Category Archives: Pediatrics

Physical Therapy for Sensory Integration

August 24, 2017 Teresa Stockton - Blog, Pediatrics

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.

Age Appropriate Strength and Performance Training

August 17, 2017 Teresa Stockton - Blog, Pediatrics, Sports and Fitness

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 (JRA; Juvenile Chronic Polyarthritis; Stills Disease)

July 11, 2017 Teresa Stockton - Blog, Pediatrics

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:
- Anterior uveitis with eye pain
- Inflammatory back arthritis (ankylosing spondylitis)
- Inflammatory bowel disease
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.

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.

What We Know About Concussions is Changing

June 29, 2017 Teresa Stockton - Blog, Pediatrics, Sports and Fitness

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:

Winter Safety Tips for Children

January 3, 2017 Teresa Stockton - Blog, Pediatrics

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.

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

For more winter safety tips to keep you out of harm’s way this season check the articles below!

Backpack Safety 101

August 4, 2016 Teresa Stockton - Back, Blog, Pediatrics

It’s that time of the year again when the kids are heading back to school. Learn the proper guidelines and precautions about backpack safety in this week’s PTandMe blog post.

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

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

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.

Juvenile Rheumatoid Arthritis

July 19, 2016 Teresa Stockton - Blog, Pediatrics

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 Juvenile rheumatoid arthritis, 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 juvenile rheumatoid arthritis:
• 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

Juvenile rheumatoid arthritis 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.

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

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:
• Anterior uveitis with eye pain
• Inflammatory back arthritis (ankylosing spondylitis)
• Inflammatory bowel disease

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 juvenile rheumatoid arthritis . For example:
• 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 bone

• 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 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.

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 JRA 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

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. Treatment options include the following:

Medication

There are several types of medication that may be used:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
• Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
• Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
• Interleukin inhibitors—to reduces disease activity
• Corticosteroids through IV or by mouth—for swelling
• Steroid injections into the joint—may help relieve swelling and pain in some children

Polyarticular JRA may become inactive in children who begin medications within 2 years of onset.

Physical Therapy

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.

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 JRA.

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 website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

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’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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

Can Physical Therapy Help Kids with Arthritis?

May 26, 2016 Teresa Stockton - Blog, Pediatrics

Did you know that physical therapy can help kids with arthritis? Juvenile Rheumatoid Arthritis (JRA), also called Stills disease, is the most common form of arthritis seen in children and young adults.Children commonly complain of joint pain and stiffness, along with an occasional fever.

JRA can impact fine movements and overall mobility if left untreated. While medical therapy is the mainstay of treatment, physical therapy and rehabilitation are essential to restoring full movement and quality of life.

How does physical therapy help?
Physical therapists are trained experts at delivering a variety of treatments to help reduce pain and improve joint movement. A child experiencing pain and dysfunction can feel isolated and left out, unable to participate in group activities with other children. A physical therapist can help the child to improve muscle tone, strength and reduce joint inflammation. This helps children regain the quality of life they deserve; allowing them to live with less pain and enjoy the benefits of unrestricted movement.

This information was written by Oregon Spine and Physical Therapy, a physical therapy group located in Eugene, Oregon. At Oregon Spine & Physical Therapy, your care begins with a comprehensive evaluation of your condition by your physical therapist. This initial assessment will allow the physical therapist to accurately reach a diagnosis and then prepare your appropriate, personal treatment plan. For more information click here.

Treating Pediatric Incontinence with Physical Therapy

February 25, 2016 Teresa Stockton - Blog, Pediatrics

UNDERSTANDING PEDIATRIC INCONTINENCE

Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors.
The pelvic floor is made up of muscles and other tissues that form a sling from the pubic bone to the tailbone. They help to support the abdominal and pelvic organs and assist with the control of bladder and bowel activity.

Pelvic floor dysfunction refers to a wide range of problems that occur when these muscles are weak and/or in spasm. The tissue surrounding the pelvic floor organs may have increased sensitivity and irritation or decreased sensitivity, causing the resulting dysfunction seen in children.

Although millions of children suffer from pelvic floor dysfunction, most don’t get the help they need. Typically, children are toilet trained by age 4 with only very occasional accidents. After age 4 childhood bowel and bladder dysfunction is considered a major medical problem and greatly affects quality of life for the whole family. Every day, five million American children wake up not knowing if their bed will be wet or dry. Many of these children feel embarrassed and ashamed. Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors, because of its embarrassing nature.

Dysfunctional elimination in children occurs when the pelvic floor muscles are not working together with the bladder and /or bowel and the normal voiding or emptying reflexes can be disrupted. This can lead to a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or sensing bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable.

If your child has experienced any of the above symptoms they may have been seen by a physician or specialist, who is now recommending therapy to relax and retrain the pelvic floor muscles. Therapy can provide the tools your family needs to take control of your child’s bladder and bowel functions.

PHYSICAL THERAPY CAN HELP
If any of the below problems sound familiar, then PT can help:
• Urinary incontinence (loss of urine)
• Urinary urgency (constant/strong need to urinate)
• Urinary frequency (urinating over 8 times in a 24 hour period)
• Urinary retention (not fully emptying your bladder)
• Bed-wetting (nocturnal enuresis)
• Fecal urgency, frequency and/or retention
• Bowel incontinence, pain with defecation, inability to empty bowels
• Excessive gas, abdominal bloating
• Constipation, diarrhea with/out soiling/staining

How do we treat pediatric incontinence?
We meet with a child and their parent/s or guardian about pediatric incontinence we get a thorough knowledge of history and current problems. We then do a physical examination, looking at the muscles of the abdomen, legs, back and others we feel applicable to the specific problem. This exam is with an adult present and over clothing. Finally, we consult with the referring physician to develop an individualized treatment plan. Treatment is one-on-one, hands on, with the child dressed and lasts about one hour-in comfortable, private treatment rooms. We work with each child and family member very closely and modify our treatment according to what works best for each individual. We incorporate a holistic approach, looking at diet, sleep patterns, and other behavioral issues that could be contributing to the current problem.

What exactly do we do?
Treatment includes:
• Biofeedback-surface electromyography (external electrodes or “stickers”)
• Behavioral and diet modification
• Soft tissue mobilization, myofascial release and deep tissue massage if needed
• Hot and cold therapy
• Stretching and strengthening of pelvic floor and surrounding muscles as appropriate
• Relaxation techniques.
• Scheduled bladder retraining
• Pelvic floor muscle re-education

THE FACTS
Medical research has shown that proper pelvic floor muscle training and biofeedback drastically improves voiding dysfunctions in children.

We use animated biofeedback used a computer program with images of dolphins or space shuttle to get children to activate and relax the pelvic floor muscles.

Your child is not alone
• 20% of pediatrician visits are for incontinence problems
• 15% of visits to gastrointestinal doctors are for lower bowel dysfunction
• 3% of visits to pediatricians are for constipation
• 5 million children complain of nocturnal enuresis (nighttime bedwetting)

Common Myths
Myth: Decreasing my child’s fluid intake will decrease their incontinence?
Fact: Decreasing fluids can actually lead to dehydration, which can actually increase incontinence.

Myth: Once my child has been diagnosed with incontinence, nothing can be done about it?
Fact: Incontinence can almost always be successfully resolved, treated or managed. Physical Therapy can help!

Myth: All children gain control of their bladder and bowels at the same age?
Fact: Children develop control at different ages depending on their physical and cognitive development, as well as their environment. It is typical for a child to develop bladder and/or bowel control between two and five years of age.

HOW COMMON IS BED WETTING?
It might reassure you to know that around 19% of school-aged children wet the bed. It’s really one of the most common of all childhood problems. To give you an idea, in a class of 30 children:

Aged 5 years: 5 wet the bed at least twice a week
Aged 7 years: 2 wet the bed at least twice a week
Aged 12 years: 1 wets the bed at least twice a week
Aged 15 years: 1 child in every two classes wets the bed at least twice a week.

HEALTHY BLADDER TIPS:
1. Maintain adequate fluid intake
2. Practice prompted voiding
3. Practice bladder retraining
4. Limit intake of colas, root beer and other dark soft drinks
5. Limit caffeine intake
6. Avoid constipation
7. Exercise on a regular basis
8. Drink fluids throughout the day and limit fluids at night (2 hours before bed)
9. Keep a bladder diary

Is Physical Therapy Right for Your Child?

January 14, 2016 Teresa Stockton - Blog, Pediatrics

PEDIATRIC PHYSICAL THERAPY
is recommended for infants, children, and teens who have a musculoskeletal injury or who have movement problems from an illness, disability or disease. Physical therapy after an injury is required to decrease pain, improve range of motion and strength thus returning the youngster to pre injury status. We will also teach the child and parent strategies to prevent future injury.

What Can Therapy Do?
PHYSICAL THERAPY IS TYPICALLY RECOMMENDED WHEN A CHILD HAS LIMITATIONS IN MOBILITY AND DIFFICULTY WITH ADL’S (Activities of Daily Living).

What To Expect
In the pediatric population, physical therapists use purposeful play in the evaluation and treatment of each child. Following the child’s lead we create a fun and empowering treatment session. The primary role of physical and occupational therapists is to help children, play grow and achieve their developmental milestones. Skills are learned and mastered through the context of therapeutic play in hopes of enhancing performance of functional and purposeful activities. Developmental skills are emphasized allowing for progress toward age appropriate activities and movement patterns. This therapeutic approach addresses the needs of the child’s physical, social and emotional needs.

APPROACHES / TOOLS
• Strengthening, Endurance & Coordination
• Developmental Screenings / Evaluations
• Sports Rehab
• Orthopedic Rehabilitation
• Manual Therapy

The following is a list of diagnosis, conditions, or disease entities that may benefit from pediatric physical therapy:

• Acute Trauma affecting muscles, joints, or bone or limiting mobility and function
• Birth Defects such as Spina Bifida
• Developmental Coordination Disorders
• Cancer Related Fatigue
• Cerebral Palsy
• Developmental delays
• Down Syndrome
• Genetic disorders limiting mobility and function
• Diseases affecting the heart or lungs
• Head Injury
• In or Out toeing when walking
• Orthopedic disabilities or injuries
• Limp when walking
• Limb deficiency or Amputation
• Muscle diseases
• Muscular Dystrophy
• Muscle tone issues – spasticity or hypotonicity
• Spinal Cord Injury
• Sports injuries
• ACL knee injury pre or post op
• Shoulder Pain
• Ankle sprain / pain
• Toe Walking
• Back Pain / Scoliosis
• Torticollis
• Brachial Plexus injury
• Cerebral Palsy
• Elbow or hand pain
• Fetal Alcohol Syndrome
• Juvenile Arthritis
• Juvenile Diabetes
• Headaches / Neck pain
• Hip Pain
• Urinary Incontinence (from a specialist)
• Knee Pain
• Patellar dislocation
• Patella Tendonitis / Jumpers knee
• Obesity
• Osgood-Schlatters
• Sever’s Disease
• Shoulder dislocation

What Role Does Family Play?
Family participation is encouraged for successful implementation and carry over into the home environment. Comprehensive individualized home programs are created further empowering the family and child.