Developmental exam

Question 1

Spina bifida cx

Answer 1

• Vision
• VP shunt / hydrocephalus (HC important)
• Behavioural/learningissues–usuallymilder
• Motor disability – lower limb (upper limb normal) * LMN (wasting)
• Deformity(AFOs)
• (Urologicalissues:Mitrofanoff)

Question 2

Diplegia definition

Answer 2

Both legs affected (both arms may be affected to lesser degree)

Question 3

Quadriplegia definition

Answer 3

bth arms and legs affected
muscles of trunk, face nad mouth often also affected to lesser degree

Question 4

Hemiplegia

Answer 4

One side of body (one arm and one leg) is affected

Question 5

Rett syndrome

Answer 5

Clues:
* Microcephaly,female
* Presentation / regression common in 1-4 years
* Unusualnon-purposefulhandmovements
* Relative eye contact preserved
* Limited expressive communication (regression common)
* ASD traits
* Relatively normal motor skills (will have loss skills, may be later)

Question 6

Where is the lesion? Spastic CP

Answer 6

Motor cortex

Question 7

Where is the lesion? Dyskinetic CP

Answer 7

Basal ganglia

Question 8

Where is the lesion? Ataxic CP

Answer 8

Cerebellum

Question 9

Define and describe mx steps of Dystonia

Answer 9

• movement disorder characterized by involuntary muscle contractions/stiffening -> slow repetitive, twisting movements and abnormal postures that can be painful
• Conservative mx
  - Positioning
  - Splints/AFOs
  
  • Meds
    - Baclofen (intrathecal pump - implanted under surface of skin for direct insertion into spinal column)
    - Diazepam
    - Clonidine
    - Gabapentin
  • Surgical intervention

Question 10

Mx of Sialorrhoea

Answer 10

• Speech path exercises
• Meds: anticholinergics
  - Glycopyrollate, Artane (benzhexol), hyoscine (SE - constipation, urinary retention, dry eyes)
• Surgical
  - Botox (lasts ~6mo)
  - Salivary gland excision

Question 11

Optimisation of respiratory health in children with physical disability

Answer 11

• Assess for aspiration as this will increase risk of respiratory illness
  - Assess for dysphagia: Questionnaire such as DOSS (dysphagia outcome and severity scale) to determine if safe to E&D, thickened/puree only, NBM
  - Comprehensive clinical swallow assessment with a speech path and implementation of safe feeding plan and strategies to develop oral motor skills
  - Sx: chronic wet cough, recurrent LRTI infections, choking episodes
  - Assess for underlying conditions that will incr risk of aspiration
  - Dysphagia
  - Epilepsy (both the seizures and side effects of medications ie sedation can worsen secretions or drooling and lead to aspiration)
  - Reflux
  - Drooling/poorly controlled secretions
  - Video fluoroscopy to help assess for silent aspiration
  - Optimise airway clearance - ensure effective cough
  - Refer to chest physiotherapist - can help with exercises for airway clearance and chest wall compliance (prevention of restrictive lung disease later on)
  - Optimise positioning and tone management for airway clearance and lung expansion
  - Management of underlying OSA from upper airway obstruction (enlarged tonsils/adenoids/turbinates etc)
  - Optimise physical activity and fitness: shown to improve pulmonary function (although not necessarily respiratory health)
  - Optimise asthma management
  - Optimise dental hygeine (reduces reservoir of pathogenic bacteria)
  - Daily dental care
  - Twice yearly dental reviews
  - Immunisations
  - Yearly flu shot
  - Avoid smoking exposure