Bone Abstracts

Background: Osteogenesis Imperfecta (OI) is most commonly caused by a defect in the genes which produce type 1 collagen. Features of OI include fractures, hypermobility and weakness. Severely affected children can present with deformities such as bowing of long bones and spinal curves. Mobility may be significantly impaired. The medical management of children with severe OI includes orthopaedic surgery and bisphosphonate treatment. Physiotherapy to promote function and participation is central to their overall management. This includes facilitating motor development, strengthening and rehabilitation post fracture or surgery. Some severely affected children struggle with land-based physiotherapy due to the extent of their bone fragility, weakness, or limitations caused by the shape of their bones.

Clinical management: Hydrotherapy, therapeutic exercise in water, is regularly used by the physiotherapy team at a highly specialised centre for paediatric OI. The aim of this poster is to demonstrate the effectiveness of hydrotherapy in the management of children with severe OI, illustrated by three case examples. Three children, aged eleven months, four years and seven years, attended six sessions of hydrotherapy. Sessions were led by a physiotherapist experienced in OI. Parents were invited to take part in sessions. Child focused goal-setting was used to assess effectiveness, and parent experience was recorded.

Discussion: Hydrotherapy enabled an eleven month old with marked limb bowing and gross motor delay to achieve positions he was initially unable to achieve on land. Parental confidence increased when handling their child. Hydrotherapy introduced a non-ambulant four year old to graded weight-bearing activities following bilateral rodding surgery, enabling progression to land-based gait re-education. Land based therapy was limited for a child aged seven years, due to his fragility, weakness and severe kyphoscoliosis. Hydrotherapy enabled him freedom of movement, muscle resistance training and an opportunity to improve his cardiovascular fitness. All parents reported that hydrotherapy was very important in their child’s overall management and that their child had benefited significantly from sessions. These three case examples illustrate that hydrotherapy is a valuable and effective therapy adjunct for the physiotherapy management of children with severe OI. Its benefits for the child and family are numerous and versatile.

Disclosure: The authors declared no competing interests.