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CHAPTER 6: Musculoskeletal System: Considerations and Interventions for Specific Pediatric Pathologies

Linda Pax Lowes, PT, PhD; Lindsay Alfano, DPT, PCS; Margo Orlin, PT, PhD

Introduction

This chapter applies principles of musculoskeletal development to common pediatric conditions and discusses intervention strategies. For educational purposes, this book is divided into systems. The human body, however, operates through an interaction of all of the systems. Individuals with neurological impairment are affected by the musculoskeletal system, and in contrast, individuals with musculoskeletal impairment can make improvements through refinements in the nervous system. For example, someone who repeatedly injures a joint may alleviate the problem by educating the nervous system to move in a new pattern. Likewise, functional abilities of an individual with neurological impairment can be enhanced through improvements in ROM or force production. In this chapter, only the musculoskeletal aspects of disease will be addressed. For information on the neurological components, please refer to Chapters 7 and 8. The end of the chapter provides more in-depth information and intervention suggestions for two common pediatric conditions with significant musculoskeletal concerns: cerebral palsy and Down syndrome.

Musculoskeletal Pathologies of Connective Tissue

The first diseases to be discussed are those that affect a child's connective tissue, which includes ligaments, tendons, and cartilage (Table 6.1). Ehlers-Danlos syndrome, juvenile idiopathic arthritis (JIA), and hemophilia are the three pediatric connective tissue disorders that will be discussed in this chapter. Osteogenesis imperfecta is also a collagen disorder but will be discussed in the section on bone due to the significant bone pathology that accompanies it. Lupus erythematosus is another condition affecting the connective tissue, primarily of women between the ages of 15 and 45. Although less common, pediatric systematic and neonatal lupus erythematosus affect children. Detailed information about lupus is not discussed in this text, but some general information is presented in Table 6.1.

Table 6.1

Pediatric Diseases Affecting Connective Tissue

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Table 6.1

Pediatric Diseases Affecting Connective Tissue
Diagnosis Etiology Pathology Body Functions and Structure Impairments Potential Activity Limitations and Participation Restrictions
Classic Ehlers-Danlos Syndrome (EDS)(Parapia & Jackson, 2008) Autosomal dominant inheritance Abnormal Collagen Type V Developmental delay, hyperextensibility of the skin and joints, scarring, hernias, easy bruising, muscle hypotonia, structural cardiac anomalies

  • Need to avoid physical activities that put bones and joints at risk

  • May encounter social stigma

  • May limit choice of hobby or activities as isometric and strenuous weight-bearing exercise must be avoided
Hypermobility EDS Autosomal dominant inheritance Unknown Skin laxity, velvet skin, joint hypermobility with frequent dislocations
Vascular EDS Autosomal dominant Abnormal Collagen Type III Arterial rupture, varicose veins, easy bruising, hypermobility of small joints
Kyphoscoliosis EDS Autosomal recessive Deficiency of an enzyme that provides stability to collagen (lysylhydroxylase) Joint laxity (b715)*, scoliosis from birth, sclera fragility, hypotonia in infants
Arthroclasia EDS Autosomal dominant Abnormal Collagen Type I Joint hypermobility and frequent dislocations, kyphoscoliosis, skin fragility, easy bruising, hypotonia
Dermatosparaxis EDS Autosomal recessive Abnormal Collagen Type I Sagging, redundant skin with soft doughy feeling, easy ...

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