‫مكتبه‬

Make your Coffee & let's Study Together

Subject : Pediatric rehabilitation

Lecture : lec 5

Price : 2.5

PT 5
‫اربط حزام امانك فلقد أوشكت الرحهل عىل الانهتاء‬

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Pediatric rehabilitation .lec 5

‫ وان الفرق بين االطفاال والكبار !؟‬muscle test ‫ الدكتور بدأ المحاضرة بيتكلم عن ال‬
resistance ٗ١‫اػط‬ٚ ‫ذن‬٠‫ اسفغ ا‬ٚ‫ٌٗ اعحة أ‬ٛ‫ال‬ٚ ‫ا‬ٙ‫ػىغ‬ٚ ‫ح‬١‫ ِغ اٌدارت‬grade ‫ؼًّ وزا‬١‫ش ت‬١‫ طثؼا اٌؾخـ اٌىث‬
Manual muscle test ‫ٕذسج ذحد تٕذ اي‬١‫ ت‬ٛ٘ ٌٍٝ‫ ا‬individual muscle test ًّ‫ؼ‬٠ ‫مذس‬١‫٘ىزا ف ت‬ٚ

_: ‫ ف االطفال عىدوا قسميه‬

functional َ‫ تغرخذ‬ٟ‫ ٌىٓ ف‬individual muscle test ٖ‫مذسػ اػًّ ِؼا‬١ِ spastic ً‫ طف‬ٌٛ ‫ طثؼا‬
‫ تراػٗ اي‬grades ‫ ب‬isolation ًّ‫ ِمذسػ اػ‬pattern ‫رحشن ف‬١‫ الٔٗ اٌطفً دا ت‬muscle test
individual muscle test
functional muscle ٍّٗ‫ وذا تؼ‬command ‫ُ آي‬ٙ‫ف‬٠ ‫مذسػ‬١ِ ٚ ٓ١ٕ‫ ع‬٣ ِٓ ً‫ طفً أل‬ٌٛ LMNL ً‫ طف‬ٌٛ 
test
 Functional muscle test
Done if child less than 3 years , spastic , LMNL can’t understand command
 Grade 0 null function :- complete muscle paralysis
 Grade 1 Sub functional :- flicker contraction
 Grade 2 functional :- child can perform tasks

 Individual muscle test

 Done if child more than 3 years and not spastic , can understand command and has good
tone as in cases of “ BPI , Infantile paralysis ”
‫ بتاعه كويس‬tone ‫ النه هيكون بيعرف يستجيب و ال‬

 Grades of individual muscle test : Zero

Poor
Trace
Fair
Good
Normal

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 ٓ‫خرٍف ػ‬١‫ ت‬individual muscle test ‫ الٔٗ اي‬muscle test ‫ا‬ٍّٙ‫ ٘ؼشف اػ‬muscles ‫ ٌّا اػشف اي‬
‫ً صِاْ ٌىٓ ِخذٔاػ‬١‫تاٌرفق‬individual muscle test ‫احٕا اخذٔا اي‬functional muscle test , ‫اي‬
‫ش‬١‫ ف االطفاي الٔٗ دا طفً فغ‬functional ‫اي‬
‫ ترمذس‬diagnostics ‫ا‬ٙٔ‫ّٗ خذا ف االطفاي أل‬ِٙ ٜ‫د‬foot ‫اي‬foot deformity ‫ ب‬ٜ‫ْ خا‬ٛ‫ى‬٠ ً‫ ٌّا اٌطف‬
ًّ‫ؼ‬٠ ‫مذس‬١٘ ً‫ ً٘ اٌطف‬ٚbalance between ms ‫ اي‬ٚ diagnosis ‫ اي‬ٚdeformity ‫ٔحذد ِٕٗ اي‬
foot ‫ اي‬ٌٝ‫تاٌرا‬foot deformity ‫دٗ اي‬١‫مذس ٔر‬١٘ ‫ال ِؼ‬ٚstanding and weight bearing on foot
.... ُ٘‫ش‬ٙ‫شٖ خذا ٌىٓ أؽ‬١‫ور‬deformities ‫ا‬ٙ١‫حقً ف‬٠ ٓ‫ِّى‬
 Talipes Equino Varus
 Talipes Equino valgus
 Talipes calceno Varus
 Talipes calceno valgus

‫ض‬٠ٛ‫ ٔحٍٗ ف اٌى‬ٟ‫ اٌثال‬ٚ talipes equinoverous : ٞ‫ ٕ٘اخذ اٌّحاضشج د‬

 Talipes = deformities around the foot, Equino = planter flexion deformity , Varus= inversion of
subtitler and adduction of midtarsal

club foot = congenital club foot = postural ُ‫ا خذا تاع‬ٙ١ٍ‫ِرؼاسف ػ‬ٚ ٖ‫س‬ٛٙ‫ ِؾ‬ٞ‫ د‬deformity ‫ اي‬
ٞ‫ي اٌفرشٖ د‬ٛ‫ ط‬contracted ٍٗ‫ فرشٖ اٌحًّ اٌطفً سخ‬ٟ‫ ف‬mall position ‫دٗ اي‬١‫ترحقً غاٌثا ٔر‬ٚ club foot
‫ا‬ٙ١‫ٌذ ت‬ٛ‫ر‬٠ ٚ ‫ ف اٌؼضالخ‬tightness ً‫حق‬١‫فث‬
most tight and weak muscle in each ‫ ويجي بقي للسؤال المهم اللي بىتسأله اللي هي ال‬
‫؟‬deformity !
‫ !؟ ٔثـ‬ٟٕ‫ا تّؼ‬ٙ‫ٔؼًّ ػىغ‬ٚ Deformity ‫ف اي‬ٛ‫ ٕ٘ؾ‬talipes equinoverous deformity ‫ ٔرىٍُ ػٓ اي‬
( planter- inversion- adduction) ْ‫فف وذا وا‬ٌٛ‫ ا‬ٍٟ‫ ػ‬ٟٔ‫ٕا ذا‬١ٕ‫تؼ‬
 Most tight muscles:-
planter flexion+ inversion ➡ ًّ‫ؼ‬١‫ٓ ت‬١ِ ٟ‫لر‬ٌٛ‫ د‬ٟٕ‫ؼ‬٠ position , ‫ اي‬ٍّٟ‫ ترؼ‬ٌٍٟ‫ْ اٌؼضالخ ا‬ٛ‫ ترى‬
tibialis posterior

 Most weak muscle ➡

dorsiflexion + eversion ➡ ٍّٟ‫ ترؼ‬ٌٍٟ‫ اٌؼضٍٗ ا‬ٟٕ‫ؼ‬٠ position ‫ ػىظ اي‬ٍّٟ‫ ترؼ‬ٌٍٟ‫ اٌؼضالخ ا‬
peroneus Tertius
facilitation ‫ و ازاي وعملها‬ms test ‫ مه دول ليها‬ms ‫ طبعا كل‬

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  Clinical differential diagnosis between upper and lower motor neuron lesion
ٖ‫اسد‬ٙٔ‫ْ ِذخً ِحاضشذٕا ا‬ٛ‫ى‬١٘ ٚ ‫ فاذد‬ٌٍٝ‫ض اٌّشٖ ا‬٠ٛ‫ْ اخاتٗ عؤاي و‬ٛ‫ى‬١٘ ‫ دا‬
motor neuron (efferent pathway ) ٓ١‫ؼح ت‬٠‫ ػٓ ِماسٔح عش‬physiology ِٗ‫ تظ الصَ ٔاخذ ِمذ‬
sensory neuron (afferent pathway) ٚ
Sensory neuron motor neurons
Transmit impalses of sensation such as more than 500,000 in CNS&PNS
pain, touch, temperature to CNS divided to ➡
upper motor neurons
lower motor neurons

Upper motor neurons:

 transmit impulses from cerebral cortex to before Anterior Horn cell
 so UMNL site = any lesion in Motor neuron area above the ant.horn cell either pyramidal
( responsible for conscious voluntary movement ) or extra pyramidal ( responsible for
unconscious movement of balance and posture , and basal ganglia for inhibition of ms tone)
 Upper motor neurons consist of tracts as vestibulospinal tract , reticulospinal tract , rubrospinal
tract , corticospinal tract ) … so any lesion of these tracts lead to UMNL as CP and TBI
 UMNL characterized by abnormal ms tone either in the form of hypertonic rigidity or spasticity
Differential diagnosis of upper motor neurons lesion :
 As in CP , there is no fasciculations , normal EMG
Lower motor neurons:-
 transmit impulses from anterior horn cell to organs & muscle
 So LMNL site = any lesion from Anterior Horn cell to muscle

‫ي حاخٗ تؼذ وذا اي‬ٚ‫ ا‬Axon ‫ اي‬ٟ‫ ثُ ف‬Ant.horn cell ‫ ِٓ اي‬ٟ‫ اإلؽاسج ترّؾ‬lower ‫ اي‬ٟ‫ٔاخذ تإٌا اْ ف‬
‫ـ ِخرٍف‬١‫ ذؾخ‬ٟٕ٠‫ي ٘رذ‬ٚ‫ حاخٗ ِٓ د‬ٟ‫ فىً ِؾىٍح ف‬muscle ‫ٓ اي‬٠‫تؼذ‬ٚneuromuscular junction
Differential diagnosis of Lower motor neurons lesion :
 There is fasciculation especially in tongue , abnormal EMG
Ant.horn cell affection ‫ ِثاي ػٓ اي‬: ‫ ِثال‬ٕٝ‫ؼ‬٠ 
ٛ٘ ٌٍٟ‫ خذٔاٖ لثً وذا ا‬ٌٍٝ‫ا‬werdnig Hoffman syndrome ّٗ‫ ف االطفاي اع‬disorder ‫فد‬ٛ‫ ؽ‬ٌٛ 

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 ‫دا‬characterized by hypotonia, hyporeflexia , delayed milestone, respiratory disorder
degeneration of Anterior Horn cell ٗ‫ي أٗ دا عثث‬LMNL ‫ ب‬ٜ‫ خا‬ٚ genetic disorder ٟٕ٠‫ذ‬١‫ت‬

ٚ‫أ‬polio virus ٛ٘ ٌٍٝ‫ا‬virus ‫ دا ِؼأا أٔٗ دا‬disorder ‫ا‬ٍٙ‫ا حق‬ٍٙ‫ و‬Lower motor neurons ‫ اي‬ٌٛ ْ‫ إر‬
ٖ‫ دا ػثاس‬ٚ ٗ٠‫ ٕ٘اخذٖ اٌّحاضشج اٌدا‬infantile paralysis ّٗ‫اع‬
 viral infection and affection of Motor neuron any one in Spinal cord , medulla, cerebral cortex
( characterized by Ms paralysis , ms weaker , hypotonia , hyporeflexia , asymmetrical voluntary
distribution )

‫ إٌاط‬ٞ‫ص‬ms paralysis ٛ٘ ٌٍٝ‫ا‬tone ‫ْ ف اي‬ٛ‫ا ترى‬ٍٙ‫و‬motor neurons ‫ تراػٗ اي‬affinity ‫ ٕ٘ا اي‬ٚ 
" ‫اخاخ اٌخافح‬١‫ االحر‬ٞٚ‫ ِرحشوح " ر‬ٟ‫ وشاع‬ٍٟ‫ا ػ‬ٛ‫ّؾ‬١‫ ت‬ٌٍٟ‫ا‬

Guillian Barre syndrome ‫ ٕ٘اخذ ف االطفاي اي‬polyneuropathy ‫ حاالخ اي‬ٜ‫ ص‬Axon ‫ تؼذ وذا اي‬
‫س خذا‬ٛٙ‫ِؾ‬
myasthenia gravis ًّ‫ؼ‬١٘ neuromuscular junction ‫ تؼذ وذا اي‬
Myopathy ‫ وذا‬ٟ‫ثم‬٠ muscle ‫ تؼذ وذا‬

: »»» ‫دا مىضىع اوهاردة‬

‫ اي‬ٕٝ‫ؼ‬٠ floppy ٕٝ‫ؼ‬٠ ٕٗ١‫ اٌطفً اٌؼد‬ٛ٘ Rag doll ‫اي‬
RAG-DOLL SYNDROME "FLOPPY
bad ٖ‫ ػٕذ‬ٚ trunk ‫ اي‬ٍٝ‫ ِؼ فاٌثٗ ػ‬head
INFANT"
supine or prone ‫اء‬ٛ‫ ع‬posture

 Causes
warding Hoffman ‫ُ اي‬ٌٙٚ‫ق أ‬ٛ‫ٌٕا٘ا ف‬ٛ‫ ل‬ٌٍٝ‫ا‬LMNL ‫ وً اٌّحطاخ تراػٗ اي‬ٜٛ‫ ِغر‬ٍٝ‫ ػ‬LMNL ‫تغثة‬ 
general topic ‫ع ن‬ٛ‫ض‬ٌّٛ‫اسدٖ تراخذ ا‬ٙٔ‫ ا‬ٚinfantile paralysis ‫ٗ ٕ٘ؾشذ اي‬٠‫ أْ ؽاء هللا اٌّشٖ اٌدا‬ٚ
. ٌٗ‫ ٌىً حا‬diagnosis ًّ‫ػؾاْ اػشف اػ‬

extensive lesion of ٗ‫د‬١‫ ٔر‬CP ‫ اي‬ٜ‫ص‬floppy infant ْٛ‫ى‬٠ ٚ UMNL ْٛ‫ى‬٠ ً‫ا اٌطف‬ٚ‫ِّىٓ تشد‬ 
ataxia or ٟ‫ ِّىٓ ذثم‬ٚ spastic or hypotonia , ٟ‫ثم‬٠ ٓ‫اع ِّى‬ٛٔ‫ ا‬CP ‫ ألٔٗ اي‬pyramidal tract
ًّ‫ ترؼ‬ٌٍٝ‫ اٌقفشا ف االطفاي ا‬neonatal jaundice ‫ عثثٗ اي‬dyskinesia ‫شاي‬ٙ‫ أؽ‬dyskinesia
bilirubin above ‫ادٖ اي‬٠‫دٗ ص‬١‫ طفً خاٌه اففش وذا ٔر‬ٌٛ ٗٔ‫ُ أ‬ِٙ ‫ دا‬ٚ hypotonia or fluctuating tone
٩ ‫فً ي‬ٚ ٌٛ ‫ خُ دَ ) ف‬ٍٍِٝ ١١١ ً‫ ٌى‬٢ ‫ ي‬١ ِٓ ( ْٛ‫ى‬٠ ‫ك‬ٚ‫ اٌّفش‬ٛ٘ ٌٍٝ‫ ا‬ٕٝ‫ؼ‬٠ physiological level
distraction to ًّ‫ؼ‬١‫ُ ت‬٠‫الخ ٌٍىثذ ػؾاْ ذٕؾظ أض‬ٛ‫رؼاٌح ب اِث‬٠ َ‫ الص‬ٟ‫ثم‬٠ physiological ‫ ِٓ اي‬١١ ٚ‫أ‬
premature and suffer from ‫ا‬ٛ‫ثم‬١‫ُ ت‬ّٙ‫ ِٓ اٌدغُ الٔٗ اٌطفً دا ِؼظ‬bilirubin ‫خشج اي‬٠ ‫ ف‬jaundice
ٛ٘ deficiency of liver enzymes ٗ‫د‬١‫ ػشضٗ ٔر‬ٟ‫ثم‬١‫ ت‬ٌٝ‫ تاٌرا‬hypoglycemia and hypothermia

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 ٟ‫ثم‬١٘ ‫ دا‬١٤ ‫فً ي‬ٚ ٌٛ .... ُ‫ك اٌدغ‬٠‫سٖ ذطٍغ ػٓ طش‬ٛ‫ ف‬ٌٝ‫سٖ ضاسٖ إ‬ٛ‫ ِٓ ف‬bilirubin ‫ اي‬ٌٝٛ‫ح‬١‫ ت‬ٌٍٝ‫ا‬
‫اي‬photo therapy ‫الٔٗ ِغ اي‬blood transfusion and photo therapy ‫حراج‬١‫ الصَ ت‬ٚ pathological
‫ىغش اي‬٠ ٚ absorption ًّ‫ؼ‬١‫دا ت‬photo therapy ‫ ف ٕ٘ا اي‬under skin ‫د‬ٛ‫خ‬ِٛ ٟ‫ثم‬١‫ ت‬bilirubin
‫ ترمً ٔغثٗ اٌقفشا‬ٌٝ‫ تاٌرا‬ٚ ُ‫طشدٖ ِٓ اٌدغ‬٠ ٚ‫ دا‬bilirubin
‫ػ‬ٛٙ‫فف‬ٛٔ ‫ ػؾاْ ِا‬CP child ‫ظ‬١ٌ ٚ ‫ِثال‬child with CP ‫ي‬ٛ‫أٔٗ ٔم‬ethics ‫ٓ أٔٗ ِٓ اي‬١‫ طثؼا ػاسف‬N.b 
ٗ‫زٖ اٌقف‬ٙ‫ت‬

 Description

1. Hypotonia ➡ abnormal bad posture

➡ Diminished resistance to passive movement
➡ Abnormal joint movement ROM
2. delay in motor milestones
3. Problem in sucking and feeding due to weakness of ms
4. Rectus Exavatum due to weakness of chest wall ms
5. Decreased activity
‫ا‬ٙ١ٌ action ٜ‫ؼًّ ا‬١‫ دتأٗ لشفرٗ ِؼ ت‬ٌٛ ٝ‫ حر‬
6. Decreased spontaneous reflex of child
7. Developmental delay
8. Loss of head control
9. Can’t perform counter balance or co-contraction between ms
10. Abnormal posture in supine and prone “ poor postural control “ , no head control
‫ وً اي‬flexion tone ‫ؼ‬١‫ ِف‬frog like position‫ضغ اي‬ٚ ‫اخذ‬٠ supine ّٗ١ٕ‫ ت‬bad posture :- ‫ ّٔغه اي‬
ٟ‫ق وذٖ ف‬ٛ‫ ف‬ٌٍٟ‫سٖ ا‬ٛ‫ اٌق‬ٞ‫ ص‬C shape ‫ضغ اي‬ٚ ‫اخذ‬٠ prone ٛ٘ٚ ‫ذن‬٠‫ ا‬ٍٟ‫ٍٗ ػ‬١‫ ذؾ‬، ٗ‫ٗ خّث‬١ِ‫ِش‬limbs
ٚshoulder drag ‫ اي‬flexion or extension ٟ‫اء ف‬ٛ‫ ساعٗ ِٓ االخش ع‬ٟ‫رحىُ ف‬٠ ‫ ِؼ لادس‬head lag
‫ٔاصٌٗ ٌرحد‬
tone ‫شخغ اي‬٠ٚ ٖ‫اخذ فرش‬١‫ف أٔٗ ت‬ٚ‫اٌّؼش‬ٚ UMN ٟ‫د‬٠ ٓ‫ ِّى‬floppy ‫ٌٕا اي‬ٛ‫ احٕا ل‬ٟ‫لر‬ٌٛ‫ُ د‬ِٙ ‫طة عؤاي‬ 
! ‫ ؟‬hypo ًّ‫ى‬١‫ال ت‬ٚ ٗ٠‫شخغ خالي لذ ا‬١‫ك اٌطفً دا ت‬ٚ‫ش فاٌّفش‬ٙ‫ظ‬٠
) centeral & transient ) ‫ ا‬hypotonia : ( ‫ (االجابه أن عىدي وىعيه مه ال‬
hypotonia ًّ‫ى‬١٘ ٗٔ‫ دا ِؼٕاٖ أ‬hyper ‫ ي‬hypo ِٓ ‫ٌؼ‬ٛ‫ ِرح‬ٌٛ ٓ١ٕ‫ ع‬٣ ‫ا ٌحذ‬٠‫فضً ِؼا‬١‫ ت‬central :_ ‫ اي‬
mental retardation , seizure in ٖ‫ ِؼا‬ٟ‫ثم‬١‫الٔٗ ت‬PT ًّ‫ّا ذؼ‬ِٙ poor prognosis ‫دا طثؼا‬ٚ

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 addition to hypotonia and delayed milestone and speech disorder
ْ‫طٍغ ٌغأٗ إر‬١‫رٗ ت‬١‫ ٌم‬ٌٛ ٞ‫مٍة ص‬١٘ ٗٔ‫ اٌطفً اػشف أ‬ٍٟ‫ش ػ‬ٙ‫ ػالِاخ ترظ‬ٟ‫ ف‬transient ًٌ ٟ‫ تإٌغثح تم‬
dyskinesia ‫مٍة ي‬١٘
 Nystagmus ‫ ➡هيقلب‬ataxia
 Clonus sign - positive Babinski ‫ ➡ هيقلب‬spasticity
sign of UMNL ٟ‫ثم‬١٘ ٓ١‫ وًّ تؼذ اٌغٕر‬ٌٛ ٚ ٓ١‫ عٕر‬ٚ‫ ٌحذ عٕٗ ا‬ٟ‫ثم‬١‫ ت‬positive Babinski ‫ اي‬
‫ ػىظ‬ٍٟ‫ ػ‬function ًّ‫ اػ‬ٟٔ‫ ٘رغاػذ‬spasticity ٟ‫ ف‬ٌٛ ٟ‫ حر‬central ‫ش ِٓ اي‬١‫ احغٓ ور‬transient ‫طثؼا اي‬ٚ 
‫ق‬ٛ‫ٌٕا٘ا ف‬ٛ‫ ل‬ٌٍٟ‫ ا‬hypotonia ‫اي‬

 Examination

1. observation
‫ اي‬ٟ‫س ِؼ ٘رالل‬ٛٙ‫ ؽ‬٥ ٚ‫ أ‬٤ ٛ٘ ٌٛ ... ‫ وذا‬ِٟ‫ْ ِش‬ٛ‫ى‬١٘ supine &prone ‫ي حاخٗ ف اي‬ٚ‫ ا‬
ًِ‫ ػا‬frog like position ٛ٘ ٌٍٝ‫ ا‬bad posture ٟ‫ذالل‬physiological tone flexor of upper limb
ٗ‫ حشو‬ٜ‫ؼ ا‬١‫ وذا ِف‬ِٝ‫ اٌضفذػٗ ِش‬ٜ‫ص‬
2. traction response
ٕٝ‫ؼ‬٠ ‫ع‬ٛ‫ اعث‬٣٣ ِٓ ً‫ أل‬ٚ‫ٌذ‬ٛ‫ر‬١‫ ت‬ٌٍٝ‫ األطفاي ا‬ٟ‫د ف‬ٛ‫خ‬ِٛ ‫دا ِؼ‬
ٟ‫ؼ‬١‫حقً ف اٌطفً اٌطث‬١‫ دا ت‬response ‫ ٌىٓ اي‬، ‫اٌطفً اٌّثرغش‬
 Application :
Introduce your thumb in child palm , with 4 fingers
support
liable ٗٔ‫ ال‬subluxation or dislocation ‫ػ‬ٍٛ‫حق‬١ِ ْ‫ ػؾا‬more proximal ‫ ف تّغه‬floppy ٗٔ‫ تّا أ‬
‫ٌىذا‬
pull to sit .... ٍّٗ‫ اػ‬ٚ ‫ دا‬grasp ‫ة اٌطفً ِٓ اي‬١‫ تد‬
In normal full term baby :
Head is supported on trunk , shoulder not dropped , and can sit Easily .
In floppy infant :
Due to hypotonia , and ms weakness and no physiological co-contraction ▶there is a rag
doll " excessive head extension / head lag "

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 3. ligament laxity
 In UL : flexion wrist , thumb extension
with abduction ▶ thumb will reach to
forearm if lax
 In LL : dorsum of foot will touch tibial chin
4. scarf sign
 When child do horizontal adduction ▶ elbow
will cross the midline without limitations

5. heel to ear or mouth

ٗ‫ل‬ٛ‫حظ سخٍٗ ف ت‬١‫ ت‬ٚ ‫ضحه‬١‫ اػالْ تاِثشص اٌطفً ت‬

6. popliteal angle
frog ‫ضغ اي‬ٚ ‫ ٕ٘ا تغثة‬ٟ‫ؼ‬١‫ْ اوثش ِٓ اٌطث‬ٛ‫ ٘رى‬

7. vertical suspension
vertical ٗ‫ ػٍّر‬ٚ axilla ‫د ِغىرٗ ِٓ ػٕذ اي‬١‫ خ‬ٌٛ ٟ‫ؼ‬١‫اٌطفً اٌطث‬ 
ٟ٘ ‫ٌىٓ ٕ٘ا‬، control ٖ‫ ػٕذ‬ٚ UL & LL flex ‫ اي‬ٟ‫٘رالل‬suspension
tone ‫ؼ‬١‫مغ الٔٗ ِف‬٠ ٚ ‫ ِٕه‬sink

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 8. horizontal suspension
ٚ ‫ سأعٗ ذمغ‬ٟ‫ ٘رالل‬، ‫ذن وذا‬٠‫ ا‬ٍٝ‫ً اٌطفً ػ‬١‫ ترؾ‬
control‫ؼ‬١‫ٕٗ وذا ِف‬١‫ ػد‬UL & LL flial ‫اي‬

 problems of floppy infant :

 liable to subluxation or dislocation
 develop mental retardation
 passive personality
 poor attention
 can't bear weight
 delayed milestone
 sensory problem
 respiratory problem

 treatment :
1. positioning :
ms weakness, ‫دٗ اي‬١‫ ٔر‬sitting ‫ ال‬ٚ quadriped ِٓ weight bearing ًّ‫ؼ‬٠ ‫ اُ٘ حاخٗ الٔٗ ِثؼشفؼ‬
hypotonia, hyporeflexia
‫قٍة ٌٍحظاخ ترؼشف‬٠ ‫ لذس‬ٌٛ ، ٗ‫لف‬ٛ‫ ذ‬ٚ ٗ‫ؾرى‬ٙ‫ي ذ‬ٚ‫ا ترحا‬ٙٔ‫ا أ‬ٍٙ‫س االَ ترؼًّ اخرثاس ٌطف‬ٛٙ‫ ؽ‬٣ ٓ‫ ِٓ ع‬ٌٝ‫ تاٌرا‬
ٚ ‫س اطفاي‬ٛ‫ٗ ٌذور‬٠‫د‬ٛ‫ذ ذ‬ٚ‫ ِقٍثؼ ٌٍحظاخ ترش‬ٚ ‫مغ‬٠ ٚ ‫ا‬ِٕٙ ‫ٕخ‬٠ ٕٝ‫ؼ‬٠ sink ٞ ٗٔ‫ تذا أ‬ٌٛ ، ٝ‫ؼ‬١‫ا طث‬ٕٙ‫أٔٗ ات‬
‫قٍة‬٠ ‫مذسػ خاٌـ‬١ِ ٕٗ١‫ اٌؼد‬ٜ‫ٗ ػاًِ ص‬١‫ ترالل‬floppy infant ‫ثاْ اورش ف اي‬١‫ دا ت‬ٚ ‫قٍة‬١‫ٌٗ أٔٗ ِؼ ت‬ٛ‫ذم‬
can't Maintain position against gravity
2. facilitation of milestone
3. facilitatory techniques for hypotonia
4. sensory facilitation
 " increase sensory input to give motor response " through ....
A. extroceptive as wrapping , brief ice application , scratch
B. proprioception as tactile stimulation , squeezing , painful stimulation on opposite side ,
TVR , Electrical stimulation(ES)

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 N.B
ٚ ، convulsions‫ظ اي‬ٚ‫ض‬١‫ الٔٗ ت‬ES ٖ‫ ِؼٍّؼ ِؼا‬seizure ٖ‫ طفً ػٕذ‬ٌٛ ٗٔ‫ ال‬ES ‫ ِٓ اي‬ٌٝ‫ُ اخذ تا‬ِٙ 
poor prognosis ٟ‫ثم‬١‫ ف ت‬seizure ٖ‫ ِؼا‬ٟ‫ثم‬١‫ ت‬central hypotonia CP ‫ِؼظُ اطفاي اي‬

5. special sense stimulation

A. vestibular through (vestibular stimulation , hammock technique ) to increase alertness of
vestibular system
B. vision through ( special room for visual rehabilitation )
C. auditory through ( different sounds )
D. tactile stimulation

6. Adaptative technology & assistive devices Used in rehabilitation of handicapped

children

ٗ‫قٍة سأع‬٠ ٗ١ٍ‫خ‬٠ ٚ ٗ٘‫ؾذ أرثا‬٠ ْٛ‫ٍٗ اٌف‬٠‫ فرذ‬head control ‫ػ‬ٚ‫ً ِثال طفً ِؼٕذ‬٠‫تا‬ٌّٛ‫ ا‬ٜ‫ ص‬
ٖ‫طاسد‬١‫ حذ ت‬ٚ ٗ‫ وأٔٗ ف غات‬ٜ‫ ص‬game ‫ُ ٕ٘ذخٍٗ ف‬ٙ‫ف‬١‫ اٌطفً ت‬ٌٛ ، ٟ‫الغ االفرشاض‬ٌٛ‫ ا‬virtual reality ‫ اي‬ٜ‫ ص‬
ٗ‫ض تراػ‬١‫د اٌرشو‬ٚ‫ض‬٠ ‫ف‬
support body against gravity ًّ‫ؼ‬١‫ ت‬ٌٍٝ‫ؿ ا‬ٛ‫ اٌّخق‬ٟ‫ اٌىشع‬ٜ‫ ص‬
7. weight bearing exercise from different positions
8. Rising Mechanism
 ( Gentle position from supine to sitting to stand or from prone to quadriped to
kneeling to half kneeling to standing )

9. Facilitation of rightening, equilibrium , protection reaction on medical ball or roll

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