop an individualized plan using treatment techniques to promote the ability to move, develop function, prevent further impairment and disability, reduce pain if present, and enhance participation in life. Pediatric physical therapy involves the treatment of neuromotor disorders with methods, such as massage, manipulation, manual therapy, therapeutic exercises, gait training (walking), aquatic therapy, and neurodevelopmental activities to promote qualitiy of life and to maximize function in developmental disabilities. PT's are also versed in the prescription and design of adaptive equipment including wheelchairs, other seating devices, standers and more. PT's are integral for the design and fabrication of various splints and orthotics, especially those for the lower extremities (legs). Ultimately in PT the most important outcome for a child is to assist that child in achieving the ability to participate in family and community life to its fullest.
Serial Casting/ Inhibitive Casting
A non-surgical treatment used for children who have limited mobility of a joint due to muscle tightening. A series of casts are used to provide prolonged elongation of affected muscles and tendons. The child will gain functional use of the affected area by increasing available range of motion and decreasing muscle tightness. Casting may also serve to increase proprioceptive awareness of alignment. Physical And/or Occupational Therapy are usually recommended both during and after casting. Serial casting is sometimes used in conjunction with Botox injections.
Speech Therapy
Pediatric speech therapy helps children to communicate more effectively. The pediatric speech-language pathologist provides services to infants, children and adolescents who have genetic, congenital developmental or acquired conditions that affect receptive language, expressive language, articulation and phonological processes, oral-motor, feeding and swallowing, respiration, voicing and stuttering (fluency). The SLP evaluates and treats a variety of disorders, including articulation disorder, phonological disorder, childhood apraxia of speech, stuttering, vocal dysfunctions, cleft lip and palate, orofacial myofunctional disorders (tongue thrust), and feeding swallowing difficulties ( also called dysphagia).
Specialization of infant therapy includes muscle strengthening and organization of the oral-motor system to allow for improved sucking, swallowing, and ability to transition to various textured foods. The role of the SLP has become more prominent with a new generation of behavioral feeding disorders secondary to gastroesophageal reflux...
Augmentative and alternative (AAC) to help children with severe speech and language problems to communicate is provided at PTA. SLPs provide training in special equipment ranging from alphabet boards to more sophisticated electronic speaking devices.
Family/caregiver education is an important piece of the training and education provided by the SLP. The SLP helps the family to adapt the environment and use strategies to help enhance communication and oral-motor skills
Threshold Electric Stimulation (TES) is based on low-intensity (subthreshold), long duration, electrical stimulation using electrodes placed on the skin. In the TES protocol, developed by Dr. Karen Pape, low-intensity electrical stimulation is used to increase local blood flow. This, in combination with the nightly secretion of trophic hormones, will enlarge the atrophied (weak) muscles. This then can improve motor function. Dr. Pape has shown positive results of treatment in patients with several neurological diagnoses (Pape 1991, Pape et al. 1993). Since the electric stimulation is not strong enough to cause a muscle contraction and is at a sensory level most children tolerate this protocol very well. It is worn at night while sleeping so the treatment does not take a lot of effort on the part of the families so with a small amount of effort, treatment can have good results in many children.
Torticollis (also known as developmental muscular torticollis, congenital muscular torticollis, or infantile torticollis) is an increasingly common condition in which a child's head is tilted to the side, and generally rotated to the opposite side. This may or may not also present with Plagiocephaly - cranial/facial deformation or asymmetry from asymmetric forces being placed on the child's developing head and face. Both of these conditions are managed at PTA through hands on treatment during therapy sessions, and more importantly through instruction to caregivers about stretching, strengthening, and positioning at home and in the child's everyday environment. Referrals to specialized craniofacial doctors are also made when a child requires a custom helmet fabrication to decrease the appearance of plagiocephaly, as there can be long term consequences for the child should asymmetry remain.
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