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Peds > CP > Flashcards

CP Flashcards

1
Q

Most common neuro disorder encountered by pediatric PTs

A

CP

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2
Q

Cerebral palsy

A

Non-progressive lesion of brain resulting in disorder of posture and voluntary movement.
Occur during fetal development of first year of life
Progressive musculoskeletal impairment

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3
Q

Etiology of CP

A 
Hypoxic, ischemic, infection, congenital, or traumatic
MRI studies 
CVA (1/3 Infant bilaterally)
Maternal infection
Prematurity
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4
Q

Discriminate infant neuromotor tests to assist in prediction and ID of CP

A

AIMS
TIMP and NSMDA before or after term
GM

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5
Q

Best combo of sensitivity and specificity for predicting CP in early months

A

Prechtl’s assessment of general movements

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6
Q

Best for predicting CP in older infants

A

AIMS

NSDMA

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7
Q

Characteristics of CP

A 
Cog delays
Behavioral issues 
Speech impairment
Hearing impairment
Vision impairment
Seizure disorder
Urinalysis incontinence
Constipation 
Sensory impairments visual-spatial, visual perception, tactile
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8
Q

Tetraplegia

A

All four limbs involved (quad)

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9
Q

Diplegia

A

All four limbs involved. Both legs are more severely affected than the arms

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10
Q

Hemiplegia

A

One side of body affected. Arm is usually more involved than leg

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11
Q

Triplegia

A

Three limbs involved, usually both arms and a leg

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12
Q

Monoplegia

A

Only one limb affected, usually an arm

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13
Q

Motor differences CP: spastic

A

Motor cortex

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14
Q

Motor differences dyskinesia

A

Basal ganglia

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15
Q

Motor differences CP: ataxic

A

Cerebellar lesion

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16
Q

Motor differences CP: mixed

A

Spastic and dyskinesia

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17
Q

Gross motor function classification system

A

Five level
Self initiated movements - sitting, transfer, mobility
Age bands
<2, 2-4, 4-6, 6-12, 12-18

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18
Q

GMFCS general heading level 1

A

Walks w/out limitations

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19
Q

GMFCS general heading level 2

A

Walks w/ limitations

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20
Q

GMFCS general heading level 3

A

Walks using a hand held mobility device

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21
Q

GMFCS general heading level 4

A

Self mobility w/ limitations, may use powered mobility

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22
Q

GMFCS general heading level 5

A

Transported in a manual w/c

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23
Q

GMFCS before 2nd bday level 1

A

More in and out of sitting and floor sit w/ both hands free to manipulate objects
Creep, pull to stand and walk holding onto furniture
18m-2y walk without AD

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24
Q

GMFCS before 2nd bday level2

A

May require use of hand in sitting
Combat crawl or creep
May pull to stand and walk holding onto furniture

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25
Q

GMFCS before 2nd bday level 3

A

Sit with low back supported

Roll and combat crawl

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26
Q

GMFCS before 2nd bday level 4

A

Require trunk support for sitting, able to control head

Roll to supine and may roll to prone

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27
Q

GMFCS before 2nd bday level 5

A

Unable to maintain antigravity head and trunk postures in prone and sitting
Require assistance to roll

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28
Q

GMFCS before 2nd to 4th birthday level 1

A

Transition in and out of sitting and standing w/out assistance
Walk as 1 deg mobility

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29
Q

GMFCS before 2nd to 4th birthday level 2

A

Pull to stand at surface
Creep w/ reciprocal pattern and cruise
Walk w/ AD as preferred mobility

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30
Q

GMFCS before 2nd to 4th birthday level 3

A

Frequent “w” sit
Combat crawl or creep as 1deg mobility
Walk short distances indoor w/ walker and adult assistance for steering

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31
Q

GMFCS before 2nd to 4th birthday level 4

A

Adaptive equipment for sitting and standing

Self mobility limited to short distance

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32
Q

GMFCS before 2nd to 4th birthday level 5

A

No means of (I) movement

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33
Q

GMFCS before 4th to 6th birthday level 1

A

Walk indoors and outdoors
Climb stairs
Emerging fun and jump

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34
Q

GMFCS before 4th to 6th birthday level 2

A

Short indoor walking w/out mobility device, outdoor on level surface
Climb stairs w/ rail
Unable to jump or run

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35
Q

GMFCS before 4th to 6th birthday level 3

A

Walk w/ handheld mobility device on level surface
Require assistance to climb stairs
Frequently transported long distances

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36
Q

GMFCS before 4th to 6th birthday level 4

A

Self mobility possible w/ powered WC

Transported in community

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37
Q

GMFCS before 4th to 6th birthday level 5

A

No independent movement

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38
Q

GMFCS before 6th to 12th birthday level 1

A

Walk at home, school, outdoor and in community
Climb stairs w/out railing
Gross motor skills but speed, bal, coord limited

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39
Q

GMFCS before 6th to 12th birthday level 2

A

Walk in most settings,
Climb stairs holding rail
Difficulty walking long distance and balancing on uneven terrain, inclines, crowds, small spaces
May walk w/ physical assistance, hand held mobility device or wheeled mobility for long distance
Minimal ability to perform gross motor skills such as running and jumping

40
Q

GMFCS before 6th to 12th birthday level 3

A

Children walk using hand held mobility device in most indoor setting
Climb stairs holding onto rail w/ supervision or assistance
W/C when traveling long distances, may self propel shorter distances

41
Q

GMFCS before 6th to 12th birthday level 4

A

Children use methods of mobility that require physical assistance or powered mobility in most settings
May walk short distances at home w/ physical assistance or use powered mobility or body support walker
Manual or power w/c in other settings

42
Q

GMFCS before 6th to 12th birthday level 5

A

Manual w/c in all settings

Limited in ability to maintain antigravity head and trunk postures and control leg and arm movement

43
Q

GMFCS before 12th to 18th birthday level 1

A

Walk at home, school, outdoor, community
Climb curb and stairs w/out assistance or railing
Perform gross motor but speed, balance, coordination limited

44
Q

GMFCS between 12th and 18th birthday level 2

A

Walk in most settings but enviro factor and personal choice influence mobility choices
At school/work, require hand held mobility device for safety, climb stairs holding onto a railing
Outdoors, use w/c when traveling long distance

45
Q

GMFCS between 12th and 18th birthday level 3

A

Walking using hand held mobility device
Climb stairs w/ railing w/ sup or assist
Self propel manual or power w/c at school
Outdoors - transported in w/c

46
Q

GMFCS between 12th and 18th birthday level 4

A

W/c in most settings
Physical assist 1-2 people required for transfers
Indoor- short distance w/ physical assist, w/c or walker
Operate powered chair or manual w/c

47
Q

GMFCS between 12th and 18th birthday level 5

A

Manual w/c in all settings
Limited in ability to maintain antigravity head and trunk postures and control leg and arm movements
Self mobility is severely limited

48
Q

Strongest predictor of walking ability in all types of CP

A

Cog function

49
Q

Best predictor for amb of 15+ m by age 8

A

Independent sitting by 24 mo

50
Q

If indep sitting not obtained by age 3,

A

Likelihood of functional walking is very low

51
Q

Most children w/ CP reach 90% of motor pro entail before age

A

3 for most sever

5 for least involved

52
Q

Most common contracture in children w/ CP

A 
Shoulder add
Elbow, wrist, finger flex
Hip flex and add
Knee flex
Ankle PF
53
Q

Primary impairment in CP

A

Diminished force production capability

54
Q

CP muscle strength

A

Low EMG
Greater weakness
Distal> prox, con > Eccles, fast > slow
Contributes to bone deformity

55
Q

CP skeletal impairments

A

Torsion of long bones, joint instability, premature degenerative changes
Scoliosis
Hip subluxation

56
Q

CP selective control

A

Isolated muscle activation in selected pattern in response to voluntary posture
Poor selective control contributes to impaired motor function

57
Q

CP motor learning

A

Difficulty anazlying their own movements and using feedback to improve performance
Motor memory often impaired

58
Q

CP pain

A

61% of amb children

59
Q

Modified ashworth and CP

A

Low reliability

60
Q

Modified tardieu

A

Point of catch to rapid movement
Mechanical resistance to slow stretch indicates muscle length
Difference b/n catch and mechanical resistance

61
Q

Modified tardieu large difference

A

Indicates large reflexive component to motion limitations

62
Q

Modified tardieu small difference

A

Indicates a more fixed contracture

63
Q

Selective control assessment of LE

A

SCALE

Rating specific isolated movement

64
Q

CP other exam and eval

A

ROM, MMT, endurance and efficiency of movement
Observation of sway or repsonse to perturbation
SATCO
Pain (asses frequently)
Activity part, differentiate b/n capacity, performance, motivation

65
Q

CP exam considerations - infancy

A

Consider infant’s temperment, state of regulation and handling tolerance
Provide baseline for monitoring

66
Q

CP exam consider - pre school aged

A

Require more frequent reassessment

67
Q

CP strengthening

A

Both concentric and eccentric

68
Q

CP PRE

A

4-12x week
3x/wk
80-90% max load

Lower resistance for increased reps for endurance

69
Q

CP CV endurance

A

EE walking can be up to 3x >

GMFCS levels 1 and 2 respond well to specific training
Swimming programs for all levels

70
Q

CP modified constrain induced movement therapy

A

Useful w/ hemiplegia
Constraining unaffected UE
Mass practiced w/ affected UE

71
Q

CP spasticity management

A

Intervetion if interfering w/ function or comfort
Passive stretching - short term ,minor effect
SDR
Botox
Baclofen

72
Q

Muscle length best maintained

A

Through active movement in lengthen position

Casting
Orthoses
Positioning

73
Q

Solid AFO

A

Max restriction of ankle movement

74
Q

Hinged orthoses

A

Permit DF

75
Q

Dynamic or posterior leaf spring orthoses

A

Reduce equinus in swing
Permit ankle DF in stance
Absorb more energy in midstance
Reduce desireable power generation at push off

76
Q

SMO

A

For pronation

77
Q

Orthotic and GMFCS level 1-3

A

Used to allow for more efficient gait and prevent deformity

78
Q

GMFCS level 4, 5 orthotic

A

Prevent deformities

May allow child to be positioned in standing for physiological and psychosocial benefits

79
Q

AFOs and gain in children w/ CP

A

Increased velocity, reduced cadence, increased step and stride length, increased duration of SL support
Improved EE and possibly decreased O2 consumption

80
Q

Muscle lengthening AFO

A

Minimum of 6 hours/day

81
Q

AFO and sit to stand

A

Solid AFO may impede transition unless it is positioned w/ a forward inclination

82
Q

GMFCS levels 4 and 5 individualized postural management

A

Prevent positional contractures/deformities
Prevent skin breakdown
Facilitate function and participation
Promote safe, comfortable and biomechancially optimal sleep position

83
Q

GMFCS levels 1-3 weight bearing program

A

Increase/maintain bone mineral density
Maintain LE extensibility
Promote acetabulum development

84
Q

GMFCS levels 1-3 may indicate use of stander at age

A

1

85
Q

Posterior walkers

A

Improve posture and gait pattern,

Less EE than anterior walker

86
Q

Safe and effective mobility in power w/c can be achieved as early as

A

17 mo of age

87
Q

CP tx focus infancy

A 
Positioning, carrying, feeding, etc
Symmetry, handling, posturing, functional motor 
Biannual activity
Inhibition of hyperextension
Trunk then lateral control
88
Q

CP to pre school

A

Reduce primaryimpair, prevent secondary impair
Engage outside family
Hip joint integrity

89
Q

Goal attainment scaling

A

Individualized, criterion referenced measured of change

-defined a set of unique goals for client, then specify range of outcomes

90
Q

PEGS

A

Percieved efficacy and goal setting
Age 5-9
Picture of task
Allows child to self report percieved competence in every day activites and set goals for intervention
Parallel questionnaires for caregivers and educators

91
Q

GAS 5 point rating scale

A

-2 much less expected outcome
-1 less than expected outcome
0 expected outcome after intervening
+1 greater than expected outcome
+2 much greater than expected outcome

92
Q

Amb skill direct intervention

A 
Ther ex
Functional training in self care and home management
Manual therapy 
Modalities
AD, ortho, adaptive equipment
93
Q

Amb skills levels 4 and 5

A

PWB on treadmill
Supported amb
Focus on CP fitness
Address/monitor ROM and strength

94
Q

Amb skills 4 and 5

A

Explore all options for (I) mobility
Equipment may be required to compensate for postural and movement control limitations
Shock absorption concern
Energy conservation is not expected

95
Q

Amb skills intervetion for level 3

A

Upright posture and stability
Developing forward progression
Shock absorption
Energy conservation

96
Q

Amb skills level 1 and 2

A

Ongoing analysis of posture and stability in diff enviro and functional activities
Regular even of orthotic fit/function
Monitor gait efficiency
Fitness program w/in community

Peds (18 decks)

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