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Pediatrics Fall 2024 > Unit 2 (Getting my ass fucked) > Flashcards

Unit 2 (Getting my ass fucked) Flashcards

1
Q

Autism is

A

Atypical brain organization
- genetic risk
- environmental risk
- a lot of trouble in the social domain

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2
Q

What is the first sign of autism?

A

Generalized low muscle tone and motor delay

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3
Q

Places of the brain affected by Autism

A

Amygdala= sympathetic system response-fight, flight, fear

Hippocampus= memory, mirror neurons

Brain Stem= primitive functions of the body

Basal ganglia= fluid movement

Corpus Callosum= connections between left and right hemispheres- critical for shared connectivity and processing

Cerebellum= Center of balance, fluid body movements, and memory

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4
Q

How does mTOR play a part in Autism?

A

mTOR= is a protein that is part of the creatine kinase family
- current research states that there is a difficulty with an inflammatory response in children with autism /there are pro-inflammatory markers such as the mTOR pathway
- mTOR pathway shows excessive production of synapses/which are supposed to regulate cell activity
- the signaling protein being decreased causes some of these chaotic synapses to occur in the children’s brain

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5
Q

What is level 1 of the Autism Spectrum

A
  • requiring support
  • may get services 2-3x a week
  • difficulty in the social domain / decreased interest in socialization
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6
Q

What is level 2 of the Autism Spectrum

A
  • requires substantial support
  • may get all their services in a very coordinated fashion with assistance from a service coordinator
  • marked deficits in verbal and nonverbal social communication skills
  • limited initiation of social interaction
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7
Q

What is level 3 of the Autism Spectrum

A
  • requiring very substantial support
  • Classroom 1-1 aid, host supports, offsite/medically appropriate daycare if parents work due to typically daycare unable to manage needs of child
  • severe verbal and nonverbal communication skills
  • severe impairments in functioning
  • very limited initiation of social interaction and responses
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8
Q

Autism: Infant to age 2

A
  • do not smile
  • does not respond to name
  • not affectionate
  • low tone
  • no babbling
  • no words by 16 months
  • no pointing or gestures by age 1
  • no imaginative play
  • REGRESSION OF TYPICAL SKILLS
  • GROSS MOTOR DELAY
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9
Q

Autism: 2-5 year

A
  • does not use imaginative play
  • avoids eye contact/stares
  • dislikes tactile input
  • does not speak/stops speaking
  • speaks in a monotone voice
  • echolalic
  • hyper-arousal or hypo-arousal
  • fixated/preservative play
  • INCREASED FALLS
  • DECCREASED ENDURANCE
  • COMPENSATORY MOTOR STRATEGIES-ITW
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10
Q

Echolalia

A

child mirroring or repeating what they hear, rather than speaking in cohesive language

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11
Q

Idiopathic Toe Walking

A

is exclusively walking on their toes to the point the pads of the foot are affected
- skin breakdown
- gastroc becomes extremely tight
- a sensory processing problem
- diagnosed after age 3
- able to self correct at first
- responds to Botox, serial casting, orthotics, load sensors

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12
Q

Interventions for Autism: Infant/Toddlers

A
  • postural control
  • milestones
  • sensory exploration
  • tolerance of vestibular input
  • functional and graded sensory input
  • 5 domains
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13
Q

Interventions for Autism: Preschoolers/Young Children

A
  • structure
  • floor play
  • set up a plan
  • use pictures
  • set times, see meltdowns before they happen
  • take turns
  • strength
  • endurance
  • movement/vestibular
  • trampoline
  • obstacle courses
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14
Q

Interventions for Autism: Adolescents

A
  • vigorous exercise
  • Aerobic + resistance training
  • Water aerobic conditioning
  • Yoga
  • therapeutic horseback riding
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15
Q

The power sensations:
Proprioception: conscious/unconscious
Vestibular/balance: rotatory movements/linear

A
  1. Conscious proprioception= cerebrum
  2. Unconscious proprioception= cerebellum
  3. vestibular rotary movement= three semi-circular canals
  4. Vestibular linear movement= otoliths
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16
Q

Sensory over - responsivity

A
  • threshold for sensation is very low
  • hyper sensitive
  • they feel things too intensely, constantly
  • poor sleepers because they hear everything
  • fight, flight, fear response on high
  • sometimes called sensory defensive
  • try to minimize any sensation that sets off the child
  • very distractible, very anxious, very ridged
  • their whole purpose in life is to create structure for themselves
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17
Q

Sensory Under responsivity

A
  • hyposensitive kid
  • low registration of incoming sensory data
  • very high threshold for incoming data
  • passive clueless child, bruises
  • dull affect, appear to be uninterested
  • miss out on social cues that guide behavior’s
  • unaware of their own self boundaries and the enviornment
  • Treatment by increasing the sensory input to meet the threshold so that the child can function at their best
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18
Q

Sensory Craving

A
  • risk takers, easily bored, driven to obtain sensory stimulation
  • seek out whatever it is they are seeking and then they are so disorganized that they are not satisfied, cannot come back from it
  • constantly moving, jumping, crashing, pushing
  • kids will need 1-1 aid in preschool setting and beyond
  • often misdiagnosed as ADD or ADHD
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19
Q

Dyspraxia

A
  • difficulty thinking about, planning, and executing a skilled movement especially a new one
  • difficulty forming a goal, planning action, especially anything that is more than a sequence of 2 items
  • very accident prone
  • they avoid sports
  • tend to be adults with obesity
  • lack muscle memory
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20
Q

Postural Disorder

A
  • poor body perception in space based on poor proprioceptive feedback, poor core stability and poor muscular endurance
  • slouchers, leaning on everything
  • Treatment= special pencils, seating surfaces to give them proprioceptive feedback
  • how can we strengthen and increase the sensory input so that they can then go to work academically in a way that is feasible for them
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21
Q

Sensory Discriminative Disorder

A
  • visual
    -auditory
  • tactile
  • taste/smell
  • position/movement
  • interoception
  • Children having difficulties interpreting the subtleties of objects, places, people foods
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22
Q

DCD

A

Developmental Coordination Disorder
- AKA dyspraxia
- Movement difficulties that are unrelated to specific neurological conditions or cognitive related impairments

Poor motor coordination and quality of movement that interferes with:
- academic performance
- self care
- participation in leisure activities

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23
Q

DCD Movement System Diagnosis

A

movement pattern coordination deficit

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24
Q

Tests and Measures of DCD

A
  • Observational movement assessment
  • Movement ABC
  • Bruininks Osteretsky test of motor proficiency
  • Functional strength measure
  • Peabody developmental motor scales
  • Perceived efficacy and goal setting system
  • Standin-walking -obstacle course
  • CAPE
  • COPM
  • Goal Attainment Scaling
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25
Q

Interventions for DCD: Top down

A
  1. motor skill training
  2. neuro-motor task training
  3. cognitive orientation to occ. performance
  4. motor imagery
    NO VIDEO GAMES
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26
Q

Interventions DCD: Body Structure and Function

A
  1. core stability/postural training
  2. cardio-training
  3. functional movement power training
  4. education and community intergration
  5. participation
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27
Q

DCD ICF: Body Structure and Function

A
  • decreased strength
  • decreased coordination
  • fine and gross motor deficits
  • joint laxity
  • poor visual perception/spatial organization
  • decreased muscle memory and motor feedback
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28
Q

DCD ICF: activity limitations

A
  • awkward gait
  • delayed oral motor skills
  • immature movement patterns
  • poor quality of fine and gross motor skills
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29
Q

DCD ICF: Participation Restrictions

A
  • “recess”
  • physical education
  • team sports
  • decreased social participation
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30
Q

DCD ICF: Environmental Factors

A
  • difficulty completing work on time
  • difficulty with academic subjects that require handwriting
  • difficulty dressing, using a fork, brushing teeth, doing zippers, organizing a backpack
  • slow with activities
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31
Q

DCD ICF: Personal Factors

A
  • depression
  • anxiety
  • decreased self confidence
  • lack of motivation–> lazy, clumsy, clown
  • difficulties coping with change/transisitions
  • avoids socializing with peers
  • associates with younger children or seeks adults as playmates
  • frustration with seemingly easy tasks
  • may seem dissatisfied with his/her performance
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32
Q

what is the gold standard for intervention and gait

A

motor learning intervention

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33
Q

Hypotonia

A
  • little to no resistance to passive movement
  • very difficult for that child to move
  • pushing against resistance of gravity
  • very little gratification associated with moving
34
Q

Hypertonia

A

Lots of resistance to passive movement
- used to modified Ashworth scale
- generally lack of descending inhibition
- spasticity

35
Q

What does the central motor system consists of ?

A

Cerebral hemispheres
Brainstem
Cerebellum
Spinal Cord

36
Q

How does the gamma motor neuron system work

A

Fusimotor system
- Set the baseline level of activity so that the AMN can regulate how the muscle moves
- Intrafusal muscle fiber gets stretched, info gets sent right to the AMN the muscle then contracts and the GMN stays on
- it is like background noise system that continually informs the individual where their body in space is
(with hypotonia it goes array)

37
Q

What are the 4 diagnostic paths to Hypotonia

A
  1. Damage to the immature brain
  2. Genetic disorder
  3. central developmental hypotonia
  4. Delays in development after 1st 6 months –> lower motor neuron
38
Q

Hypotonia Classification: Mild

A
  • movement patterns similar to children without DS at similar stage of development
  • sufficient muscle ton e, strength and voluntary control to initiate, adapt, and sustain movements during play
39
Q

Hypotonia Classification: Moderate

A
  • able to initiate, adapt, and sustain movements during play, but movement patterns are less efficient compared to children without DS
  • excessive motion in some weight bearing joints, wide base of support, reduced balance, compensatory movements when strength and tone are insufficient to meet task demands
40
Q

Hypotonia Classification: Severe

A
  • difficulty initiating, adapting and sustaining movements during play: frequency of movement may be limited
  • Movements inefficient and characterized by compensation: may have limited voluntary control of movements
41
Q

What are the 4 test for Hypotonia

A
  1. Pull to sit
  2. Scarf sign
  3. Slipping through axilla
    4.ventral suspension
42
Q

Hypotonia: Body Structures and Functions

A
  • decreased joint stability and ligamentous laxity
  • joint hypermobility
  • weakness
  • decreased endurance
  • delayed milestones
  • difficulty with functional activites
43
Q

Characteristics of Down Syndrome

A
  • hypotonia
  • brachicephaly= short round skull with flat occiput
  • short neck
  • small posteriorly rotated ears
  • flat face/small nose
    single transverse palmar crease
  • small stature
  • lower than typical bone mineral density
44
Q

Karyotype Down Syndrome

A

Resulting when 3 rather than the normal 2 copies of chromosome 21 are present in each cell

45
Q

What are the general 3 types of etiologies of DS

A
  1. Nondisjunction= failure of a pair of chromosomes to disjoin properly they stick together and its problem of cell division
  2. Translocation= occurs when the long arm of the chromosome 21 is attached to another chromosome, often chromosome #14
  3. Mosaicism= when there is an extra chromosome 21 present in some but not all cells of the body
46
Q

Atrial Septal Defect

A
  • found in 60% of babies born with DS
  • accompanies pulmonary hypertension
  • This defect is a hole in the septum between the atria
  • lower than normal amounts of oxygen as it gets pooled in the atria and can have free reign to flow into the lungs
    –> this extra blood pumped into the lungs forces the heart and lungs to work harder, leading to congestive heart failure
47
Q

Atlantoaxial Instability (AAI)

A
  • hypoplastic Odontoid Process
  • Junction between the atlas C1 and the axis C2
  • when the odontoid is smaller it allows for more play/movement of the entire vertebral system- one vertebra can slide/slip over another causing significant damage to the nerves in that area
  • A AAI interval that is greater than 4.5mm is concerning
48
Q

Signs and Symptoms of Myelopathy

A
  • neck pain, limited neck mobility, torticollis
  • difficulties walking /altered gait
  • in-coordination / clumsy
  • sensory deficits
  • spasticity
  • hyperreflexia (hemiplegia)
  • reports of recent incontinence
49
Q

Motor Skills in Children with Down Syndrome Standardization

A
  • Sitting = 12-18 months
  • Creeping= 26-36 months
  • walking= 36 months
  • running= 72 months
  • Stairs= 72 months
  • Jumping = 72 months
50
Q

Therapeutic Recommendations for DS

A
  • tummy time activities
  • infant massage
  • treadmill training
  • orthotics
  • adaptive equipment
  • postural strengthening
  • Hip surveillance
51
Q

What is Myelomeningocele?

A

Swelling/herniation of the spinal cord
- folate/vitamin B6 play a huge role in managing and preventing the neural tube defects
- force production deficit (movement systems diagnosis)

52
Q

What are the 3 types of Myelo?

A
  1. Occulta
  2. Meningocele
  3. Myelomeningocele
53
Q

Occulta=

A
  • meaning hidden
  • spinal cord doesn’t protrude and it is the most common case
  • there is a defect in the formation of the spinal canal
54
Q

Meningocele=

A

Spinal cord protrudes but the meninges are not exposed
- least common form of spina bifida

55
Q

Myelomeningocele=

A

Spinal cord that is malformed- myelodysplasia- poor formation
- lack of posterior arches allow for protrusion of the nerves, meninges, spinal fluid
- there is damage to the area BELOW the lesion and it is both spinal cord and neurological injury

56
Q

Is Myelomeningocele an UMNL or LMNL?

A

Both

57
Q

Endoderm =

A

Innermost layer of neurulation forms the inner lining of the GI tract, lungs and airways

58
Q

Ectoderm=

A

What differentiates into the NS

59
Q

Mesoderm=

A

differentiates into the msk system

60
Q

Arnold Chaiari Malformation=

A

Caudally displaced rhombencephalon with 2 main subtypes:
1. Chiari 1
2. Chiari 2

61
Q

Chiari 1 Malformation

A
  • downward displacement of the cerebellar tonsils as they descend into the foramen magnum
  • the fourth ventricle does remain in the posterior fossa, so there is a little bit of concern - they may need a laminectomy decompression/ but not as emergent and difficult to manage as Chiari 2
  • Syringomyelia= collection of fluid unknown why it occurs here but it can also press on vital spinal nerves
62
Q

Chiari 1 Malformation

A
  • Requires urgent surgical procedure/ decompression and laminectomy
  • Where the cerebellum, brainstem, fourth ventricle, pons and medulla descend with the cerebellar tonsils into the foramen magnum into the cervical spine and with resultant buildup of intracranial pressure
  • Basically a blockage here that causes increased ICP as IC increases there are very important cranial nerves in the brain stem that get compressed and at risk for hydrocephalus
63
Q

What is hydrocephalus

A

accumulation of fluid outside of the cranial vault
- causes the brain to swell, pushes against the skull and causes pressure and close monitoring
- as the intracranial pressure increases, very irritable baby
- shunt is made of silicone so it can get infected and reject

64
Q

Flow of CSF

A
  1. Choroid plexus is the place within the lateral ventricles to secrete and form the CSF –> over to the 3rd ventricle through the foramen monore–> cerebral aqueduct–> aqueduct sylvius to the 4th ventricle –> fourth ventricle gets the most damage thereby causing the blockage
65
Q

Ventriculoperitoneal Shunt

A
  • placed catheter into one of the lateral ventricles and there is a little valve that releases and opens the flow and dump it into the stomach or heart
  • we can look at signs of redness, swelling, bulging, lethargy, babies cranky, marked decrease in reflexes, head enlarged, vomiting, sleep problems, sunset sign (upward gaze - paralyzed due to obstruction of CN3,4,6)
66
Q

What is a tethered cord?

A
  • cord stuck
  • pulled tightly at the end and this can be due to a growth spurt especially in the first year and again in years 2-4 and again in 6,7,8 and up to 12-14
  • where the lesion is surgically prepaed , scar tissue can lay down and cause spinal nerves and all of the structures in that area to tether down
    -Can be tethered to a lipoma, a fatty area that is also part of that surgical repair site, it can be tethered to fascia to skin
67
Q

Myleo Chiari 2 Malformation Latex Allergy

A
  • swelling of eyes and mouth
  • chest tightness- difficulty breathing
  • hives/rash
  • nausea
  • cramping
  • vomiting
  • dizziness
68
Q

Myelo: Motor Paralysis and Ortho Conditions

A

Complete:
- normal function to the level of the lesion, flaccid paralysis, loss of sensation and absent reflexes DTRS below the level of the lesion

Incomplete:
- skip lesion
- one or more functional segments interposed between functional segments

DETERMINE THE MOTOR LEVEL BY THE LOWEST INTACT MUSCLE GROUP

69
Q

Spine Level and possible function L2-L3

A

L2=
Hip Flexors 3/5
Hip adductors 3/5

L3=
Knee Extensors 3/5

70
Q

Spine Level and possible function L4-L5

A

L4=
Medial Knee Flexors 3/5
Ankle Dorsiflexors 3/5

L5=
Hip Abductors 2/5
Lateral Knee Flexors 3/5
Ankle Invertors 3/5
Long Toe Extensors

71
Q

Spine Level and possible function S1-S2

A

S1=
Hip abductors 3/5
Hip extensors 2/5
Plantar Flexors 2/5

S2=
Hip extensors 4/5
Plantar flexors 3/5
Toe Flexors 3/5

72
Q

what kids are most at risk for hip dislocations due to what lesion level

A

L1-L2 because lower lumbar lesions have poor hip abduction and extension there for resluting in asymmetry

73
Q

T/F L2 motor paralysis are they are not ambulatory

A

True

74
Q

L3 Function level (motor paralysis)

A

Marginal household ambulator
- high risk for hip dislocation
Primary motion
- hip flexion
- hip adduction

Primary muscles:
- iliopsoas (lumbar plexus /femoral nerve)
- Hip adductors (obturator nerve)

75
Q

L4 Function Level (motor paralysis)

A
  • Household ambulator plus
  • key level because quads can function

Primary motion:
- knee extension
- ankle dorsiflexion and inversion

Primary Muscles :
- quads (femora nerve)
- Tib anterior (deep peroneal nerve)

76
Q

L5 Function Level (motor paralysis)

A
  • Community ambulator

Primary Motion:
- toe dorsiflexion
- hip extension
- hip abduction

Primary muscles:
- EHL (deep peroneal)
- EDL (deep peroneal)
- Glute med and min (superior gluteal nerve)

77
Q

S1 Function Level (motor paralysis)

A

normal ambulator

Primary Motion :
- foot plantar flexion

Primary muscle:
- gastroc soleus (tibial nerve)

78
Q

S2 functional level (motor paralysis)

A

Normal ambulator

Primary motion:
- toe plantar flexion

Primary muscle FHL (tibial nerve)

79
Q

S3-S4 functional level (motor paralysis)

A
  • normal ambulator

Primary motion:
- bowel and bladder function

80
Q

Vertical talus

A
  • talus shifts vertically due to the muscle imbalance
  • some of the muscular forces can cause a rocker bottom foot
  • foot wont fit in orthosis or tolerate an AFO, or be able to use the surface area it needs to be in an upright ambulatory capacity
81
Q

Cavocarus Deformity

A

The S1 levels are excessively strong- posterior tib, peroneus longus, causing PF, eversion so a forefoot valgus with a rearfoot varus
- shortening from front to back basically, everything gets cramped

82
Q
A

Pediatrics Fall 2024 (2 decks)

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