|
Andrew M. Ball PT PhD -> Re: Hypertonia (March 26, 2006 1:58:00 AM)
|
Dr. Dorton,
The first problem isn't with finding a hip orthosis, but rather with getting the parents on board --- if that doesn't happen, the best orthotic won't ever be worn --- which won't do the child or family any good anyhow.
As for a subluxing hip, usually that's a symptom, not the primary problem (though there are clear exceptions to be sure). Sure you can "band-aid" the situation with a hip-hugger HKAFO or something comparable (and there are a handful of kids where there is no other choice), but usually, the problem lies with core positioning and reduction of an anterior pelvic tilt resultant hip internal rotation.
Go back to your developmental kinesiology and spend lots of time on play in runner's stretch and half-knee positions. Use THAT as an educational tool to show the parents the impact of core positioning both up (e.g. poor lower trunk --> retracted scaps for upright stability --> arms yoked to postural system --> elbow flexion --> upper extermity hypertonic flexion synergy) and down (e.g. poor lower trunk --> APT/weak gluts --> tight hip abductors --> crouch and internally rotated LE's in standing position --> increased risk for hip subluxation) the kinematic chain.
Then, and only then, is it appropriate to bring up the idea of an orthotic --- AFTER you've done all you can therapeutically, AFTER you've educated the parents regarding chain of events and how you're helping it, and AFTER you've explained how improvement in the core over time may result in a decreased need for a hip orthotic.
Finally, (and I'm not saying that this is the case) keep in mind that a DPT doesen't allow for you to make these kind of recommendations in a vaccum any more than a BSPT. DPT's who make recommendations like this without consultation with the referring MD and/or PCP, may want to check themselves on that. If one doesn't have the parent's nor the MD on board with (D)PT recommendations, ultimately, the public perception with respect to the DPT is devalued.
Make sure that if you think the parents will be non-compliant, after approaching the situation as defined above, that you get the medical physician on-board with your orthotic recommendations --- you're going to need his/her authorization for payment anyhow.
Dr. Andrew M. Ball, PT, DPT, PhD
|
|
|
|