Category Archives: Pediatrics

PT News PTandMe

PT News October 2019

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PT News PTandMe

This time in PT News we recap what our clinics have been posting throughout October 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

sport specialization

1. Sports Specialization Vs. Sports Diversification in Youth Athletes

Written by The Center for Physical Rehabilitation with multiple locations throughout greater Grand Rapids.

Early specialization in one sport has become a trend in youth athletes across the country. This shift is one that has young athletes training year round to develop a specialized skill be able to play at the highest level of competition. Read more

 

food is fuel

2. Food is Your Fuel

Written by Rebound Physical Therapy, an outpatient physical therapy practice with locations throughout greater Bend, OR. 

Truth: we are not nutritionists. That said, after a bit of trial and error and working with patients and various health professionals, we have picked up on these and common do’s and dont’s. Lindsey Hagen, PT, and healthy running nut discusses the importance of balance in your diet and making sure you do what is best for your body, as they say, “You do you…” Read more

 

walking up stairs

3. Climbing Stairs – One Step at a Time

Written by The Jackson Clinics an outpatient physical therapy practice with locations across Kansas, Missouri, and Iowa

Although going up the stairs may feel challenging, some people experience more pain going down. This is because your muscles have to work hard to control your weight as you descend. If you have suffered from knee problems in the past or continue to have problems, it is probably time to look at increasing strength to make navigating stairs less difficult. Read more

Find these locations and others to start feeling better today!

physical therapy near me

concussion baseline testing

Post Concussion Recovery: Why Baseline Testing is Important

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Concussion Baseline Testing

Concussions are serious

Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious.

Once an athlete has been suspected of having a concussion… when is it safe to go back to play? The answer is different for everyone, but there are few baseline tests that medical professionals can administer to make sure that a gradual return to play, work and activity is safe and won’t lead to further damage.

When an athlete has a concussion, it’s important to know how much their functional and cognitive abilities have been affected. With a baseline test you give medical professionals an accurate starting point to correctly evaluate the impact of the injury.

FAQs about Concussion Baseline Testing

Concussion baseline testing is a pre-season exam conducted by a trained health care professional. Baseline tests are used to assess an athlete’s balance and brain function (including learning and memory skills, ability to pay attention or concentrate, and how quickly he or she thinks and solve problems), as well as for the presence of any concussion symptoms. Results from baseline tests (or pre-injury tests) can be used and compared to a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion.

Baseline testing generally takes place during the pre-season—ideally prior to the first practice. It is important to note that some baseline and concussion assessment tools are only suggested for use among athletes ages 10 years and older.

How is baseline testing information used if an athlete has a suspected concussion?

Results from baseline testing can be used if an athlete has a suspected concussion. Comparing post-injury test results to baseline test results can assist health care professionals in identifying the effects of the injury and making more informed return to school and play decisions.

Education should always be provided to athletes and parents if an athlete has a suspected concussion. This should include information on safely returning to school and play, tips to aid in recovery (such as rest), danger signs and when to seek immediate care, and how to help reduce an athlete’s risk for a future concussion.

What should be included as part of baseline testing?

Baseline testing should include a check for concussion symptoms, as well as balance and cognitive (such as concentration and memory) assessments. Computerized or paper-pencil neuropsychological tests may be included as a piece of an overall baseline test to assess an athlete’s concentration, memory, and reaction time.

During the baseline pre-season test, health care professionals should also assess for a prior history of concussion (including symptoms experienced and length of recovery from the injury). It is also important to record other medical conditions that could impact recovery after concussion, such as a history of migraines, depression, mood disorders, or anxiety, as well as learning disabilities and Attention-Deficit/Hyperactivity Disorder.

Baseline testing also provides an important opportunity to educate athletes and others about concussion and return to school and play protocol.

Who should administer baseline tests?

Baseline tests should only be conducted by a trained health care professional such as a physician, physical therapist or trained ATC.

Who should interpret baseline tests?

Only a trained health care professional with experience in concussion management should interpret the results of a baseline exam. When possible, ideally a neuropsychologist should interpret the computerized or paper-pencil neuropsychological test components of a baseline exam. Results of neuropsychological tests should not be used as a stand-alone diagnostic tool, but should serve as one component used by health care professionals to make a return to school and play decisions.

How often should an athlete undergo concussion baseline testing?

If baseline testing is used, research suggests that most components of baseline testing be repeated annually to establish a valid test result for comparison. Baseline computerized or paper-pencil neuropsychological tests may be repeated every 2 years. However, more frequent neuropsychological testing may be needed if an athlete has sustained a concussion or if the athlete has a medical condition that could affect the results of the test.

Many physical therapy clinics have therapists that have been trained in baseline testing software and techniques. Physical therapists can also specialize in return to sports programs for athletes that have experienced concussions.  The decision of when you go back to your sport can be a critical one… especially if you go back to soon. Prevent this by having an accurate baseline available for your healthcare professionals.

Need Physical Therapy? Find a PT Near You!

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more information can be found at http://www.cdc.gov/headsup/

Additional articles from PTandMe about concussions can be found here:

concussion physical therapy   

concussion treatment   

Back Pack Safety

Back Pack Safety 101

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Back Pack Safety
With summer coming to an end and the need for school supplies and backpacks returning, here are a few tips to keep in mind when shopping with your child. Continue below for back pack safety tips to make sure your kids don’t have any unnecessary back pain this year.

Size

  • Should Not Extend Above Shoulders
  • Should Rest In Contour Of Low Back (Not Sag Down Toward Buttocks)
  • Should Sit Evenly In Middle Of Back

Fit

  • Shoulder Straps Should Rest Comfortably On Shoulders And Underarms, With Arms Free To Move – Tighten Shoulder Straps To Achieve This Fit
  • Tighten Hip And Waist Straps To Hold Pack Near Body
  • Padded Straps Help Even Pressure Over The Shoulders

ThinkstockPhotos-78779211

Weight Of Pack

  • Should Never Exceed 15% Of The Child’s Weight To Avoid Excess Loads On The Spine

BackPack Weight Charts

Lifting Of Pack

  • Proper Lifting Is Done By Bending The Knees, Squatting To Pack Level, And Keeping Pack Close To Body To Lift First To Waist Level And Then Up To Shoulders

Carrying The Pack

  • Keep Both Shoulder Straps In Place And Pack Centered
  • Spinal Forces Increase With Distance From The Body’s Center

Posture

  • Uneven Stresses On The Spine Can Cause Muscle Imbalances. This Can Lead To Pain And Possibly Functional Scoliosis.

If your child does start to complain of constant back pain, talk to your pediatrician and make sure that it isn’t a more serious issue such as scoliosis.

Scoliosis is a medical condition in which the spine is curved either front to back or side to side and is often rotated to one side or the other. It can occur at birth (congenitally), develop over time having no obvious cause, but often seen related to posture and growth (idiopathically) or due to an injury or the other condition (secondarily), such as cerebral palsy or muscular dystrophy. The most common type is adolescent idiopathic scoliosis. It usually develops between the ages of 10 and 15, during periods of rapid growth. There are two kinds of curves, single or “C” curves and double or “S” curves. “C” curves are slightly more common than “S” curves. The curve can occur in the upper back (thoracic), lower back (lumbar), or a combination of both.

Strength for necessary upright postures of daily life is essential. Sometimes it cannot be maintained due to a “growth spurt,” fatigue from daily postural demands or poor postural habits common among adolescents. A physical therapist can analyze a patient’s history, habits and activities which may be contributing to their curvature and symptoms. Common findings include tightness and decreased motion and strength in the hips and pelvis, causing the lumbar spine to compensate with side bending and rotation. Treatment will include muscular re-educating techniques and manual techniques to restore motion, posture training, specific strengthening and home exercises.

PT News PTandMe

PT News September 2018

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PT News PTandMe

This September in PT News. Featuring published articles from PTandMe partnering clinics!

Juvenile Arthritis

1. Childhood Arthritis and How Physical Therapy Can Help
Written by Cornerstone Physical Therapy with 5 physical therapy locations in Ohio.

Juvenile arthritis (JA) isn’t a specific disease, but an inflammatory and autoimmune condition in youngsters under age 16. JA affects approximately 300,000 children just in the U.S. and it’s classified within seven different types, depending upon a range of symptoms and coconditions. Read more

 

shoulder physical therapy

2. Hands-on physical therapy effective for common shoulder conditions
Written by the Therapy Team at Rehab Associates with physical therapy locations throughout Central, VA.

Shoulder problems are one of the more common issues that affect the musculoskeletal system, as its prevalence in the general population has been reported as high as 4.8%. The most common shoulder condition that causes pain is shoulder impingement syndrome (SIS), which often results from too much overhead activity.  Read more

Tummy Time

3. Tummy Time Positions
Written by the Therapy Team at The Center for Physical Rehabilitation (CPR) in Grand Rapids, MI and the surrounding communities.

The American Academy of Pediatrics recommends that babies are placed on their backs for sleeping and on their tummies for supervised play time as part of their daily routine. So many of our carriers, including car seats, car seat stroller combos, bouncers and swings put our kids into a supine (aka, on their backs) position and make it more challenging to incorporate tummy time into your day. Read more

childhood obesity

Treating Childhood Obesity With Activity

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When talk focuses on childhood obesity in the United States, words like “critical” and “epidemic” are often used. The tried-and-true prescription of more exercise and better nutrition still holds true, but overweight children face unique challenges when it comes to weight loss.

Why Has Childhood Obesity Increased and What Are the Effects?
The statistics are disturbing. Not only are the overall obesity rates increasing, the heaviest kids are heavier than they were 30 years ago. Why is this happening? Experts who have studied childhood obesity attribute it to a change in lifestyle. The active lifestyle of the past—walking to school, playing outside, and engaging in after-school activities—has been replaced by a sedentary lifestyle of watching TV, playing video games, and using electronic devices like phones, computers, and tablets. Eating habits have changed noticeably, with convenience foods that are higher in fat and calories replacing fruits and vegetables.

The consequences of obesity are significant. A child who is obese may develop high blood pressure, high cholesterol, and type 2 diabetes. These conditions can increase the risk of cardiovascular disease such as a heart attack and stroke. In addition, older teens who are obese may have an increased risk of death during adulthood.

Obesity can also affect emotional health. A child who is obese may have emotional problems in school, and struggle with low self-esteem and depression.

What Is One of the Best Solutions?
Exercise is one of the main tools to fight childhood obesity. The US Department of Health and Human Services encourages children of all ages to be physically active. If your child is overweight, obese, or even of normal weight, recommendations to improve your child’s health include:

  • Encouraging your young child (aged 1-4 years old) to actively play daily in a safe environment
  • Encouraging your older child (aged 5 years and up) to participate in moderate to vigorous activity every day—Your child should aim for at least one hour per day of moderate to vigorous activity. At least 3 days out of the week should be vigorous activity.

Since children often engage in shorter bursts of activity throughout the day, it is okay to count these times as exercise.

Examples of different types of physical activity include:

Moderate-intensity: Brisk walking, hiking, skateboarding, baseball, rollerblading, and bike riding
Vigorous-intensity: Jumping rope, running, and playing sports like basketball, hockey or tennis

The main difference between moderate- and vigorous-intensity exercises is the demand on the body. Vigorous activities force the body to work harder. The heart beats faster and breathing becomes more rapid, but energy is used up faster.

  • Rollerblading
  • Learning karate
  • Playing organized sports (field hockey, soccer, football)
  • Swimming
  • Gymnastics
  • Strength training with weights
  • Rock climbing
  • Cross-country skiing

Before your child jumps into a new fitness routine, it is important that you work with your child’s doctor. Being obese can put a strain on muscles and bones, possibly causing back pain and foot or ankle problems. The doctor can assess your child’s overall health and recommend safe exercises.

What Else Can Be Done to Encourage Activity?
Another important piece to the puzzle is to focus on screen time. Screen time refers to how many hours per day your child spends in front of a screen—whether it be watching TV, playing video games, or using electronic devices. These are sedentary activities that contribute to obesity. The NHLBI recommends that screen time should be limited to less than 2 hours per day, which leaves more time for exercise. You can further encourage your child to be active by planning family outings, like going on a hike, riding bikes, or playing flag football. That way, the whole family can become healthier together.

by Patricia Kellicker, BSN and Rebecca J. Stahl, MA

RESOURCES:
American Council on Exercise
http://www.acefitness.org

Shape Up America
http://www.shapeupus.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Healthy Alberta
http://www.healthyalberta.com

REFERENCES:
Aerobic, muscle, and bone-strengthening: What counts? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm. Updated June 5, 2015. Accessed March 2, 2016.

Chapter 3: Active children and adolescents. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/chapter3.aspx. Accessed March 2, 2016.

How much physical activity do children need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/index.htm. Updated June 4, 2015. Accessed March 2, 2016.

Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7(4):352-356.

NCHBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 12, 2013. Accessed March 2, 2016.

Obesity in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 10, 2016. Accessed March 2, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 3/2/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

sensory integration

Physical Therapy for Sensory Integration

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What Is Sensory Integration?
It is the organization of our senses for use. Our senses include vision, auditory, tactile, olfactory, gustatory, vestibular, and proprioception. Our senses give us information about physical aspects of our body and the environment around us. This is a higher functioning process that takes place inside the brain. The brain is responsible for organizing all sensations to assist us in learning and behaving normally. When your sensory system is functioning appropriately we can form perceptions, manifest appropriate behaviors, and learn without complications. When your sensory system is not functioning appropriately, everything seems to be disorganized and chaotic.

What is Sensory Processing?
The brains ability to receive, organize, and efficiently use information provided to us from all the senses. This means taking information in the environment, organizing it within the central nervous system, and peripheral nervous system resulting in a motor response.

What is Sensory Processing Disorder (SPD)?
Sensory Processing Disorder (also known as SPD), is when the central nervous system is not processing correctly.

There are 3 types of SPD:

1.) Sensory Modulation Disorder
2.) Sensory Discrimination Disorder
3.) Sensory Based Motor Disorder

Sensory Integration Program Goals:

  • Increase Sensory Processing
  • Increase Self Regulation
  • Increase Self Esteem
  • Increase Learning Ability
  • Increase Social Skills
  • Increase Gross/Fine Motor Skills
  • Increase Motor Planning
  • Increase Coordination
  • Increase Socialization
  • Increase Coping Skills
  • Increase Visual
  • Motor/Perception

AND HAVE FUN!

This information was written by ProCare Physical Therapy, an outpatient physical therapy group with 11 locations in Pennsylvania. ProCare physical therapists select only appropriate tests to evaluate and quantitatively measure the patient’s problem. Then, in consultation with the referring physician, an appropriate rehabilitation plan is developed. For more information click here.

strength training

Age Appropriate Strength and Performance Training

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In recent years there has been discussion on training for our adolescent athletes and what is appropriate, whether it be how much, how soon, how specialized? Here are some answers to common strength training questions we hear:

When Can My Athlete Start Lifting Weights?
The NSCA’s position statement states pre-adolescence (7-8 y/o) is a safe age to begin resistance training with graduated modalities and loads. Basically, if the athlete is ready for organized sports, they are ready for some kind of resistance training.

Why Can’t I Just Buy a Blu-Ray Workout for My Adolescent to Train By?
No athlete is the same, and doing a cookie-cutter workout without properly screening for potential injury risk would be negligent. The risk is too great to potentially hurt an athlete by trying to perform exercises their bodies cannot physically handle.

What Should I Look for with Overtraining?
Ongoing decreased performance on field. Often injured or sick. Disengagement from sport and school. Mood swings. Physically tired all the time. Sleep issues. Overreactive emotional response to failure. Depression. Nutrition issues.

A strength training and conditioning specialist can screen each athlete’s movements in order to determine a baseline level of movement and strength. They then develop exercises and drills that will enhance the good movement qualities while addressing any bad motor patterns that may exist. Main components that are often noticed by trained professionals are mobility(flexibility) and stability (strength) issues.

For more on strength & conditioning or to inquire about training with the Center for Physical Rehabilitation at the Academy for Sports & Wellness, please visit: www.pt-cpr.com/academy

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis (JRA; Juvenile Chronic Polyarthritis; Stills Disease)

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JRA_FBsize
DEFINITION
Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In JRA, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child’s growth and development.

There are 5 major types of JRA:

  • Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
  • Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
  • Enthesitis associated arthritis—swelling of the tendon at the bone
  • Psoriatic arthritis—associated with a skin disease called psoriasis
  • Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA

CAUSES
JRA is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

RISK FACTORS

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:

  • Family history of:
  • Arthritis and a family history of psoriasis in a first-degree relative (for psoriatic arthritis)

SYMPTOMS
Symptoms may include:

  • Joint stiffness, especially in the morning or after periods of rest
  • Pain, swelling, tenderness, or weakness in the joints
  • Fever
  • Weight loss
  • Fatigue or irritability
  • Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
  • Swollen lymph nodes
  • Growth problems, such as:
    • Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
    • Joints grow unevenly, off to one side
    • Overall growth may be slowed

Some symptoms are specific to each type of JRA. For example:

  • Symptoms common with polyarticular JRA include:
    • Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
    • Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
    • May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
    • One type of polyarticular JRA may occur with:
      • A low-grade fever
      • Nodules—bumps on parts of body that receive a lot of pressure such as elbows
  • Symptoms common with pauciarticular JRA include:
    • Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
    •  If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
    •  May also have swelling and pain at on the tendons and ligaments attached to the bon
  • Symptoms common with systemic onset JRA include:
    • Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
    • May have swelling in the heart, lungs, and surrounding tissues
    • The lymph nodes, liver, and/or spleen may become enlarged
  • Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
  • Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

arthritis_card_dealt

DIAGNOSIS
You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if Juvenile rheumatoid arthritis is suspected. The specialist is a doctor that focuses on diseases of the joints.

Images may be taken of your child’s bodily structures. This can be done with x-rays.

Your child’s bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Tests of joint fluid

JUVENILE RHEUMATOID ARTHRITIS TREATMENT
Talk with your doctor about the best plan for your child. The plan will work to control swelling, relieve pain, and control joint damage. The goal is to keep a high level of physical and social function. This will help keep a good quality of life.

PHYSICAL THERAPY FOR JUVENILE RHEUMATOID ARTHRITIS
Exercise is done to strengthen muscles and to help manage pain. Strong nearby muscles will support the joint. It also helps to recover the range of motion of the joints. Normal daily activities are encouraged. Non-contact sports and recreational activities may be good options. Physical activities can also help boost a child’s confidence in their physical abilities.

Physical therapy may be needed. This will help to make the muscles strong and keep the joints moving well.

JUVENILE RHEUMATOID ARTHRITIS MAINTENANCE DEVICES
Splints and other devices may be recommended. They may be worn to keep bone and joint growth normal. Some joints may get stuck in a bent position. These devices can help prevent this.

PREVENTION
There is no known way to prevent Juvenile rheumatoid arthritis.

by Jacquelyn Rudis

RESOURCES:
American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:
Hofer MF, Mouy R, et al. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.

Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T506592/Juvenile-idiopathic-arthritis-JIA-enthesitis-related. Updated July 15, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114122/Juvenile-idiopathic-arthritis-JIA-oligoarticular. Updated July 16, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116580/Juvenile-idiopathic-arthritis-JIA-polyarticular. Updated July 15, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset. Updated July 15, 2016. Accessed September 29, 2016.

JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.

Petty RE, Southwood TR, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.

2/5/2013 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.

2/24/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.

9/2/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.

Last reviewed December 2015 by Kari Kassir, MD Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

concussion physical therapy

What We Know About Concussions is Changing

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As concussion research continues we’ve learned that a few of the things we have held as truth isn’t entirely accurate. Including the fact that a person with a concussion shouldn’t be allowed to sleep for long periods of time. So let’s take a look at how concussion treatment is evolving from what was… to what it is now.

Old School vs. New School Concussion Treatment
The first step to treating a concussion is to seek medical help.  Your health care provider is knowledgeable and can help you or your child return to work or sport safely.

Old School Concussion Rehabilitation

  • It’s just a “Mild, Grade-1” concussion.
  • They didn’t have loss of consciousness, it’s not a concussion.
  • Should we have a CT scan or MRI?
  • An athlete needs to be hit on the head to sustain a concussion
  • Injury to the brain only occurs at the initial impact of the concussion.
  • Should I wake them up every couple of hours?
  • Male athletes have a higher chance of sustaining a concussion than females.
  • He’s young, he’ll bounce back quick.
  • Protective equipment will prevent concussion if the newest modelis used.

New School Concussion Rehabilitation

  • Medical professionals with “up-to-date” education on concussions will not use the historic grading scale. The grading scale has been abandoned in favor
    of a symptom-based, multi-faceted approach to concussion management that emphasizes the use of objective assessment tools aimed at capturing the spectrum of clinical signs and symptoms,cognitive dysfunction and physical deficits, and a symptom-limited, graduated exercise protocol leading to a return to play.
  • Approximately 90% of concussions are NOT accompanied with loss of consciousness.
  • Conventional CT or MRI scans will not diagnose a concussion and are not needed or recommended for the vast majority of sport related concussions. While these types of neuroimaging are crucial in the diagnosis of intercranial hemorrhaging and detecting brain lesions, approximately 78% of concussions will have normal scans.
  • Concussions can occur with any movement or jostling of the head as in whiplash injuries or rotational force, causing injury to the brain.
  • Traumatic brain injury is an evolving process at the microscopic level of thebrain. Chemical and metabolic changes occur for days, weeks to months after impact. That is why it is important to prevent any additional concussions andavoid a second impact syndrome during this time period.
  • Encourage plenty of rest with uninterrupted sleep. Since fatigue and drowsiness are common symptoms associated with concussions, sufficient sleep will allow the brain to heal and is necessary for recovery.
  • Studies show a higher probability in female vs. male athletes. This is likely due to their genetic make up and the fact that women are more likely to self report symptoms vs their male counterparts.
  • Due to their continued brain development at these ages, children and adolescents actually recover more slowly.
  • Evidence shows that protective equipment such as helmets, mouth guards and other protective devices may lower risk but no equipment eliminates the risk of concussion

This article about concussions was provided by PTandMe physical therapy partner: The Center for Physical Rehabilitation. More information about the Center and their locations throughout Grand Rapids, MI can be found on their website at www.pt-cpr.com

Additional articles from PTandMe about concussions can be found here:

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Winter Safety Tips for Children

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winter safety tips for Children PTandMe
When the temperature drops and snow is on the ground, your children can still benefit from some outdoor physical activity. All it takes is a little extra planning to stay safe.

Layer Up!
Infants and children lose heat more quickly due to their size. As a result, they are more likely to suffer from low body temperature, also known as hypothermia. Dressing in layers is a good way to provide your child with added warmth during the winter months. Your child should wear 1 more layer than an adult would wear. Choose fabrics that wick moisture to help pull sweat away from your child’s skin and keep them warm.

Here are some other winter stafety tips to help keep your child safe in the cold:
• Mittens are warmer, but gloves allow your child to use their fingers more. Consider having your child wear mittens over a pair of light gloves.
• Keep your child’s feet warm and dry with 2 pairs of socks.
• Avoid long scarves and drawstrings or ties, which could become a choking hazard. Consider neck warmers or turtleneck garments.
• Choose hats and hoods that do not obstruct your child’s vision.
• Keep a dry set of clothing at school in the event your child’s clothes become wet.

Winter Sport Safety
Winter safety tips for sports such as skiing, skating, snowboarding, and sledding require adult supervision and added safety measures. To help keep your child safe:
• Make sure your child wears a helmet and other protective gear such as wrist guards for snowboarding and a mouth guard for ice hockey.
• Teach your child to be aware of and avoid hazards when sledding such as cars, trees, and ponds.
• Do not allow your child to skate on surfaces until you are sure the water is frozen solid.
• Do not allow your child to wear headphones while playing. Headphones will block traffic or grooming machine sounds.
• Encourage your child to keep moving when outdoors to help generate body heat.

Bring your child inside at the first sign of frostnip—skin that is red, numb, and tingly. Soak your child’s skin in warm water until the symptoms go away. Do not rub the skin. If symptoms do not improve, call your child’s doctor. If your child’s skin becomes white, hard, and swollen, your child may have frostbite. The skin may also burn, tingle, or become numb. If you think your child has frostbite, bring your child inside and put your child in dry clothes. Do not rub the skin, rubbing can cause more damage. Call for medical help right away.

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Don’t Skip the Sunscreen
It is possible for your child to get a sunburn in the winter since sunlight reflects off of the snow and ice. Your child should use a sunscreen with an SPF of at least 30. Apply it to your child 20 minutes before going outside and reapply it every 2 hours.

Fuel Up for Fun
Dehydration can contribute to hypothermia. Encourage your child to drink plenty of fluids, especially during vigorous physical activities. Your child will also need to fuel up to generate body heat needed for outdoor play. Provide your child with plenty of healthy snacks such as trail mix, fruit and bread.

When to Play
Freezing temperatures and wind are risk factors for hypothermia and frostbite. Avoid severe cold. Keep an eye on weather forecasts and plan outdoor activities for warmer days without snow or rain.

Following these winter safety tips will allow you and your child to safely enjoy the beauty of winter.

by Cynthia M. Johnson, MA

RESOURCES:
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:
Canadian Paediatric Society
http://www.cps.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Chillin’ with winter safety. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/safety-prevention/at-play/Pages/Chillin-With-Winter-Safety.aspx. Updated January 19, 2016. Accessed February 11, 2016.

Frostbite in children. Lucile Packard Children’s Hospital Stanford website. Available at: http://www.stanfordchildrens.org/en/topic/default?id=frostbite-in-children-90-P02820. Accessed February 11, 2016.

Keeping kids safe in the cold. American Academy of Pediatrics website. Available at: http://www2.aap.org/sections/schoolhealth/ECarchivenovember11.html. Accessed February 11, 2016.

Sunscreen FAQs. American Academy of Dermatology website. Available at: https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens. Accessed February 11, 2016.

Last reviewed February 2016 by Michael Woods, MD Last Updated:10/20/2014

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