1st Test Flashcards
IDEA
Individuals with Disabilities Education Act
IFSP
- Individualized Family Support Plan
IFSP
Identifies the strengths and needs of the child and family an
Sets forth a plan for implementation of needed services
Identifies who, what ,when, and specific goals and outcomes
IFSP environment
Free, appropriate, public education in the least restrictive environment
IEP
Individualized Educational Plan
IEP
Identifies the present level of performance
Sets forth a plan for implementation of needed services
Identifies who, what ,when, and specific goals and outcomes
Gross Motor assessment
ing – propping – turning – sitting – crawling – creeping – kneel standing – pull to standing – squatting – walking
Fine
Grasping – bilateral manipulation – pinching – placing – inserting
Moro reflex
develops 24-28 weeks of gestation. Elicited by suddenly lowering infant with a response of straightening the arms and legs to extension
Extensor reflexes
seen after four weeks of age when body tone is greater in the extensor muscles. Influenced by the position of the head and pressure on the soles of the feet.
symmetric tonic neck reflex (STNR)
( 1- 4 months) When the face is lifted up, the two upper limbs or arms bend; when the baby looks down the legs straighten.
The asymmetric tonic neck reflex
ATNR) rotation of the head will produced arm extension on the ipsilateral side of rotation and flexion on the contralateral side of rotation
Reflex Stepping
pressure on plantar surface causes LE extension
Labyrinthine reflexes
In supine (lying face-up) extension of the head causes extension of the limbs and hyper-extension of the trunk, in prone flexion of the head causes limb and trunk flexion.
Righting reactions
return the body into the anatomical position and are mediated by afferent messages from visual, labyrinthine and neck or spinal muscles as well as touch and pressure receptors in the skin, influencing the position of the head in space, the head and neck relative to the trunk, and of the trunk relative to the limbs
Parachute reactions
vestibular and visually mediated. Begins months after birth. The forward parachute is elicited when the infant is sharply lowered head-first: the arms are extended to cushion the fall. This response also occurs laterally and in extension.
Equilibrium reactions
Equilibrium reactions are the final stages in the acquisition of balancing skills up to the point of independent walking. Further balancing skills are learned throughout early childhood. Such reactions involved highly coordinated responses of the body as a whole in response to displacing stresses, demanding the brains ability to integrate its widely separated regions
Motor Development (1-4 months)
Rooting and sucking reflexes are well developed.
Swallowing reflex and tongue movements are immature;inability to move food to the back of the mouth.
Grasp reflex – automatic grasp when object is placed in palm
Landau reflex appears near the middle of this period; when baby is held in a prone (face down) position, the head is held upright and legs are fully extended.
Grasps with entire hand; strength insufficient to hold items. Holds hands in an open or semi-open position.
Movements are large and jerky.
Raises head and upper body on arms when in a prone position.
Turns head side to side when in a supine (face up) position; can not hold head up and in line with the body.
Upper body parts are more active: clasps hands above face, waves arms about, reaches for objects.
Team Members
Parents / child PT OT ST / SLP MSW Child-Life Therapists Nursing Physicians Othotists
Communicating with babies
not able to communicate what they feel or want
Benefits of positioning
Maintenance or improvement of ROM Prevention of or minimization of contractures Maintenance or improvement of strength Facilitation of developmental skills To promote social interaction with peers To promote functional skills
Mats
for free floor mobility
Wedges
for prone, supine, side-lying or sitting positions & promotes weight-bearing through UEs & LEs
Side-lie
– promotes hands to midline for function or positioning purposes, increases visibility of hands to the child
Bolsters
good for various forms of therapeutic exercise to stimulates normal postural responces and balance (ie: in a straddle position)
Balls
Good for Therapeutic exercise, balance, strengthening, trunk control, stimulates normal postural responces and coordination.
Scooter-board
used to promote floor level mobility in prone, strengthening of spinal extensors and UEs, mobility and play
Floor level carts
used for floor level seated mobility for young children
Support Components
placed strategically to support the trunk or pelvis or provide better alignment of the limbs
Prone stander
provides anterior support
Stimulates postural activation of head & trunk extensors
Supine stander
provides posterior support (good for head control)
Encourages full weight bearing yet provides full support
Standing frame
support is anterior to knees, poster to hips and trunk
Parapodium
stander/static support feet on pads- allow shuffle
Dynamic wheeled standers
supported standing with ability to mobilize by pushing/pulling the wheels
Pediatric Orthoses
Provide external support to maintain or correct alignment of extremities or trunk
Allow for greater mobility and function (due to postural stability
Reduce the effects of spasticity through alignment of joints and muscle
AFO
ankle foot orthosis
KAFO
knee ankle foot orthosis
HKAFO
hip knee ankle foot orthosis
RGO
reciprocating gait orthosis
TLSO
thoracic lumbar sacral orthosis
SMO
supramalleolar orthoses
Neuro- developmental ( NDT) – Bobath
A form of sensory input to effect changes in motor output
Responses to sensory input can be affected by
Environment
Health
Emotions
Inhibition
To decrease motor output
Inhibition techniques
Use gentle handling Rocking Firm but gentle touch Rhythmic movements Slow movements Gentle deep pressure stroking Consistent sensory input Soft singing Warm water Wrapping or swaddling Relaxing soft music
Sensory-motor Integration (SI)
Is based on the belief that problems arise when there is faulty integration of sensory input including Learning difficulties Attention deficits Behavioral problems Visual perceptual problems
SI Treatments
Treatment includes provision of systematic sensory input to help the child organize motor output
MOVE
mobile opportunities via education
Developmental Dysplasia of the Hip (DDH)
Poor alignment of the acetabulum and head of the femur in the developing hip
Developmental Dysplasia of the Hip Signs / symptoms
Asymmetrical hip abduction in flexion Asymmetrical groin or buttock skin folds Postponing of affected hip Apparent femoral shortening on affected side Positive test for hip subluxation Usually begins with a limp Mild pain in groin, medial knee or thigh Decreased ROM (especially hip abduction and IR Trendelenburg gait Thigh, calf, or buttock disuse atrophy Leg length discrepancy
During ambulation in the older child
Trendelenburg gait
Decreased hip abduction
Thigh pistoning
Bilateral DDH
Lumbar Lordosis
Swaying (waddling) gait typical of a bilateral Trendelenburg
Bracing & splinting to hold hip in flexion and abduction
under 9 mo
Usually use a Pavlik harness which allows for active kicking which promotes strength and mobility and decreases the occurrence of avascular necrosis of thee hip
Bracing & splinting to hold hip in flexion and abduction
over 9 mo
Need abduction orthosis that allows for gait
over 18 mo
Traction & surgery
Legg-Calve’-Perthes Disease (LCPD)
Usually self-limiting degeneration of femoral head causing
Pain
Decreased ROM
Gait deviations
More common in boys 4 to 7 years of age
LACK OF BLOOD TO FEMORAL HEAD
(LCPD) initial stage
failure of femoral head to grow due to decreased blood supply
(LCLPD) Fragmentation
Epiphysis appears fragmented
Revascularization of the femoral head is occurring
(LCPD) Re-ossification
bone density returns to normal with changes in shape and structure of femoral head and heck
(LCPD) Healed stage
Femoral head and neck retain deformity from the repair process
LCPD Etiology:
Disturbance in blood supply to femoral head
Can be result of:
Genetic pre-dispositIon
Trauma
Anatomical variation
Generalized disorder of epiphyseal cartilage
Slipped Capital Femoral Epiphysis (SCFE)
Hip deformity related to slippage of femoral epiphysis
SCFE Etiology
Hormonal influences
Genetic predisposition (weak growth plates)
Occurs in boys 2 to 3 times more than girls
More common in:
Children who are tall with delayed skeletal maturity
Obesity
In children between 9 and 16 years old
Can occur bilaterally (25 to 30%)
Can be precipitated by trauma
SCFE Signs/Symptoms
Intermittent limp Pain in: Groin Buttock Knee Thigh Antalgic gait Trendelenburg (weakened abductors on involved side) LE held in ER Decreased ROM
SCFE Treatment
Goals include
Minimize or reduce slippage of femoral head on neck
Maintain hip ROM & function
Minimize possible future degeneration
Surgery usually required to pin the hip & prevent further slippage in mild to moderate cases
Surgery – Varus - Osteotomy
Bed rest / traction may be used to reduce pain & spasm before surgery
SCFE Interventions
Providing appropriate assistive devices (wheelchair/ crutches
Gait & mobility training
ROM (active & passive)
Strengthening exercises
Assessment of home environment to accommodate mobility and safety
Family training for all of the above
Consultation with teachers for campus mobility
Juvenile Rheumatoid Arthritis (JRA)
A group of disorders characterized by inflammation of connective tissue including joints and other systems
Classified in children under 16 years of age with condition lasting > 6 weeks
JRA Oligo-articular
(<5joints)
JRA Poly-articular
(>5 joints)
JRA Etiology
unknown (may have several contributing factors
Viral or bacterial infection that triggers the auto-immune response
May be genetically pre-disposed
JRA Signs / Symptoms
Pain, swelling, stiffness in joints Fever Rash (more common in systemic) Inflammation of the iris of the eye Myalgia Involvement of (more common in systemic) Lymph nodes Jeart Liver Spleen Pericardium Lungs
JRA Medications
NSAIDS Slow acting antirheumatic drugs (SAARDS) Corticosteroids Immunosuppressive and cytotoxic agents Cyclosporing or methotrexate
JRA Surgical treatment:
Synovectomy Soft tissue releases Osteotomy Joint fusion Total joint replacement
Osteogenesis Imperfecta Etiology
Genetic
Problems with the amount & quality of collagen in the body
Presents with fragile bones / low bone density
Osteogenesis Imperfecta Signs & Symptoms
Frequent fractures
Scoliosis/Kyphosis
Short stature
Hearing loss
Osteogenesis Imperfecta Goals
Minimize fractures through protective measures
Joint protection
Promote bone strength
Maximize activity & weight bearing for increased bone strength
Maximize functional skill
Arthrogryposis (Multiples Congenita
Non-progressive neuromuscular disorder
Presents with
Multiple contractures (distally > proximally) due to decreased fetal movement
Dislocation at hips or knees
Deformities of joints (fusiform or cylindrical shape)
Joint fusion (in some cases)
Thinning of subcutaneous tissue
Absence or decreased size of muscle groups
Absent skin creases
Arthrogryposis (Multiples Congenita) Etiology
Unknown Possible trauma during first trimester Maternal history of a condition that limits fetal movement Fevers during pregnancy MS Myasthenia gravis Myotonic dystrophy Uterine abnormalities
Pediatric Fractures
Fracture patterns are different due to bones that are more flexible, more porous, and less dense than adult bones
Due to thicker periosteum than adults, there is better blood supply therefore healing is faster (2-4weeks)
Pediatric Fractures Etiology
Trauma
Child abuse
MVA
Genetic (Osteogenesis imperfect)
Pediatric Fractures Common sites
Distal radius
Tibial shaft
Clavicle
Elbow
Pediatric Fractures Signs / Symptoms
Redness Swelling Pain Heat and deformity of extremity Muscle spasm Crying Not using extremity
Ankle / Foot Deformities Etiology
Congenital deformities In-utero positioning Neuromuscular disorders Myelomeningocoele Arthrogryposis Genetic disorders
Ankle / Foot Deformities Classification
Metatarsus adductus Talipes Equinovarus (clubfoot) Calcaneovalgus (dorsiflexion of foot with eversion or valgus of hind-foot)
Ankle / Foot Deformities Sign/symptoma
Obvious deformities
Gait abnormalities
Delay is gross motor and mobility skills
Ankle / Foot Deformities Treatment
Serial Casting
Surgery
ANOXIC ENCEPHALOPATHY
Definition - brain damage due to lack of oxygen
aka
CEREBRAL PALSY
Caused by an insult to the developing brain and resulting in permanent and non-progressive damage
Affects tone, posture, and movement
CP Prenatal
Genetic
Viral Infections
Bacterial infections
Drug exposure
CP Peri-natal
Prematurity’ Low-birth weight Severe jaundice Intra-ventricular hemorrhage Poor nutrition Asphyxia
CP Post-Natal
Infection Asphyxia TBI MVA Fall Shaken baby syndrome Child abuse CVA Near drowning Brain tumor
CP Diplegia
Both LEs Trunk and UEs to a lesser extent may be affected Standing Posture (typical) Crouched with trunk flexion Adduction, & IR at both hips Knees are flexed Ankles are plantar-flexed
Diplegia
Typically child has
spasticity / high tone
In both LEs
Diplegia gait
Poor disassociation between trunk and legs
Body rotates during gait
UEs held in the “high guard” position for balance
Diplegia assissitive devices
Crutches
Walker
wheelchair
Hemiplegia Posture
Same side UE & LE Standing Posture (typical) Shoulders in adduction & IR Elbow & wrist flexion IR of hip Knee extension Ankle plantar flexion
Hemiplegia Gait (typical)
Asymmetrical gait pattern
Circumduction of LE
Hemiplegia assissitive devices
Crutch or cane for balance
Quadriplegia/Tetraplegia
All 4 extremities are involved
Triplegia
3 extremities are involved
Usually both LEs and one UE
CP / ABNORMAL TONE - HYPOTONICITY
Also referred to as LOW TONE / HYPOTONIA
“Rag Doll” / floppy
Soft mushy feel to muscles
DTRs are weak
Likelihood of obesity due to decreased activity
Usually demonstrate impaired speech due to impaired oral motor control and drooling
CP / HYPOTONICITY Gait
Wide base of support
Short stride lengths
Impaired balance
CEREBRAL PALSY / HYPERTONICITYSigns & Symptoms
HIGH TONE / HYPERTONIC / SPASTICITY
Hyperactive DTRs
Hard, stiff, tight feel to muscles
Persistence of primitive reflexes which prevent development of normal movement patterns
ATNR
STNR
TLR
Usually thin due to excessive energy output
Speech usually impaired due to poor oral motor control, drooling
Hypertonic gait
Impaired muscle control
Impaired balance due to abnormal variations & distribution of muscle tone
CEREBRAL PALSY / SIGNS & SYMPTOMS - DYSTONIA
Also referred to as
Mixed tone
Fluctuating tone
Athetosis
Dystonia Characteristics
More than one type of tone
Can be mild to severe
In infancy presents as low tone and changes with maturity
Stringy, elastic muscles to the touch
Child is usually thin due to extreme expenditure of energy
Impaired speech as in hypertonia
Dystonia gait
Gait is only possible to those who have enough stability to stand or walk
Excessive movements
Impaired balance
Walker or crutches can be used but for the most part these children use a wheelchair
As children grow and become stronger, they can present a challenge with management of transfers etc. to their caregivers / family.
Ataxia characterisitcs
Poor balance
Wide base of support and “high-guard arm position” during gait
Tremors
Low postural tone
Poor visual tracking
Distributed throughout the body
ROM usually normal or excessive due to low tone
Hyporeflexia of DTRs, with weak primitive reflexes
Muscles have a soft doughy feel to the touch
Secondary Conditions / Impairments of Children with CP
Mental retardation (50 – 75%) Seizures (30% Visual impairment (50 Speech/language deficits or delays (50%)
General Principles for PT Interventions / Cerebral Palsy
Intervention is individualized
Intervention is optimal through a team approach with child and family involved in setting goals
Pediatric Traumatic Brain Injury (TBI)
An acquired injury to the brain resulting in a change in consciousness or an anatomical abnormality in the brain
Pediatric Traumatic Brain Injury Etiology
Trauma Child abuse In infants, “Shaken Baby Syndrome” is most common injury MVA Falls Sports related Injuries GSW
TBI Secondary causes
Increased intracranial pressure due to edema
Hematoma due to bleeds in the brain from trauma
TBI Signs & Sympt
Depends on
Severity
Area of brain involved
Length of time for loss of consciousness (coma)
Other injuries to the body and their severity
Sequelae of brain injury can include
Motor impairment Spasticity Ataxia Weakness Contractures and resultant deformities Cognitive impairment Language disorders Sensory impairments Psychosocial disorders
SPINA BIFIDA
A group of congenital malformation of the spine, including the vertebrae and the spinal cord
SPINA BIFIDA Etiology
Genetically predisposed
Nutritional deficiencies (especially maternal folic acid deficiency)
Environmental (IE: alcohol during first 4 weeks of pregnancy when neural tube closes)
Occulta
(not visible) No disability usually
Acculta or cystic
visible
Meningocele
no disability usually
CSF and superficial tissue protrudes from the spine in a sac at the level of the lesion
Neurological tissue is rarely involved
Myelomeningocele
Meninges and parts of spinal cord protrude in a sac at the level of the lesion
There is an abnormality of the spine
Disability includes paralysis with loss of sensation below the level of the lesion
Extent of the disability depends on the level of the lesion and scope of the neurological involvement
SPINA BIFIDA / Hydrocephalus
Awareness of potential shunt malfunction ~~~safety issue~~
Signs of malfunction: (may require emergency response)
Irritability Headache Vomiting Lethargy Fever Bulging eyes or fontanel Change in behavior or level of alertness Seizure activity Change in coordination
Duchenne Muscular Dystrophy
The most common form of congenital, degenerative disease of muscle tissue
Almost always in boys
Duchenne Muscular Dystrophy Signs & Symptoms
Muscles appear hypertrophied due to fat and connective tissue replacing muscle tissue
Starts at approx. 2 years of age and progresses till death
Some live to early adulthood
Gower’s sign –
Evident by 4 to 7 years of age
When a child uses his hands in a walking motion up the thighs to assist while attempting to stand (hip & knee extensors
Contractures develop in
Heel-cords
TFL
Hamstrings
Hip flexors
CYSTIC FIBROSIS
Chronic suppurative pulmonary disease which causes the greatest mortality
Median age of survival now is approximately 36 years of age which is an improvement due to newer management strategies and techniques
HIPPO-THERAPY PRECAUTIONS/POSSIBLE CONTRAINDICATION
Abnormal fatigue Allergies Arnold Chiari malformation Cardiac condition Diabetes Heterotrophic ossification Hip Dislocation Subluxation Dysplasia with significant restriction of hip abduction History of breakdown of grafting over bony/weight –bearing areas Any child 2-4 yrs of age Hydrocephalus
HIPPO-THERAPY / Contraindications
Orthopedic: Acute herniated disc, Atlanto-axial instability Coxal arthrosis (degeneration of the hip joint) Excessive kyphosis or lordosis Hemivertebrae Severe osteoporosis Orthopedic: (cont’d) Pathologic fractures (osteogenesis imperfecta) Spondylolisthesis Structural scoliosis greater then 30 degrees Unstable spine
