AMPLIFIED PAIN SYNDROMES: WHAT SHOULD YOU KNOW

Amplified pain syndromes (APS) is an umbrella term used to describe increased sensitivity to pain due to abnormal nerve connections in the nervous system. Diagnoses in children that fall under this umbrella term include juvenile fibromyalgia, central sensitization, and generalized chronic pain, among others.

In combination with a variety of factors, APS may be caused by:

• Injury
• Illness
• Psychological stress

 Individuals with APS may experience:

• Pain that is localized or widespread
• An onset of pain that is sudden or gradual
• Pain with an unknown cause
• Pain triggered by stress, illness, or prior injury, with pain continuing beyond a typical healing phase
• Pain described as achy, dull, sharp, shooting, burning, throbbing, and/or stabbing
• Pain that affects function and the ability to participate fully in daily activities
• Decreased school attendance, decreased involvement in sports, and disinterest in social participation

Signs and Symptoms

• Pain that is heightened in response to a normal event or minor injury that wouldn't typically be perceived as painful
• Impaired muscle endurance and weakness, poor cardiopulmonary (heart) endurance, poor posture, impaired balance, and/or impaired functional abilities
• Pain in response to a sensation such as a light touch, pressure, temperature, and/or vibration that would not normally provoke pain
• Swelling, temperature, and/or color changes to the skin of the affected area

Other common associated signs/symptoms may include: headache, blurry vision, memory problems, chest pain, heart palpitations, dizziness, abdominal pain, nausea, vomiting, diarrhea, constipation, abnormal limb movements, sleep disturbance, and fatigue.

Treatment

Physical therapists work with other medical professionals to provide physical therapy and education for people experiencing APS. Working one-to-one with individuals with APS, physical therapists teach exercises to decrease the fear of movement and apply exposure-based treatments to help desensitize painful areas. They aid in shifting focus from pain to function, encourage the use of stress management strategies, and help people recognize daily causes of stress.

Treatment may be provided in an inpatient or outpatient setting and may include:

• Exercise therapy: Daily strengthening and aerobic exercise to retrain the nervous system, decrease the fear of movement, and help people work through pain and discomfort and focus on functional improvements
• Desensitization: Daily repeated exposure to sensations that are perceived as painful in order to retrain the nerves' response to light touch, pressure, vibration, and temperature
• Stress education: Guidance about stress management, which may include recommended counseling services, relaxed breathing exercises, mindfulness training, and/or self-regulation strategies
• Decreased attention to pain: Education on how to limit discussion and decision makingdue to pain in order to decrease its importance to the brain, and return to normal daily activities.

Authored by: Brandi Dorton, PT, DPT, and Danielle Feltrop, PT, DPT, of Children's Mercy Hospital

BRISK WALKING CAN REDUCE HIP FRACTURES IN MEN BY UP TO 62%

Long-term studies open our eyes to changes in the adult body as we age. As those studies get published, our knowledge of how to prevent injuries and maintain healthy bodies into old age increases significantly, and gives you the power to control your own life years before the risks increase. 

FOR EXAMPLE:

Hip fractures in older adults can be severely debilitating and can lead to significant medical expenses, but a study published in the American Journal of Public Health (“Physical Activity and Inactivity and Risk of Hip Fractures in Men” – April 2014) suggests that 4 hours of walking each week can significantly reduce hip fracture risk later in life.

Data from a study of nearly 36,000 men, conducted over a 24-year period, revealed that men who walked 4 or more hours a week at a brisk pace had a 62% lower risk of hip fracture than men who walked fewer than 4 hours a week, and that even men who walked 4 or more hours a week at a slower pace experienced a 43% lower risk of fracture than men who walked fewer than 4 hours a week.

VERTIGO + PHYSICAL THERAPY

Vertigo usually is described as a spinning sensation, whereas dizziness usually is described as "lightheadedness." Often, they have different causes and different treatments.

If you have vertigo accompanied by one or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

• Double vision
• Difficulty speaking
• A change in alertness
• Arm or leg weakness
• Inability to walk

What Is Vertigo?

Vertigo is the sensation of spinning—even when you're perfectly still, you might feel like you're moving or that the room is moving around you. Most causes of vertigo involve the inner ear ("vestibular system"). A number of conditions can produce vertigo, such as:

• Inner ear infections or disorders
• Migraines
• Tumors, such as acoustic neuroma
• Surgery that removes or injures the inner ear or its nerves
• Head injury that results in injury to the inner ears
• A hole in the inner ear
• Stroke

You also might have:

• Nausea
• Vomiting
• Sweating
• Abnormal eye movements

One of the most common forms of vertigo is benign paroxysmal positional vertigo, an inner-ear problem that causes short periods of a spinning sensation when your head is moved in certain positions.

How Is It Diagnosed?

Your physical therapist will use your answers to the following questions to help identify the cause of your vertigo and to determine the best course of treatment:

• When did you first have vertigo (the sensation of spinning)?
• What are you doing when you have vertigo (turning your head, bending over, standing perfectly still, rolling in bed)?
• How long does the vertigo last(seconds, minutes, hours, days)?
• Have you had vertigo before?
• Do you have hearing loss, ringing, or fullness in your ears?
• Do you have nausea with the spinning?
• Have you had any changes in your heart rate or breathing?

Your physical therapist will perform tests to determine the causes of your vertigo and also to assess your risk of falling. Depending on the results of the tests, your therapist may recommend further testing or consultation with your physician.

How Can a Physical Therapist Help?

Based on your physical therapist's evaluation and your goals for recovery, the therapist will customize a treatment plan for you. The specific treatments will depend on the cause of your vertigo. Your therapist's main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements or other exercises to help eliminate your symptoms. Conditions such as benign paroxysmal positional vertigo have very specific tests and treatments.

If you have dizziness and balance problems after your vertigo has stopped, your physical therapist can develop a treatment plan that targets those problems. Your physical therapist will teach you strategies to help you cope with your symptoms:

• Do certain activities or chores around the house cause you to become dizzy? Your therapist will show you how to do those activities in a different way to help reduce the dizziness.
• Have simple activities become difficult and cause fatigue and more dizziness? Your therapist will help you work through these symptoms right away so you can get moving again and return to your roles at home and at work more quickly.

Physical therapy treatments for dizziness can take many forms. The type of exercise that your therapist designs for you will depend on your unique problems and might include:

• Exercises to improve your balance
• Exercises to help the brain "correct" differences between your inner ears
• Exercises to improve your ability to focus your eyes and vision

In addition, your physical therapist might prescribe exercises to improve your strength, your flexibility, and your heart health—with the goal of improving your overall physical health and well being.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people with dizziness. You may want to consider:

• A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological vestibular rehabilitation focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurological physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with inner ear injury.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

WHO'S IN SURGERY WITH YOU??

Many of our patients have no idea who all is in the operating room with them when they go in for their procedure, and that's really no surprise. It's very common for multiple people who are not vital to the procedure to be present - some may even be there just to learn, or manage equipment being utilized. When you have surgery, a team of medical staff helps the surgeon during the operation. Who is on the team depends on the type of surgery. Most teams include the following professionals:

Surgeon

A surgeon has finished 4 years of medical school and 4 or more years of special training after medical school. Most surgeons have passed exams for board certification. The American Board of Surgery is the national group that gives this certification for general surgery in the U.S. Some surgeons also have the letters FACS after their name. This means they have approval of the Fellows of the American College of Surgeons (FACS).

Anesthesiologist

An anesthesiologist has finished 4 years of medical school and 4 years of special training in anesthesia. Anesthesiologists may get additional training in certain surgery specialties. This might be neurosurgical anesthesia or cardiac anesthesia. The anesthesiologist takes part in all 3 phases of surgery: before, during, and after.

Certified registered nurse anesthetist (CRNA)

The nurse anesthetist gives you anesthesia care before, during, and after surgery or labor and delivery. The nurse constantly watches every important function of your body. He or she can change the anesthesia medicine to make sure you are safe and comfortable. A nurse anesthetist has a bachelor's degree in nursing and at least one year of experience as a registered nurse in a critical-care setting. He or she also has at least a master's degree from a nurse anesthetist program. Nurse anesthetists must pass a national certification exam to become CRNAs.

Operating room nurse or circulating nurse

Registered nurses are registered and licensed by each state to care for patients. Some nurses focus on a certain field such as surgery. The operating room nurse helps the surgeon during surgery. Operating room nurses are certified in various areas of surgery. Nurses must pass an exam to be certified.

Surgical tech

Surgical techs assist with the surgery by setting up a sterile operating room. They get supplies and surgery tools ready. And they hand the surgeon the tools he or she asks for. They must pass an exam to be certified by the National Board of Surgical Assisting (NBSTA).

Residents or medical students

In many teaching hospitals, resident doctors in training and medical students may be a part of the surgical team.

Physician assistant

Physician assistants practice medicine under the supervision of a doctor. They may act as an assistant to the surgeon. Or they may close incisions with stitches (sutures) or staples.

Medical device company representative

Sometimes surgeons will have a representative from a company that makes medical equipment in the operating room. Such equipment might be artificial joints, spine stabilizers, or pacemakers. The representative can help the surgeon with sizing and function of the equipment.

IRREGULAR HEARTBEAT (ARRHYTHMIAS)

My child's heart seems to beat very fast. Does she have an irregular heartbeat?

Your child's heart rate normally will vary to some degree. Fever, crying, exercise, or other vigorous activity makes any heart beat faster. And the younger the child, the faster the normal heart rate will be. As your child gets older, her heart rate will slow down. A resting heart rate of 130 to 150 beats per minute is normal for a newborn infant, but it is too fast for a six-year-old child at rest. In a very athletic teenager, a resting heart rate of 50 to 60 beats per minute may be normal.

The heart’s regular rhythm or beat is maintained by a small electrical circuit that runs through nerves in the walls of the heart. When the circuit is working properly, the heartbeat is quite regular; but when there’s a problem in the circuit, an irregular heartbeat, or arrhythmia, can occur. Some children are born with abnormalities in this heart circuitry, but arrhythmias also can be caused by infections or chemical imbalances in the blood. Even in healthy children, there can be other variations in the rhythm of the heartbeat, including changes that occur just as a result of breathing. Such a fluctuation is called sinus arrhythmia, and requires no special evaluation or treatment because it is normal.

So-called premature heartbeats are another form of irregular rhythm that requires no treatment. If these occur in your child, she might say that her heart “skipped a beat” or did a “flip-flop.” Usually these symptoms do not indicate the presence of significant heart disease. 

If your pediatrician says that your child has a true arrhythmia, it could mean that her heart beats faster than normal (tachycardia), very fast (flutter), fast and with no regularity (fibrillation), slower than normal (bradycardia), or that it has isolated early beats (premature beats). While true arrhythmias are not very common, when they do occur they can be serious. On rare occasions they can cause fainting or even heart failure. Fortunately, they can be treated successfully so it’s important to detect arrhythmias as early as possible.

Signs and symptoms 

If your child has a true arrhythmia, your pediatrician probably will discover it during a routine visit. But should you notice any of the following warning signs between pediatric visits, notify your doctor immediately. 

• Your infant suddenly becomes pale and listless; her body feels limp. 

• Your child complains of her “heart beating fast,” when she’s not exercising. 

• She tells you she feels uncomfortable, weak, or dizzy.

• She blacks out or faints.

Diagnosis

It's unlikely that your child will ever experience any of these symptoms, but if she does, your pediatrician will perform additional tests and perhaps consult with a pediatric cardiologist. In the process the doctors may do an electrocardiogram (ECG), to better distinguish a normal sinus arrhythmia from a true arrhythmia. An ECG is a tape recording of the electrical impulses that make the heart beat, and it will allow the doctor to observe any irregularities more closely. 

Sometimes your child's unusual heartbeats may occur at unpredictable times, often not when the ECG is being taken. In that case the cardiologist may suggest that your child carry a small portable tape recorder that continuously records her heartbeat over a one- to two-day period. During this time you'll be asked to keep a log of your child's activities and symptoms. Correlating the ECG with your observations will permit a diagnosis to be made. For example, if your child feels her heart "flutter" and becomes dizzy at 2:15 P.M. and the ECG shows her heart suddenly beating faster at the same time, the diagnosis of tachycardia will probably be established.

Occasionally irregular heartbeats will occur only during exercise. If that's the case with your child, the cardiologist may have your youngster ride a stationary bicycle or run on a treadmill while her heartbeat is being recorded. When your child is old enough to participate in sports, ask your pediatrician if any special tests or restrictions are necessary.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

HEART DISEASE: REDUCE YOUR CHILD'S RISK

Heredity is clearly an important risk factor for conditions such as heart disease, cancer, and diabetes. However, researchers are steadily gathering strong evidence about how diet influence development of diseases. Experts agree that healthy eating habits from an early age can lower the risk of developing several deadly diseases later on. A diet designed to lower the risk of heart disease, diabetes, and other serious diseases is one that benefits the whole family, adults and children alike. 

Risk Factors for Heart Disease 

Heart disease is the number one killer of men and women in the United States and most industrialized countries. The chief risk factors are:

• Smoking
• High blood pressure
• Diabetes
• High blood level of cholesterol
• Physical inactivity
• Obesity
• Family history of early-onset heart disease

Following a Heart-Healthy Diet From an Early Age 

American children and adolescents, on average, eat more saturated fat and have higher blood cholesterol levels than young people their age in most other developed countries. The rate of heart disease tends to keep pace with cholesterol levels. One study found early signs of hardening of the arteries (atherosclerosis) in 7% of children between ages 10 and 15 years, and the rate was twice as high between ages 15 and 20. 

According to the American Heart Association, a heart-healthy diet from an early age lowers cholesterol and if followed through adolescence and beyond, should reduce the risk of coronary artery disease in adulthood.

All children older than 2 years should follow a heart-healthy diet, including low-fatdairy products. For children between the ages of 12 months and 2 years with a family history of obesity, abnormal blood fats, or cardiovascular disease, reduced-fat milk should be considered.

Is There a Family History?

When you and your children first saw your pediatrician, you were probably asked if there was a history of heart or vascular disease in your family. If your children were young, their grandparents were probably relatively young as well and may not have had a heart attack or stroke (even though they may have been headed for one). If heart disease in the grandparents becomes apparent later on, be sure to bring it to your pediatrician’s attention at the next checkup. 

Cholesterol Testing for Adopted Children  

Complete biological family medical histories are not usually available to adopted children and their parents, even for those adopted in open proceedings. To prevent the development of diseases linked to high blood cholesterol levels, adopted children should be screened periodically for blood lipid (fat) levels throughout childhood. 

Additional Information  

• Healthy Active Living for Families
• The 5 Food Groups: Sample Choices
• Overcoming Obstacles to Physical Activity
• What About Fat and Cholesterol? 
• Your Family Health History & Genetics 

Source - 11/21/2015

Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011)

SCOLIOSIS

Our spine is naturally curved in order to distribute the weight of the body. A side-view X ray of a soldier standing rigidly at attention would show the cervical spine in his neck arched slightly forward. The twelve thoracic vertebrae curve gently to the rear. Then the lumbar spine, which bears most of our upper-body weight, arches forward as it nears the pelvis. 

About one in twenty-five adolescent girls and one in two hundred teenage boys develop scoliosis. Captured on an X-ray, their spines form, to varying degrees, a more pronounced S shape. When imaged from the back, a normal spine exhibits no curvature. A youngster is said to have scoliosis if her curvature is greater than ten degrees. 

The condition can occur as a complication of polio, muscular dystrophy and other central nervous system disorders, but four in five cases among teenage girls are idiopathic—that is, of unknown cause. Very often, though, a family member will also have had scoliosis. 

Symptoms Suggestive of Scoliosis May Include: 

• Conspicuous curving of the upper body 
• Uneven, rounded shoulders 
• Sunken chest 
• Leaning to one side 
• Back pain (rare) 

Scoliosis can develop quietly for months to years so it may only be picked up by the pediatrician during an examination of the teen’s back. Progression may occur quickly during the teen’s growth spurt. One in seven young people with scoliosis have such severe curvature that they require treatment. 

How Scoliosis Is Diagnosed 

• Physical examination and thorough medical history 
• X-rays 

How Scoliosis Is Treated 

• Bracing: Many such cases never progress to the point that treatment is necessary. Follow-up visits are scheduled approximately every six months for those diagnosed with curves between fifteen and twenty degrees. 

Curvature above twenty-five degrees may call for bracing. There are two main types of orthopedic back braces. The Milwaukee brace has a neck ring and can correct curves anywhere in the spine; the thoracolumbosacral orthosis (TLSO for short, thankfully) is for deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back. 

Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete; usually that’s about ages seventeen to eighteen for girls, and eighteen to nineteen for boys. The braces are more cosmetically appealing than they used to be and can be hidden easily under clothing. Having to wear an orthopedic brace interferes only minimally with physical activity. Only contact sports and trampolining are off-limits for the time being. 

• Surgery: Posterior spinal fusion and instrumentation, the operation to surgically correct scoliosis, is typically recommended when the spine’s curvature is fifty degrees or more. The surgical procedure fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. On average, this takes about twelve months. Although teenagers who have the surgery still face some restrictions on physical activity, they can say good-bye to the brace. 

Helping Teens Help Themselves 

Only about 50 percent of young scoliosis patients wear their braces. Parents need to convey the importance of complying with the doctor’s instructions. At the same time, they should be sensitive to the tremendous impact the condition can inflict on a teenager’s body image, which at this age is inextricably entwined with self-identity and self-confidence. You might want to consider asking your pediatrician or orthopedist for a referral to a mental-health professional experienced in counseling children with chronic medical problems. A patient support group, like those run by the Scoliosis Association may also be helpful.

Source - 11/21/2015

Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)

HIP DYSPLASIA DETECTION IN KIDS

Why does my pediatrician check my baby's hips at each check-up?

Hip dysplasia (developmental dysplasia of the hip) is a condition in which a child's upper thighbone is dislocated from the hip socket. It can be present at birth or develop during a child's first year of life. 

No one is sure why hip dysplasia occurs (or why the left hip dislocates more often than the right hip). One reason may have to do with the hormones a baby is exposed to before birth. While these hormones serve to relax muscles in the pregnant mother's body, in some cases they also may cause a baby's joints to become too relaxed and prone to dislocation. 

Factors that may increase the risk of hip dysplasia include 

• Sex - more frequent in girls 
• Family history - more likely when other family members have had hip dysplasia 
• Birth position - more common in infants born in the breech position 
• Birth order - firstborn children most at risk for hip dysplasia 

Detecting Hip Dysplasia 

Your pediatrician will check your newborn for hip dysplasia right after birth and at every well-child exam until your child is walking normally. 

During the exam, your child's pediatrician will carefully flex and rotate your child's legs to see if the thighbones are properly positioned in the hip sockets. This does not require a great deal of force and will not hurt your baby. 

Your child's pediatrician also will look for other signs that may suggest a problem, including 

• Limited range of motion in either leg 
• One leg is shorter than the other 
• Thigh or buttock creases appear uneven or lopsided 

If you live in the state of Kansas as opposed to Missouri, you can visit a physical therapist like our own Hope Hillyard at Champion Performance and Physical Therapy for an assessment of possible hip dysplasia. If special tests are found positive, at that point it may be beneficial to schedule an appointment with your Pediatric physician for further imaging or testing. If your child's pediatrician suspects a problem with your child's hip, you may be referred to a pediatric orthopedic specialist who has experience treating hip dysplasia. 

Hip dysplasia is rare and in spite of careful screening during regular well-child exams, a number of children with hip dysplasia are not diagnosed until after they are 1 year old.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

PIGEON TOES IN YOUR TOT

Pigeon Toes (Intoeing)

Children who walk with their feet turned in are described as being “pigeon-toed” or having “intoeing.” This is a very common condition that may involve one or both feet, and it occurs for a variety of reasons. 

Intoeing During Infancy 

Infants are sometimes born with their feet turning in. This turning occurs from the front part of their foot, and is called metatarsus adductus. It most commonly is due to being positioned in a crowded space inside the uterus before the baby is born. 

You can suspect that metatarsus adductus may be present if: 

• The front portion of your infant’s foot at rest turns inward. 
• The outer side of the child’s foot is curved like a half- moon. This condition is usually mild and will resolve before your infant’s first birthday. Sometimes it is more severe, or is accompanied by other foot deformities that result in a problem called clubfoot. 

This condition requires a consultation with a pediatric orthopedist and treatment with early casting or splinting. 

Intoeing In Later Childhood 

When a child is intoeing during her second year, this is most likely due to inward twisting of the shinbone (tibia). This condition is called internal tibial torsion. When a child between ages three and ten has intoeing, it is probably due to an inward turning of the thighbone (femur), a condition called medial femoral torsion. Both of these conditions tend to run in families. 

Treatment 

Some experts feel no treatment is necessary for intoeing in an infant under six months of age. For severe metatarsus adductus in infancy, early casting may be useful. 

Studies show that most infants who have metatarsus adductus in early infancy will outgrow it with no treatment necessary. If your baby’s intoeing persists after six months, or if it is rigid and difficult to straighten out, your doctor may refer you to a pediatric orthopedist who may recommend a series of casts applied over a period of three to six weeks. The main goal is to correct the condition before your child starts walking. 

Intoeing in early childhood often corrects itself over time, and usually requires no treatment. But if your child has trouble walking, discuss the condition with your pediatrician who may refer you to an orthopedist. A night brace (special shoes with connecting bars) was used in the past for this problem, but it hasn’t proven to be an effective treatment. Because intoeing often corrects itself over time, it is very important to avoid nonprescribed “treatments” such as corrective shoes, twister cables, daytime bracing, exercises, shoe inserts, or back manipulations. These do not correct the problem and may be harmful because they interfere with normal play or walking. Furthermore, a child wearing these braces may face unnecessary emotional strain from her peers. 

Nevertheless, if a child’s intoeing remains by the age of nine or ten years old, surgery may be required to correct it.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

EXERCISE COUNTERS COGNITIVE DECLINE

A recent study in the journal, Medicine Science in Sports & Exercise, adds to the ever-growing body of evidence supporting the benefits of exercise. In addition to the plethora of physical benefits, it was found that moderate-to-vigorous exercise can reduce the risk of cognitive decline by 36%, as reported in Time (Exercise Keeps the Brain Young: Study - December 29, 2016).

With an aging population and continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia, these findings give hope that older adults can help delay the onset of cognitive decline. 

The study provided 6,400 people aged 65 years and older with an activity tracker for a week, and assessed their cognitive abilities during tasks. After 3 years, people who performed moderate-to-vigorous levels of physical activity were significantly less likely to experience cognitive problems than those who were sedentary or did light physical activity. 

Other studies have shown that receiving physical therapy first for low back pain lowers costs, including basic education from a physical therapist prior to back surgery, and in instances when advanced imaging has been prescribed. 

As movement experts, physical therapists can design exercise programs for people with dementia or Alzheimer’s disease to include keeping them active and independent for as long as possible.