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
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
3
Q
By 24 fetal weeks, spinal cord ends at
A
S1
4
Q
At birth spinal cord ends at
A
L3
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
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
7
Q
Infants are born with:
A
-6 fontanelles, an anterior and posterior, 2 mastoid, 2 sphenoid
8
Q
Posterior fontanel closes by
A
-2 months of life
9
Q
Anterior fontanel closes by
A
-the 2nd year of life
10
Q
Temporal bones at birth
A
- 3 parts: petrosal, squamous, tempanic ring
- the most cranial nerves pass through this bone: CN 3-11
11
Q
Petrous portion of temporal bone houses
A
-acoustical vestibular organ
12
Q
Growth of petrous portion
A
- rotate external auditory meatus into sagittal plane
- tips eustachian tube from horizontal position to an oblique angle
13
Q
Occipital bones at birth
A
four parts: base, squama, 2 lateral, condylar parts
14
Q
Flexion of the basicranium
A
30 degrees in infants
-51 degrees in adult
15
Q
Basicranial flexion creates
A
the supra laryngeal space
16
Q
Sphenoid bones at birth
A
3 parts: central body with lesser songs; two greater wings; pterygoid processes
17
Q
Frontal bones at birth
A
two parts: metric suture present
18
Q
Parietal bones at birth
A
large in proportion to other bones; cover parietal lobes of brain; no venous sinus grooves
19
Q
Atlas at birth
A
3 parts`
20
Q
Maxilla at birth
A
2 parts
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
Hypoglossal canal CN dysfunction
-CN 12-poor sucking due to infant's difficulty moving tongue-->cannot suckle properly
26
Temporal bone cranial dysfunction in infants
- 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
Bone development in toddlers (1-4 years)
ossification increases--some bones become fused
28
Bone development in school-age children
- 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
3 types of bone growth areas
epiphyseal growth plate
epiphysis/articular surface
Apophysis
30
Epiphyseal growth plate
proximal/distal end of bone
| -made of hyaline cartilage
31
Epiphysis/articular surface
-made of hyaline cartilage
32
Apophysis
- 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
Hyaline cartilage
more vulnerable to loading and compression
34
Fibrocartilage
more vulnerable to tensile forces and shearing
35
Wollf's law
- 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
Scoliosis
- 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
Scoliosis screening
- forward bending test
- twice for females: 10-12
- once for males: 13-14
38
Bone changes in adolescents
- epiphyseal plates closing/closed
- innominate fuse by age 20
- sacrum fuses in late adolescence
- adolescent athletes are particularly susceptible to somatic dysfunction
39
In adolescents with hyper mobility, what treatment is relatively contraindicated?
HVLA
40
Approaching children osteopathically
- 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
Treatment modalities for children
- 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
Neurologic model
-addresses peripheral, autonomic, and CNS causes of pain and dysfunction
43
Respiratory/Circulatory Model
-normalize pulmonary, cardiovascular function, circulation of fluid
44
Metabolic/Nutritional model
-maximize efficiency of patient's self regulatory/self-healing mechanisms
45
Behavioral/biopsychosocial model
-addresses mental, emotional, social, spiritual aspects
46
Biomechanical model
structural perspective
| -treat SD
47
Neurologic model treatments
-cranial, chapman reflexes, counterstain, ME, exercise
48
Respiratory/circulatory model treatments
- lymphatics
- visceral
- cranial
- respiratory diaphragm release
49
Metabolic/nutritional model treatments
lymphatics
visceral techniques
lifestyle changes (stress reduction, nutritional counseling, exercise)
50
Behavioral/biopsychosocial model treatments
addresses mental, emotional, social, spiritual aspects
51
Biomechanical model treatments
- HVLA
- ME
- Counterstrain
- MFR
- FPR
- Still
- Etc.
