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Developmental Dysplasia of the Hip (DDH)

Pavlick Harness2DDH can also be referred to as congenital dislocation of the hip, which is an umbrella term for numerous biomechanical hip joint abnormalities. Such abnormalities can include hip dislocation, increased susceptibility to hip subluxation, or inadequate hip joint development (see figure 1). DDH has an occurrence of 1:1000 live births; girls tend to be more commonly affected than boys; and left hip DDH more prevalent than right (although bilateral dislocations are not uncommon).

 

Risk Factors For DDH

  • Family history of DDH
  • Breech position during pregnancy
  • First born child
  • Female
  • Large birth weight

 

Signs & Symptoms

  • Uneven skinfolds in the buttock and thigh region
  • One leg is longer than the other
  • Leg may be turned outward
  • Reduced movement of affected leg
  • Clicking sound or clunking feeling with leg movement
  • Difficulty/delay with crawling or walking

 

Diagnosis

Your baby is screened for DDH on numerous occasions by pediatric healthcare providers and can usually be diagnosed within the first 2 years of life. If under 4 months old, ultrasound in conjunction with a physical examination (including an Ortolani and Barlow test) are the diagnostic tools used to determine whether your infant has DDH. In the case of a 4 month old or older, x-rays may be required, as the bones that comprise the hip joint have typically begun to develop by this stage.

 

Treatment & Prognosis

If DDH is detected in early infancy (younger than 6 months), a simple pavlick harness (see figure 2) can usually be worn in conjunction with physiotherapy stretches and exercises to successfully correct this condition. If detected after 6 months of age, it is more likely that surgery will be required and physiotherapy treatment to follow. The later DDH is detected the poorer the prognosis. Untreated DDH may lead to arthritis and deterioration of the hip, resulting in a severely incapacitating state.

If your baby is displaying any signs or symptoms of DDH please call Stepping Forward Therapy Services today on (03) 8609 1730 for an assessment by one of our experienced physiotherapists.

 
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References

Medline Plus. (2013). Developmental Dysplasia of the Hip. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000971.htm

 

Physiopedia. Developmental Dysplasia of the Hip (DDH). Retrieved from http://www.physio-pedia.com/Developmental_Dysplasia_of_the_Hip_(DDH)

 

Article written by Nikki Ceeney

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Education, elementary school, learning and people concept - grou

Funding for Students with a Physical Disability

Providing adequate access, assistance and equipment for children with special needs is expensive, however funding is often available.

Children who are enrolled in school are eligible for funding for physiotherapy, occupational therapy and speech therapy to support the student with the educational curriculum, including access, mobility and participation.

Funding is also for integration aides and equipment. Schools may be eligible for additional funding for building works (to provide disabled access). This often requires a separate application process.

Funding for Students with Disabilities in Victorian Government schools

Funding for children in Government schools is based on a student disabilities index. Funding is provided by the Department of Education and Early Childhood Development (DEECD). Students are assigned a level of funding according to their level of need.

Funding for students in independent schools

Association of Independent Schools Victoria (AISV): AISV administers funding for students eligible for support under the Victorian Government State Support Services Programme. Students are approved for a number of hours for the year, and an hourly rate is set for funding based on the amount allocated by the Victorian Government and the total number of hours approved in all schools.

Schools are provided with funds to support eligible students for example children with an intellectual or physical disability, to access mainstream education. Additional funds are also available for eligible students with physical disabilities for physiotherapy and occupational therapy. (Students with learning difficulties are not eligible under this programme).

Applications for funding through the AISV specifically requires the use of standardised assessments such as the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2) to provide evidence of the student’s physical limitations. Stepping Forward physiotherapists are able to provide this assessment and the associated report needed. Contact us.

Funding for Students within the Catholic Education System

Funding is available through the Catholic Education Commission of Victoria. There are 7 categories in which students may be eligible for funding, including physical disability. Stepping Forward physiotherapists can provide assessments and reports to support your application for funding.

Alternative sources of funding

In some situations the student’s physiotherapy related needs do not fall under the scope of supporting their educational curriculum and/or additional funding is needed. For example: Funding for physiotherapy to develop of home programs or to prescribe and source equipment such as wheelchairs and orthoses.

Alternative/ Additional sources of funding can be found under the following:

Better Start Early Intervention (FaHCSIA): Eligible children are aged under six years and have been diagnosed with a disability such as Down syndrome or cerebral palsy. This entitles the child up to $12,000 in funding for early intervention services and treatments. Parents or carers of eligible children need to register their child for the Better Start early intervention funding before the child turns six.

Medicare Better Start Medicare Program: This includes items in the Medicare Benefits Schedule (MBS) that provide therapy assessment and intervention such as physiotherapy and individual assistance packages for children with disability, their families and carers.

Once approved, Medicare will rebate a portion of the session fee. Children under 15 years of age with a suspected disability, can claim up to 4 sessions for assessment. Children under 15 years of age with a Cerebral Palsy, Fragile X, Downs Syndrome, Hearing Impairment and/or Vision Impairment can claim up to 20 sessions of ongoing therapy.

Chronic Disease Management Plan: This is a government initiative that aims to coordinate healthcare teams to provide you with better, comprehensive care for people a chronic or terminal condition who may also have complex (team) care needs. Families can claim a Medicare rebate on up to 5 allied health services each calendar year on referral from your GP.

Private Health: The amount of funding available for the child depends on the family’s insurance agency and their level of cover. Additionally, if they family does not have private health insurance but are considering it, the Medicare Private Health Insurance Rebate reduces the amount they pay for private health insurance.

Additional funding for equipment

State Wide Equipment Program (SWEP): The Victorian State-wide equipment program (SWEP) provides people with a permanent or long-term disability with subsidised aids and equipment. SWEP aims to enhance the independence and safety of people with a disability in their own home, facilitate their participation in the community and support families and carers.

Although SWEP funded equipment is to be used in the home and community, rather than specifically an educational setting, mobility and seating equipment is often used in a variety of settings.

What do I do from here?

To access many of the funding options, students must be assessed as eligible in one of the categories of disability. A thorough report from a Stepping Forward physiotherapist that includes results from a standardised assessment (such as the BOT2) can quantify a child’s eligibility.

NDIS:

The National Disability Insurance Scheme is set to roll out in Victoria beginning in July, 2016. NDIS will provide disability support to assist people with a disability to work towards functional goals. This includes funding physiotherapy. For more information about the NDIS, see http://www.ndis.gov.au/document/what-national-disability-insuran

As you can see there are many sources of funding available.  If you would like to know more about how Stepping Forward Therapy Services can help access this funding, then please contact us on 9899 4004.

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Educating Others: A school presentation about cerebral palsy and special needs.

At Stepping Forward we do much more than just hands-on physiotherapy.

One of the students that we worked with in 2014 was in grade three and has a diagnosis of cerebral palsy.  At the student’s request, and facilitated by his parents and the school, one of our physiotherapists did a presentation to the whole year level teaching the students and their teachers about cerebral palsy and what it means to have special needs.

This gave the students the opportunity to learn more about their friend’s condition and how it affects him, what might change such as having surgery and how his friends and teachers can be helpful. The students were engaged and asked very sensitive and appropriate questions, like “do you grow out of it?” and “does it hurt?”.

Our physiotherapist finished by demonstrating some of the exercises included in the student’s program, and friends wanted to join in and try the exercises themselves. Overall it was a great success!

Please contact us, if this service is something you would like to find out more about.

Note: Education sessions such as these assist the student in feeling included, provide a sense of belonging, and gives them the opportunity to share their story. The benefits to the school go beyond education and awareness, but encourages empathy and compassion and broadens their perspective. Sometimes students with special needs need to learn in a different way, and this can benefit the whole class. And sometimes, a greater understanding, can lead to new friendships.
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The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2)

Stepping Forward physiotherapists are trained in assessing specific needs of children with disabilities and can administer standardised assessments.

These assessments are used to support an application for funding from funding providers. BOT2: The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT2) is the most widely used motor proficiency test and provides a comprehensive assessment of motor development.

It comprises of a series of sub-tests in fine motor control, manual coordination, body coordination, strength and agility. Physiotherapists use the scores to determine the child’s functional level compared to norms and interpret the information to determine their needs.

If you have any queries about what the test involves, how it can help with getting more funding at your school, or whether it is suitable for a child that you are looking after call us on 9873 3333, and we are happy to discuss this with you.

Read more about funding for students at school please refer to the following link

http://www.deewr.gov.au/Schooling/Programs/Pages/funding_for_students_with_disabilities.aspx

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