Question

A 4-year-old child with Rett syndrome has characteristic excessive hand wringing and hand-to-mouth patterns. The neurologist ordered a right volar long arm immobilization orthosis to control the negative effects of these movements, and the COTA fabricated the orthosis 2 weeks ago. During a follow-up appointment, the parents report difficulty adhering to the prescribed wear schedule because the child removes the orthosis when the parents are not in line of sight. After inspecting the child’s skin and ensuring an effective fit, which action should the COTA take to support better compliance with the wear schedule?

A. Change the orthosis to a circumferential clamshell design.
B. Provide the parents with a stockinette to place over the orthosis.
C. Replace the hook and loop straps with riveted snap closures.

Answer 1

To support better compliance with the wear schedule for the 4-year-old child with Rett syndrome, the COTA can take the following actions:

1. Educate the parents about the importance of consistent wear of the orthosis and how it can help manage the excessive hand movements.

2. Advise the parents to use positive reinforcement techniques, such as praise or small rewards, when the child wears the orthosis according to the prescribed schedule.

3. Suggest using distractor techniques to divert the child's attention away from removing the orthosis, like providing toys or activities that engage their hands.

4. If the child continues to remove the orthosis, consider making modifications to increase its comfort and effectiveness, but consult with the child's healthcare provider first.

In this specific scenario, providing the parents with a stockinette to place over the orthosis could be a helpful step. The stockinette can make the orthosis more comfortable and potentially reduce the child's desire to remove it.

Remember to involve the child's healthcare team in determining the best course of action for their safety and compliance with the wear schedule.

In the given scenario, the child with Rett syndrome is experiencing difficulty adhering to the prescribed wear schedule for the orthosis, as they remove it when their parents are not around. The goal is to find a solution that will support better compliance with the wear schedule.

Option B suggests providing the parents with a stockinette to place over the orthosis. A stockinette is a stretchable, tubular fabric that can be worn underneath the orthosis. By placing the stockinette between the child's skin and the orthosis, it can act as a barrier, providing a layer of cushioning and comfort.

The stockinette can help in a few ways:

1. Comfort: The child may be removing the orthosis due to discomfort caused by direct contact with the orthosis on their skin. The stockinette can reduce friction and provide a softer surface against the skin, making the orthosis more comfortable to wear. This increased comfort can reduce the child's motivation to remove the orthosis.

2. Sensory response: Children with Rett syndrome often have sensory sensitivities. The stockinette can help provide a more pleasant sensory experience, reducing any negative sensory input from the orthosis and potentially improving the child's tolerance for wearing it.

3. Protection: The stockinette can also serve as a protective barrier between the orthosis and the child's skin. This can help prevent any potential skin irritation or pressure sores that may result from prolonged wear of the orthosis.

It is important to note that while providing a stockinette may be a helpful step, it may not guarantee full compliance with the wear schedule. It is crucial for the COTA to continue working with the child's parents and healthcare team to address any underlying reasons for the non-compliance and to explore other strategies to support the child in wearing the orthosis consistently.

Remember, the ultimate goal is to manage the negative effects of the excessive hand movements associated with Rett syndrome. By ensuring the child wears the orthosis according to the prescribed schedule, their functionality and quality of life can be improved.

Answer 2

B

Step-by-step explanation:

To support better compliance with the wear schedule for the 4-year-old child with Rett syndrome, the COTA can take the following action:

1. Education: The COTA should educate the parents about the importance of consistent wear of the orthosis and its positive impact on managing the excessive hand movements. They should explain how the orthosis helps in reducing hand wringing and hand-to-mouth patterns, improving the child's overall functionality and quality of life.

2. Reinforcement: The COTA can suggest strategies to reinforce the wear schedule. For example, they can advise the parents to use positive reinforcement techniques such as praise or small rewards when the child wears the orthosis according to the prescribed schedule. This can motivate the child to adhere to the schedule.

3. Distractor techniques: The COTA can suggest using distractor techniques to divert the child's attention away from removing the orthosis. For instance, providing the child with toys or activities that engage their hands and keep them occupied can help reduce their inclination to remove the orthosis.

4. Modifications: If the child continues to remove the orthosis despite the above strategies, the COTA may consider making modifications to the orthosis to increase its comfort and effectiveness. However, it is important to consult with the neurologist or the child's healthcare provider before making any modifications.

In this specific scenario, option B, providing the parents with a stockinette to place over the orthosis, could be a helpful step. The stockinette can serve as a barrier between the child's skin and the orthosis, making it more comfortable and potentially reducing the child's desire to remove it.

Remember, it is important to involve the child's healthcare team in determining the best course of action to ensure the child's safety and compliance with the orthosis wear schedule. I tried my hardest:)