AGGRESSIVE TREATMENT OF INFANTS WITH ARTHROGRYPOSIS MULTIPLEX CONGENITA (AMC)
Douglas Barnes, MD Becky Ligon, OTR Janet Dawson, PT, Shriners Hospitals for Children - Houston, Texas
This case study is a unique, non-surgical, preliminary approach in the management of AMC. The technique is designed to attain maximum joint motion. Traditional treatment for AMC has always included passive joint range of motion (ROM), splinting and casting. The use of these modalities in new ways is the key to this approach. Taping as an alternative to casting allows ROM and stretching to continue in conjunction with taping. Impairment of active muscle movement is minimized and development of early motor skills can be encouraged. Splinting also pairs nicely with taping techniques to allow for more dynamic applications.
Findings at our institution, The Shriners Hospitals for Children - Houston, indicate remarkable gains in range of motion from birth until 3 months of age with an aggressive passive ROM and stretching program. Common techniques are used but in a non-traditional manner with very early intervention. Affected joints are stretched 2-4 times daily. One non-traditional technique employed is creative dynamic serial taping of clubfeet (Robert Jones method) versus traditional static casting. Serial splinting is used with these patients in conjunction with the taping. Daily adjustments to the splints are made to accommodate rapid changes in ROM. Parent participation is crucial and closely supervised. It is individually modified as needed. The initial intensity of the program solidifies the parent's commitment to the ongoing needs of their child.
Awareness of the benefits of early, intense nonoperative treatment of AMC by physicians and therapists can significantly impact the lives of these children. One of the most significant benefits is the bonding between parent and child. Generally, the parents are overwhelmed, but the weeks spent working daily with the therapists eases their apprehension of handling their children. The parents are then able to commit to the lifelong needs of their child. Proper fitting splints and braces, ongoing therapy, a home exercise program and routine physician assessment is essential throughout the children's growing years.
Functional positioning of the extremities, maximized with remarkable gains in the joint motion, promotes a lifetime of independence and mobility. The gains achieved by early passive motion may reduce the need and extent of future musculoskeletal surgery. The techniques may offer new opportunities to explore usage in other restrictive joint motion disorders as well.
The taping techniques for clubfoot deformity are illustrated on the following pages, 9 to 13.
For Questions and correspondence please contact:
Janet Dawson PT-713-793-3798
Becky Ligon OTR- 713-793-3785
Shriners Hospital for Children