SMALL STEPS, BRIGHT FUTURES: ADAPTING JOINT MOBILIZATION TO MEET THE NEEDS AND PRESENTATION OF THE PEDIATRIC PATIENT

Theory/Body: Manual therapy has undergone extensive research within the adult population, yielding benefits such as pain reduction, enhanced range of motion (ROM), improved muscle strength, heightened muscle tone, and refined proprioception. Although the research is less comprehensive for pediatric patients, it remains a safe and viable option once factors unique to pediatric treatment are considered.

The PUMT (Pediatric Utilization of Manual Therapy) decision tool was created to help guide physical therapists in the safe and effective use of joint mobilizations while considering the adaptations that need to be made to accommodate the unique attributes of pediatric care.1

These adaptations include customized positioning to accommodate tone and ensure pediatric comfort, alongside red flags that account for the patient’s diagnosis, presentation, and the provider's skillset. Other modifications are crafted to the patient’s communication abilities, the developing skeletal system, potential growth plates stress, and the latest research findings on pain categorization and how that influences joint mobilization prescription.

The PUMT decision tool begins with the targeted developmental task, recognizing that pediatric therapy is more function-driven than impairment-driven. It guides the pediatric therapist's clinical decision-making as they determine if joint mobilization is appropriate for their patient and what techniques will be most effective. The tool also acknowledges the importance of a multimodal treatment plan specific to the pediatric patient.

The platform will cover the PUMT decision tool, the 3-part red flag chart, pictures of modified positioning accompanied by a description of the technique, and a chart to represent the different adaptations necessary for joint mobilization to be most effective in the pediatric setting.

Clinical Relevance: A survey of expert pediatric therapists identified manual therapy knowledge as a key factor in determining their utilization of manual therapy techniques. The researchers reported that therapists indicated they would be more likely to utilize manual therapy if they understood how and when to apply the techniques.2 This presentation will increase manual therapy pediatric evidence-based knowledge and allow therapists to integrate the suggested accommodations into their clinical practice, enhancing their ability to screen patients for joint mobilization and apply techniques with increased safety and efficacy.