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Neuromuscular > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What all is part of the Cognitive-Affective Domain?

A 
Level of consciousness
Communication
Orientation
Attention
Memory
Perception/Judgment
Mood and Pain
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2
Q

Alert

A

Eyes open, interacting with their environment

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3
Q

Lethargic

A

Drowsy, in and out of consciousness, not attending to tasks

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4
Q

Glasgow Coma Scale

A

Level of consciousness and severity of injury with trauma to head/brain
Assessed by MD in ER/ICU

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5
Q

What levels of consciousness may PT be done?

A

Active participation in alert and lethargic states

PROM and positioning if unconscious

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6
Q

Difference between Orientation x3 and Orientation x4

A

x3: Person, place, and time
x4: Person, place, time, and diagnosis

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7
Q

Aphasia

A

Inability to comprehend written or spoken language, formulate written or spoken language, or use written or spoken language

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8
Q

Expressive Aphasia

A 
Non-fluent
Broca's Aphasia
Limited vocabulary
Slow, hesitant speech with good auditory/reading comprehension (communication board)
May have impaired written skills
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9
Q

Receptive Aphasia

A

Fluent
Wernicke’s Aphasia
No problem speaking, no comprehension

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10
Q

Global Aphasia

A

Inability to produce or comprehend language

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11
Q

Dysarthria

A

Lesion in brain that mediates speech production

Labored speaking skills, but understand communication and can express in written

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12
Q

Aphonia

A

Inability to produce speech due to paralysis of vocal cords or diaphragm

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13
Q

Broca’s Aphasia Physiology

A

Lesion of frontal lobe (anterior motor association - inferior frontal gyrus)
Usually seen with CVA/TBI
Refer to SLP for assessment

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14
Q

Wernicke’s Aphasia Physiology

A

Lesion in posterior portion of temporal lobe and part of parietal lobe
Reading and writing are impaired

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15
Q

Dysarthria Physiology

A

Acquired
Impairment of speech production from damage to the PNS/CNS causing weakness of the motor/speech system (respiration, phonation, articulation, resonance)
Production is not altered, but melody and rhythm changed
CP, TBI, CVA, MS, PD, ALS
May coexist with aphasia in CVA/TBI

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16
Q

Attention

A

Ability to select and attend to a specific stimulus while suppressing extraneous stimuli
Ability to remain on task

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17
Q

Amnesia

A

State of memory dysfunction

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18
Q

Perception

A

Ability of an individual to recognize and interpret sensory information, high order function as it requires the individual to integrate auditory, sensory, visual, and somatosensory information
Should be screened for any type of brain injury

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19
Q

Clinical indicators of perceptual difficulty

A 
Brain Damage
Unable to perform self ADLs/simple tasks
Difficulty initiation/completing a task
Unable to identify common onbjects
Unable to follow simple directions
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20
Q

Unilateral Neglect

A

Not aware of one half of their body/plate/environment
Typically right-sided brain injury that impairs left side
Brain damage over eye damage
Lesion located in Right parietal lobe (parietal sensory association cortex)
Often right middle cerebral artery CVA

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21
Q

Clinical measures of neglect

A

Line Bisection: draw horizontal line and ask to draw line bisecting (bisect line to the right of the center in neglect)
Cancellation tests: cross out all objects they see on piece of paper

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22
Q

Hemianopia

A

Defective vision in half of the visual field
Lesion in optic pathway or tract
Check visual fields
May present with hemianopia and neglect

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23
Q

Apraxia

A

Movement disorder resulting in inability to perform movements without underlying cause
Cognitive deficit that interferes with motor planning
Lesion in frontal and posterior parietal lobes
i.e. when given scissors, try to use as a comb

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24
Q

Types of Apraxia

A

Ideomotor
Ideational
Constructional
Childhood apraxia of speech

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25
Q

Ideomotor Apraxia

A

Disconnect between idea of a movement and the execution
Knows what to do but can’t
Can’t walk on command, but can get up and get a coffee
Lesion in frontal and/or posterior parietal lobe

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26
Q

Ideational Apraxia

A

Inability to figure out how to perform a task
Given a hairbrush and told brush hair, but doesn’t know how to
Lesion in parietal lobe

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27
Q

Constructional Apraxia

A

Faulty spatial analysis and conceptualization of task
Unable to understand relationship of parts to whole
Can’t put sandwich together even though they are given the ingredients; all parts of clock are there but not correct
Lesion in posterior parietal lobe

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28
Q

Childhood Apraxia of speech

A

Developmental challenge in the brain and can’t form speech correctly
2-4 years: issues getting the wrong sounds/words
Won’t just grow out, refer to SLP

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29
Q

Judgment

A

Part of executive function
Impairments lead to impulsiveness, socially inappropriate behavior
Assess executive function if they can figure out how to fold/open a walker, find number in phone book, differentiate photos

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30
Q

Mood

A

Affects participation and treatment

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31
Q

What are the emotional states?

A 
Fatigue
Anxiety
Depression - impacts recovery
Delusion
Disinhibition - inappropriate expression of emotion
Aggressiveness
Apathy
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32
Q

Components of Musculoskeletal Domain

A

Strength: need at least 3/5 for most functional activities
ROM: visual screening followed by goni in limited range (AROM and PROM)
Posture: sitting and standing

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33
Q

Pressure Sores

A

Most common preventable secondary condition PTs need to assess for in neurologic dysfunction

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34
Q

Bony prominences at risk for pressure ulcers

A

Calcaneus
External Occipital Meatus
Sacrum

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35
Q

Causes of Ulcer

A 
Immobility
Moisture
Lack of Sensation
Poor Oxygenation
Poor Nutrition
Shearing Force
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36
Q

Trophic skin exam changes

A

Skin color: venous stasis (bluish/purple in LE)
Skin texture: smooth and shiny, absence of hair
Skin Temp: cool = impaired; hot=infected
Edema
Calf pain + increased temp + edema may = DVT
Braden scale: administered by nursing to determine risk

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37
Q

Upper Motor Neuron Lesions (cortex, brainstem, corticospinal tracts, spinal cord)

A 
Spasticity/Hypertonia
Exaggerated reflexes
Babinski and Clonus
Synergy
Weakness
Disuse Atrophy
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38
Q

Lower Motor Neuron Lesions (cranial nerves/nuclei, spinal cord - AHC, spinal root, peripheral nerve)

A 
Flaccidity/Hypotonia
Decreased or absent reflexes
No primitive reflexes
Weakness
Atrophy due to lack of innervation (severe wasting)
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39
Q

Reflexes

A

Muscle
Developmental: ATNR; STNR; postural synergy patterns: observed muscle hypertonicity and gross movement patterns
Primitive Reflexes: babinski, clonus
Cranial Nerve Testing

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40
Q

UE Synergy Patterns

A

Flexor component: elbow, wrist, and finger

Extensor component: shoulder ADD and IR, and forearm pronation

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41
Q

LE Synergy Patterns

A

Extensor component: Hip IR and ADD, knee extension, plantarflexion and inversion

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42
Q

Tonal Abnormalities

A 
Flaccidity
Hypotonia
Normal
Spasticity
Dystonia
Rigidity
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43
Q

Spasticity

A

Resistance to external stretch increases with increasing speed of stretch and varies with direction of movement
Resistance to external stretch rises above threshold speed

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44
Q

Dystonia

A

Involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both

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45
Q

Rigidity

A

Resistance to external stretch is present at very low speeds of movement, does not depend on speed, and doesn’t exhibit speed or angle threshold

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46
Q

Spasticity Physiology

A

Injury to pyramidal tracts (corticospinal)
CVA, CP, TBI
UMN Syndrome (babinski and clonus)
Chronic spasticity leads to contractures, deformity, activity limitations
Clasp knife response: feeling of letting go of resistance when stretching spastic muscle (autogenic inhibition)

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47
Q

Modified Ashworth Scale

A

Grades tone from:
0 (no increased tone)
4: Extremely stiff

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48
Q

Rigidity Physiology

A

Basal Ganglia lesion

Leads to contractures and activity limitations

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49
Q

Types of Rigidity

A

Cogwheel: alternating letting go and increased resistance (PD)
Leadpipe: constant
Decorticate: UE flexed and LE extended; above superior colliculus, reduce stimuli and position (TBI)
Decerebrate: UE and LE extended; between vestibular nucleus and superior colliculus; reduce stimuli and posture (TBI)

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50
Q

Positions that affect tone

A

UE: antigravity: UE flexed, adducted, wrist flexed = spasticity
LE: antigravity: LE extended, adducted, plantarflexed: spasticity

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51
Q

Dynamic components of tone

A 
Volitional effort
Arousal
Stress
Position
Medications
Temperature
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52
Q

Functional Balance Tests

A 
Berg/PBS
Tinetti
TUG and TUDS
Dynamic Gait Index; Functional Gait Assessment
BOT-2
Pediatric Functional Reach
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53
Q

Coordination

A

Ability to execute smooth, accurate, controlled motor responses
Based on intact and functioning nervous system
Fluidity of movement

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54
Q

Coordination characterized by:

A 
Appropriate speed
Distance (dysmetria)
Direction
Timing
Accuracy
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55
Q

Dysdiadochokinesia

A

Problems with alternating pronation/supination

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56
Q

Dysmetria

A

Problem with pointing and past pointing

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57
Q

Tremor

A

Either a resting tremor or intention worsens

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58
Q

Bradykinesia

A

Slowed gross and fine motor movement

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59
Q

Sensation Testing

A

Results from sensory testing => clinical judgments about diagnosis, prognosis, and outcomes
Sensory input impacts motor output

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60
Q

Sensory Testing Principles

A 
Position Patient: informal with supine
Socks off
Strict about eyes closed
Simple instructions
Remove clothing
Obscure vision
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61
Q

Sensory System classification

A

Receptors

Spinal Pathways

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62
Q

Receptors

A

Mechano, thermo, chemo, and pain
Cutaneous: nociceptors, Meissner’s corpuscles (touch), Pacinian corpuscles (deep pressure); Merkel’s disks (light pressure, 2 point discrimination)
Deep Sensory: Ruffini corpuscles (muscle and joint receptor)

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63
Q

Spinal Pathway

A

Spinothalamic: pain and temperature

Dorsal Column: discriminative touch

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64
Q

Spinothalamic

A

Nondiscriminative
Small, slow conduction
Skin origin
From dorsal root horn, cross in spinal cord, lower brainstem, thalamus

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65
Q

Dorsal Column

A

Discriminative
Large, fast conduction
Skin, joint, tendon origin
Dorsal column, cross in medulla to contra thalamus, sensory cortex

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66
Q

Dermatome Testing

A

Cutaneous area supplied by single dorsal root

Less likely to be dermatomal and more likely to to homunculus, but still test

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67
Q

Sensory Exam

A

Light touch (sharp/dull)
2 point: dorsal column
Kinesthesia/proprioception: dorsal column
Vibration: early screening in diabetic cases
Pain and temperature: lateral spinothalamic tract
Cranial nerve screening

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68
Q

Cranial Nerve Testing

A 
CN I: Smell
CN II: Read nametag and check visual fields
CN II, IV, and VI: eye movement and pupillary reflexes; Ptosis, diplopia, and strabismus
CN V: Open and close jaw
CN VII: Smile
CN VIII: hearing and scratch test
CN XI: MMT of SCM and trap
CN XII: stick tongue out
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69
Q

Cerebellum Function

A

Regulates coordinated movements
Rapid movement
Maintain posture, muscle tone, and equilibrium

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70
Q

Cerebellar Dysfunctions

A

Ataxia: uncoordinated
Hypotonia: Gamma input determined by cerebellum, so less function
Dysmetria: can’t judge distance or range
Dysdiadochokinesia: can’t perform rapid alternating movements
Tremor

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71
Q

Cerebellar Dysfunction Features

A

Movement decomposition: inability to perform smooth, coordinated movements
Gait Disorder: wide BOS, high guard
Rebound: loss of check reflex
Dysarthria: inability to perform motor component of speech articulation

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72
Q

Coordination Exams

A

Nonequilibrium: finger to nose, pronation/supination, tapping, heel to toe, heel on shin
Equilibrium: standing, feet together, tandem, perturbations, eyes open/closed

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73
Q

Basal Ganglia Function

A

Regulates initiation of movement, planning of complex motor tasks, automatic and postural adjustments

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74
Q

Basal Ganglia Dysfunctions

A

Bradykinesia
Rigidity: lesion in basal ganglion and extrapyramidal tracts
Resting Tremor
Akinesia
Chorea: ongoing, involuntary, discrete movements, rapid, jerky motions
Athetosis: continuous, flowing motions, writhing, twisting

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75
Q

Hyperkinetic Disorders

A

Unwanted excess movement (involuntary or voluntary)
Chorea
Athetosis
Dystonia

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76
Q

Cerebral Cortex Function

A

Perceiving and interpreting sensory information
Controlling voluntary movement
Controlling co-contraction

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77
Q

Cerebral Cortex Dysfunction

A

Spasticity

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78
Q

Activity Limitations Domain

A

Bed Mobility
Transfers
Locomotion
MOST IMPORTANT ASPECT OF EXAM

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79
Q

What are the core dimensions of PT Expert Practice?

A

Knowledge
Clinical Reasoning
Movement
Virtues

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80
Q

Knowledge

A

Multidimensional

Patient-Centered

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81
Q

Clinical Reasoning

A

Collaborative Process

Reflection-in-action

82
Q

Movement

A

Central Focus

Centered on Function

83
Q

Virtues

A

Caring

Commitment

84
Q

Clinical Reasoning

A

Sum of the thinking and decision-making processes associated with clinical practice
Process of reflective inquiry, in collaboration with a patient or family, which seeks to promote a deep and contextually relevant understanding of the clinical problem to provide a sound basis for clinical intervention

85
Q

Clinical reasoning is…

A

a continuous reflective activity
engages the patient and family in a collaborative decision-making process
acknowledges key contextual factors that will impact clinical interventions and patient outcomes

86
Q

Types of reflection

A

Reflection-on-Action: after the experience
Reflection-in-Action: make changes in real time
Reflection-for-Action: anticipate change for future interactions

87
Q

Types of clinical reasoning

A 
Hypothetico-deductive (Deductive Reasoning) 
Pattern Recognition (Inductive Reasoning)
88
Q

Hypothetico-Deductive Reasoning

A

Generation of a hypothesis based on results of tests/measures and testing that hypothesis
Used by novices in all situations and experts in challenging/unfamiliar situations

89
Q

Pattern Recognition

A

Quick retrieval of info from a well-structured knowledge base contrived upon previous clinical experience
Frequently used by experts during familiar situations as they recognize patterns previously encountered

90
Q

Deductive Reasoning Process

A 
ICF Framework
Patient Management Model
Clinical Practice Guidelines
Clinical Prediction Rules
Algorithms
91
Q

Inductive Reasoning Process

A 
Requires previous experience
Involves recognition of familiar clinical patterns
Reflection
Open-Ended questions
Writing clinical narrative
92
Q

Clinical Reasoning Framework

A

Cognitive Knowledge/Experiences
Analytical Skills/Critical Thinking
Situational Awareness/Context/Reflection/Frames of Reference

93
Q

Normal Newborn Behaviors

A

Flexion contractures at hips and knees
Flexion for everything in order to fit inside
Respond to auditory stimuli

94
Q

Abnormal Newborn Behaviors

A

Less flexion/resting extension
Shine light and disgusted/not alert/not crying
Cognition correlates to motor performance

95
Q

Normal Newborn Tone

A

Constant flexion

96
Q

Abnormal Newborn Tone

A

Passive motion easier to perform

More flaccid

97
Q

Normal Newborn Head

A

Little neck flexion, but keep chin off chest and keep head up a few seconds

98
Q

Abnormal Newborn Head

A

Zero flexion in UEs and neck

Can’t keep head up in sitting

99
Q

Components of pediatric PT Exam

A

Child/Family History
Systems Review
Tests and Measures

100
Q

Pediatric Exam

A

Developmental milestones: have they always been delayed or are there certain things they are behind in
Re-evaluation/roles in growth: expect to get better as they age
Culture/Family dynamics/Environment: some populations don’t let kids lay on ground, less motion in extremities, less neck muscles, decreased strength

101
Q

History-Parent/Child Interview

A 
Major Concerns
Developmental Goals
Start asking child around age 5
Important people in child's life
Typical day
102
Q

School, Behavioral, Psycho-social history

A

MH, LD, ADHD/ADD, TBI
Behaviors: sleeping and eating habits, activity level, temperament, drive/motivation, compliance/motivation, discipline, interests
Time spent in school/daycare, transport, play

103
Q

Cardiopulmonary Systems Review (Peds)

A

Heart Defects
Cystic Fibrosis
Muscular Dystrophy
Quieter voice, can’t breathe as deep, won’t be as physically active

104
Q

Musculoskeletal Systems Review (Peds)

A

Decreased strength on that side of body

Contractures

105
Q

Integumentary Systems Review (Peds)

A

Pressure Ulcers

106
Q

Neuromuscular Systems Review (Peds)

A 
Tone
Synergy patterns
Bed mobility
Transfers
Locomotion
Balance
107
Q

Cognitive-Affective Domain

A

Cognition: what toys they use, ask questions if older
Communication: hearing, vision, and ability to verbalize
Reflexes: differentiate UMN and normalcy

108
Q

Integumentary Domain

A

Visual tracking/attending
Auditory attending/Orienting
Sensory processing (body awareness, proprioception, motor planning, tactile input)

109
Q

Musculoskeletal Domain

A 
Observation
Palpation (soft tissue, bony)
Assessment of static/dynamic posture
AROM/PROM
Postural Alignment: thigh folds, leg length, pelvic height, genu varus/valgus, ankle/foot position
110
Q

Neuromuscular Domain

A 
Reflexes (developmental and MSR)
Coordination and balance
Tone
Functional Strength
Sensory Testing
111
Q

Activity Limitations/Gross Motor Skills Domain

A

Knowledge of age appropriate gross motor skills

Determine where child is in relation to norms

112
Q

Pediatric HOP-FA

A

Clinical framework designed to guide clinical reasoning in peds PT practice
Provides systematic, stepwise guide to the patient/client management process where the PT is asked to consider factors and issues that may affect clinical reasoning for the child and family

113
Q

Examination for infants and young children

A 
Observation!
Establish rapport in a relaxed atmosphere
Interactive play
Undress if appropriate
"Hands on" may be last to assess
Arena/play-based assessments
Change your agenda as you go
114
Q

Exam for preschool

A 
Observation
Play
Explain what you're doing
Arena/play-based
Self-care and ADL's
115
Q

Exam for School-aged children, adolescents, and adults with developmental delays

A

Custom techniques
Talk with patient
Approach cognitive age, not chronological

116
Q

Functional exam of motor function

A 
Playground, school, home, and community
Fine motor skills
Language skills
Receptive/Expressive
Self help-adaptive skills
Social/behavioral skills
117
Q

Purpose for Tests and Outcome Measures

A

Discriminative Measure: identify gross motor delay from “norm”
Predictive measure: prognosis - GMFCS
Evaluative Measure: detect progress over time
Baseline Measures: diagnosis and prognosis
Measure effectiveness of intervention
Research

118
Q

Construction of Peds Tests

A

Screening vs outcome measures

Norm vs criterion-referenced

119
Q

Norm-Referenced Tests

A

Utilize normal subject tests results as standards for interpreting scores
Not needed if given a diagnosis
Compare to typically developing children
Tests: AIMS, PDMS-2, PEDI, BOT-2

120
Q

Criterion-Referenced Tests

A

Scores interpreted on absolute criteria
Scores based on number of items performed correctly
Tests: GMFM, PBS

121
Q

Standardization of Tests

A

Process of systemization of the methods used to obtain a measurement
Reliability
Validity
MCID

122
Q

Screening Tools

A 
Purpose: identify developmental delays
Quick and cost effect
Identify need for outcome measure
Overview of child's development
Don't establish diagnosis
Milani-Comparetti Motor Development, Denver, AIMS, BINS
123
Q

Outcome Measures

A

Purpose: in-depth view of gross motor development
Help provide diagnosis or school placement
More time consuming and costlier
AIMS, PDMS-2, PEDI, GMFM, BOT-2, SFA, Wee-FIM

124
Q

Selection of Peds Tests

A 
Child and family goals
Disability domain
Test purpose
Age criteria
Norm vs criterion-referenced
Sensitivity vs specificity
MCID
125
Q

Domain of Disability: Body Structure/Function

A

PBS

Milani-Comparetti

126
Q

Domain of Disability: Activity

A 
AIMS
Denver II
PDMS-2
PEDI
BOT-2
SFA
Wee-FIM
127
Q

Domain of Disability: Participation

A

PEDI

SFA

128
Q

Scoring and Score Interpretation

A

Raw Score

Standard Score: expressed as deviation from mean; needed for norm-referenced

129
Q

Percentile Score

A

of children of same age expected to score lower than child tested

130
Q

Age Equivalent Score

A

Chronological age for which a certain score represents the average performance

131
Q

Scaled Score

A

Performance along a continuum
Not related to age
Don’t report, but helps you get deviation

132
Q

PDMS-2

A

Purpose: Gross and fine motor development by direct observation
Age: Birth - 6 years
Areas tested: reflexes (0 - 12 months), stationary, locomotion, object manipulation, grasping, visual-motor
Norm Referenced
Entire: 45 min
GM portion: 30 min

133
Q

PDMS-2 Scoring

A 
Must directly observe action
Scored "0", "1", or "2"
Basal Level: 3 "2's"
Ceiling Level: 3 "0's"
12 months or less: reflexes last
134
Q

PEDI

A

Purpose: Children with disability (physically or cognitively) and measures functional skills vs normality
Age: 6 months - 7.5 years
Areas: self-care, mobility, and social function
Norm-referenced
Time: 30-60 minutes

135
Q

PEDI Scoring

A

0 or 1

Caregiver assistance and modification 0 - 5

136
Q

SNAPPS

A 
Advanced clinical reasoning process
Summarize the most important aspects
Determine 2-3 appropriate tests
Compare and contrast tests to determine most appropriate
Ask about areas of uncertainty
Select areas to review and study
137
Q

BOT-2

A

Purpose: Assess gross and fine motor skills
Age: 4-21 years; higher level balance and coordination
Areas: fine manual control, manual coordination, body coordination, strength, and agility
Norm-referenced
OT and PT both use

138
Q

BOT-2 Administration

A

Must observe child performing

Used in school systems with children who are mildly involved due to high level coordination and balance required

139
Q

GMFM

A

Purpose: measure change in gross motor function over time in kids with CP
Age: 5 months to 16 years
Areas: GM function (lying, rolling, sitting, crawling, kneeling, standing, walking, running, and jumping)
Typically developing 5 yo should get 100%
Criterion-referenced with norm values using GMFCS for CP and DS
45-60 min

140
Q

GMFCS - CP

A

Purpose: Classification for children with CP looking at trunk control and walking to describe the level of involvement/severity
Age: 6 - 12 years
Levels I - V based on severity of involvement

141
Q

GMFCS General Classifications

A

Level I: walks without limitations
Level II: walks with limitations
Level III: walks using a hand-held mobility device
Level IV: self-mobility with limitations, may use power mobility
Level V: transported via manual chair

142
Q

GMFCS Level I

A

Walk at home/school/outdoors/community
Climb stairs without using railing
Perform running and jumping, but speed, balance, and coordination are limited

143
Q

GMFCS Level II

A

Children walk in most settings and climb stairs holding rail
Difficulty walking long distances and balancing uneven terrains/inclines/confined spaces
Walk with physical assistance, hand-held mobility device, or used wheeled mobility over long distances
Minimal ability to perform gross motor skills (running and jumping)

144
Q

GMFCS Level III

A

Walk using hand-held device in most indoor settings
May climb stairs holding rail with supervision/assistance
Use wheeled mobility when traveling long distances and may self-propel for shorter distances

145
Q

GMFCS Level IV

A

Use methods of mobility that require physical assistance or powered mobility in most settings
May walk for short distances at home with physical assistance or use powered mobility or body support walker when positioned
Manual wheelchair or powered mobility at school/outdoors/community

146
Q

GMFCS Level V

A

Transported in manual wheelchair in all settings

Limited in their ability to maintain antigravity head and trunk postures and control leg/arm movements

147
Q

Level I vs Level II

A

Level II - limitations walking long distances and balancing; may need a hand-held mobility device when first learning to walk
May use wheeled mobility when traveling long distances outdoors and in the community
Requires use of a railing to walk up and down stairs, and are not as capable of running and jumping

148
Q

Level II vs Level III

A

Level II: can walk without a device after age 4 (but may choose to use it)
Level III: need handheld device to walk indoors and use wheeled mobility in community

149
Q

Level III vs Level IV

A

Level III: sit on own, but require limited support; slightly independent in standing transfers, walk with handheld device
Level IV: supported sitting but self-mobility is limited; more likely to use manual or powered mobility in community

150
Q

Level IV vs Level V

A

Level V: severe limitations in head/trunk control, require extensive assisted technology and physical assistance; self-mobility achieved if child/youth can learn to operate power wheelchair

151
Q

MACS

A

Purpose: Describes how children with CP use their hands to handle objects in home/school/community
Age: 4-18 years

152
Q

MACS Level I

A

Handles objects independently and successfully

153
Q

MACS Level II

A

Handles most objects but with reduced quality and/or speed

154
Q

MACS Level III

A

Handles objects with difficulty; need help to prepare/modify environment

155
Q

MACS Level IV

A

Handles a limited selection of easily managed objects in adopted situations

156
Q

MACS Level V

A

Does not handle objects and has severely limited ability to perform simple actions

157
Q

Pediatric Balance Scale

A 
Purpose: assess balance in children; pediatric version of Berg
Age: Any age
Areas: Balance
Criterion-referenced
Time: 20 min
158
Q

PBS Bottom Line

A

Use with caution if not normalizing for age and gender, as they can’t determine delays in balance if not

159
Q

SFA

A

Purpose: assess function and guide planning for students in school
Age: K-6th grade
Areas: participation, task supports, activity performance, physical tasks, cognitive tasks
Criterion-referenced
Time: up to 2 hours

160
Q

Wee-FIM

A

Pediatric version of the FIM
Locomotion and transfers
Appropriate for child in inpatient rehab to observe functional abilities

161
Q

GMFM Scoring

A

Section C: crawling and kneeling
Section D: standing
Section E: walking, running, and jumping

162
Q

When does suck, swallow, and breathing on their own begin?

A

35 weeks

163
Q

Neural tube is formed at…

A

4 weeks

164
Q

Divisions of thigh, knee, calf, and foot; forming of umbilical forms…

A

8-9 weeks

165
Q

Eyes are almost fully formed…

A

9-12 weeks

166
Q

Inspiratory movements at the head/neck occur; ossification of skeleton, very active…

A

16 weeks

167
Q

Initial CNS/PNS myelination…

A

22 weeks

168
Q

Lungs mature to potentially viable state and begin to secrete surfactant… usually administer in addition to, but can breathe on their own…

A

24 weeks

169
Q

Generalized avoidance reflexes at lips and nose to light touch…

A

8-9 weeks

170
Q

Palmar grasp starts to emerge; mouth opening (without sucking) can be elicited; global flex/ext movements occur…

A

9-12 weeks

171
Q

Sucking reflex emerges…

A

17 weeks

172
Q

Head and extremities can move in isolated fashion; sucking/swallowing both present…

A

20 weeks

173
Q

Alert state, random movements, overall hypotonia…

A

28 weeks

174
Q

State differentiation more pronounced, movement dominated by trunk; hand to mouth movement begin; hypotonia decreases some but UE > LE…

A

32 weeks

175
Q

Vigorous; sustained cry; behavioral states clear; visually fixates and can briefly follow movement; hip knee and ankle flexion contractures are minimally present; well-coordinated suck-swallow-breathe…

A

36 weeks

176
Q

Physiologic flexion for UEs and LEs; more organized and coordinated movement; brief but sustained behavioral states; hand to mouth well establish; able to regulate systems better…

A

40 weeks

177
Q

Birth weight classifications

A

Extremely Low Body Weight < 2.2 lbs
Very Low Body Weight < 3.3 lbs
Low Body Weight: 3.3 - 5.5 lbs
Small for Gestational Age < 10%

178
Q

Maternal malnutrition vs gestational diabetes

A

Shoulder problems, brachial plexus injuries, hypotonic

179
Q

Cigarette smoking problems

A

Decreased circulation

180
Q

Alcohol use problems

A

Impacts Nervous System

181
Q

Illicit Drug Use

A

Impacts Nervous System

182
Q

HIV problems

A

Prophylactic medications reduce transmission

183
Q

Multiple Pregnancy

A

Twins => conditions, smaller, one may take more nutrition

184
Q

Hyperbilirubinemia (jaundice)

A

Liver function is immature; RBC differences present
Treatment: prevent kernicterus (unconjugated bilirubin at basal ganglia and hippocampus)
Phototherapy or exchange transfusion

185
Q

Gastroesophageal Reflux

A

Immature sphincters
Correlated to apnea events in premature and term infants
Treatment: smaller more frequent feedings; thick feedings; elevated head/upright; left sidelying, medication

186
Q

Necrotizing Enterocolitis

A

First 6 weeks of life and <2000 g
Factors: intestinal ischemia, infectious gents, poor formula tolerance
s/s: vomiting, abdominal distention, bloody stools, retention of stool, lethargy, decreased urine, respiratory status change
MEDICAL EMERGENCY
Treatment: withhold oral feeding, antibiotics, remove intestine

187
Q

Patent Ductus Arteriosus, Atrial Septal Defective, Ventricular Septal Defect

A

May close with or without medication, surgery perhaps

188
Q

PDA

A

May give medication and catheter with rubber band, but may need surgery
Usually close fairly easily

189
Q

Respiratory Distress Syndrome (hyaline membrane disease)

A

Most common cause of distress (lungs last to mature)
Pulmonary immaturity and lack of surfactant
Steroid pharmacologic management is common
Ventilator or ECMO may be needed
Surfactant may be administered if <30 weeks

190
Q

Patent Ductus Arteriosus Physiology

A

Ductus Arteriosus connect the pulmonary artery to the aorta
Usually closes soon after birth
High incidence in premature infants
Mixing of deoxygenated and oxygenated blood, so inadequate amounts of oxygenated blood to all extremities (feeding and breathing are intertwined in young infants)

191
Q

Ventricularseptal Defect

A

Similar to PDA in mixing of oxygenated and deoxygenated blood, but on a larger scale

192
Q

Bronchopulmonary Dysplasia

A

> 28 days chronological age and still need O2, as well as abnormal physical exam
Chronic diuretic medications may be needed
Monitor closely for infections

193
Q

Chronic Lung Disease

A

> 36 weeks and still need O2, as well as abnormal physical and radiographic exams

194
Q

NICU Musculoskeletal Conditions

A 
Club foot
General Asymmetry
Arthrogryposis
Plagiocephaly: flat spot
Congenital torticollis: birthing process
Congenital hip dysplasia
Tibial Torsion
Brachial Plexus Injury
195
Q

Myelomeningocele

A

High levels of alpha feto- protein (screened in pregnancy with prenatal care)
Surgery to close open back area often done 1-2 days after being born (C-section)

196
Q

Periventricular Leukomalacia

A

Associated with IVH
Symmetric, ischemic lesion of the brain (dying tissue)
With cysts: lots of problems, brain tissue not really there
Without cysts: less neurological issues
Need to try and minimize sequelae and monitor closely for seizures

197
Q

Retinopathy of Prematurity

A

Higher risk when on ventilator (can detach retina)
Ischemic event at retinal vessels
5 stages/zones
Contributions: BPD, VLBW, extreme prematurity, hyperoxemia, shock, hypothermia, vitamin E deficiency, light exposure

198
Q

Hypoxic-Ischemic Encephalopathy

A

Decreased oxygenation and blood flow: not always death, but deceleration of activity (usually larger term babies with cord wrapped around)
Low APGAR
Therapy = blanket
Seizures and abnormal tone/reflexes/behavioral state
Impairments may present in pulmonary, cardiovascular, hepatic, and renal function

199
Q

Intraventricular Hemorrhage

A

Common when <32 weeks and/or <1500 g
Blood filling in ventricles and tissue death along ventricles
Risk factor for CP
Most occur within first 72 hours of birth
Grades I-IV

200
Q

Failure to Thrive

A

Nonspecific diagnosis when infant is below 5th percentile on growth charts for height, weight, and head circumference
Can be related to feeding intolerance, cardiac or pulmonary compromise, etc.

201
Q

Lead Poisoning

A

Can cause mental retardation, neural tube defects, general risk for neurologic insults
Old homes tend to have lead paint (mouthing infants can ingest)

202
Q

Maternal Drug Use

A 
May lead to intrauterine growth restriction/retardation (cigarettes, alcohol, heroin, cocaine)
Growth Deformities
Neonatal Withdrawal syndrome
CNS injuries
Premature labor

Neuromuscular (1 decks)

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