Concept #25 Mobility
Muscular Dystrophy (MD) / Group of disorders characterized by:
-progressive muscle weakness / wasting , and contractures with the loss of independent
ambulation by 9 to 12 years of age.
-Inherited
-Duchenne’s - most common form of MD
oSex-linked recessive -occurs only in males.
-Ultimately affects the muscles of Respiration allowing pneumonia to develop easily.
Death usually occurs about age 20 due to respiratory or heart failure.
Muscular Dystrophy- symptoms
-Normal development- s/s start to be apparent about age 3.
oWaddling
oWide-based gait
oLordosis, scoliosis
oDifficulty climbing stairs, running, or peddling a bike.
-Gower’s sign- if sitting on floor cannot get up.
oMust roll onto stomach, push self-up to knees, then “walk” their hands up their
thighs to stand.
-Need to use wheelchair by 9 to 12 years old
MD- diagnostic tests
-EMG- Decreased electrical impulses in muscles.
-Serum creatine kinase: If elevated indicative of early MD
-Nerve conduction velocity: Abnormal nerve response to electrical stimulus
-Muscle biopsy-identifies degenerative muscle fibers
MD- treatment
-No CURE
-Major goal it to keep the child as active as possible and out of the wheelchair for as long
as possible.
oPrevent obesity.
oPhysical therapy to help maintain muscle tone.
oOccupational therapy to help master ADL’s.
-Treat complications-infection, trauma
-Surgery for contractures
MD Nursing care
-Help coordinate services.
-Ensure independence as possible.
-Fluids and diet
-Modify care as needed.
-Support for individual and family
Medications
-Glucocorticoids
-Anticonvulsants
-Immunosuppressants
-Antibiotics
Developmental Dysplasia of Hip (DDH)
-Variety of conditions in which femoral head and acetabulum are improperly aligned.
oHip instability= dislocation
oSubluxation= partial dislocation
oDysplasia= abnormal development leading to instability
DDH- Infant Assessment
-Affected limb is shorter.
-Uneven placement of skin folds on posterior thighs
-Positive Ortolani sign
owhen hips are abducted hear a clicking sound
-Wide perineum
DDH Assessment in older children-
-Limp or walk on toes.
-History of a delay in walking
-Affected leg shorter.
-Waddling gait
DDH- treatment
-Positioning hip into a flexed, abducted position to press femur head against the
acetabulum and deepen its contour.
-Infants <3 months
oplace in a Pavlik harness
-Children 3-18 months:
oskin traction followed by spica cast application.
-Children over 18 months:
oSkin traction, surgery then rehab.
Cast Care
-Watch rough edges
-Don’t allow anything in cast
-Neurovascular checks (5 P’s)
oPain (unrelieved by analgesia)
oPallor
oPulselessness (or lack of capillary refill)
oParesthesia
oParalysis (or progressive loss of motion)
-Presence of any of the P’s indicates possible tissue ischemia. NOTIFY PHYSICIAN
IMMEDIATELY
Club foot-Congenital
-Exact cause is unknown
-Foot is twisted in a fixed abnormal position.
-Affected foot is usually smaller and shorter.
Incidence & Diagnosis
-Males more often than females
-May be unilateral or bilateral.
-Suspect heredity and race, NOT environment (intrauterine packing)
-Can be diagnosed prenatally on ultrasound.
-Easily recognized on physical exam- radiographic imaging not usually necessary.
Goal of treatment
-Reduce or eliminate deformity.
-Optimize:
oFunction
oStructure
oMobility
-Avoid unnecessary treatment.
Treatment – clubfoot
-French physiotherapy
-Ponseti Casting Method
oMost common treatment
oSerial casting begun as soon as possible.
oFoot casted in overcorrected position
oCast is changed every week to two for 8 – 12 weeks.
-Abduction orthosis used after casting.
-Surgery if casting/bracing not successful
Nursing Care – clubfoot
-Neurovascular checks
-Monitor cast and cast care.
-Elevate foot/ankle on pillow.
-Careful diaper changes
-Pain management
Family education and support
-Education
-Emotional support
-Developmental stimulus
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