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Andrew M. Ball, MS, PT -> Re: what do you think? (April 27, 2000 4:31:00 AM)
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Dana,
You can usually find a developmental pediatrician at your local UAP. Up in your area, check out the one in Valhalla, NY and Rochester NY.
Steve Sulkes, MD, is a developmental pediatrician and brilliant when it comes to these issues. You can find him at the Strong Center for Developmental Disabilities - Center for Developmental Assessment, University of Rochester.
Shree Pandya, PT is also an excellent resource if you're thinking about MD. SMA's are REALLY hard to pick up on radiograph or genetic marker that early, and Duchanne Dystrophy usually does not show up so early. Also, there are some pontocerebellar hypoplasia's that present like Werdnig-Hoffman SMA but have no genetic markers, and usually don't show anything on radiograph. I'll provide references for this stuff if you wish, but I don't think it's going to help you much with your specific situation.
I'd keep searching for another answer than MD.
I'd also STRONGLY suggest picking up a copy of Lois Bly's Motor Skills Acquisition in the First Year of Life, and Facilitation techniques based upon NDT Principles. You can get either at amazon.com or through Therapy Skill Builders (that reminds me I have to get my copy back from my mentee ...) If you graduated within the past two years or so, it was likely your pediatrics book.
In the facilitation book, you'll find reference to a position called hurdler stretch. It's the million dollar NDT technique if you ask me. By dissociating the legs, you lock the pelvis in a neutral position. Also, the child, being in prone, is locked out of saggital plane motion at the trunk. This allows for you to work with the child to facilitate (your hand placement should be at the sternum) trunk movement and control in the frontal plane of movement at the trunk. I think that you'll find that frontal plane control is this kid's biggest issue. In addition, you can work on glut max and serratus anterior control (by reaching above horizontal) both of which likely need a little work.
Finally, a really good resource/mentor for you might be to call or e-mail Stephanie Watkins, PT (RehabEdge member SeaWatkins???). She's a graduate of MCV and we've been working together lately in a mentor-mentee relationship regarding NDT techniques and these specific clinical problems. Although intially overwhellemed with my style of providing as much information as possible, in as small a time span as possible, she's now tried some of this stuff, and now tells me that she's getting some major results in kids that she was otherwise almost about to give up on. Let me know if you're interested, and I'll forward you her e-mail address.
She may be able to speak in a language that is less intimidating that mine, and is a little closer to that overwhelming learning process than I am on these handling issues.
Finally, and I know that I'm sounding like a broken record, PWB-GT has shown to be of value in correcting gait abnormalities, postural abnormalities, and balance . . . usually with greater quality and efficiency than traditional therapy alone.
Hope that helps
Drewfus
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