OT & Podiatry in Paediatrics Mutual areas of concern

Caryn Mincherton OT

Outline• When to refer to OT• How do we assess?• What do we look for?• Tips for parents• Pearls to take back to your practice

Occupational Therapy Podiatry

PAED

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Still basket weaving??

How do we work together?We know podiatrists don’t just look at feet.

Similarly, OT’s don’t just look at hands

Co-Morbid Issues

• The child with low muscle tone– Flat and pronated feet– Poor postural control– Difficulty sitting for fine motor tasks– Feeding issues

…and further

• Hands need arches too In hand manipulation and

Speed and dexterity

Building blocks for development and learning

Emotional Regulation

Social – Play Skills

Sensory Processing• Body Awareness• Sensory Modulation Motor Skills

• Co-ordination• Bilateral Integration• Gross Motor• Fine Motor

Visual Skills• Visual Perception

• Where we come in…– Assess– Skills training – Strategies– Adaptations– Building skills

First step, assessment

• Informal (Clinical Observations)• Formal (Standardised Assessments)

– Gross and fine motor movement– Sensory processing– Visual perceptual and visual motor– Developmental assessments– Handwriting

Treatment

• Where?• How?• What?

Benign Joint Hypermobility Syndrome (BJH)

BJH48% Clumsy

36%Poor Coordination

14% Speech and language issues

48%Issues with

participation in PE

40% Handwriting difficulties

BJH – Joint Involvement

92% Knees

75%Ankles

79% Fingers/MCP

87%Elbows

82% Wrists

BJH

• 84% of children with BJH have motor skill difficulties.

• 14% correlation with speech and language concerns.

Quick checks

• Ask the child to fully extend elbows– Greater than 180°?

• Gently see if their fingers bend back at the MCP’s– Greater than 90°?

• If BJH present, but no functional limitation NO OT

What works to improve strength

Activities/Exercises• Increase strength• Increase stability

especially in the mid-range (Co-contraction)

• Heavy work

Joints?

• Provide stability– Use splints, lycra or

neoprene• Conserve joints

– Decrease load/weight– Alternate methods to

complete a task

What do we use

• Adapted equipment• Adapt the environment

High school years

• Handwriting– Legibility– Speed

• Exams• Curriculum Council process

Toe Walkers

• Co-morbidity• Ideopathic

toe walkers• Non-ideopathic

toe walkers

Toe walkers and sensory processing

• Proprioceptive seekers• Tactile Avoiders on

different surfaces.

Sensory Processing

We all do it, every day.

• Tactile• Proprioceptive• Vestibular/Movement• Oral• Auditory• Visual• Olfactory

Sensory Seekers and AvoidersThis is the child that you have bouncing off the walls in your clinic

This is the child that you see that is unusually tentative or avoidant of touch/movement

Motor Skills

• Assessment• Treatment

– Top-down– Bottom-up

Motor Skills

• Vestibular- children need good quality efficient movement skills and tactile skills for motor planning

• DCD/orthotics link

Red Flags• At any age, the child who is

– Too busy– Too quiet (defensive/anxious)– Low tone (fatigues)

More …. Red FlagsAt Three

• Arms in high guard when walking• Drooling• Can’t hold their own bodyweight on monkey bars

At Four

• Can’t cup their hand• Can’t imitate simple finger actions like Twinkle Twinkle• Can’t balance on one leg for 2-7 seconds

At Five

• Hand dominance not well developed – sometimes swaps• Can’t heel toe walk along a 2 metre line• Cant complete 10 hops on preferred foot.

At Six

• Thumb collapses with circle thumb-finger test• Cannot Skip- 85% can skip well.• Cant hop on one leg for 3 mtrs (first left then test right).

Pearls…

• Physical activity– Increase good quality

movement, decrease screen time

• Heavy work– Can calm a deregulated child– Stimulates muscle strength

in the hypotonic child– Improves proprioception in

poorly coordinated children

Top 3 fine motor activity pearls

Theraputty / super strengthening kit from Skillbuilders

Tricky Fingers Game

Highly motivating writing tools e.g. crayon rocks , overwriters , silkies

Top 3 gross motor activity pearls

Animal walks

Scooter boards

Space Hoppers

Take away points

Toe walking

BJHS

Flat feet

Warts OT is a highly engaging,

motivating process helping children meet

their goals.

Questions for you???

• What are your thoughts on trampoline use and toe walking?

• When should children have their orthotics on and off?– During our therapy sessions?– At the beach?– On trampolines?

info@skillbuilders.com.au