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1 Flashcards

1
Q

MSK development in infants

A
  • most joints/articulations are cartilaginous
  • bones are at maximum flexibility
  • sutres have not formed; cranial bones are at their freest
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2
Q

Infant spine development

A
  • spinal curvatures very immature
  • primary flexion curves of thoracic and pelvis caused by flexion position of embryo
  • extension curves in cervical and lumbar regions are due to functional muscle development (erector spinae muscles)
  • C-spine has slight lordosis, which increases as baby can support his/her own head
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3
Q

By 24 fetal weeks, spinal cord ends at

A

S1

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4
Q

At birth spinal cord ends at

A

L3

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5
Q

Infant rib development

A
  • ribs begin primarily as cartilage and are horizontal in infants
  • progress towards bucket handle and pump handle motions as the child grows
  • the diaphragm inserts horizontally on the inner surfaces of the ribs in an infant instead of obliquely as in the adult
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6
Q

Infant cranial bone development

A
  • sphenoid is in 3 parts, temporal is in 3 parts, occiput is in 4 parts
  • cartilage is intervening between all of these
  • frontal, maxilla, and mandible are in 3 parts
  • these exist to help to protect the CNS during vaginal delivery
  • the vault bones overlap at the sutures
  • the cartilaginous base bends, torques, and rotates during labor and delivery
  • they are vulnerable to dysfunction
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7
Q

Infants are born with:

A

-6 fontanelles, an anterior and posterior, 2 mastoid, 2 sphenoid

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8
Q

Posterior fontanel closes by

A

-2 months of life

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9
Q

Anterior fontanel closes by

A

-the 2nd year of life

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10
Q

Temporal bones at birth

A
  • 3 parts: petrosal, squamous, tempanic ring

- the most cranial nerves pass through this bone: CN 3-11

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11
Q

Petrous portion of temporal bone houses

A

-acoustical vestibular organ

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12
Q

Growth of petrous portion

A
  • rotate external auditory meatus into sagittal plane

- tips eustachian tube from horizontal position to an oblique angle

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13
Q

Occipital bones at birth

A

four parts: base, squama, 2 lateral, condylar parts

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14
Q

Flexion of the basicranium

A

30 degrees in infants

-51 degrees in adult

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15
Q

Basicranial flexion creates

A

the supra laryngeal space

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16
Q

Sphenoid bones at birth

A

3 parts: central body with lesser songs; two greater wings; pterygoid processes

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17
Q

Frontal bones at birth

A

two parts: metric suture present

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18
Q

Parietal bones at birth

A

large in proportion to other bones; cover parietal lobes of brain; no venous sinus grooves

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19
Q

Atlas at birth

A

3 parts`

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20
Q

Maxilla at birth

A

2 parts

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21
Q

Cranial Dysfunction in infants

A
  • estimated 88% of infants have cranial somatic dysfunction
  • most dysfunctions self-resolve through the infant’s crying and sucking
  • common cause is birth trauma
22
Q

Infant cranial bone most susceptible to dysfunction

A

Occiput

23
Q

Cranial nerve dysfunction in infants

A
  • CN 6 and 7 may be injured during forceps delivery
  • CN 6: lateral rectus plays, nystagmus
  • CN 7: facial palsy, smooth forehead, inability to fully close eye
  • CN 9-12 may be impinged by occipital bone dysfunction
24
Q

Jugular foramen CN dysfunctions

A
  • CN 9-poor sucking
  • CN 10-excessive vomiting/spitting up
  • CN 11-colic, poor sucking; often affected by occipital-temporal bone dysfunction
25
Q

Hypoglossal canal CN dysfunction

A

-CN 12-poor sucking due to infant’s difficulty moving tongue–>cannot suckle properly

26
Q

Temporal bone cranial dysfunction in infants

A
  • internal rotation associated with increased incidence of otitis media
  • impairment of middle ear drainage due to Eustachian tube blockage
  • cradle occiput in hands and gently place tips of index fingers on mastoid portion/attachment of SCM muscle
  • if one side is more prominent then there is an internal rotation of the temporal bone
27
Q

Bone development in toddlers (1-4 years)

A

ossification increases–some bones become fused

28
Q

Bone development in school-age children

A
  • cranium fully ossified
  • epiphyseal plates still open
  • rapid growth taking place in long bones–>growing pains
  • may develop a leg length discrepancy during this period: short leg syndrome, functional scoliosis
29
Q

3 types of bone growth areas

A

epiphyseal growth plate
epiphysis/articular surface
Apophysis

30
Q

Epiphyseal growth plate

A

proximal/distal end of bone

-made of hyaline cartilage

31
Q

Epiphysis/articular surface

A

-made of hyaline cartilage

32
Q

Apophysis

A
  • are of cartilaginous growth at insertion of a tendon
  • made of fibrocartilage
  • creates bony tubercles like tibia tubercle or AIIS
  • apophysitis, avulsion fractures are more common in pediatric patients because of unsoiled apophysis
33
Q

Hyaline cartilage

A

more vulnerable to loading and compression

34
Q

Fibrocartilage

A

more vulnerable to tensile forces and shearing

35
Q

Wollf’s law

A
  • mechanical stressors will affect tissue differentiation and growth characteristics of musculoskeletal tissues
  • normal compression stimulates growth (condrogenesis and epiphyseal plate growth)
  • affect collagen synthesis->increase tissue strength and ability to absorb energy
  • excessive compression->osteogenesis decreased epiphyseal plate growth
  • musculoskeletal tissue most vulnerable to mechanical forces during periods of growth
  • strain patterns treated just prior or during periods of growth->more dramatic long lasting effect
36
Q

Scoliosis

A
  • abnormal lateral curvature of the spine in the saggital plane
  • postural curves develop with weight bearing during childhood and postural abnormalities such as scoliosis can progress rapidly during growth spurts
  • females undergo more rapid progression of curvature
  • most common etiology is idiopathic
37
Q

Scoliosis screening

A
  • forward bending test
  • twice for females: 10-12
  • once for males: 13-14
38
Q

Bone changes in adolescents

A
  • epiphyseal plates closing/closed
  • innominate fuse by age 20
  • sacrum fuses in late adolescence
  • adolescent athletes are particularly susceptible to somatic dysfunction
39
Q

In adolescents with hyper mobility, what treatment is relatively contraindicated?

A

HVLA

40
Q

Approaching children osteopathically

A
  • tissue manipulation response different in children than adults
  • treat during periods of growth
  • less is more
  • OMT may increase temperature 1-2 degrees for a very short time after treatment
41
Q

Treatment modalities for children

A
  • HVLA rarely in young children
  • also relatively contraindicated in anyone with hyper mobility joints
  • ME may be difficult to perform in young children (ability to follow directions)
  • Articulatory (including Still’s), myofascial, indirect, FPR, lymphatic, and cranial treatments all very useful regardless of age
  • infants and pre-school children: articular mobilization and soft tissue treatment especially useful
  • As children age, other modalities may increase in use
42
Q

Neurologic model

A

-addresses peripheral, autonomic, and CNS causes of pain and dysfunction

43
Q

Respiratory/Circulatory Model

A

-normalize pulmonary, cardiovascular function, circulation of fluid

44
Q

Metabolic/Nutritional model

A

-maximize efficiency of patient’s self regulatory/self-healing mechanisms

45
Q

Behavioral/biopsychosocial model

A

-addresses mental, emotional, social, spiritual aspects

46
Q

Biomechanical model

A

structural perspective

-treat SD

47
Q

Neurologic model treatments

A

-cranial, chapman reflexes, counterstain, ME, exercise

48
Q

Respiratory/circulatory model treatments

A
  • lymphatics
  • visceral
  • cranial
  • respiratory diaphragm release
49
Q

Metabolic/nutritional model treatments

A

lymphatics
visceral techniques
lifestyle changes (stress reduction, nutritional counseling, exercise)

50
Q

Behavioral/biopsychosocial model treatments

A

addresses mental, emotional, social, spiritual aspects

51
Q

Biomechanical model treatments

A
  • HVLA
  • ME
  • Counterstrain
  • MFR
  • FPR
  • Still
  • Etc.

afdkfjsd (8 decks)

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