Exam 3 (Peds and Geriatrics) Flashcards

Question

Infant Fine Motor Milestones

Answer 1

· Reach and grasp (VOLUNTARY, pre reqs for reaching) · Grip progresses from Ulnar side to radial side during 4 months - 1year · Sequence: Ulnar palmar/primitive squeeze (4 months) to palmer (5 months) to radial palmer (6/7 months) to radial digital (8/9 months) to pincer/precision grip (9/10 months for inferior/pads of fingers, 11/12 for superior/tips of fingers)

Answer 2

· Ducts/shunts CLOSE at birth, pulmonary still NOT efficient · Increased HR (120-180 bpm) and RR (30-40 breaths/min)

Answer 3

· Large Heads · High center of gravity · Growth is cephalo-caudal and proximo-distal

Answer 4

· Hypertrophy after birth (Hyperplasia before birth)

Answer 5

· Excess motor neurons at birth is normal · Natural pruning occurs · Myelination occurs over time (ex: cerebellum by 1.5 years)

Answer 6

1) Vestibular · First system to develop (6 months after conception) · Use begins BEFORE birth 2) Auditory · Acuity is low/poor · Perception increases around 4 months for Primary caregiver's voice 3) Visual · Not fully developed, myelination and synaptic potential continues · Contrast> color initially · Good visual acuity by 6 months · Most change occurs during 1st year

Answer 7

· Cognition: intention, attention, memory, information processing · Perception: understanding the meaning of information

Answer 8

· Receptive: localize familiar sound (4 months) · Expressive: babbling sounds (5 months), reinforces sounds (11 months)

Answer 9

1) Prenatal: -9 mo to birth 2) Reflexive: Birth to 2-4 wks 3) Pre-adapted: 2-4 wks to 1yr 4) Fundamental Skills: 1 to 7yrs 5) Context-specific: 7 to 11yrs 6) Skillful: 11+yrs

Answer 10

· Rooting: 7 mo gestation to 2-3 month · Sucking: ^ · ATNR: birth to 4-6 mo · Positive support: 8 mo gestation to 2-3 mo · Step: ^ · LE placing: ^

Answer 11

· Heading righting (optical): 4 mo · Head righting (labyrinth): 4 mo · Neck (on body): 5 mo · Body on body: 5 mo

Answer 12

· Sit: protective extension (FWD): 6 mo · Sit: protective extension (SIDEWAYS): 8 mo · Sit: protective extension (BKWD): 10 mo · Sit Equilibrium: 8 mo · Quadraped Equilibrium: 10 mo

Answer 13

· Baby has eyes covered ("vision obliterated") · Uses vestibular system to perform head righting, determines if vestibular system is in tact

Answer 14

1) Mobility and locomotor · Walking, running, jumping 2) Manipulative Skills · fine motor skills (eating, writing, drawing) · gross motor skills (throwing, catching, kicking, dressing) 3) Balance · static or dynamic

Answer 15

· Dominant handed/footed · Preference by age 4

Answer 16

· Birth to 2yr: sensorimotor driven · Age 2-7 yr: Preoperational (classification, egocentric, avoids punishment)

Answer 17

· FLACC: face, legs, activity, cry, consolability · Children 3& under who can't self-report pain using faces or analog scale (unless cant verbalize pain) · 2 pts per category, 10 pts max (high score is high pain) ·

Answer 18

· Ages 3-7 · Happy face = no pain, sad face = pain · Scale from 0 (no pain) to 10 (hurts worst), score greater than 3/10 requires action

Answer 19

1) Walking 2) Running 3) Galloping and jumping (vertical bounce) 4) Jumping (broad/standing long/2 feet) 5) Hopping (1 foot) 6) Skipping

Answer 20

· Age 1 & under (pre-verbal) - use parents - use infant talk - expect only 2-3 words (low verbal communication) · Ages 2-5 (pre-school): - use play - 1:1 instructions * FLACC Scale for ages 3 & under · Year 5-7 (school-age) - simple sentences - can express needs - game-like activities - multi-step instructions can begin -group instructions * Faces Scale for ages 3-7

Answer 21

· Development emerges from interactions among constraints (environment, organism, task)

Answer 22

· Cardiopulmonary: - smaller SV - HR: 120 to 90 BPM · Lungs: -small airways - RR: 22- 35 breaths/min · MSK: - flat/inverted feet, knee varus (age 2) · Knee VALGUS (3-4 yo) - excess lumbar lordosis - plantar arch developed by age 4 · NS myelination - injury at young age could present w/ deficits later in life - overinclusive (take in a ton of information but cant process/focus it all, thus cant dual task and hard to grab attention) · Visual Perception - know what something is * PT: simple, grab attention, use bright colors · Proprioceptive Awareness (still developing): - clumsy

Answer 23

· Overinclusive: taking in a lot of information but unable to process/focus on specifics * PT Job: get attention for instructions bc kids are easily distracted

Answer 24

· Qualitative (movement PROCESS/ how it's happening): - components - sequences *coordination (ex: accuracy and precision of throwing a ball) · Quantitative (movement PRODUCT/outcome): - result - distance/height/speed - completed vs not completed *performance (ex: how far they can throw a ball)

Answer 25

· Ages birth/18 mo - 5 yo (but best to use AIMS for 0-18mo) · BEST for 18mo- 5 yo · Identifies atypical/delays in development · Product (amount) > Process (form)

Answer 26

· Learning to control skills and combine movements (ex: Control- terminating mvmnt, Combine- throwing a baseball) · Learning cognitive strategies for movement · Learning culturally appropriate motor skills

Answer 27

1) Structural: rate of change - structure and size of body (physical) - changes in myelination, synaptic connections, experience driven connections (perceptual-cognitive dev.) 2) Functional: how they can use their environment - strength (physical) - cardiovascular efficiency - Aerobic vs anaerobic power - Norms vs consequences (perceptual-cognitive dev.) * Experience driven

Answer 28

· Begins to dominate during context specific stage · Hyper-focus on one thing

Answer 29

· Ages 4- 21 · Discriminative and evaluative (can discriminate between different levels/concepts and can evaluate if someone is delayed/behind in development) · 7 items

Answer 30

· To build verbal (declarative/explicit): - teach back strategy - positive feedback · To build motor (procedural/implicit): - increasing reps - pt explain as performing

Answer 31

· Be authority figure · Interact directly · Explain why · Challenge them but allow success · Understand what motivates them, use that to offer rewards

Answer 32

· High Tone appears more rigid/stiff · Low tone appears more flaccid

Answer 33

· Beginner: - UE: push and reach to bilateral push - Trunk: FULL Rotation - LE: jump to squat · Advanced: - UE: symmetrical reach - Trunk: NO rotation - LE: symmetrical narrow based squat with balance step

Answer 34

Newborns have greater flexor tone (initial conditions) and use head and arms to initiate, momentum carries to other side

Answer 35

1) PDMS · Reflexes · Stationary (push ups) · Locomotion (walking down stairs) · Object Manipulation (throw ball at target) 2) BOT-2 ·Bi-lateral coordination (jumping jacks w same sides synchronized, tapping feet and fingers w same sides synchronized) ·Balance ·Running speed and agility (stationary/side hop, shuttle run) · Upper Limb Coordination (dribbling a ball, throwing at target) · Strength (wall sit, push up, sit up)

Answer 36

1) PDMS · Grasping · Visual-motor integration (building tower) 2) BOT-2 · Fine Motor Precision (filling in shapes) · Fine Motor Integration (copying shape) · Manual dexterity (placing pegs into pegboard, sorting cards, etc)

Answer 37

· 0-2 pts per subtest (0= did not perform correct, 2= performed correctly) · Score of 3 "0's" in a row = ceiling (bc not going to do any better on following tests) · Score of 3 "2's" in a row = basement

Answer 38

· Context-Specific: COMBINE mvmnts and control skills · Skillful: COORDINATE and control

Answer 39

1) APGAR (birth) 2) AIMS (0-18mo) 3) FLACC ( 3 and under) 4) FACES (3-7 yo) 5) PDMS-2 (birth/18mo - 5 yo) (best to use AIMS for 0-18 mo) 6) BOT-2 (4-21yo)

Answer 40

· Biomechanically efficient coordination (energy conservation) · Control of coordination · Variety of contexts (kicking ball in multiple planes and lengths, penalty kick vs corner kick) · Automation, do 2 things at once

Answer 41

· Power: hormonal (estrogen/testosterone affects FORCE) and cultural influences (nutrition) attribute to males having greater power than females · NO difference in balance between sexes

Answer 42

1) cognitive and moral (conventional/external ethics to post-conventional/personal ethics) development 2) Body Parameters 3) Problems of adolescence and puberty 4) Task and environmental constraints

Answer 43

1) Fundamental: pre-operational (classification NOT conservation/logical thinking) 2) Context-specific: concrete operational (ex: kick ball hard on playground but soft inside house) 3) Skillful: formal operational/abstract thinking

Answer 44

· Physical inactivity is a leading cause of disease and death · Half of adults over 18 meet guidelines for aerobic physical activity · 1/4 of adults over 18 meet guidelines for aerobic and muscle strengthening activities

Answer 45

Damage, harm, loss, fragility, or failure associated with aging systems (slow, progressive decline)

Answer 46

1) Primary (Genetic Theory): internal causes, genetically determined · Hayflick Limit theory- limited number of times a cell can divide 2) Secondary: external causes and damage systems · Weak and Tear Theory · Cellular Garbage/Mutation theories · Immune Systems Theory: body loses ability to fight infections · Hormonal Theory: loss of hormones

Answer 47

1) Linear Decline: inevitable decline 2) Catastrophe: neuronal function remains optimal w/ aging unless disease occurs and causes a decline in function

Answer 48

· Successful Aging: higher stress tolerance · Non-Successful: lower stress tolerance

Answer 49

· Age 30: 1% strength loss/ year or 10%/decade, 40% decline in force generation follows · Type I and II fibers decrease, protein synthesis decreases, harder to build muscle * TYPE II DECREASE FASTER THAN TYPE I · Strength and Power are important for function

Answer 50

· Type I: - slow twitch - endurance *ex: distance runners · Type II A: - fast twitch - strength/power *ex: sprinters · Type II B: - FASTEST twitch (fatigues quickest) - power *ex: sprinters * Type A can be converted to Type B

Answer 51

· Age-related muscle mass loss · Diagnosis Requirement: low muscle mass AND low strength OR low physical performance

Answer 52

Age 30, accelerates around age 50

Answer 53

· Normal: collagen fibers and synovial membranes degrade, synovial fluid decreases · Pathological: degenerative joint diseases (osteoarthritis)

Answer 54

· Normal: - M1 and S1 lose neurons - reduction in nerve conduction velocity resulting in DECREASED MVMNT FLUIDITY AND INCREASED PROCESSING TIME * BG AND BRAINSTEM REMAIN STABLE

Answer 55

· decreased processing speed · decreased accuracy · shortened attention span

Answer 56

· decline in HR and aerobic capacity · Increased stiffness of heart and vascular tissues

Answer 57

· Visual System normal aging · hardening of lens and flattening or cornea, hard to focus on close objects

Answer 58

·Auditory system normal aging · sensorineural hearing loss · Difficulty hearing high pitch

Answer 59

· Vestibular System normal aging · Inability to use vestibular cues fo postural control (ex: standing w eyes closed on foam pad)

Answer 60

· Diabetic Peripheral Neuropathy: sensory changes in distal extremities due to nerve damage by high blood sugar

Answer 61

1) Hyposmia: diminished sensitivity to SMELLS 2) Hypogeusia: diminished sensitivity to TASTE

Answer 62

1) Balance 2) Gait 3) Transfers 4) Reaction Time 5) Eye-Hand Coordination 6) Bilateral Activities 7) ADL's

Answer 63

1) Postural Control (balance): increased sway, decreased anticipatory - results in INCREASED FALL RISK 2) Gait: shorter step, increased cadence, increased ankle eversion, decreased ankle ROM 3) Reaction Time: increased, LE > UE 4) EYe-Hand Coordination: increased manipulation time, decreased hand dexterity

Answer 64

1) BADL: bathing, dressing, feeding, toileting 2) IADL: transportation, meal prep, housework, phone usage/basic communication * Most functional bi-lateral movements require NON-SYMMETRIC actions of each hand

Answer 65

* Frail: Must meet at least 3 of the criteria * Prefrail: 1-2 criteria 1) Unintentional weight loss 2) Low grip strength 3) Self-reported exhaustion 4) Slow Gait 5) Physical inactivity

Answer 66

1) Have you fallen in the last year? · Amount? · Injured? 2) Do you feel unsteady when standing or walking? 3) Do you worry about falling? * If yes to any questions then pt is considered to be at increased fall risk

Answer 67

1) IQ: remains steady through adulthood 2) Crystallized Intelligence: gradually increase through adulthood (acquired knowledge) 3) Fluid Intelligence: peaks during adolescence, declines rapidly during adulthood (ability to think on feet/mental speed, problem solving, spatial manipulation)

Answer 68

· Memory and language affected · Criteria: multiple memory deficits and AT LEAST ONE of the following - Aphasia: loss of expressing or understanding speech - Apraxia: loss of ability to perform purposeful actions - Agnosia: loss of sensory processing, such as recognizing sound/faces/objects - Executive Functioning disturbances

Answer 69

1) Alzheimer's Disease (most common) · Memory loss followed by language · Atrophy and shrinkage of brain tissue 2) Vascular Dementia: multiple small/large strokes 3) Lewy Body Dementia: mimics PD symptoms · Parts of Brain Impacted: 1) Frontal Lobe: executive/impulse control 2) Temporal Lobe (L>R): language 3) Hippocampus: memory 4) Occipital Lobe: vision (peripheral vision impacted, approach pt from FRONT)

Answer 70

1) No memory deficit 2) Begin masking cognitive issues 3) Denial, begin getting lost in unfamiliar locations 4) Poor safety awareness, poor historians * LAST STAGE TO TEACH WALKING W DEVICE, INCREASED FALL RISK * PT should use VISUAL CUES 5) No safety awareness, tunnel vision * PT should frame sessions similar to activities pt enjoyed in past 6) Increased fall risk due to shuffled gait and decreased step length, dont recognize objects, no fine motor 7) Dependent with ADL/s and all functional activities * PT should consider positioning, skin integrity, weight, and preventing contractures

Answer 71

1) Functional Reach · balance · stability in fwd direction 2)TUG (standard, cognitive, manual) · Mobility and balance 3) Chair Stand (30 second and 5x STS) · 30 Sec: strength and endurance · 5x STS: strength and function (and power{force/time}) 4) Romberg (Standard, Sharpened, Challenged) · STATIC balance · proprioception, balance, and NMR pathologies · Standard: feet together (EO, EC) · Sharpened: tandem/heel-toe (EO, EC) · Challenged: tandem with cervical rotation 5) 10 Meter Walk Test · Gait speed 6) Four Square Step Test (FSST) · DYNAMIC balance 7) Grip Strength · hand strength 8) Box and Blocks Test · UE function (gross and fine motor) · Good for stroke pts 9) 9 Hole Peg · Visual-motor coordination (UE speed, intrinsic hand muscle control, visual perception) 10) Sequential Finger-Thumb Test (EO and EC) · Coordination (all ages)

Answer 72

1) Allow extra time for processing 2) Sit face to face 3) Speak slowly