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731: Pediatrics > Cerebral Palsy (Part 2) > Flashcards

Cerebral Palsy (Part 2) Flashcards

1
Q

What are 5 ways to distinguish an infant with CP from an uninvolved infant at 4 months of age?

A
  • neck hyperextension
  • shoulder retraction
  • ability to bear weight on the forearms while prone
  • ability to maintain a stable head position in supported or independent sitting
  • flex the hips actively against gravity
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2
Q

What are the 3 purposes of the assessment?

A
  • discover the functional abilities and strengths of the child
  • determine the primary and secondary impairments
  • discover the desired functional and participation outcomes of the child and family
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3
Q

What are 9 positions you should assess a child’s functional antigravity control?

A
  • supine
  • prone
  • side-lying
  • sitting (shirt, long, side, ring)
  • quadruped
  • kneeling
  • half-kneeling
  • standing
  • walking
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4
Q

What are 5 things to assess in a child who functions from a wheelchair?

A
  • Alignment and mobility of body
  • Shifting of weight
  • Propulsion of the wheelchair
  • Management of the wheelchair and its parts
  • Transfers
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5
Q

What is the most important thing to assess in a wheelchair bound child?

A

ALIGNMENT

- check for contractures, scoliotic deformation, pressure ulcers, etc.

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6
Q

Historically, posture was defined through reflex terminology and facilitated through what?

A

controlled sensory feedback

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7
Q

What role does sensory feedback have on postural control?

A

The child received feedback from having completed the task previously and makes the necessary postural adjustments to complete the task in the most efficient way

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8
Q

Describe postural setting

A

Muscles become active around a joint or joints, without obvious movement, in anticipation of a task

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9
Q

How is postural control through feedforward learning learned?

A

through trial and error

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10
Q

What are 3 questions to ask yourself when assessing a child’s posture?

A
  • Does the child have a variety of ways to transition between postures or only stereotypical choices?
  • Does the child actively push into the supporting surface with the pelvis or extremities
  • Can the child repeat movements or tasks and make small changes in motor performance?
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11
Q

What does the clinical term “tone” describe?

A

the impairments of spasticity and hypo/hyper extensibility of muscles

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12
Q

What are 4 signs of increased tone?

A
  • distal fixing (toe-curling or fisting)
  • difficulty moving a body segment through a range
  • asymmetric posture
  • retracted lips and tongue
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13
Q

What are 3 signs of decreased tone?

A
  • excessive collapse of body segments
  • loss of postural alignment
  • inability to sustain a posture against gravity
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14
Q

What are 2 forms of CP that exhibit fluctuating levels of stiffness?

A
  • athetosis

- ataxia

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15
Q

What 10 things should be included in the musculoskeletal assessment of children with CP?

A
  • ROM
  • spine evaluation
  • thoracic movement
  • eval of the shoulder girdle and UE
  • exam of the hip and pelvis
  • femoral anteversion
  • knee exam
  • tibial torsion
  • foot examination
  • leg length discrepancy
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16
Q

When performing ROM measurements you should perform the limb slowly through the range to avoid eliciting a stretch reflex.
The first “catch” is considered what?
What is the second “catch”?

A

functional range: the range that the child can access for function

absolute range: the actual length of the muscle

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17
Q

What is the goal of stretching?

A

To bring the functional and absolute range numbers as close to each other as possible

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18
Q

Describe the process of assessing spinal flexion

A

Place the child in supine and round the spine putting the child’s knees up to their chest

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19
Q

What is considered abnormal spinal flexion?

A

When there is a flattened area (without SP chowing or showing less) this is considered reduced spinal flexion

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20
Q

What position are spinal extension, lateral flexion, and rotation most easily assessed in?

A

sitting

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21
Q

What muscle groups in the spine do children with CP typically have limitations in?

A

spinal and capital extensors

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22
Q

Describe rib position in a typically developing baby under 6 months. What happens to this position as the child develops upright posture?

A

There is an approximate 90 degree angle between the ribs and spine.
There is a PA downward slant to the ribs

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23
Q

What 2 things does the PA downward slant of the ribs allow for?

A

1) an increased ability to expand the diameter of the thorax in both an AP (pump-handle) and lateral (bucket-handle) direction
2) the thoracic (external intercostals) and abdominal (obliques) muscles to fix the ribcage

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24
Q

Because the downward slant of the ribs nerve fully develops in children with CP what is the result?

A

1) The mechanical advantage of the pump-handle and bucket-handle motions of inspiration are minimized

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25
Q

CP children do not have the muscle tone to necessary to stabilize the rib cage which results in what?

A

Sternal fibers cause depression of the xyphoid process and the sternum during inspiration

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26
Q

What does the combination of reduced thoracic expansion and sternal depression result in?

A

Shallow respiratory efforts which will result in vocalizations that will be of short duration and will be low in intensity

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27
Q

What trunk muscles are the most important to train and why?

A

the obliques because they aid in forceful expiration needed for coughing and sneezing

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28
Q

Why do children with CP demonstrates tightness and limitation of the shoulder girdle, most notably pec major?

A

they never attain adequate UE weight bearing in prone

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29
Q

What shoulder motions are the most restricted in a child with CP?

A
  • flexion
  • abduction
  • ER
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30
Q

What are 4 other UE limitations observed in the child with CP?

A
  • elbow extension
  • forearm supination
  • wrist extension
  • finger extension
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31
Q

What position should hip adduction and abduction be measured in?

A

in supine with the hip and knee extended

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32
Q

What position should hip IR/ER be measured in?

A

in prone with hip extended and knee flexed

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33
Q

Because children with CP have very tight hip flexion, adduction, and internal rotation they are at risk for what?

A

hip dislocation/subluxation

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34
Q

In what direction do subluxations tend to occur? What does this lead to?

A

superior and posterior

A leg length discrepancy in which the involved side leg appears shorter than the uninvolved side

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35
Q

What is the most important measurement for a PT to consistently track?

A

hip abduction with knee and hip extension

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36
Q

If any child under the age of 8 has less than __ degrees of hip abduction they should be referred to an orthopedic surgeon

A

45

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37
Q

Femoral anteversion is a torsion or _____ rotation of the femoral shaft on the femoral neck

A

internal

38
Q

At birth an infant has approximately how many degrees of femoral anteversion?

A

40

39
Q

As a person ages they have how many degrees of femoral anteversion? Why?

A

15

Because active extension and ER of the hip tighten the anterior capsule of the hip joint

40
Q

When can excessive femoral anteversion be suspected?

A

When ER at the hip is substantially less than IR

41
Q

What will indicate the degree of hamstring tightness?

A

passive straight leg raising or measurement of the popliteal angle

42
Q

What does tibial torsion describe?

A

a twist of the tibia along its axis so that the leg is rotated internally or externally

43
Q

What are the 2 ways in which tibial torsion can be determined?

A

1) by the intersection of a line drawn vertically from the tubercle and a line drawn through the malleoli
2) the thigh-foot angle

44
Q

What are the landmarks used when measuring the thigh-foot angle?

A
  • transmalleolar axis

- femur

45
Q

Describe the relationship between tibial torsion and hip anteversion and how a child with CP presents

A

The tibia typically “unwinds” from a position of IR to ER due to changes in force on the tibia arising from the decrease in femoral anteversion that occurs as a typical child grows. In children with CP excessive femoral anteversion often results in compensatory external tibial torsion to maintain the foot facing forward

46
Q

What ankle motion is often limited in a child with CP?

A

dorsiflexion

47
Q

Depression of the medial longitudinal arch is caused by what?

A

adduction and plantarflexion of the talus with relative eversion of the calcaneus

48
Q

What percentage of children with CP demonstrate a LLD?

A

70%

49
Q

How can LLD be managed?

A

shoe lifts

50
Q

What tool is helpful in determining whether a child with CP will walk?

A

GMFCS

51
Q

Describe the gait of a child with hemiplegic CP

A
  • the majority of their weight is borne on the uninvolved LE
  • there is brief and incomplete weight shift on the uninvolved LE
  • involved shoulder held in hyperextension and elbow flexion
  • commonly walk on toes
52
Q

What are the 7 potential types of gait deviations in children with diplegic CP?

A
  • Equinovarus
  • Planovalgus
  • Crouch
  • Jump knee
  • Stiff knee
  • Recurvatum
  • Idiopathic toe walking
53
Q

Describe the gait of a child with equinovarus gait

A
  • PF through stance phase

- hips and knees hyperextended

54
Q

Describe the gait of a child with planovalgus gait

A

Equinas of the hindfoot and pronation of the forefoot which results in excessive loading of the plantar, medial portion of the foot and increased foot drop

55
Q

Describe the gait of a child with crouched gait

A

Knees and hips are flexed throughout the gait pattern

56
Q

In children who display crouched gait midstance knee flexion greater than __ degrees results in functional ambulation becoming imporsisble

A

30

57
Q

Describe the gait of a child with jump knee gait

A
  • anterior pelvic tilt
  • hip flexion
  • ankle equinus
58
Q

Describe the gait of a child with stiff knee gait

A

persistent knee extension through swing phase

59
Q

Describe the gait of a child with recurvatum gait

A

Knee extension in early stance phase progressing to hyperextension in mid to late stance

60
Q

How can you tell the difference between idiopathic toe walkers and mild diplegic CP?

A

Idiopathic toe walkers only have mild gastroc tightness and no hamstring tightness. They can also walk normal when instructed to do so

61
Q

What are the 6 most common gait deviations seen in kids with quadriplegia?

A
  • stiff knee
  • crouch
  • excessive hip flexion
  • intoeing
  • equinus
  • scissoring
62
Q

True or False

Functional community amubulation throughout life is not a realistic goal for children with quadriplegic CP, however it is important to encourage ambulation through their adolescent years

A

True

63
Q

Describe the gait of a child with athetotic CP

A
  • high flexion of hip initially during stepping
  • LE placed into extension with adduction, IR, and PF
  • thoracic spine is excessively flexed with rotation of the cervical spine with the jaw jutting forward and rotated to one side
64
Q

Although it is difficult to make improvements with PT in children with athetotic CP what intervention strategies may be helpful in improving balance?

A

Weighted vest/ankle weights

65
Q

Describe the gait of a child with ataxic CP

A
  • Widened BOS

- Increased double-limb support time

66
Q

Ataxia typically follows initially ___ tone

A

low

67
Q

What is the purpose of physical therapy in children with CP?

A

to allow the infant or child to become the most independent possible in performing functional tasks throughout his or her lifetime

68
Q

What are the 2 focuses of the therapeutic intervention?

A
  • Prevention of disability by minimizing effects of impairment
  • Preventing or limiting secondary impairment such as contractures, scoliosis, etc.
69
Q

What are 4 therapeutic interventions?

A
  • stretching
  • weight bearing activities
  • alignment in sitting
  • respiratory exercises
70
Q

What 2 muscles are essential to elongate?

A

hamstrings and heel cords (gastroc)

71
Q

Why are weight bearing activities important?

A

to increase muscle tone and strength

72
Q

How should you position a child with CP in sitting?

A
  • head in neutral
  • hips, knees, ankles at 90 degrees’ flexion
    hips in abduction
73
Q

What are 2 ways in which the therapist can provide sensory input to help facilitate the appropriate motor output?

A
  • Gentle muscle rubbing

- Joint approximation

74
Q

If a CP patient is in a weight bearing position for too long they fatigue which causes them to do what?

A

rely on their ligaments for support

75
Q

When used with invasive procedures, strength training may _____ the outcomes of these procedures

A

prolong

76
Q

The original focus of NDT was to treat what type of patients?

A

Those with pathophysiology of the CNS, specifically children with CP and adults with hemiplegia

77
Q

What is the ultimate goal of NDT?

A

for the child to have the most independent function as possible according to age and abilities

78
Q

Describe in general how NDT is performed

A

‘Handling’ is used to establish or re-establish the postures and movements that the client needs to become functional in a meaningful way and feedforward is developed as the child practices the skill or task with the therapist’s guidance

79
Q

What is the key to orthopedic intervention?

A

Prevent deformity through detection at an early stage

80
Q

What is the most common pattern of spinal deformity is children with CP?

A

neuromuscular scoliosis

81
Q

What is neuromuscular scoliosis primarily caused by?

A

an imbalance between agonist and antagonist muscles that leads to the development of S-shaped or C-shaped curves

82
Q

In what type of children is scoliosis the most severe?

A

In nonambulatory children functioning at levels IV and V on the GMFCS

83
Q

Scoliosis progresses quickly during puberty with curve progression up to - degrees per month

A

2-4

84
Q

True or False

Neuromuscular scoliosis is responsive to orthotic treatment (stretching, strengthening, joint mobs, or ES)

A

False

85
Q

What is the treatment of choice in children older than 10 years with curves greater than 50 degrees?

A

spinal fusion

86
Q

What is the standard surgery for excessive femoral anteversion?

A

femoral derotation osteotomy with blade plate fixation and medial hamstring release

87
Q

Describe windswept deformity

A

the pelvis is oblique and the legs may (typically do) or may go the opposite direction

88
Q

What is the most common deformity at the knee?

A

knee flexion contracture

89
Q

What does a knee flexion contracture lead to?

A

contracture of the knee joint capsule and shortening of the sciatic nerve

90
Q

Describe pes valgus positioning of the foot

A
  • Eversion, plantarflexion, and inclination of the calcaneus
  • Abduction of the forefoot
91
Q

What is the typical treatment choice for children with CP?

A

Combination of baclofen (systemic) and Botox (injection) works best

731: Pediatrics (19 decks)

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