Chapter 30. Special Populations

At the completion of this chapter, the reader will be able to:

1. Discuss the physical therapy role with a variety of orthopaedic subtypes and the challenges each presents.

2. Describe the various pathologies for these populations in terms of the presentation and the role that physical therapy plays.

3. Outline the differences between a congenital condition and an acquired condition.

4. Describe the normal aging process as it relates to orthopaedics.

5. Outline the various theories of aging.

6. Describe the common pathological conditions and functional limitations associated with the geriatric population.

7. Describe some of the conditions that can affect women's health.

8. Describe the physiologic changes that occur during pregnancy within the various bodily systems.

9. Describe the physical therapy interventions for pregnancy-related dysfunctions.

10. Describe the complications related to breast-cancer-related lymphedema.

There are a number of population subtypes that require special consideration in terms of the orthopaedic examination and intervention. These include pediatrics and geriatrics, and the whole spectrum of women's health. Each of these populations is described in this chapter.

The term pediatric refers to the 0- to 21-year age range during which an individual undergoes many changes while aging, evolving, and maturing. During the preschool years, physical growth, neurologic growth, and maturation are quite rapid and apparent, with new skills being acquired at a quick pace.1 This process continues throughout the middle years (ages 6–11) at a somewhat slower pace. As a child enters puberty, rapid development of physical and sexual characteristics become more apparent and is accompanied by important psychosocial development. It is important to remember that chronologic age does not necessarily correlate well with many physiologic and somatic changes.

A typical adult has a smaller surface area-to-mass ratio and a lower metabolic rate than a child. These discrepancies result in a greater transfer of heat and a greater challenge to the thermoregulatory system, respectively, in the pediatric population.

The major characteristics of somatic and skeletal growth and maturation during adolescence are outlined in Table 30-1. In addition, the following differences exist between the adult and the pediatric patient:2

• Cardiovascular system. The pediatric heart is smaller than that of the mature adult, resulting in a smaller capacity as a reservoir for blood, and thus a lower stroke volume at all levels of exercise, which is compensated for with an increased heart rate. As with the adult patient, systolic blood pressure rises during exercise in the pediatric patient, but the elevation is less. Finally, the thoracic cavity is obviously smaller in the younger child than that of the mature adult, resulting in the pediatric patient demonstrating a smaller vital capacity than the adult and an elevated resting respiration rate.3 The red blood cell count for young boys and girls are similar with comparable abilities to carry oxygen to exercising organs. After menarche, however, females demonstrate lower blood volume and fewer red blood cells ...