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The Treatment of the Pediatric Hand Patient: Part I

The Treatment of the Pediatric Hand Patient: Part I
Valeri Calhoun, MS, OTR/L, CHT
January 17, 2016

Pediatric Hand Patients

Pediatric hand patients can span anywhere from birth to the age of 18.  Most of my talk will focus on the younger pediatric patient, because teenage patients are very similar to adult patients, as far as how you are going to treat them and the protocols that you are going to use.  However, the younger pediatric patients (infant to about age 12) are very different. 

They are smaller and have a different body composition than adults.  As you know, pediatric patients’ hands and forearms are pudgy which can greatly affect treatment and splints.  They do not yet have their defined bony landmarks, so your evaluation is definitely altered.  They have a limited attention span, if they have any attention span at all.  They have limited understanding, so they are not going to follow directions the same way that an older child or an adult would.  Most of all they are fearful.  They are fearful of strangers.  They are fearful of the unknown.  They do not know what you are going to do.  Your whole treatment approach is going to be different with this population.

Pediatric patients also do not sit still.  You are always working with movement, which can make splinting, wound care, and exercises very difficult.  However, the pediatric patient does not get as much resultant stiffness.  They have a much higher rate of collagen in their body.  You can immobilize them for four, five, to six weeks and they will still come out with great motion and without getting the stiffness that an older child or an adult would get.  They also heal quickly.

With this population, you must deal with the parents or caretakers.  A child is not going to follow your instructions.  Their home setting is very important and to understand who is going to be taking care of them.  Is it a parent?  Do they go to daycare every day?  Do you need to work with the daycare worker?  Do they go to school?  Who is responsible for that child? 

They also have developing systems.  You need to understand normal development for muscle, neurological, skeletal, cognitive, and language development.  You need to have a great grasp of this population. You need to know their cognitive and language level in order to communicate effectively with the child.

valeri calhoun

Valeri Calhoun, MS, OTR/L, CHT

Valeri is an occupational therapist with over 30 years of experience in a variety of settings, with the last 8 being in an exclusive pediatric hand therapy setting. She received a BS in OT from Indiana University, and an MS in Community Health from The University of Kansas. Valeri has been a Certified hand Therapist since 1994. In addition to working in clinical settings, Valeri’s experience includes over 15 years teaching at the graduate level for occupational therapy programs in the Midwest. She has provided professional presentations and lectures both nationally and internationally for therapists on a variety of therapy topics. For the past six years, she was on the faculty of the CHT test prep course for ASHT. Valeri is an active member in a pediatric hand surgeon and therapist special interest group.  She is involved in research projects regarding pediatric orthopedic care, and has published results.  She was co-author of a pediatric hand therapy protocol book.  She was implemental in the development and execution of Hand Camp, a camp for children with upper limb differences. Her special interest areas of practice include splinting for orthopedic populations, children with arthrogryposis and congenital hand differences.

Related Courses

Series: The Pediatric Hand
Presented by Valeri Calhoun, MS, OTR/L, CHT
Recorded Webinar
Course: #3371Level: Intermediate2 Hours
Part I: This course will outline the evaluation and treatment principles for the pediatric orthopedic hand patient, including the traumatic hand injured patient, and how it differs from the adult hand population. This course will provide specific evaluation techniques along with treatment ideas. Part II: This presentation will build on the foundational information provided in Part I. It provides the learner with specific information on the evaluation and treatment of the congenital hand patient and the unique challenges this brings to clinicians. Explore functional issues unique to this population and interventions that may assist in improving their abilities.

Please note: This course series is comprised of the following individual recordings: #2533 and #2599.

This course is part of the “Hand and Upper Extremity Review Series.”

Put Down the Drugs: Evidence-Based Interventions to Reduce Unwanted Behaviors with Dementia
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, OTR/L
Recorded Webinar
Course: #3072Level: Intermediate1 Hour
PTs can apply evidence-based interventions to improve dementia care. This session reviews the etiology of common behaviors. Cognitive-emotion, multi-sensory, animal-assisted, and exercise interventions to reduce agitation are discussed as well as specific strategies for improving task-related engagement. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Supporting the LGBTQ Senior in Healthcare
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, OTR/L
Recorded Webinar
Course: #4096Level: Intermediate2 Hours
This training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Clinical Use of the Reformer for the Lower Body
Presented by Rhondi Miller, PT, MS, SCS, ATC
Recorded Webinar
Course: #3329Level: Intermediate2 Hours
The reformer is an effective tool for rehabilitating the lower body. This course will provide exercises appropriate for progressing lower extremity rehab from ankle injury, to post-op knees, to hip pain. Exercises focus on the concepts of motor control, stability/mobility system balance, movement competency and training functional movement patterning. This course is part three of our four part series on Pilates. This course is directly related to the practice of physical therapy and athletic training and therefore appropriate for the PT/PTA and AT.

Wheelchair Seating: Considerations for the Hands-Free Sitter
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar
Course: #3585Level: Advanced1 Hour
Wheelchair seating is designed to provide postural support and alignment, stability for function and mitigate pressure issues. This course will address assessment and intervention when working with a client who can sit without the support of their hands, referred to as the ‘hands-free’ sitter.