Unit 2 (Getting my ass fucked) Flashcards
Autism is
Atypical brain organization
- genetic risk
- environmental risk
- a lot of trouble in the social domain
What is the first sign of autism?
Generalized low muscle tone and motor delay
Places of the brain affected by Autism
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
How does mTOR play a part in Autism?
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
What is level 1 of the Autism Spectrum
- requiring support
- may get services 2-3x a week
- difficulty in the social domain / decreased interest in socialization
What is level 2 of the Autism Spectrum
- 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
What is level 3 of the Autism Spectrum
- 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
Autism: Infant to age 2
- 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
Autism: 2-5 year
- 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
Echolalia
child mirroring or repeating what they hear, rather than speaking in cohesive language
Idiopathic Toe Walking
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
Interventions for Autism: Infant/Toddlers
- postural control
- milestones
- sensory exploration
- tolerance of vestibular input
- functional and graded sensory input
- 5 domains
Interventions for Autism: Preschoolers/Young Children
- 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
Interventions for Autism: Adolescents
- vigorous exercise
- Aerobic + resistance training
- Water aerobic conditioning
- Yoga
- therapeutic horseback riding
The power sensations:
Proprioception: conscious/unconscious
Vestibular/balance: rotatory movements/linear
- Conscious proprioception= cerebrum
- Unconscious proprioception= cerebellum
- vestibular rotary movement= three semi-circular canals
- Vestibular linear movement= otoliths
Sensory over - responsivity
- 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
Sensory Under responsivity
- 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
Sensory Craving
- 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
Dyspraxia
- 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
Postural Disorder
- 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
Sensory Discriminative Disorder
- visual
-auditory - tactile
- taste/smell
- position/movement
- interoception
- Children having difficulties interpreting the subtleties of objects, places, people foods
DCD
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
DCD Movement System Diagnosis
movement pattern coordination deficit
Tests and Measures of DCD
- 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
Interventions for DCD: Top down
- motor skill training
- neuro-motor task training
- cognitive orientation to occ. performance
- motor imagery
NO VIDEO GAMES
Interventions DCD: Body Structure and Function
- core stability/postural training
- cardio-training
- functional movement power training
- education and community intergration
- participation
DCD ICF: Body Structure and Function
- decreased strength
- decreased coordination
- fine and gross motor deficits
- joint laxity
- poor visual perception/spatial organization
- decreased muscle memory and motor feedback
DCD ICF: activity limitations
- awkward gait
- delayed oral motor skills
- immature movement patterns
- poor quality of fine and gross motor skills
DCD ICF: Participation Restrictions
- “recess”
- physical education
- team sports
- decreased social participation
DCD ICF: Environmental Factors
- 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
DCD ICF: Personal Factors
- 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
what is the gold standard for intervention and gait
motor learning intervention
Hypotonia
- 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
Hypertonia
Lots of resistance to passive movement
- used to modified Ashworth scale
- generally lack of descending inhibition
- spasticity
What does the central motor system consists of ?
Cerebral hemispheres
Brainstem
Cerebellum
Spinal Cord
How does the gamma motor neuron system work
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)
What are the 4 diagnostic paths to Hypotonia
- Damage to the immature brain
- Genetic disorder
- central developmental hypotonia
- Delays in development after 1st 6 months –> lower motor neuron
Hypotonia Classification: Mild
- 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
Hypotonia Classification: Moderate
- 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
Hypotonia Classification: Severe
- 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
What are the 4 test for Hypotonia
- Pull to sit
- Scarf sign
- Slipping through axilla
4.ventral suspension
Hypotonia: Body Structures and Functions
- decreased joint stability and ligamentous laxity
- joint hypermobility
- weakness
- decreased endurance
- delayed milestones
- difficulty with functional activites
Characteristics of Down Syndrome
- 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
Karyotype Down Syndrome
Resulting when 3 rather than the normal 2 copies of chromosome 21 are present in each cell
What are the general 3 types of etiologies of DS
- Nondisjunction= failure of a pair of chromosomes to disjoin properly they stick together and its problem of cell division
- Translocation= occurs when the long arm of the chromosome 21 is attached to another chromosome, often chromosome #14
- Mosaicism= when there is an extra chromosome 21 present in some but not all cells of the body
Atrial Septal Defect
- 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
Atlantoaxial Instability (AAI)
- 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
Signs and Symptoms of Myelopathy
- neck pain, limited neck mobility, torticollis
- difficulties walking /altered gait
- in-coordination / clumsy
- sensory deficits
- spasticity
- hyperreflexia (hemiplegia)
- reports of recent incontinence
Motor Skills in Children with Down Syndrome Standardization
- Sitting = 12-18 months
- Creeping= 26-36 months
- walking= 36 months
- running= 72 months
- Stairs= 72 months
- Jumping = 72 months
Therapeutic Recommendations for DS
- tummy time activities
- infant massage
- treadmill training
- orthotics
- adaptive equipment
- postural strengthening
- Hip surveillance
What is Myelomeningocele?
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)
What are the 3 types of Myelo?
- Occulta
- Meningocele
- Myelomeningocele
Occulta=
- 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
Meningocele=
Spinal cord protrudes but the meninges are not exposed
- least common form of spina bifida
Myelomeningocele=
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
Is Myelomeningocele an UMNL or LMNL?
Both
Endoderm =
Innermost layer of neurulation forms the inner lining of the GI tract, lungs and airways
Ectoderm=
What differentiates into the NS
Mesoderm=
differentiates into the msk system
Arnold Chaiari Malformation=
Caudally displaced rhombencephalon with 2 main subtypes:
1. Chiari 1
2. Chiari 2
Chiari 1 Malformation
- 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
Chiari 1 Malformation
- 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
What is hydrocephalus
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
Flow of CSF
- 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
Ventriculoperitoneal Shunt
- 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)
What is a tethered cord?
- 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
Myleo Chiari 2 Malformation Latex Allergy
- swelling of eyes and mouth
- chest tightness- difficulty breathing
- hives/rash
- nausea
- cramping
- vomiting
- dizziness
Myelo: Motor Paralysis and Ortho Conditions
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
Spine Level and possible function L2-L3
L2=
Hip Flexors 3/5
Hip adductors 3/5
L3=
Knee Extensors 3/5
Spine Level and possible function L4-L5
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
Spine Level and possible function S1-S2
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
what kids are most at risk for hip dislocations due to what lesion level
L1-L2 because lower lumbar lesions have poor hip abduction and extension there for resluting in asymmetry
T/F L2 motor paralysis are they are not ambulatory
True
L3 Function level (motor paralysis)
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)
L4 Function Level (motor paralysis)
- 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)
L5 Function Level (motor paralysis)
- 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)
S1 Function Level (motor paralysis)
normal ambulator
Primary Motion :
- foot plantar flexion
Primary muscle:
- gastroc soleus (tibial nerve)
S2 functional level (motor paralysis)
Normal ambulator
Primary motion:
- toe plantar flexion
Primary muscle FHL (tibial nerve)
S3-S4 functional level (motor paralysis)
- normal ambulator
Primary motion:
- bowel and bladder function
Vertical talus
- 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
Cavocarus Deformity
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
