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 range of motion (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 conditions 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. Pediatric systemic and neonatal lupus erythematosus, dermatomyositis, and scleroderma are other disorders that may affect connective tissue in children. Detailed information about these conditions is not discussed in this text; however, general information is presented in Table 6.1.
TABLE 6.1Pediatric Diseases Affecting Connective Tissue ||Download (.pdf) TABLE 6.1 Pediatric Diseases Affecting Connective Tissue
|Pathology ||Etiology ||Body Functions and Structure Impairments ||Potential Activity Limitations and Participation Restrictions and Potential Management |
|Juvenile Dermatomyositis |
Inflammation, vasculitis, and perifascicular atrophy
Noted with proximal more than distal muscle weakness and rash
Inflammatory cells are predominantly B cells and are found around blood vessels, in the septa between muscle fascicles, and in fibroadipose tissue around muscle
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Characterized by vasculitic inflammation of striated muscle, skin, and the gastrointestinal tract (Cassidy & Petty, 2016)
If creatine phosphokinase (CPK) levels are high, need to focus on movement and function.
Work on range of motion (ROM) and gentle stretching.
Avoid resistive exercises when CPK levels are high.
|Classic Ehlers-Danlos Syndrome (EDS) (Parapia & Jackson, 2008) |
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Developmental delay, hyperextensibility of the skin and joints, atrophic scarring, slow wound healing, hernias, easy bruising, muscle hypotonia, structural cardiac anomalies
Need caution with physical activities that put bones and joints at risk.
May encounter social stigma.
May limit choice of hobby or activities.
Strenuous weight-bearing exercise or contact sport activities may need to be avoided.
|Hypermobility EDS (hEDS) |
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