Indlæg nr. 4 om tågængere.

Posted on 21. mar, 2017 by in Ikke kategoriseret

Behandling af tågængere.

Litteraturen er desværre fuld af dårlig dokumenteret behandling.

Hvis barnet er idiopatisk tågænger, er behandling måske ikke nødvendigt. Barnets gang bør dog evalueres mindst hver 6. måned for kontrakturer, stive led og svage muskler. Hvis der er et fysisk problem, eller hvis ikke gangmønsteret spontant er rettet ved 3 år, skal behandling overvejes. Behandling kan inkludere f.eks. fysioterapeut, der strecher ben og fødders muskulatur samt træner svag muskulatur. Fysioterapi med bl.a. stretching er den mindst invasive behandling og er derfor ofte førstevalg. Med udgangspunkt i de mange muligheder for problemer i sanseapparatet, ser jeg det som udbytterigt at samarbejde med en fysioterapeut, der har særlig interesse i sansemotorik.

Øvelsesprogram.

Børn, der går på tæer, kan udvikle stram lægmuskulatur bag på deres ben og have nedsat bevægelighed i ankelleddene. Oveni kan musklerne foran på benene blive svage. Hvis der er stramhed og svaghed, vil barnet have svært ved at gå på sine hæle. Tidlig identifikation kan være en hjælp til at forebygge disse muskelproblemer. Udstrækning af lægmuskulaturen og styrkelse af musklerne foran på benene vil hjælpe barnet til succesfuldt at kunne gå – fra hæl til tå.

Stretching bør følges op med aktivitet, hvor barnet bruger sine muskler i den nye længde – helst på en for barnet sjov måde.

Sansemotoriske øvelser er oftest en form for anderledes leg.

Stretching og styrkeøvelser for børn under 6 år.

Barnet ligger på en briks med strakt knæ og benet en presses mod ansigtet ved at trykke på foden med bøjet ankelled. Hold strækket 15 – 30 sek. (må ikke gøre ondt). Gentages 10 gange med hvert ben dagligt.

Achillessenestræk.

Barnet ligger på en briks med bøjet knæ. Ankelleddet bøjes opad. Hold strækket 15 – 30 sek. (må ikke gøre ondt).

Gentag 10 gange med hver fod dagligt.

Fra siddende til stående.

Sæt barnet på en barnestol. Placer dine hænder på knæene, så trykket holder hælene i gulvet. Bed barnet rejse sig op med hælene i gulvet. Gentag 10 gange.

Øvelser for børn over 6 år.

Lægstretch.

Barnet skal stå 2 fod fra væggen med begge hænder mod væggen i skulderhøjde. Med højre knæ strakt bedes barnet træde mod væggen med venstre fod, for derefter at læne det sig frem indtil der føles et stræk i læggen. Det er vigtigt at højre hæl forbliver i gulvet. Hold strækket 15 – 30 sek. (må ikke gøre ondt). Gentag 10 gange med hvert ben dagligt.

Generelt om stretching af benets muskler, så er de så stærke, at det kræver patientens egen vægt for at få et godt udbytte.

Andre øvelser:

Marchering på stedet med høje knæløft

Squats

Gang opad bakke

Gang på ujævnt/forskellige former for underlag og/eller i sand

Gang på hæle

Gang med svømmefødder, da det er næsten umuligt at gå på tæer med svømmefødder

Male med fødderne

Fodtøj.

Fodtøj i sig selv retter ikke tågang, men fodtøj med høje skafter, med stive eller halvstive såler (må ikke være fleksible i midtsonen) og fast hælkappe kan hjælpe.

Sko med hjul under hælene er et alternativ, da det er nødvendigt at vende tæerne opad for at få hjulene til at rulle. Det gør dem vant til presset på hælene og det stretcher achillessenen. De er dog kun egnede hos de børn, der ikke irriteres af lyden fra hjulene.

Indlæg.

Hælkiler kan i nogle tilfælde vænne barnet til at have underlag under bagfoden.

 Anden behandling.

Da idiopatisk tågang ikke er en alvorlig lidelse, men ofte udbedres spontant giver det ikke barnet alvorlige problemer udover de kosmetiske.

Der findes sansemotoriske øvelser i forbindelse med dysfunktionel vestibulær sans. F.eks. bliver det vestibulære system aktiveret, når et barn svinges på en gynge.

Børn, der er hypersensitive i forhold til berøring kan have ulyst til at sætte hele foden i gulvet. De føler det ukomfortabelt at føle underlaget eller hele deres egen vægt på fødderne. Har en aversion mod strømper, fodtøj eller bare fødder mod ujævnt underlag. Her vil taktil terapi være egnet.

Der kan også være en forbindelse med synet, så specielle briller på et øjeblik kan afhjælpe problemet. Barnet skal typisk gennemgå et synsprogram i et år, og behøver derefter ikke længere briller.

Skinner og gipsninger kan komme på tale. I nyere tid er der brugt botox til at gøre lægmuskulaturen svagere, så tågang ikke kan lade sig gøre. Kirurgisk forlængelse af sener og muskulatur bør ikke ske før konservativ behandling er afprøvet.

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