Review of Pediatric Orthopedic Conditions

Review of Pediatric Orthopedic Conditions 

Randi DiBuono, SPT

 

Background

            Coming into physical therapy school, I knew that I was interested in working with the pediatric patient population. Throughout my time in the program, my passion for treating children has grown immensely. During my outpatient pediatric rotation my second year, I realized I felt more prepared to treat neurologic pediatric conditions such as Cerebral Palsy, Spina Bifida, and Down Syndrome compared to orthopedic conditions. I concluded this was due to our current curriculum’s coverage of pediatric conditions in our neuro courses. Unless students take PHYT 880, the pediatric elective course, they have limited exposure to non-neurological conditions. Even the exposure to conditions in PHYT 880 is limited and not a comprehensive review of conditions commonly seen in pediatric physical therapy. After my rotation and completion of pediatric focused didactic material, I determined that supplemental academic material focused on less frequently covered conditions would be beneficial for the program. This project allowed me to further my understanding of commonly seen pediatric conditions, specifically orthopedic conditions, while also helping prepare for the NPTE. Additionally, it allowed me to give back to the program that shaped me into the clinician I am soon to become by creating supplemental material to educate future students.  

            This project required an extensive review of literature focused on specific pediatric conditions. Along with review of literature available in online databases, I also consulted the Campbell’s Physical Therapy for Children textbook to supplement content as needed. Articles reviewed included the most up-to-date information to provide the audience with the most applicable evidence for clinical practice and education. The information concluded from the literature review was synthesized to develop content for the lecture presentation. The presentation materials were reviewed in depth multiple times by my committee and I to ensure the materials are up to par with doctoral-level education.   

 

Statement of Need

 

Purpose         

            This project aimed to bridge the gap in our current DPT curriculum regarding pediatric conditions and provide students with preparation for the NPTE, review of common conditions prior to starting a pediatric clinical rotation, and orthopedic-focused lecture material for 3^rd years taking the pediatric elective. The PowerPoint and VoiceThread provide an in-depth review of four pediatric conditions with an orthopedic focus as many of the pediatric conditions reviewed in our current curriculum are neurological in origin. The following conditions will be discussed in this lecture: Torticollis, Blount’s Disease, and Legg-Calve-Perthes Disease, and Slipped Capital Femoral Epiphysis (SCFE). For each condition the following categories will be reviewed in detail: Incidence, pathology, prognosis, presentation of patient, indications and role of physical therapy, and potential treatments.

 

The following learning objectives were created for the target audience:

1. After watching the lecture, students will be able to define the following pediatric conditions: Torticollis, Slipped Capital Femoral Epiphysis (SCFE), Blount’s Disease, and Legg-Calve-Perthes Disease
2. After watching the lecture, students will be able to recall the pathology for each conditions discussed.
3. After watching the lecture, the students will be able to identify at least three signs or symptoms of each pathology that are pertinent to physical therapy diagnosis.
4. After watching the lecture, students will be able to identify the most prevalent patient population of each condition.
5. After watching the lecture, students will be able to develop a treatment plan consisting of two interventions and two pieces of patient/caregiver education for each condition discussed.

 

Products

 

Link to VoiceTread: https://voicethread.com/share/22617054/

Link to PowerPoint: Review of Pediatric Orthopedic Conditions

 

      When working with the pediatric patient population, one must be able to explain the child’s condition, how the condition may impact their development, importance of attending physical therapy, and home exercises to concerned parent(s) or caregiver(s). As a result, it is important the physical therapist can communicate these topics using patient friendly language to set the family up for success. To address this component of health literacy, I have created an educational handout for parents of babies with torticollis. This handout can be found below.

 

Link to health literacy handout: Torticollis Educational Handout

 

Evaluation

            Throughout the year, my primary advisor and capstone committee have provided me with valuable feedback to my VoiceThread, PowerPoint, and educational handout. They provided expert feedback on content within the presentation—especially the physical therapist’s role in treatment, organization of slides, and ideas to create an aesthetically pleasing lecture for student engagement. This project underwent multiple rounds of edits allowing me to implement all the feedback provided thus ensuring each item produced within my capstone project was appropriate for UNC’s DPT curriculum. 

            Since the VoiceThread and PowerPoint were created for current physical therapy students, I asked members of my cohort to evaluate the effectiveness of my presentation via a Google Form. Multiple students, with varying amount of experience treating the pediatric population, viewed the materials and provided valuable feedback. After reviewing the results, 100% of those who reviewed the products felt it was an in-depth review of pediatric orthopedic conditions that served to fill the gap in our current DPT curriculum and provide review for the NPTE. Additionally, 100% of the respondents felt they had learned something new by the end of the presentation, and this new knowledge is transferrable to clinical application. Furthermore, each participant felt that the organization and presentation of the material was clear and succinct while adequately addressing each learning objective. The link to the evaluation tool can be found below. 

 

Link to the Google Form: https://docs.google.com/forms/d/e/1FAIpQLSczDqPYnKnECIqQuoAbgju9zJO4bIKCu4amtkYbp8hbwAjbIQ/viewform?usp=sf_link

 

Self-assessment

 

Acknowledgements

To Dr. Dana McCarty PT, DPT, PCS, thank you for being my primary advisor on this project and providing me with expert feedback to create doctorate-level educational material. I am grateful that you allowed me to create materials for the PHYT 880 course to be used in future years. Thank you for all your time and input throughout this project, I appreciate it!

 

To Dr. Jessica Cassidy PT, DPT, PhD, thank you for donating your time to be on my capstone committee. As a professor that I very much admire, I am very grateful for all your input for each of my project’s components. Your guidance and expertise played an instrumental part in the success of this project.

 

To Dr. Mae Thomas PT, DPT, PCS, thank you for being a fundamental member of my capstone committee. Thank you for volunteering your time and sharing your clinical expertise. I remember discussing capstone options with you during my last week of my rotation in my 2^nd year and knew that you would be an asset on my committee. Finally, thank you for confirming my love for pediatric physical therapy. I will never forget my rotation at the CRC and all the valuable skills you taught me!

 

Big thank you to the UNC DPT Class of 2023! Can you believe we did it? I could not imagine going through the last three years without you all! From completing first year separated into four different classrooms linked by zoom, to becoming some of the most important and influential people in my life! I appreciate each of you and cannot wait to see where your careers take you!

 

References

1. Palisano RJ, Orlin MN, Schreiber J. Campbell’s Physical Therapy for Children. 5th ed.; 2016:642-650. 
2. Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2018;30(4):240-290. doi:10.1097/PEP.0000000000000544
3. Sternocleidomastoid Tumor of Infancy | Children’s Hospital of Philadelphia. Accessed January 14, 2023. https://www.chop.edu/conditions-diseases/sternocleidomastoid-tumor-infancy
4. Demirbilek S, Atayurt HF. Congenital muscular torticollis and sternomastoid tumor: results of nonoperative treatment. J Pediatr Surg. 1999;34(4):549-551. doi:10.1016/s0022-3468(99)90070-2
5. Palisano RJ, Orlin MN, Schreiber J. Orthopedic Conditions: Blount’s Disease. In: Campbell’s Physical Therapy for Children . 5th ed. ; 2016:1036-1037.
6. Blount’s Disease Symptoms, Causes & Treatment. Accessed February 2, 2023.
7. Birch JG. Blount disease. J Am Acad Orthop Surg. 2013;21(7):408-418. doi:10.5435/JAAOS-21-07-408
8. Erkus S, Turgut A, Kalenderer O. Langenskiöld classification for blount disease: is it reliable? Indian J Orthop. 2019;53(5):662-664. doi:10.4103/ortho.IJOrtho_679_18
9. Karkenny AJ, Tauberg BM, Otsuka NY. Pediatric Hip Disorders: Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes Disease. Pediatr Rev. 2018;39(9):454-463. doi:10.1542/pir.2017-0197
10. Palisano RJ, Orlin MN, Schreiber J. Campbell’s Physical Therapy for Children. 5th ed.; 2016:1067-1074.
11. Palisano RJ, Orlin MN, Schreiber J. Campbell’s Physical Therapy for Children. 5th ed.; 2016:1076-1082.
12. Nasreddine AY, Heyworth BE, Zurakowski D, Kocher MS. A reduction in body mass index lowers risk for bilateral slipped capital femoral epiphysis. Clin Orthop Relat Res. 2013;471(7):2137-2144. doi:10.1007/s11999-013-2811-3
13. Peck K, Herrera-Soto J. Slipped capital femoral epiphysis: what’s new? Orthop Clin North Am. 2014;45(1):77-86. doi:10.1016/j.ocl.2013.09.002
14. How much physical activity do children need? | Physical Activity | DNPAO | CDC. Accessed March 22, 2023. https://www.cdc.gov/physicalactivity/basics/children/index.htm