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Neuro management 2 > CP > Flashcards

CP Flashcards

1
Q

Twisting of the femur

A

torsional deformity

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2
Q

highly correlated with CP

A

IVH. But not predictive (just correlation)

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3
Q

questions to determine prognosis regarding pregnancy

A

ask about pregnancy history (illness (fever) during 21-40 weeks AGA, infection during labor and delivery, intrauterine crowding, family history of CP, delivery type, prematurity, Apgar scores at 1 min, birth weight

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4
Q

any one born before 38 weeks are

A

premature

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5
Q

any one born 28-32 weeks are

A

less good prognosis (larissa worries about them) GMFCS III and II

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6
Q

24-28 weeks

A

generally GMFCS IV and V

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7
Q

The key thing that will help with prognosis

A

Gross Motor Function Classification Scale

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8
Q

Precaustions or contraindications

A

shunt precautions, seizure disorders

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9
Q

If you think your pt has vision problems, who do you refer to?

A

opthamology

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10
Q

what causes bronchopulmonary dysplasia

A

supplemental oxygen as a neonate

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11
Q

SDR surgery has best outcomes when performed on patients with what type of CP

A

spastic diplegia

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12
Q

common places for scarring

A

gastroc and popliteal fossa

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13
Q

APA in standing

A

fast forward reach, standing on one foot, coming up on tip toes. (CP pts have excessive co-contraction)

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14
Q

RPA in standing

A

distal to proximal pattern for ankle strategy. Hip strategy (proximal to distal) not as much of a problem for CP pts

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15
Q

knee wobble is the same thing as

A

jump gait (quad spasticity or gastroc)

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16
Q

STRENGTHEN the PLANTAR FLEXORS

A

yes do it

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17
Q

All femurs have a _____ twist

A

medial (condyles move in)

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18
Q

antetorsion is

A

an excessive medial twist of femur (you cannot change this voluntarily)

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19
Q

anteversion

A

femur is rotated in in relation to the acetabulem ( you can change this voluntarily) This is a common intervention to change this (less anteversion) to make their feet point forward.

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20
Q

baby tibias starts out

A

with no twist

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21
Q

The adult tibia has a

A

lateral twist

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22
Q

kissing patellas indicate

A

femur first (probably your biggest problem)

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23
Q

if patellas are forward, but still have negative FPA (pigeon toed)

A

think tibia

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24
Q

Thigh foot angle test

A

measures relationship between tib-fib

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25
Q

T/F do modified ashworth before ROM

A

T because if you want to test spasticity, you don’t want to stretch them first.

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26
Q

Maternal risk factors for CP

A

fever during 21-40 weeks, labor/delivery complicated by infection, multiple births complicated by growth restrictions, genetic component, smoking/illicit drug use

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27
Q

birth history risk factors for CP

A

emergency c section, early gestational age (less than 32 weeks). very premature less than 26 weeks, Apgar score at 1 min, low birth weight

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28
Q

an area of neural precursor cells with fragile vasculature that increases risk of hemorrhage

A

germinal matrix

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29
Q

Germinal matrix hemorrhage grade 1

A

subependymal hemorrhage only confined to germinal matrix

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30
Q

Germinal matrix hemorrhage grade 2

A

intraventricular hemorrhage without hydrocephalus

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31
Q

Germinal matrix hemorrhage grade 3

A

intraventricular hemorrhage with hydrocephalus

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32
Q

Germinal matrix hemorrhage grade 4

A

intraparenchymal hemorhage

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33
Q

parenchymal hemorrhage leads to perventricular leukomalacia which is

A

a strong predictor of CP

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34
Q

3 types of CP

A

spastic, athetoid dystonic, ataxic

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35
Q

T/F almost all pts with spastic hemiplegia are ambulatory

A

T

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36
Q

T/F arms are more affected than legs in spastic diplegia

A

F. Legs are

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37
Q

regarding movement patterns, what is the difference between spastic diplegia and hemiplegia

A

diplegia-symmetrical, hemi-asymmetrical

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38
Q

T/F almost all spastic quadriplegia pts are ambulatory

A

F most are wheelchair bound

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39
Q

Athetoid dystonic quadraplegia preferr

A

end range (difficulty maintaining midline)

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40
Q

ataxic CP patients prefer

A

midline (avoid end range)

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41
Q

T/F almost all athetoid dystonic quads are ambulatory

A

F most are wheelchair bound

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42
Q

T/F almost all pts with ataxic CP are ambulatory

A

T

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43
Q

T/F Ataxic CP pts have symmetrical mvmt

A

T

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44
Q

Walks without limitations

A

GMFCS 1

45
Q

Walks with limitations

A

GMFCS 2

46
Q

walks using a hand-held mobility device

A

GMFCS 3

47
Q

self-mobility with limitations, may use powered mobility

A

GMFCS 4

48
Q

Transported in manual w/c

A

GMFCS 5

49
Q

Fine motor control and coordination efficiency limitations

A

MACS 1

50
Q

reduced speed/quality of mvmt

A

MACS 2

51
Q

environmental accommodations needed

A

MACS 3

52
Q

require continuous help for participation

A

MACS 4

53
Q

performs only simple movements

A

MACS 5

54
Q

Practice parameters for intervention for children with CP

A

strength training for min of 6 weeks with frequency 3x per week.
Aerobic training 2-4 times per week for 6 weeks

55
Q

9 interventions that improve coordination

A

constraint induced mvmt therapy, bimanual therapy, goal directed training, context focused therapy, balance training, home programs, biofeedback, hippotherapy, assistive technology

56
Q

regarding force production, is upper or lower strength training more important

A

lower

57
Q

recommended interventions for improving flexibility

A

serial casting, orthotics, surgical management

58
Q

serial casting

A

usually 4-6 weeks, change it every week with more flexibility

59
Q

when managing spasticity which three drugs have systemic effects?

A

diazepam, tizanidine, dantrolene

60
Q

downfall of oral mm relaxants

A

drowsy

61
Q

spasticity injectables

A

botox, phenol

62
Q

What is the good thing about intrathecal baclofen

A

good for pts with lots of spasticity and does not have the cognitive effects

63
Q

Which patients do we think selective dorsal rhizotomy will work best

A

spastic diplegia pts who can walk

64
Q

Good ways to reduce negative foot progression angle and reduce pain

A

theratogs, kinesiotape

65
Q

how do we simplify the movement

A

part practice or limit degrees of freedom (body weight support, assistive device, orthotics, manual support)

66
Q

precautions or contraindications

A

shunt precautions, seizure disorder

67
Q

potential non-PIPs

A

cognition, social-emotional development, visual impairment, hearing impairment

68
Q

regarding cardiopulm, question that determines need for referral

A

ask about history of supplemental oxygen for 1st 28 days

69
Q

common places for contracture

A

gastroc, iliospoas, adductors, and hamstring length

70
Q

in an infant unable to maintain head in midline while in supine, suggests lack of activation of ____ _____. forearms an thighs are on the surface, suggests lack of activation of _____ _____ as well as ____ and _____

A

bilateral SCM.
pectoralis/biceps.
iliospoas, adductors

71
Q

in prone, what is a common impairment for children with CP

A

to lift head against gravity ( no activation of cervical/thoracic paraspinals)

72
Q

Common gait patterns in patients with spastic hemiplegia (5)

A 
drop foot
true equinus 
true equinus with recurvatum knee
true equinus with jump knee
true equinus with jump knee and hip flexion, adduction, and internal rotation
73
Q

what is impaired during drop foot

A

TA activation, timing/sequencing TA and gastroc, muscle tone of gastroc

74
Q

what is impaired during true equinus

A

excessive activation of gastroc, length of gastroc, muscle tone of gastroc

75
Q

what is impaired during true equinus with recurvatum knee

A

length of gastroc

76
Q

what is impaired during true equinus with jump knee

A

muscle tone in gastroc and quad

77
Q

What is impaired during true equinus with jump knee and hip flexion, adduction, and internal rotation

A

muscle tone in gastroc, quad, hamstrings;
muscle length gastroc, iliopsoas, medial hamstrings;
excessive antetorsion;
medial tib-fib torsion

78
Q

excessive plantarflexion with knee wobble in SLS, along with a negative FPA

A

true equinus with jump knee and hip flexion, adduction, and internal rotation

79
Q

excessive plantarflexion with knee wobble in SLS

A

true equinus with jump knee

80
Q

excessive plantarflexion with knee hyperextension in SLS

A

true equinus with recurvatum knee

81
Q

excessive plantarflexion during SLS

A

true equinus

82
Q

Excessive plantarflexion during SLA

A

drop foot

83
Q

common gait patterns of pts with spastic diplegia

A

true equinus
jump knee
apparent equinus
crouch gait

84
Q

apparent equinus impairments

A

excessive activation of gastroc, length of gastroc, muscle tone of gastroc

85
Q

excessive plantarflexion to neutral during SLS

A

apparent equinus

86
Q

crouch gait impairments

A

muscle power in gastroc, length of hamstrings, muscle tone of hamstrings, length of iliopsoas

87
Q

excessive hip flexion, knee flexion, and ankle dorsiflexion

A

crouch gait

88
Q

an adaptive assessment that includes domains of self-car, mobility, and social functions for kids under 7. it is sensitive to small changes

A

pediatric evaluation of disability inventory

89
Q

Activity level measures recommended for CP

A

GMFM, quality of upper extremity skills test

90
Q

evaluate change in gross motor function in children with CP. each dimension is validated independently

A

Gross Motor Function Measure

91
Q

Evaluate change in fine motor function in children with CP. must perform entire measure, not separate domaines

A

quality of upper extremity skills test

92
Q

impairments related to a negative foot progression angle

A

medial tibiofibular torsion, internal rotation contracture, femoral anteversion, femoral antetorsion

93
Q

If patella is in frontal plane in standing, then hypothesize

A

medial tibiofibular torsion

94
Q

if patella is medial to frontal plane in standing, then hypothesize

A

internal rotation contracture, femoral anteversion and femoral antetorsion

95
Q

what is the thigh foot angle test for

A

to determine the magnitude of rotation of the leg in medial tibiofibular torsion

96
Q

what is the axial tibiofibular torstion test used for

A

to determine the magnitude of tibiofibular axial rotation in medial tibiofibular torsion

97
Q

the typical adult has a ___ thigh foot angle

A

10 lateral

98
Q

an infant has a thigh foot angle of

A

0 that increases with age

99
Q

what is an atypical thigh foot angle

A

thigh angle is negative (medial)

100
Q

To perform the axial tibiofibular rotation test, you rotate the leg, ankle, and foot ____ to max end range

A

medially and laterally

101
Q

when interpreting the axial tibiofibular rotation test, the lateral rotation should be ___ as much as the medial

A

twice

102
Q

Ratio should be ___ when looking at medial and lateral hip rotation

A

1:1

103
Q

atypical hip rotation

A

lateral hip rotation less than 25 degrees

104
Q

what test estimates femoral antetorsion

A

ryder’s test

105
Q

Typical ryder’s for teens and adults

A

0 degrees (estimate antetorsion = 16 degrees medially

106
Q

Typical ryder’s for infants

A

25 degrees medial (estimate antetorsion= 40 degrees medial)

107
Q

Atypical ryders for adults

A

greater than 15 degrees medial for over 14 years old

108
Q

atypical ryders for under 14 years old

A

greater than 25 degrees medial

109
Q

which spasticity measure has the best test-retest and inter-rater reliability in kids with CP

A

Tardieu. but the modified ashworth is also used

Neuro management 2 (9 decks)

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