Pediatric Hand Therapy, 1e

Cover
Pediatric Hand Therapy
Copyright
List of Contributors
Acknowledgments—Pediatric Hand Therapy
Preface
SECTION I -
BACKGROUND
1. Embryology and Intrauterine Diagnosis
	Introduction
	How Limbs Develop in Utero
		Embryogenesis
		Fetal Period
		Signaling Centers
			Proximodistal limb development
			Anteroposterior limb development
			Dorsoventral limb development
		Programmed Cell Death
		Genes and Molecular Abnormalities and www.omim.org
		Intrauterine Diagnostics and Treating Upper-Limb Anomalies
	Prenatal Treatment
	References
2. Hand Function: Typical Development
	Introduction
	Spontaneous Movements
	Unimanual Function
		Unimanual Reaching
		Reach to grasp
			Reach
			Grasp
			Grasp patterns
			Object release
			Manipulation
	Bimanual Function
		Bimanual Reach to Grasp
			Bimanual Reaching
			Bimanual Grasp
			Bimanual Manipulation
	Conclusion
	References
SECTION II -
 EVALUATION AND ASSESSMENT
3. Physical Examination of the Pediatric Upper Extremity
	Range of Motion
	Strength
	Sensibility Testing
	Dexterity
	References
4. Outcome Measures
	Introduction
	Types of Outcome Instruments
	Psychometric Properties of Outcome Instruments
	Considerations in Selection of Outcome Instruments
	Administration, Scoring, and Interpretation
	Functional Performance Measures
	Patient-Reported Outcome Instruments
	Computer Adaptive Tests and Short Forms
	Resources to Maintain Competency
	Summary
	References
SECTION III - COMPLEMENTARY, PRACTICAL, AND CLINICAL
APPROACHES
5. Splinting, Taping, and Adaptation
	Introduction
	Splinting: Materials and Tools
		Material Selection
		Properties of Materials
			Stretch and pliability of material
			Thickness and perforation
			Colors
		Other Materials
			Tools
		Patterns
	Splinting: Psychological Readiness and Environmental Preparation
		Psychological Readiness
		Preparing the Environment
	Splinting: Fabrication Pearls
		Creative Splint Designs
		Strapping
		Education
	NICU Considerations
		Environmental Considerations
		Materials
		Splint Types
		Skin Integrity/Risk for Factors
		Strapping
		Education
		Wearing Schedule
	Therapeutic Taping
		General Indications
		Strengths of Therapeutic Taping
		Application: Test Patch and Frequency
		Application: Tape Placement
		Education
	Adaptations
		Examples of Pediatric Adaptations for the Upper Extremity
			Custom-made adaptations
			Commercially available
		Gravity-Reduced Weightlessness
		Tablet Adaptations
	Conclusion
	References
6. Pediatric Hand Therapy—Prosthetics and Training
	Level of Amputation
	Transverse Versus Longitudinal Deficiencies
	Prosthetic Acceptance and Rejection
		Developmental Stages and Implications for Fitting
		Rehabilitation for Upper Limb Prosthetic Patients
		Acute Postsurgical Stage for Acquired Limb Deficiency
		Subacute Preprosthetic Stage for Acquired or Congenital Patients
		Basic Prosthetic Training for Acquired or Congenital Patients
		Advanced Long-Term Rehabilitation for Acquired or Congenital Patients
		Outcome Measures
		Future Trends for Pediatric Upper Limb Prosthetics
	Computer-Aided Design
	Osseointegration
	Targeted Muscle Reinnervation Surgery
	Sensory Feedback
	Vascularized Composite Allotransplantation
	Conclusion
	References
	Further Reading
SECTION IV -
 CONGENITAL DISORDERS
7. Congenital—Syndactyly
	Pertinent Anatomy and Classifications
	Syndactyly: Preoperative Evaluation
	Surgical Steps
	Syndactyly: Postoperative Evaluation
		Range of Motion
		Digital Deformity
		Web Creep
		Scar Integrity
	Syndactyly: Postoperative Immobilization
	Syndactyly: Postoperative Orthotics
	Syndactyly: Postoperative Rehabilitation
		Postoperative Precautions
		Complex Versus Simple Syndactyly Considerations
		Thumb–Index Web Space Reconstruction Considerations
		Edema Management
		Desensitization
		Range of Motion and Functional Hand Use
		Scar Management
	Complications and Outcomes
	References
8. Rehabilitation of the Pediatric Upper Extremity Congenital Part II—Polydactyly
	Polydactyly (Preaxial and Postaxial)
		Pertinent Anatomy and Classifications
		Preoperative Evaluation
		Surgical Steps
			Nonfunctional pre- and postpolydactyly
			Preaxial polydactyly
			Postaxial polydactyly
		Postoperative Rehabilitation
		Complications/Outcomes
	References
9. Congenital II: Radial Longitudinal Deficiency and Thumb Hypoplasia
	Pertinent Anatomy and Classifications
	Preoperative Evaluation and Treatment
	Surgery and Surgical Steps
		Radial Longitudinal Deficiency
			Surgical steps—bilobed flap reconstruction
		Thumb Hypoplasia
			Surgical steps—opponensplasty
			Surgical steps—pollicization
	Indications for Immobilization/Mobilization
		Radial Longitudinal Deficiency
			Postoperative therapy following a bilobed flap
		Thumb Hypoplasia
			Postoperative therapy following opponensplasty
			Postoperative therapy following pollicization
	Conclusions
	References
10. Arthrogryposis
	Introduction
	Classification
	Initial Visit Assessment and Early Management
	Referral to an Upper Limb Specialist
	Surgical Interventions and Postoperative Rehabilitation
		Humeral Rotational Osteotomy
		Elbow Release
		Elbow Flexorplasty
		One-Bone Forearm
		Carpal Wedge Osteotomy
		Thumb Metacarpophalangeal Fusion
		Thumb Reorientation Osteotomy
		Camptodactyly Release
	Conclusion
	References
	Further Reading
SECTION V - NEUROLOGICAL AND NEUROMUSCULAR
DISORDERS
11. Brachial Plexus Birth Palsy—Introduction and Initial Treatment
	Introduction
	Brachial Plexus Birth Palsy: History and Etiology
	Risk Factors
	Incidence and Prognosis
	Nerve Anatomy and Recovery
	Assessment
	Treatment
	Modalities
	Summary
	Supplementary Materials
	References
	Further Reading
12. Brachial Plexus: Primary Surgery
	Introduction
	Initial Referral
	Classification
	Nerve Injury
	Ancillary Testing
	Timing of Surgery
	Surgical Techniques
		Nerve Graft
		Nerve Transfer
			Selection of the donor nerve
			Selection of the recipient nerve
	Priorities of Surgical Reconstruction
		Hand
			Nerve grafting
			Nerve transfer
		Elbow
			Nerve grafting
			Nerve transfer
		Shoulder
			Nerve grafting
			Nerve transfer
		Rehabilitation
			Nerve grafting
			Nerve transfer
		Outcomes
			Nerve grafts
			Nerve transfers
	References
13. Brachial Plexus Pre- and Post-Op Management: Secondary
	Introduction
	Shoulder
		Evaluation
		Therapy
		Botulinum Toxin
		Surgical Intervention
	Elbow
		Evaluation
		Therapy
		Surgical Intervention
	Forearm
		Therapy/Surgery
	Wrist
		Therapy/Surgery
	Hand
		Therapy/Surgery
	Goal-Driven Therapy
		Symmetry of Motion
		Constraint-Induced Movement Therapy
		Aquatic Therapy
		Self-Management
	Conclusion
	Appendix A
	References
14. Cerebral Palsy
	Introduction
	Classification
	Assessment
	Surgical Indications/Methods
	Hierarchy of Upper Limb Function
	Shoulder Reconstruction
		Functional
		Nonfunctional
	Elbow Reconstruction
		Functional
		Nonfunctional
	Forearm Reconstruction
		Functional
		Nonfunctional
	Wrist Reconstruction
		Functional
		Nonfunctional
	Hand Reconstruction
		Functional
		Nonfunctional
	Thumb Reconstruction
		Functional
		Nonfunctional
	References
15. Tetraplegia: Nerve and Tendon Transfers
	Introduction
	Classification
	Referral for Upper Limb Reconstruction
	Tendon Versus Nerve Transfer
	Hierarchy of Upper Limb Function
	Elbow Reconstruction
		Nerve
		Tendon
		Rehabilitation
	ICSHT Grade 1
		Nerve
		Tendon
		Rehabilitation
	ICSHT Grade 2
		Nerve
		Tendon
		Rehabilitation
	ICSHT Grade 3
		Nerve
		Tendon
		Nerve and Tendon Transfer
		Rehabilitation
	ICSHT Grades 4 and 5
	ICSHT Grades 6 and 7
	ICSHT Grades 8 and 9
	References
SECTION VI -
 JOINT DISORDERS
16. Multiligamentous Laxity
	Introduction
	Classification
	Initial Referral
	Treatment
	Surgery
	Rehabilitation Following Surgery
	Summary
	References
17. Rheumatologic Disorders
	Introduction
	Presentation and Diagnosis
	Treatment of JIA
	Early Medical Therapeutic Intervention
		Intraarticular Corticosteroid Injections2
		Nonsteroidal Antiinflammatory Drugs
	Further Medical Therapeutic Intervention
		Disease-Modifying Antirheumatic Drugs
		Oral or Intravenous Corticosteroids
	Biologic Disease-Modifying Medical Therapeutic Intervention
		Antitumor Necrosis Factor Agents
		Costimulation Modulators
		Anti-Interleukin-1 (IL-1) Agents
		Anti-Interleukin-6 (IL-6) Agents
		Other Agents on the Horizon
	Occupational Therapy
	Surgical Management
		Elbow
		Wrist
		Hand
	Conclusion
	References
	Further Reading
SECTION VII -
 TRAUMA
18. Fractures: Hand and Wrist
	Introduction
	Forearm Fractures
		Clinical and Radiographic Examination
		Treatment
		Outcomes and Therapeutic Management
	Fractures of the Distal Radius
		Clinical and Radiographic Examination
		Treatment
		Outcomes and Therapeutic Management
	Scaphoid Fractures
		Clinical and Radiographic Examination
		Treatment
		Outcomes and Therapeutic Management
	Fractures of the Hand and Fingers
		Clinical and Radiographic Examination
		Treatment
		Outcomes and Therapeutic Management
	Summary
	References
	Further Reading
19. Fractures of the Pediatric Elbow and Shoulder
	Elbow Fractures
		Anatomy and Classification of Elbow Fractures
			Supracondylar humerus fractures
			Medial epicondyle fractures
			Olecranon stress fractures
		Preoperative Evaluation and Treatment for Elbow Fractures
		Surgical Steps, Indications for Immobilization, and Postoperative Rehabilitation for Elbow Fractures
			Supracondylar humerus fractures
				Surgical steps
				Surgical steps
				Indications for immobilization
				Indications for immobilization
				Postoperative rehabilitation
				Postoperative rehabilitation
			Medial Epicondyle Fractures
				Surgical steps
				Surgical steps
				Indications for immobilization
				Indications for immobilization
				Postoperative rehabilitation
				Postoperative rehabilitation
			Olecranon stress fractures
				Surgical steps
				Surgical steps
				Indications for immobilization
				Indications for immobilization
				Postoperative rehabilitation
				Postoperative rehabilitation
			Posttraumatic elbow stiffness
	Shoulder Fractures
		Clavicle Fractures
			Anatomy and classification of clavicle fractures
			Preoperative evaluation and treatment of clavicle fractures
		Surgical Steps, Indications for Immobilization, and Postoperative Rehabilitation for Clavicle Fractures
			Clavicle fractures
				Surgical steps
				Surgical steps
				Indications for immobilization/mobilization
				Indications for immobilization/mobilization
				Postoperative rehabilitation
				Postoperative rehabilitation
		Proximal Humerus and Humeral Shaft Fractures
			Anatomy and classification of humerus fractures
		Preoperative Evaluation of Humerus Fractures
		Surgical Steps, Indications for Immobilization, and Postoperative Rehabilitation for Humerus Fractures
			Surgical steps
			Indications for immobilization
			Postoperative rehabilitation
	References
20. Tendon Injuries and Trigger Digits
	Introduction
	Section I: Flexor Tendon Injury
		Background
		Rehabilitative Options
		Immobilization
		Early Passive Flexion
		True Active Flexion
		Nonoperative and Secondary Procedures
		Contextual Factors
		Recommendations
	Section II: Trigger Digits
		Trigger Digits
		Trigger Thumb
	Conclusion
	References
21. Surgical and Therapeutic Management of Volkmann’s Ischemic Contracture and Free Functional Muscle Transfer
	Introduction
	Therapy Considerations According to Type of Severity
	Free Functional Muscle Transfer
		Introduction
	Preoperative Assessment and Therapy
	Postoperative Assessment and Therapy
	Standard Assesment and Outcome Measures
	Splinting Requirements: Immobilization Phase
	Splinting Requirements: Following Immobilization Phase
	Early Passive Mobilization Versus Conventional Protocols
	Nerve Reinnervation Phase: MRC 1/AMS 1
	Muscle and Nerve Activation Phase: MRC 1–2/AMS 1–4
	Muscle Strength and Function Phase: MRC 3–4/AMS 5–7
	Case Study One: FFGT for Elbow Flexion
	Case Study Two: FFGT for Finger Flexion
	Outcomes and Timelines
		FFGT for Elbow Flexion
		FFGT for Finger Flexion
	References
	Further Reading
22. Amputations and Replants
	Introduction
	Mechanism of Injury
	Medical Intervention
	Fingertip Amputation and Nail-Bed Injury
	Digital Reconstruction for Skin Loss
	Therapy
	Pediatric-Specific Considerations
	General Evaluation and Assessment Considerations
	General Treatment Considerations
	Wound Care
	Edema Management
	Splinting
	Desensitization and Sensory Reeducation
	Therapeutic Exercise
	Functional Retraining
	Prosthetic Evaluation and Training
	Emotional and Psychological Considerations
	Conclusion
	Appendix
	Postoperative Therapy Protocols
		Postoperative Therapy Protocol for Nail-Bed Repair Procedures
		Postoperative Therapy Protocol for Fingertip Amputation Procedures
		Postoperative Therapy Protocol for Composite Grafts
		Postoperative Therapy Protocol for Ray Resections
		Postoperative Therapy Protocol for Digital Replantation
		Postoperative Therapy Protocol for Thumb Replantation
	References
	References
	Further reading
23. Pediatric Hand Burn Therapy Chapter
	Introduction
	Anatomy
	Classification
	Approach to Treatment
		Preoperative Evaluation
		Treatment
	Management of Vascular Compromise
	Surgical Debridement and Coverage
		Postoperative Immobilization and Splinting
	Postoperative Rehabilitation
	Outcomes Measurement
	Conclusion
	References
SECTION VIII -
 SPORTS
24. Pediatric Sports Injuries: Little League Elbow, Osteochondritis Dissecans of the Elbow, Gymnast Wrist
	Introduction
		Anatomical Overview
	Little League Elbow
		Anatomy and Classification
		Clinical Assessment
		Prevention
		Conservative Treatment
		Operative Intervention
		Rehabilitation
	Osteochondritis Dissecans
		Anatomy and Classification
		Clinical Assessment
		Prevention
		Conservative Treatment
		Operative Intervention
		Rehabilitation
	Gymnast Wrist
		Clinical Assessment
		Prevention
		Conservative Treatment
		Operative Intervention
		Rehabilitation
	Conclusion
	Appendices
	Supplementary Materials
	References
	Further Reading
25. Pediatric Hand Therapy—Sports Shoulder: Throwing Athletes
	Introduction/Pertinent Anatomy
	Little League Shoulder
		Background/Epidemiology
		Mechanism/Pathophysiology
		Presentation/Clinical Evaluation
		Imaging
		Treatment
	Shoulder Instability
		Background/Epidemiology
		Mechanisms/Pathophysiology
		Presentation/Clinical Evaluation
		Imaging
		Treatment
			Nonoperative
			Operative
			Post-Op Rehab
	SLAP Tears
		Background/Epidemiology
		Mechanisms/Pathophysiology
		Presentation/Clinical Evaluation
		Imaging
		Treatment
			Nonoperative
			Operative
			Post-Op Rehab
	Rehabilitation Overview
		Examination
			History and evaluation of external risk factors
			Posture
			Shoulder range of motion
			Motor performance
			Force production
			Endurance
			Control
			Kinetic chain
		Treatment Considerations
			Posture and scapular dyskinesis
			Shoulder range of motion
			Shoulder motor performance interventions
			Additional kinetic chain considerations
		Injury-Specific Treatment Considerations
			Little League Shoulder
			Gross and Microinstability
			SLAP tear
		Interval Sport Program and Return to Play: Clearance and Application
		Throwing Evaluation
	Summary
	Appendix
		Sports medicine and performance center at the Children\'s Hospital of Philadelphia
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W