Developmental Delay, Cognitive Diagnosis and Hypotonia Flashcards
Developmental Delay - Approach
Stop - need to go slow, establish trust
Listen - listen to the parent and caregiver
Look - observe
Feel - use senses
Developmental Delay - Subjective Ax.
parent concerns HPC parental expectations prenatal history birth history - gestation, weight, complications, APGAR score medical history family history milestone achievement feeding, sleeping daily routines/activity last sleep/feed
Developmental Delay - Objective Ax.
General Obs
- describe the environment
- CNS state
- CR - check colour and breathing
- size and build
- interaction and communication, appropriate for age?
- observe their movement quality and quantity
MSK - AROM, PROM, strength and endurance, allignment and arthorpometry
neuro - reflexes, coordiantion, tone
sensory - vision, hearing, proprioception, touch
Gross Motor Abilities
- ned to use standardised outcome measures for their age and condition
- either norm or criterion referenced
Body Systems
- anything haven’t already assessed
- CR
- MSK
- Neuro
- Sensory
- cognition
Developmental Delay - Symptom
Symptom - explainable, there are reasons why they differentiate from the normal
Immaturity - if less than 1SD below the norm
- prematurity with nil other issues
- able to catch up with their peers
Atypical
- symptom of another condition
- more than 2SD below the norm
Developmental Delay - Diagnosis
greater than 2SD below the norm, but no other diagnosis can be found
Global Developmental Delay
- not a permanent diagnosis
- investigation ongoing until diagnosis found
Developmental Delay - Treatment/Management
needs to be based on family goals consider the ICF participation based approach consider the individual, task and environment educate caregivers routine based
Cognitive Diagnoses - Calming/Alerting sensory techniques
SIGHT Calming - neutral light and colours Alerting - bright light - contrasting colours
SOUND Calming - rhythmical - low pitch Alerting - loud unpredictable noise - fluctuating pitch
TOUCH Calming - deep touch - touch their back - neutral warmth - smooth and soft textures Alerting - light touch - unpredictable touch - tickling
SENSE OF BODY POSITION Calming - sustained positions - moving heavy weight Alerting - change body position - quick limb movements
Possible Cognitive Differences
ADD ADHD ASD DCD FASD Epilepsy Intellectual Disability Oppositional Defiant Disorder
Autism Spectrum Disorders
complex and diverse conditions, characterised by difficulties with communication skills, social skills and repetitive behaviours
Fetal Alcohol Spectrum Disorder
brain damage caused by prenatal alcohol exposure, causes social and behavioural problems, delayed development and intellectual difficulties
Hypotonia Definition
excessively low resistance to passive movement
Hypotonia Assessment - Supine
flat and wide against support surface
reflexes are weak and absent
can’t achieve a flexed midline posture
Hypotonia Assessment - Prone
unable to control flexion/extension
will have hyperextension of neck
weakness of deep neck flexors, mouth open
difficulty weight weight shift and rotation
Hypotonia Assessment - Sitting
legs in front
excessive c curve in the spine
excessive posterior pelvic tilt
W sitting
Hypotonia Assessment - standing
overuse extensors and external support
increased anterior pelvic tilt, increased lumbar lordosis, collapsed arch
Hypotonia - Infancy
abnormally high threshold to stimulation excessive floppiness child slides out of supported sitting instability in postures risk of asymmetry reduced weight shift and transference may fear movement delayed development
Hypotonia - Toddler
minimal ability to rotate
parents report child feels heavy to carry
from supine to stand
- roll to prone, 4 point kneel, use external support
tires easily
difficulty keeping up with their peers
Hypotonia - Intervention/Management
promote functional training
use sensory input to enhance movement
facilitate postural control
want optimal joint stability
strength - build endurance, limit handling
sitting - optimise BOS using horse riding, encourage pelvic tilting, encourage movement outside the BOS
Downs Syndrome - Medical Issues
congenital heart disease increased risk of resp complications hearing and visual anomalies dental problems GI malformations renal system issues autoimmune issues ASD, ADD, epilepsy leukaemia skin conditions possible atlanto-axial instability potential DDH
Expected Gross Motor Skills - 4 yrs old
two foot jumping SL stand 3-5 seconds Hopping Running with flight phase Standing up from floor using adult movement Climbing Bike riding with stabilisers Walk on tip toes Catch with 2 hands Throw with 1 hand Kick a moving ball Copy simple movements
Developmental Delay - Assessment Tools
Aged under 1.5 years = AIMS
Aged over = NSMDA specific age
Hypotonia Assessment body systems
MSK
- muscles feel doughy and soft
- fatigue easily
- increased PROM
CR
- poor suck/swallow
- weak cry
- drooling
- ineffective cough
Neuro
- weak reflexes
- delayed reaction time
