Therapy interventions should be tailored to the individual child.

Phase 1: Post-op Day 1 to 4-6 weeks – Period in cast/full time splint

Goals: pain management, equipment, mobilize, educate and involve the family

• Provide positioning options in cast/splint
• Avoid windswept posturing during the healing period
• Frequent position changes to prevent pressure areas
• Utilize long leg casts/brace to stretch hamstrings in long sitting, if indicated
• Ankle plantarflexor stretches, if required
• Isometric contraction of the gluteus maximus, quadriceps, hamstrings, if able
• If in hip abduction splint, may remove and perform knee ROM after 10 days (earlier may lead to spasms) – Caution: splint may be difficult to re-apply if spasms present

Phase 2: Post-op 4-6 weeks to 3 months – Post cast removal

Goals: Maintain new ROM, return to previous level of function 

• Use resting splint or pillow throughout the night for 3 months and use during the day when napping, floor/sitting activities (e.g. watching television)
• Out of brace for functional mobility during the day
• Return to regular wheelchair seating with wide pommel

Consider stretching the following:

• Adductors
  • Hip in extension (ie supine) - with knee extension and knee flexion (frog leg position)
  • Hip in flexion - with knee extension and knee flexion
• Ring or cross leg sitting for play
• Hip flexors
  • Lying on stomach
• Hamstrings

Consider strengthening reciprocal muscle groups (hip abductors and extensors, knee flexors and extensors).

Continue with current individualized therapy goals.