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A 4.4-year-old boy was referred to outpatient pediatric physical therapy services secondary to global developmental delay. His medical and physical therapy records document a diagnosis of mild lissencephaly or pachygyria. There were no complications during the mother's pregnancy or after delivery, which was a normal vaginal birth at full term. The parents report that he progressed through his motor milestones slowly. He first rolled over at 7 months, sat independently at 12 months, crawled at 18 months, walked at 30 months, and ran at 42 months. He has no other significant medical history, currently takes no medications, and has no reported allergies. He attends a preschool where he is in a special education program and has an Individualized Education Program (IEP; for description of IEP, see Case 29). He is receiving physical, occupational, and speech therapy at his preschool. He wears bilateral articulating ankle foot orthoses (AFOs) during gait and play activities. His parents' primary concern and reason for seeking outpatient physical therapy is that their son frequently trips and falls and requires assistance on stairs.

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What are possible secondary impairments for a child with mild lissencephaly?

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What is the most appropriate physical therapy outcome measure for functional mobility in children with global developmental delay?

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What are the examination priorities?

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Based on his health condition, what do you anticipate will be the contributors to activity limitations?

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  • BLOCKED PRACTICE: Practicing one task for a block of trials then moving on to the next task
  • POSTURAL INSECURITY: Describes when an individual demonstrates extreme caution as a result of decreased postural ability during physical challenges that require postural strength and stability1
  • RANDOM PRACTICE: Practicing a task in random-ordered conditions with multiple skills being practiced within the same session

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  1. Identify key questions to determine the priorities of the child and family in the physical therapy plan of care.

  2. Discuss appropriate components of the examination for a child with global developmental delays.

  3. Identify the most appropriate physical therapy interventions for a child with global developmental delays.

  4. Discuss potential precautions that should be taken during physical therapy examination and/or interventions.

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PT considerations during management of the child with mobility, activity, and participation limitations due to mild lissencephaly:

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  • General physical therapy plan of care/goals: Assess gait, mobility, functional strength, and equipment needs; enhance the child's ability to participate in play, home, and school activities with functional independence and safety
  • Physical therapy interventions: Blocked and random practice with obstacle courses that provide variable practice of tasks; strengthening; improving balance and postural control; stretching; functional play activities; home exercise program
  • Precautions during physical therapy: Decreased safety awareness and postural insecurity; awareness of potential comorbidities such as seizure disorders, aspiration, pneumonia, and secondary impairments of decreased postural control, below age level transitional and core strength, and poor ...

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