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lee8558
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Posted: Thu Mar 29th, 2012 09:00 am |
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shanna wrote: Is there a spesific protocol for a 7 years old kid with osteogenesis imperfecta and abnormalities in gait?
(original question from clinician posted on facebook) 
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Doug Poage000
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Posted: Mon Jun 13th, 2011 03:16 am |
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| Treatment can be over the treadmill as long as their foot does not catch at the end range of their stance and does easily clear in the swing phase- then yes. One problem with standing and walking with OI after periods of immobilization are tight hip flexors-- and how to stretch them.
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A Elmore
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Posted: Thu Dec 30th, 2010 05:48 pm |
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| What places a child with OI to fracture is usually not linear weightbearing though the long axis of the bone-- it is torsion that fractures the bone. Yes prolonged weightbearing can further increase angular deformity. Care with avoiding torque is the key.
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A Elmore
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Posted: Thu Dec 30th, 2010 05:28 pm |
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| Hello. Regarding the questions around OI and best ambulation aides. I myself am a PT. I have 2 children both with OI - one more severe than the other-- one with 2 rods. With initial standing if the rib cage is not overly flexible - I would side with attempting the harness on the Lite Gait -- the Bisphosphonates have tended to make my 2 children's rib cages much more sturdy. Treatment can be over the treadmill as long as their foot does not catch at the end range of their stance and does easily clear in the swing phase- then yes. One problem with standing and walking with OI after periods of immobilization are tight hip flexors-- and how to stretch them. This needs to be addressed with therapy with gentle stretching. If no chest height pool is available then partial body weight supported gait out of the water is indicated to attempt with caution.
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nkarman
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Posted: Thu Dec 9th, 2010 12:16 pm |
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This child is certainly at risk for fractures, but I would think no more so in the LG than outside of it. Children with OI fracture from something as simple as muscle pull on the bone, so I would think unweighting and off-loading would, if anything, decrease fracture risk. His fractures have been in the long bones (femur, humerus), rather than the pelvis, so I would think that the harness would be less of a problem than fully-loading the legs by walking without the support would be. But I would be concerned about the flexibility of his hip flexors- no overpressure to promote trailing limb posture, just verbal cues to take nice, easy long strides. I would also consider a "softer bed" (sports/running) treadmill, to decrease impact on initial contact.
I would be careful about advancing walking speed too much (harder heel strike and more loading, greater likelihood of fracture). His cognition is likely fairly good (this is a peripheral problem), and adding force is not recommended with his fracture risk, so I would do a very "MRP" (read "Brain-based learning strategies) protocol. May want to increase friction between harness and his body with open-celled foam, to decrease compressive loading, but again, his problem seems to be more long-boned. My focus would be on eliciting the most efficient gait pattern possible. Excess muscle pull on the bone is a problem, so walking in a way that requires less pull, i.e. elicit reciprocal arm-swing, so that clearance comes with transverse plane motion, rather than excessive lateral weight shift, which would increase muscular demand...
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shanna
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Posted: Mon Dec 6th, 2010 03:55 pm |
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These are the details of the patient: Any thoughts to pass along???
My 7 years old boy has osteogenesis imperfecta (oi) type IV moderate. Till now had 25+ fractures mostly to his femurs and left humerus. He gets regularly bisphosphonates treatment since he was 9 months old which improved his bone density. He has both his femurs and his left humerus rodded with Faussier-Duval rods, meaning intramedullary tellescopic rods. He is walking independently if not recovering from a fracture or a surgery since he got his first pair of femur rods at the age of 2.5 years old. Last year his femur rods were both replaced with new ones because the old ones were bend and not expanding properly.
Since the rods were starting to bend due to fractures, his walking began to change.
-Sorry but my English are not good enough to describe the situation but I will try-
There was also a less than 2 cm leg difference. Femur deformity and leg difference made his walking difficult.
Since the last surgery Christos got strong and his gait was improved but not as much as we thought he would. He still is missing the diagonal movement although he is doing really great. Also there is some occasional discomfort at his left buttock due to the protruding male part of the FD rod. No rib fractures since birth.
He has pt for more than 3 years now. His therapist uses Litegait in her therapeutical centre and she said that she can use some protocol for Christo too. I thought that I could get her as much info as possible through my mail because my son’s condition is a quite rare one.
Thank you,
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shanna
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Posted: Sat Dec 4th, 2010 11:45 pm |
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RESPONSE from Peds clinician Los Angeles, CA:
OI is a genetic disorder characterized by bone fragility/osteoporosis and predisposition to fractures. Treatment using the BWS with LiteGait on or off the treadmill is a great choice. I would want medical clearance for loading weight through the pelvis with the harness, and be cautious around the rib cage if there is any history of rib fractures (maybe some extra padding). Gait training with BWST is ideal to work on lower extremity strengthening and cardiorespiratory endurance and the treatment protocol would vary depending on what goal you are working on. Protocol B makes the most sense to me with the therapist providing verbal cues and encouragement but no physical assistance. Start at a comfortable speed and enough BWS to allow for an optimal gait pattern. If strength is your goal you will estabish a target time for continuous walking (ie. 15-20 mins) and then progressively decrease the BWS or increase the incine to allow more resistance. If cardiorespiratory endurance is your goal, you will have a time frame for warm up, intervals, and cool down and work towards increased total time or intensity of work during intervals.
The LiteGait could also be used over ground for BWS in standing during play activities (ball games, board games), LE strengthening exercises, and transfer training.
Lots of great applications.....good luck!
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shanna
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Posted: Fri Dec 3rd, 2010 07:35 pm |
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This came from a pediatric clinician in Boston, MA:
right off the top of my head, before I even get to a protocol per se, I would want to know what type of Osteogenesis Imprefecta this child has; their history of and risk for bone fractures (especially spine, rib and pelvic); their history, if any, of intermedullary rod placement and consequent appropriateness/need for adaptation of the lightgait harness. Then I would wonder where we are starting from; is this child an independent ambulator who is recovering from a surgery, a non-ambulatory child making their first attempt to take steps or or etc...
More history etc and I would have more to say...
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shanna
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Posted: Fri Dec 3rd, 2010 01:48 pm |
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Is there a spesific protocol for a 7 years old kid with osteogenesis imperfecta and abnormalities in gait?
(original question from clinician posted on facebook)
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