早期療育—物理治療 ( 嬰幼兒扁平足 ) Use of Orthoses and Early Intervention Physical Therapy to Minimize Hyperpronation and Promote Functional Skills in a Child with Gross Motor Delays： A Case Report

期刊論文整理：劉美玉

ContentsAbstractResearch motiveReferencesCase DescriptionExaminationInterventionOutcomesDiscussionSummary

• Case description: A 25-month old girl with a 6-month gross motor delay had excessive pronation of both feet. Physical therapy included fabrication of foot orthoses to improve foot alignment and weekly facilitation. of strength, coordination, and balance , and family education activities. Outcomes : the Peabody developmental Gross Motor Scales revealed a 12-month gain in gross motor skills in 5 months time. Discussion: Physical therapy to facilitate normal foot alignment, trunk control , strength, balance, and coordination may have promoted this child's acquisition of age-appropriate gross motor skills.

Abstract

Research motive

• many studies have demonstrated improvements in impairments and function when adults' foot alignment is corrected. The improvements included diminished low back pain (Cibulka, 1999), improved tolerance for running, hiking, and dancing (Blake & Ferguson, 1991), altered lower extremity mechanics in runners (Bates, Ostemig, Mason, & James, 1979),

References-1• Supports

• 1.Gianni, Catani, and Ceccarelli (1992), and Eng and Pierrynowski (1994)

• Tax (1989)

• Turner, and Worrell (1994)

• Aharonson, Arcan, and Steinback

• Taylor and Harris (1986)

References-2

• Non-supports

• Gould, Moreland, Alvarez, Trevino, and Fenwick(1989) observe

• Sullivan (1999) and Staheli (1999)

References-3

• These studies provide some evidence

that orthoses may alter foot-ground pressure patterns while promoting improved balance and functional motor performance in children.

Case Description

• early intervention speech and language therapy three times a week

• her gross motor skill level and her frequent falling. • muscle tone as low "w" sitting 、 rounded back postu

re 、 excessive range of motion at her fingers ,hips, ankles and toes ;"very flat footed, without any arch in the foot

• She had difficulty with activities that required stability

Child Description

Examination

• Her mother re-ported that she fell 5 to 6 times per half-hour

• When she was walking, I observed early and excessive pronation in stance, tibial internal rotation, knee recurvatum, and excessive lumbar lordosis.

Intervention-1

• the initial visit ： Examination 、 discuss 、 Approval • the second physical therapy session :fabricated shoe inserts Her therapy program was 60 minutes in duration each wee

k 、 her family encouraged ring sitting and long sitting

、 promote motor planning, strength, coordination, and mi

d range muscular control .• the third visit (one week after receiving the orthoses ):was wearin

g them throughout the day 、 observe 、 record• the fourth physical therapy visit

Intervention-2

Outcomes-improved

• in barefoot weightbearing indicated improved alignment when she was standing and when walking.

• A medial longitudinal arch appeared to be developing in her right foot, and her tibiae appeared to be in neutral rotation in stance 、 transition well 、 good control in midranges of uplight activity.

• be efficient in using protective extension and righting reactions to prevent falls and injury

Outcomes-unimproved

• Persistent low muscle tone :rounded back 、” w”sitting 、 excessive mobility at her knees

Outcomes-Table2

Discussion

• the effect of the interventions from normal maturation or other factors.

• Research is needed with multiple subjects, control groups, and detailed pre-and post-measurements to determine clinical guidelines for orthotic intervention in children with excessive pronation and delayed motor milestones

Summary

• The physical therapy program can be carried out in home environments and encourages creativity and individuality. The materials used to fabricate the orthoses described are inexpensive and readily available

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