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what do you think?
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what do you think? - April 14, 2000 4:23:00 AM
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Dana D
Posts: 142
Joined: September 18, 1999
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I'm seeing a little boy.....he is 29 months.. very bright, very social...late walker, started consistently walking at 2. He was a "bottom scooter"..."diagnosed" by his doctor/pediatrician with low tone and weakness.
Now that he's been upright for 4 months, he's starting to look "different" to me. He is somewhat lordotic, arms are becoming more and more held in a medium guard position... and I had just started seeing him walk on his toes a bit...He seems disconnected in his trunk. (i have thought of what you said, Drew, about toe walking and poor scapular stability...) What concerns me, is he's not picking up "the next skills" as readily as I would expect. And when we are working on those skills, the quality is poor. He has not attempting to rise through half kneel with support....he always rises through a squat. What he has considerable trouble with is stepping over something (say my leg while i'm on the floor). He will try to step up a step, but lacks pelvic stability to keep himself upright, and will assume a peculiar posture... If I provide him with hand held support, he has difficulty generating enough force to get his body on the step, and will rely primarily on his arms...
I've also noticed, that if i place him in an odd position, say somewhat upside down on the couch with a pillow on him...he has a difficult time manipulating himself, and getting himself out of the position and off the couch....he is such a little character... cute kid, but i hear him grunting....at first i thought it was his personality..that it was harder for him, so he knew to grunt, but he does it quite often now.....
I'm starting to get a gut feeling that something more is going on with this boy, rather that unexplained weakness.
Does anyone have any input?
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Re: what do you think? - April 26, 2000 12:37:00 PM
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Dana D
Posts: 142
Joined: September 18, 1999
Status: offline
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Well, I'm having a gut feeling about the possibility of MD. A lot of signs are pointing in that direction...
I spoke with the mom, not stating my concerns of MD directly, but stating my concerns that he is showing signs of weakness in his hips, trunk and LE's... which is keeping him at this point of milestone achievements....
From personal and professional opinion, what type of doctor would be best suited to see this child?
I would suggest a neurologist, but other therapists suggest a developmental pediatrician.
Does anyone have a suggestion/rationale based on their clinical experience?
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Re: what do you think? - April 26, 2000 1:51:00 PM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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To me it depends on the physicians in your area. I do not know of a developmental pediatrician in our area, but there are several neurologists that are thorough, good listeners, and family friendly. So I would pick one of them. There is also a pediatric physiatrist (one of them rehab doctors) that is good, and I would consider him for such a patient.
So I think it depends more on the skills of the physician, than their title. If I did not know of them personally, I'd go with the neurologist.
Let us know how he does.
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Re: what do you think? - April 27, 2000 5:31:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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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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Re: what do you think? - May 25, 2000 3:23:00 PM
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Dana D
Posts: 142
Joined: September 18, 1999
Status: offline
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I've tried some of your suggestions.....thanks drew...
Today, my little guy attended our neuro clinic... I feel so relieved that I got the ball rolling, felt like a weight off of my chest...to have them pursue the matter... The neurologist was very receptive to my concerns and agreed with me in many areas. He spoke with the parents and suggested further testing (blood work for CK levels) and thyroid testing (not quite sure with the thyroid?)...then pending those results, he may suggest further testing.... his rationale to the parents was to rule out any other muscular disorders... so, we'll take it from there. Keep your fingers crossed that he is just a "peculiar low tone child"......
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