Treatment Modalities

and Assistive Devices

for pediatric
musculoskeletal
alterations
Ambulation
“to walk”
 Keeps patient more active and
improves muscle tone and strength
in his legs
 Slows the loss of bone mass and
density related to osteoporosis
 Increases peristalsis and circulation
 Gets the sense of accomplishment
and achieves greater independence
Crutch
Crutches are artificial supports that
assist patients who need aid in walking
because of disease, injury or a birth
defect.

TRIPOD POSITION – basic crutch

stance for balance and support

Watch here the proper sizing, training and use of

crutches for pediatric patients
https://www.youtube.com/watch?v=xGa2JhuOJsc
 Crutch Gait
Four - Three – Two –
point Gait point Gait point Gait
Only for patients who can move Progression from the four –
Used when one leg is
each leg separately and bear point gait that allows faster
involved
considerable amount of weight ambulation
on each of them
Cane
Canes are used for balance and
support and come in a variety of
shapes, but the majority have a curved
handle and a rubber tip.

Tripod canes offer greater support

Watch here the proper sizing and use of pediatric

canes
https://www.youtube.com/watch?v=zFacydReA5s
Purposes of Cane
1. To assist the patient to walk with greater balance and support
and less fatigue
2. To compensate for deficiencies of function normally performed
by the neuromuscular skeletal system
3. To relieve pressure on weight – bearing joints
4. To provide forces to push or pull the body forward or to
restrain the forward motion of the patient while walking
CASTS
Immobilizing device made up of layers of plaster or
fiber glass bandages molded to the body part it
encases
CASTS Functions
Provides support and stabilize
weak joints
Immobilize and hold bone fragments in reduction
Apply uniform compression of soft
tissues
Correct and prevent deformities
Permit early mobilization
CASTS Types
Short – arm cast – below the elbow to
proximal palmar crease
Gauntlet Cast – from below the elbow to
proximal palmar crease including the thumb
(thumb
Long – spica)
arm Cast – from the upper level of
axillary fold to the proximal palmar crease;
the elbow is usually immobilized at right
angle
Short – Leg Cast – from below the knee to
the base of the toes
Long – Leg cast – from the upper thigh to
the base of the toes; the foot is at a right
angle in a neutral position
CASTS Types
Body cast – Encircles the trunk, stabilizing
the spine
Spica Cast – stabilizes the trunk and lower
extremities for bone healing
Cast – brace – External support about a
fracture that is constructed with hinges to
permit early motion of joints, early
mobilization and independence

Cylinder cast – can be used for the upper or

lower extremities in cases of fracture or
dislocation, especially of the knee or elbow.
CASTS Complications
Pressure of a cast on neurovascular and bony structures causes necrosis,
pressure sores and nerve palsies

Compartment Syndrome–Vascular insufficiency, nerve and muscle

compression due to unrelieved swelling and can cause irreversible damage
to an extremity

Immobility and confinement in a cast, particularly a body cast, can

result in a multisystem problems

Superior Mesenteric Artery Syndrome – nausea, vomiting and abdominal

distention associated with cast syndrome, diminished blood flow to
bowels causing obstruction
Compartment Syndrome
 POIKILOTHERMIA

Poikilothermia is a fundamental symptom of acute limb ischemia (ALI)

and is known as “6Ps”. 
CASTS Complications
Acute anxiety reaction symptoms and psychological reactions (depression)

Thrombophlebitis and possible pulmonary emboli associated with

immobility and ineffective circulation

Respiratory atelectasis and pneumonia associated with ineffective respiratory

effort

Urinary tract infection, renal and bladder calculi associated with urinary
stasis, low fluid intake, and calcium excretion associated with immobility
CASTS Nursing Diagnoses
Altered peripheral tissue perfusion related to swelling and constrictive
bandages/casts

Impaired physical mobility related to condition and casting

Risk for injury related to potential complications

CASTS Nursing Interventions
Assess the ff:
1. Neurovascular status of extremity with a
cast for signs of compromise: 2. Skin integrity of casted extremity
* Pain
* Swelling 3. Positioning and potential pressure sites
* Discoloration (pale or blue) of the casted extremity
*Cool skin distal to injury
* Tingling or numbness 4. Cardiovascular, respiratory and
(paresthesia) gastrointestinal system for possible
* Pain on passive extension complication of immobility
(muscle stretch)
* Slow capillary refill; diminished 5. Psychological reaction to illness, cast
or absent pulse and immobility
* Paralysis
Maintaining Adequate Tissue
Perfusion
A.) Elevate the extremity on a cloth – covered pillow above the level of the heart.
Keep the heel off the matress

B) Avoid resting the cast on hard surfaces or sharp edges that can cause denting or
flattening

C) Handle the moist cast with the palm

D.) Turn patient every 2 hours while the cast dries

E) Assess neurovascular status hourly during the first 24 hours, then less frequently
as the swelling resolves
Elevating the affected leg with cast, avoiding the
heel to rest at the hard surface
Minimizing the effect of
Immobility
A.) Encourage the patient to move and exercise

B) Instruct the patient to alternately contract and

relax the muscles without moving the affected G) Encourage deep breathing exercise and
part coughing at regular intervals to prevent
atelectasis and pneumonia
C) reposition and turn the patient frequently
H) Observe for symptoms of cast syndrome
D) Avoid pressure behind the knees, that can
result to reduce venous return
I) Encourage the patient to drink liberal
(thromboembolism)
quantities of fluids to avoid UTI and
E) Use anti embolism stocking as prescribed calculi formation secondary to immobility

F) Administer prophylactic anticoagulant as

Anti embolic stocking to prevent
Thrombophlebitis
CAST CARE- DRYING
While the cast is wet, handle it gently with the hands cupped,
palm sides up (no fingertips)

If you lift the extremity, support it by the holding joint above and
the joint below

Once dry, the cast should sound hollow and be cool to the
touch. It may take 48 hours for the cast to dry.
CARE FOR THE CHILD IN A
CAST
Petaling the Cast to avoid skin irritation
CAST CARE
Avoid walking on wet floors to prevent fall. Do not place object under
the cast to prevent pressure and injury to the skin
Avoid getting the cast wet. Moisture causes skin breakdown as the
plaster becomes soft
Covering the leg cast with plastic or rubber boots may cause
condensation of air moisture and eventual wetting of cast
Avoid weight bearing or stress on plaster cast for 24 hours. And
report if the cast break or cracks.
Clean the cast by slightly removing the soiled part with a damp
cloth and scouring powder. Wipe off residual moisture
CARE FOR THE CHILD IN A
CAST
 INSTRUCT THE PARENT TO CALL THE
PROVIDER IF
FINGERS OR TOES
FOUL, UNUSUAL
TURN BLUE OR
ODOR
WHITE
BURNING,
TINGLING, OR DRAINAGE
NUMBNESS THROUGH CAST

FINGERS OR TOES SUDDEN,

SWELL, INABILITY UNEXPLAINED
TO MOVE FEVER
 INSTRUCT THE PARENT TO CALL THE
PROVIDER IF
UNUSUAL
FUSSINESS, CAST SLIPPAGE
UNABLE TO
CONSOLE
PAIN THAT IS NOT CAST CRUMBLES,
RELIEVED CRACKS OR
BREAKS
ANY OBJECTS SUCH
AS COINS, ROCKS, CAST BECOMES
OR SMALL TOYS WET OR SOGGY
GET UNDER THE AND SOFT
CAST
After CAST is Removed
Instruct to cleanse the skin with mild soap and water. Blot dry and
apply emollient lotion

Do not scratch the skin

Advise to continue the prescribed exercise

Gradually resume activities and elevate the extremity to control

swelling
Traction
Traction
Traction-Purpose
Skin Traction
Skin Traction Types
Skin Traction Types
Skeletal Traction
Skeletal Traction Types
Balkan Frame Traction Bed
Nursing Interventions
Assess the ff:
1. Pain, deformity, swelling, motor and sensory function and
circulation status of the affected limb

2. Skin condition of the affected extremity under skin

traction and around skeletal traction, as well as over bony
prominences throughout the body.

3. Signs and Symptoms of complications

4. Traction equipment for safety and effectiveness

Nursing Diagnoses
1. Impaired physical mobility related to traction
therapy and underlying pathology
2. Risk for impaired skin integrity related to pressure
on soft tissues
3. Risk for infection related to bacterial invasion at the
skeletal site
4. Altered peripheral tissue perfusion related to injury
or traction therapy
1.Nursing Diagnoses; Risk for
impaired skin integrity related to
pressure on soft tissues
• Examine bony prominences frequently for evidence of pressure or friction irritation.
• Observe for skin irritation around the traction bandage
• Relieve pressure without disrupting traction effectiveness by:
• Ensuring that linens and clothing are wrinkle – free
• Use lamb’s wool pads, heel/elbow protectors and special mattresses as needed
• Have the patient use a trapeze to pull himself/herself up and relieve back pressure
• Provide backrubs.
• Report complaint of burning sensation under the traction
Nursing Diagnoses; Impaired physical
mobility related to traction therapy and
underlying pathology
• Encourage active exercise of uninvolved muscles and joints to maintain strength and
function.
• Encourage Deep breathing hourly to facilitate expansion of the lungs and movement of
respiratory secretions
• Encourage fluid intake of 2,000 to 2,500ml daily
• Provide balanced high – fiber diet rich in protein.
• Establish bowel routine through diet and/or use stool softeners, laxative and enemas as
prescribed
• Prevent pressure on the calf. Evaluate periodically for development of thrombophlebitis
1.Nursing Diagnoses; Risk for
infection related to bacterial invasion
at the skeletal site
Avoid infection at Pin Site

1. Monitor VS for fever and tachycardia

2. Watch for signs of infection, especially around the pin tract

- Pin should be immobile in the bone and skin wound should be dry
- If infection is suspected, percuss gently over the tibia; this may elicit pain if infection is developing
- Assess for other signs of infection; heat, redness and fever

3. Clean the pin tract with sterile applicators and a prescribed solution or ointment to clear the drainage at the entrance of
the tract and around the pin because plugging at this site can predispose to bacterial invasion of the tract and bone.
1.Nursing Diagnoses; Altered
peripheral tissue perfusion related to
injury or traction therapy
• Assess the motor and sensory functions of specific nerves that might be
compromised
• Determine adequacy of circulation (color, temperature, motion and capillary
refill of peripheral fingers or toes)
• For buck’s traction, inspect the foot for circulatory difficulties within a few
minutes and then periodically after the elastic bandage has been applied
• Report promptly if a change in neurovascular status is identified.
Thank you!