Orthopedic Impairment

The term orthopedics was coined by a French physician, Nicholas Andre, who published
a book in 1741 on the prevention and correction of musculoskeletal deformities in children. He
united the Greek term ‘orthos’, meaning straight, with ‘paedeia’, the rearing of children.
Early orthopedics concentrated on the correction of such childhood conditions as
scoliosis (curved back), paralysis as with poliomyelitis, tuberculosis of the bone, and congenital
defects such as clubfoot or deformed hip. Gradually, orthopedists included fractures,
dislocations, and trauma to the spine and skeleton within their specialty.
Characteristics and Symptoms
 Paralysis, unsteady gait, poor muscle control, loss of a limb, etc. (causes limited
mobility).
 Speech production and the expressive language of the child.
 Difficulty with large motor skills and fine motor skills.
 Limited ability to perform daily living activities.
Causes
 Being born with or acquire problems with their bones, their joints, and/or their muscles
 Problem stemming from deformities, diseases, injuries, or surgeries (loss of a limb,
bone, or muscle tissue)
 Genetic abnormality (e.g., the absence of a member, clubfoot)
 Disease (poliomyelitis, bone tuberculosis)
 Injury
 Birth trauma
 Amputation
 Burns
 Fractures
 Cerebral palsy
Treatments
1. Imaging procedures can help diagnose or even treat many orthopedic conditions. Your
health care provider may order:
 Arthrogram (joint x-ray)
 Bone scans
 Computed tomography (CT) scan
 Discography
 Magnetic resonance imaging (MRI) scan
 X-rays

2. Sometimes, treatment involves injections of medicine into the painful area. This may
involve:
 Corticosteroid injections into joints, tendons, and ligaments, and around the spine
 Hyaluronic acid injection to help relieve arthritis pain
3. Surgical procedures used in the treatment of orthopedics include:
 Amputation
 Arthroscopic surgeries
 Bunionectomy and hammer toe repair
 
Cartilage repair or resurfacing procedures

Cartilage surgery to knee

Fracture care

Arthroplasty

Ligament reconstructions

Repair of torn ligaments and tendons

Spine surgery, including diskectomy, foraminotomy, laminectomy, and spinal
fusion.
4. Newer orthopedic services procedures include:
 Minimally invasive surgery
 Advanced external fixation
 Use of bone graft substitutes and bone-fusing protein

 'Orthopedic Impairment is one that includes impairments caused by congenital

anomalies such as absence of a member, clubfoot, impairments caused by disease
such as bone tuberculosis, poliomyelitis, or impairments for other causes to include
amputations, fractures, cerebral palsy, burns, or fractures, for example:
A neuromotor impairment is one that has caused damage to or is considered to be an,
'abnormality,' of the child's spinal cord, brain, or nervous system. Neuromotor impairments are
ones that are acquired either at or prior to the birth of the child and many times result in
complex motor issues that may affect a number of their body systems. Neuromotor
impairments may include ones such as limited limb movement, a loss of appropriate alignment
of the child's spine, or loss of urinary control. Two of the most common forms of neuromotor
impairments include spina bifida and cerebral palsy.
1) Cerebral Palsy is a general term that refers to a number of non-progressive disorders
which affect voluntary movement and posture that are caused by malfunctions or
damages to a person's brain and occur prior to or during birth, or within the first few
years of the person's life. People with cerebral palsy experience involuntary, and/or
uncoordinated movements. Four of the more common forms of cerebral palsy include
Athetoid, Spastic, Ataxic, and Mixed. Cerebral palsy may also be classified according
to the person's limbs that are affected. These classifications include:

 Diplegia - legs affected more than arms

 Hemiplegia - left or right side
 Quadriplegia - all four limbs

Symptoms
 The symptoms of CP vary from person-to-person and range from mild to severe. Some
people with CP may have difficulty walking and sitting. Other people with CP can have
trouble grasping objects.
 The symptoms can become more severe or less severe over time. They also vary
depending on the part of the brain that was affected.
 Some of the more common signs include:
 delays in reaching motor skill milestones, such as rolling over, sitting up
alone, or crawling
 variations in muscle tone, such as being too floppy or too stiff
 delays in speech development and difficulty speaking
  spasticity, or stiff muscles and exaggerated reflexes
 ataxia, or a lack of muscle coordination
 tremors or involuntary movements
 excessive drooling and problems with swallowing
 difficulty walking
 favoring one side of the body, such as reaching with one hand
 neurological problems, such as seizures, intellectual disabilities, and
blindness
 Most children are born with CP, but they may not show signs of a disorder until months
or years later. Symptoms usually appear before a child reaches age 3 or
 Call your doctor if you suspect your child has CP. Early diagnosis and treatment are very
important.
Causes
 Abnormal brain development or injury to the developing brain can cause CP. The
damage affects the part of the brain that controls body movement, coordination, and
posture.
 The brain damage usually occurs before birth, but it can also happen during birth or the
first years of life. In most cases, the exact cause of CP isn’t known. Some of the possible
causes include:
 asphyxia neonatorum, or a lack of oxygen to the brain during labor and
delivery
 gene mutations that result in abnormal brain development
 severe jaundice in the infant
 maternal infections, such German measles and herpes simplex
 brain infections, such as encephalitis and meningitis
 intracranial hemorrhage, or bleeding into the brain
 head injuries as a result of a car accident, a fall, or child abuse
Treatment
 The goal of treatment is to improve limitations and prevent complications. Treatment
may include assistive aids, medications, and surgery.
 Assistive aids include:
 hearing aids
 walking aids
 body braces
 wheelchairs
 Eyeglasses
 Medications
 Oral anticonvulsants and muscle relaxants are commonly used as first-
line treatments for CP. Your doctor might prescribe:
 diazepam (Valium)
 dantrolene (Dantrium)
 baclofen
 tizanidine (Zanaflex)
 Your doctor might also suggest local injections of botulinum toxin type A
(Botox) or intrathecal baclofen therapy, where the drug is delivered by an
implantable pump.
  Surgery
 Orthopedic surgery may be used to relieve pain and improve mobility. It
may also be needed to release tight muscles or to correct bone
abnormalities caused by spasticity.
 Selective dorsal rhizotomy (SDR) might be recommended as a last resort
to reduce chronic pain or spasticity. It involves cutting nerves near the
base of the spinal column.

 Other treatment
 Other types of treatment for CP include:
 speech therapy
 physical therapy
 occupational therapy
 recreational therapy
 counseling or psychotherapy
 social services consultations
 Although stem cell therapy is being explored as a potential
treatment for CP, research is still in the early stages.
Prevention
 The majority of problems that causes CP can’t always be prevented. However, if you’re
pregnant or planning on becoming pregnant, you can take certain preventive measures
to minimize complications.
 It’s important to get vaccinated against diseases that can cause fetal brain damage,
such as rubella. It’s also crucial to receive adequate prenatal care. Attending regular
appointments with your doctor during pregnancy can help prevent premature birth, low
birth weight, and infections.
2) Spina Bifida is a form of developmental disability involving a person's spinal column.
Spina bifida is characterized by an opening in the spinal column, often in combination
with paralysis of portions of the person's body. The disability may or may not involve
some level of affect on the person's intellectual function. Forms of spina bifida can
include occulta or cystica; occulta is a milder form of spina bifida while cystica is more
serious.
Symptoms
 An infant who is born with spina bifida may have or develop:
 weakness or paralysis in the legs
 urinary incontinence
 bowel incontinence
 a lack of sensation in the skin
 a buildup of cerebrospinal fluid (CSF), leading to hydrocephalus, and possibly
brain damage

Causes
It is unclear exactly what causes spina bifida. Scientists say it is most likely due
to a combination of inherited, or genetic, environmental and nutritional factors.
 Folic acid: Spina bifida is more likely if a mother does not have enough folic acid during
the pregnancy, although the reason is unclear. All women of reproductive age should
make sure their folic acid intake is adequate. Since the introduction of folic acid
 recommendations in the U.S. in 1992, the number of births involving neural tube defects
has fallen.
 Plant proteins, iron, magnesium, and niacin: A low intake of these nutrients before
conception may be associated with an increased risk of neural tube defects by two to
five times.
 Family history: If one infant is born with spina bifida, there is a 4 percent chance that a
future sibling will have the same condition.
 Medications: Drugs such as valproate, used to treat epilepsy or bipolar disorder, have
been associated with a higher risk of giving birth to babies with congenital defects, such
as spina bifida.
 Diabetes: A woman who has diabetes is more likely to have a baby with spina bifida,
than one who does not.
 Obesity: A woman whose body mass index (BMI) is 30 or above has a higher risk of
having a baby with spina bifida.
Treatment
 Treatment depends on several factors mainly how severe the signs and
symptoms are.
 Surgical options
 Surgery to repair the spine: This can be done within 2 days of
birth. The surgeon replaces the spinal cord and any exposed
tissues or nerves back into the newborn's body. The gap in the
vertebrae is then closed and the spinal cord sealed with muscle
and skin.
 If bone development problems occur later, such as scoliosis or
dislocated joints, further corrective surgery may be needed. A
back brace can help correct scoliosis.
 Prenatal surgery: The surgeon opens the uterus and repairs the
spinal cord of the fetus, usually during week 19 to 25 of
pregnancy. This type of surgery may be recommended to reduce
the risk of spina bifida worsening after delivery.
 Caesarian-section birth: If spina bifida is present in the fetus,
delivery will probably be by cesarean section. This is safer for the
exposed nerves.
 Hydrocephalus: Surgery can treat a buildup of cerebrospinal fluid
in the brain. The surgeon implants a thin tube, or shunt, in the
baby's brain. The shunt drains away excess fluid, usually to the
abdomen. A permanent shunt is usually necessary.
 Further surgery may be needed if the shunt becomes blocked or
infected, or to install a larger one as the child grows.
 Physical and occupational therapy
 Physical therapy: This is vital, as it helps the individual become
more independent and prevents the lower limb muscles from
weakening. Special leg braces may help keep the muscles strong.
 Occupational therapy: This can help the child perform everyday
activities more effectively, such as getting dressed. It can
encourage self-esteem and independence.
 Assistive technologies: A patient with total paralysis of the legs will need a
wheelchair. Electric wheelchairs are convenient, but manual ones help
maintain upper-body strength and general fitness.
 Preventions

 Folic acid: Women of reproductive age should consume 400 micrograms (mcg) a
day of folic acid, a nutrient that is key to healthy fetal development. Sources
include dark green, leafy vegetables, egg yolks, some fruits, and fortified cereal
products. Women who are pregnant or trying to become pregnant should take a
400-mcg folic acid supplement daily.

 Tests: Undergoing tests for neural tube defects and other problems during
pregnancy can also reduce the risk and enable preventive action to be taken.
A woman who has spina bifida or who has a child with the condition is at higher
risk of having another child with spina bifida. She may be advised to take extra folic acid
before conceiving again.

References
Cerebral palsy. (2014). Retrieved from my.clevelandclinic.org/health/diseases/8717-cerebral-
palsy
Cerebral palsy (CP). (2018). Retrieved from cdc.gov/ncbddd/cp/index.html
Mayo Clinic Staff. (2016). Cerebral palsy.Retrieved from mayoclinic.org/diseases-
conditions/cerebral-palsy/symptoms-causes/syc-20353999
Cerebral palsy: Hope through research. (2018).Retrieved from ninds.nih.gov/Disorders/Patient-
Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research
https://science.jrank.org/pages/4917/Orthopedics-History.html
https://medlineplus.gov/ency/article/007455.htm
FTC 106 :Foundations of Inclusive
and Special Education
Orthopedic Impairment

Sir Dante M. Miguel

Group Members:
Balangoy, Cherry Ann
Carabbacan, Janelle
Domase, Ardenia Fe
Florida, Rina Rose
Saldo, Khimverlie
Tino, Haziel
Tonged, Marife

October 4, 2019