OT & Podiatry in Paediatrics Mutual areas of concern Caryn Mincherton OT

Outline When to refer to OT How do we assess? What do we look for? Tips for parents Pearls to take back to your practice Occupational Therapy Podiatry PAEDS

Still basket weaving??

How do we work together? We know podiatrists dont just look at feet. Similarly, OTs dont just look at hands

Co-Morbid Issues The child with low muscle tone – Flat and pronated feet – Poor postural control – Difficulty sitting for fine motor tasks – Feeding issues

…and further Hands need arches too In hand manipulation and Speed and dexterity

Building blocks for development and learning Emotional Regulation Social – Play Skills Sensory Processing Body Awareness Sensory Modulation Motor Skills Co-ordination Bilateral Integration Gross Motor Fine Motor Visual Skills Visual Perception

Where we come in… – Assess – Skills training – Strategies – Adaptations – Building skills

First step, assessment Informal (Clinical Observations) Formal (Standardised Assessments) – Gross and fine motor movement – Sensory processing – Visual perceptual and visual motor – Developmental assessments – Handwriting

Treatment Where? How? What?

Benign Joint Hypermobility Syndrome (BJH)

BJH 48% Clumsy 36% Poor Coordination 14% Speech and language issues 48% Issues with participation in PE 40% Handwriting difficulties

BJH – Joint Involvement 92% Knees 75% Ankles 79% Fingers/MCP 87% Elbows 82% Wrists

BJH 84% of children with BJH have motor skill difficulties. 14% correlation with speech and language concerns.

Quick checks Ask the child to fully extend elbows – Greater than 180°? Gently see if their fingers bend back at the MCPs – Greater than 90°? If BJH present, but no functional limitation NO OT

What works to improve strength Activities/Exercises Increase strength Increase stability especially in the mid- range (Co-contraction) Heavy work

Joints? Provide stability – Use splints, lycra or neoprene Conserve joints – Decrease load/weight – Alternate methods to complete a task

What do we use Adapted equipment Adapt the environment

High school years Handwriting – Legibility – Speed Exams Curriculum Council process

Toe Walkers Co-morbidity Ideopathic toe walkers Non-ideopathic toe walkers

Toe walkers and sensory processing Proprioceptive seekers Tactile Avoiders on different surfaces.

Sensory Processing We all do it, every day. Tactile Proprioceptive Vestibular/Movement Oral Auditory Visual Olfactory

Sensory Seekers and Avoiders This is the child that you have bouncing off the walls in your clinic This is the child that you see that is unusually tentative or avoidant of touch/movement

Motor Skills Assessment Treatment – Top-down – Bottom-up

Motor Skills Vestibular- children need good quality efficient movement skills and tactile skills for motor planning DCD/orthotics link

Red Flags At any age, the child who is – Too busy – Too quiet (defensive/anxious) – Low tone (fatigues)

More …. Red Flags At Three Arms in high guard when walking Drooling Cant hold their own bodyweight on monkey bars At Four Cant cup their hand Cant imitate simple finger actions like Twinkle Twinkle Cant balance on one leg for 2-7 seconds At Five Hand dominance not well developed – sometimes swaps Cant heel toe walk along a 2 metre line Cant complete 10 hops on preferred foot. At Six Thumb collapses with circle thumb-finger test Cannot Skip- 85% can skip well. Cant hop on one leg for 3 mtrs (first left then test right).

Pearls… Physical activity – Increase good quality movement, decrease screen time Heavy work – Can calm a deregulated child – Stimulates muscle strength in the hypotonic child – Improves proprioception in poorly coordinated children

Top 3 fine motor activity pearls Theraputty / super strengthening kit from Skillbuilders Tricky Fingers Game Highly motivating writing tools e.g. crayon rocks, overwriters, silkies

Top 3 gross motor activity pearls Animal walks Scooter boards Space Hoppers

Take away points Toe walking BJHS Flat feet Warts OT is a highly engaging, motivating process helping children meet their goals.

Questions for you??? What are your thoughts on trampoline use and toe walking? When should children have their orthotics on and off? – During our therapy sessions? – At the beach? – On trampolines?