Therapy

Judah has had two visits to his therapist since the last post. I got kind of busy and was a few days late so I decided to put two visits in one post. The first visit was an assessment, the second teaching the exercises, and the third checking range of motion.
The Second Appointment: Learning the Exercises
The following pictures are of the therapist teaching the exercises. One "session" consists of four exercises each done ten times. This takes 10-15 minutes. The therapist told us to try to get 3 "sessions" in a day, but if we couldn't, at least two.
                                                       The therapsit talking to Mom

Teaching the exercises

After we got home, my Mom tried her hand at it.

We usually lay him on the couch and entertain him with Loony Tunes while doing the exercises. At the end of the week he gets a prize. The prizes so far have been Hot Wheels.

The Third Appointment: Range of Motion

At the third appointment, she simply checked range of motion. We have not got the scores yet, but the therapist said she thinks they haven't changed. I can post them if we get them. If not, on May 1, we go to the orthopedic doctor and I will post those. The check the ones from the last PT appointment go to >>THIS POST<<.

Cassia                                                                                                                                                    

Judah's First Therapy Appointment

Judah's first PT appointment was Tuesday. Thanks to Maw-Maw for coming to watch all us kids and bringing fruit and Oreos, Judahs favorite cookies. My mom forgot the camera, so the pictures were taken via Dad's phone. This appointment was just an assessment. He will go back in a week to learn range of motion exercises. The therapist was a lot of fun and great with kids. She immediately gave Judah toys to play with while she talked to Mom and Dad.

She measured his range of motion with an alligator measuring tool. We will get the numbers at our next visit.

She moved his legs around to see how much they would move.

She had him do a lot of exercises like running, bending over, walking up and down steps, hopping, skipping, etc.

The only thing that made my Mom nervous was when she had him jump from her table to the floor two times. I'm sure moms of Perthes children will understand how scary this is.

Judah goes back on Tuesday for us to learn how to do his range of motion exercises. After that, he will go for one more follow up appointment. His next orthopedic appointment is May 1.

Cassia

New Shoes

Last night we went and bought new shoes for Judah's hip. He has always been wearing cheap Wal-Mart shoes, but upon finding out about his condition, we decided nice shoes would help with the pain factor. Here are a few (well an excessive amount of) pictures of the occasion. :-P

It was pretty hard finding nice shoes, but a good price. Hopefully, his foot won't catch up with his teenage brother's! Yes, men's size 15.

Hopefully, his new shoes will help his little hip!

Cassia

What is Legg-Calve'-Perthes Disease?

Legg-Calve'-Perthes Disease is a rare disease of the hip that effects approximately 1 in 1200 children. Of those children, only about one in four are girls. About 5% of all diagnosed develop the disease in both hips (bilaterally). Legg-Calve'-Perthes children tend to be of shorter stature due to delayed bone age. Legg-Calve'-Perthes Disease (LCPD) is a form of osteonecrosis of the hip that is found only in children. LCPD is of unknown origin. It is known that bone death occurs in the ball of the hip due to an interruption of blood flow. As bone death occurs, the ball develops a fracture of the supporting bone. This fracture signals the beginning of bone reabsorption by the body. As bone is slowly absorbed, it is replaced by new tissue and bone.

Four Stages of LCPD
1. Femoral head becomes more dense with possible fracture of supporting bone;
2. Fragmentation and reabsorption  of bone;
3. Reossification when new bone has regrown; and
4. Healing, when new bone reshapes.
Phase 1 takes about 6 months- 2 years, Phase 2 takes one year or more, and Phase 3 and 4 may go on for many years.

First Symptoms
The first symptoms characterized in LCPD are usually a limp and pain in the hip, groin, or knee. They usually cannot tell you an instance when they hurt themselves.

Extent of Disease
New bone growth typically reshapes better in younger children and it may improve with growth.

Types of Treatment
The physician may take a wait and see approach. As long as the patients symptoms are mild, the physician may only prescribe physical therapy exercises to help maintain good range of motion.

Non-Surgical Treatment:
Crutches, casts, traction, and braces help return range of motion and mobility. Range of motion exercises may be given to you by your physical therapist to do with your child in the home.

Surgical Treatment:
Tenotomy
A "tenotomy" is a surgery that is performed to release an atrophied muscle that has shortened due to limping. Once released, a cast is applied allowing the muscle to regrow to a more natural length.
Osteotomy
There are different types of "osteotomies" (cutting the bone to reposition it) and, depending on the need they are performed at different stages of the disease.
Looking to the Future
Studies on long-term results of LCPD indicate that the incidence of late degenerative osteoarthritis is dependent on two factors. If the ball reshapes well and fits well in the socket, arthritis is usually not a concern. If the ball does not reshape well, but the socket's shape still conforms to the ball, the patient will tend to develop mild arthritis in later adulthood. Patients who's femoral head does not shape well and does not fit well in the socket usually develop degenerative arthritis before the age of 50.

Cassia

Moving Judah's Bed

We have lately been making a couple changes around the house to make it easier on Judah's hip. The first and most helpful thing was separating the beds.

                                                       Here are the beds before

Judah waiting patiently

The beds after

His big brother's bed

Judah's bed

Cassia                                                                                                                                                  

The Beginning

This is 4-year-old Judah's story. I, his sister, am writing this blog so we will have somewhere to journal his disease. Most days this will be filled with how he feels. Some days it will be doctor appointment mumbo jumbo.
We noticed Judah limping at the beginning of January 2012. Some days it would be worse and some days better. As with most Perthes patients, we thought it was his knee. By the beginning of February, we realized it was his hip. We took him to our local Urgent Care on February 6, and on the first x-ray examination they saw nothing abnormal. When the radiologist read the report they saw a "fracture", which on the report they concluded it probably was Legg Calve Perthes Disease.
 We then got an appointment with an orthopedic doctor on February 9. Dr. Hegg concluded it was Legg Calve Perthes Disease. Upon x-ray of his right hip, there was some flattening and sclerosis. We were told it can result in significant loss of motion and early development of hip arthritis. We are to try to maintain the motion in that leg with physical therapy and try to keep a four-year-old from running, jumping, and ball sports in the early phases of this disease. We go for physical therapy on March 8, and a follow-up with the orthopedic doctor May 1.
The following is his range of motion numbers for our records.
Left hip flexion 150-160
Right hip flexion 135-140
Left hip internal rotation 20
Right hip internal rotation 25
Left hip external rotation 65-70
Right hip external rotation 35-40
Left hip abduction 55
Right hip abduction 40
Left hip adduction 35
Right hip adduction 25
Right hip vascular NVI distally
Right hip palpation non-tender Howorth is positive

Cassia