Exam I Flashcards
how many weeks gestation is a child typically born?
38-40 weeks
in what order does a newborn develop from a kinesiological standpoint (starting with physiological flexion)? (3)
(1) physiological flexion
(2) anti-gravity extension
(3) anti-gravity flexion
does an infant develop mobility or stability first?
mobility is present in newborns first; stability occurs with the development of synergistic muscle control
what is the difference between structural, positional, internal, and external stability?
(1) structural: due to tight tissues
(2) positional: uses body parts to create stability (larger BOS)
(3) internal: righting and equilibrium reactions
(4) external: when an infant doesn’t any of the above stability and requires external support or caregiver for stability
what is considered a premature newborn?
born before 37 weeks gestation
what are some characteristics of premature newborns?
(1) decreased physiological flexion
(2) low muscle tone
(3) can’t lift head and neck to clear airway
(4) immature development of organ systems
(5) poor feeding skills
what does APGAR stand for? what do each mean?
- Appearance (skin color)
- Pulse (HR)
- Grimace (reflex to stimulation of foot sole)
- Activity (muscle tone)
- Respiration (breathing)
what is the max score on the APGAR? what indicates a high risk newborn?
(1) max score: 10
(2) high risk: <7
what does a score of 5-7 on the APGAR indicate? what about a score <2?
5-7: indicates less intense resuscitation or supplemental O2 is needed
<2: indicates they have asphyxia and a definite need for resuscitation
what is the difference between righting and equilibrium reactions?
(1) righting reactions occur when the COM is within the COG
(2) equilibrium reactions occur when the COM is outside the COG
in what order to equilibrium reactions occur? at what months doe these occur?
(1) prone: 6 months
(2) supine: 7 months
(3) side lying
(4) sitting: 8 months
(5) quadruped: 9 months
(6) kneeling
(7) standing: 12 months
what are some risk factors for brachial plexus injuries during birth?
(1) shoulder dystocia (shoulder stuck in birth canal)
(2) LGA (large for gestational age)
(3) gestational diabetes
(4) prolonged labor
(5) breech delivery
what nerve roots does Erb’s Palsy typically affect? what posture would an infant with this condition present?
(1) C5-C6
2) waiter’s tip position (shoulder extension, IR, adduction; elbow extension, pronation; wrist and finger flexion
what nerve roots does Klumpke’s Palsy typically affect? what posture would an infant with this condition present?
(1) C8-T1
(2) no involvement of shoulder or elbow; postures in supination with weak wrist flexors, extensors, and intrinsics
what nerve roots does Global Palsy typically affect?
C5-T1 (entire brachial plexus)
what is a main complication that can occur due to brachial plexus injuries?
(1) positional torticollis; this is because an infant will often favor the arm with sensation causing them to turn towards that direction (accompanied by unilateral neglect)
what are TORCH infections?
an acronym for a group of infections that can have a serious impact on the fetus when exposed to during pregnancy or delivery
what does TORCH stand for?
T - toxoplasmosis O - other (syphilis, chickenpox, HIV, lyme direase) R - rubella C - cytomegalovirus H - herpes infections
what can cause toxoplasmosis? (4)
(1) contact with cat feces
(2) under cooked meat
(3) contaminated water
(4) unpasteurized goat milk
what impairments can toxoplasmosis lead to? (5)
(1) hydrocephalus
(2) seizures
(3) developmental and motor delay
(4) intellectual disability
(5) blindness
what does failure to thrive mean in regards to child development?
an infant isn’t growing at their expected rate (below 5th percentile)
what impairments can syphilis lead to? (6)
(1) rash
(2) hearing loss
(3) damage to eyes or teeth
(4) CNS involvement
(5) failure to thrive
(6) fetal or perinatal death
what impairments can varicella-zoster lead to? (3)
(1) eye damage
(2) CNS damage
(3) ANS dysfunction
what are some signs and symptoms that an infant may have HIV? (3)
(1) failure to thrive
(2) yeast infection
(3) developmental delay
what impairments can rubella lead to? (7)
(1) rash
(2) cataracts
(3) hearing loss
(4) congenital heart defects
(5) diabetes mellitus
(6) liver damage
(7) IUGR
what impairments can cytomegalovirus lead to? (5)
(1) IUGR
(2) hearing loss
(3) hypotonia
(4) motor impairment
(5) cognitive impairment
what impairments can herpes simplex lead to? (5)
(1) rash
(2) eye damage
(3) encephalitis
(4) CNS damage leading to seizures and tremors
(5) multi organ damage
what is considered low birth weight, very low birth weight, and extremely low birth weight?
(1) low: 3.5-5.5 lbs
(2) very low: 2.2-3.3 lbs
(3) extremely low: <2.2 lbs
what is RDS? what causes it?
(1) respiratory distress syndrome
(2) occurs due to an insufficient amount of surfactant; sufficient levels don’t develop until 37-38 weeks gestational age
what causes bronchopulmonary dysplasia (BPD)?
results from supplemental O2 and ventilator use, especially longer than 7 days; associated with RDS
what are newborns with RDS, BPD, and chronic lung disease at risk for?
they’re at a higher risk for neurodevelopmental delay due to decreased oxygen levels to the CNS
what is meconium?
infant’s first bowel movement
what is meconium aspiration syndrome? what can this condition cause?
(1) this occurs when a baby inhales meconium within the amniotic fluid in utero or during delivery
(2) respiratory distress syndrome (leading to developmental delay)
what is intraventricular hemorrhage (IVH)? what newborns are at the highest risk for getting this condition?
(1) bleeding inside or around the ventricles of the brain (typically occurs within first 48 hours following birth)
(2) premature infants (<32 weeks GA), low birth weight
what can be said about grades IVH grades I and II?
grades I and II have minimal risk for long-term neurological deficits
what can be said about grades IVH grades III and IV?
grade III and IV have significant risk for neurological deficits
what is the leading cause of CP?
periventricular leukomalacia (PVL)
what is periventricular leukomalacia (PVL)? what can form as a result of this condition?
(1) it’s believed to be caused due to too little cerebral blood flow (ischemia)
(2) formation of cystic cavities (which can lead to diplegia or quadriplegia)
what is hypoxic ischemic encephalopathy (HIE)?
(1) brain injury due to decreased oxygen and glucose (occurs within 72 hours of birth)
what are the HIE grades? what do each involve?
(1) Mild: infants require resuscitation
(2) Moderate: infants require resuscitation and need short term assistance with respiration
(3) Severe: infants require resuscitation and prolonged mechanical ventilation
what are GER and GERD? how do they present?
(1) GER: gastroesophageal reflux; occurs when stomach contents erupt into esophagus due to wekaness of lower esophageal sphincter (present in 2/3 of healthy infants)
(2) GERD: gastroesophageal reflux disease; causes pain and poor weight gain (more common with neurological impairment
what can be done to prevent GERD?
position the baby’s head at 30 degrees or upright when feeding and at least 30 minutes following feeding
what is neonatal abstinence syndrome?
results from the mother using drugs during her pregnancy; child exhibits signs of withdrawal (irritability, tremors, failure to thrive, increased muscle tone)
what is necrotizing enterocolitis? what can this condition cause?
(1) acute inflammation of bowel (primarily seen in preemies); results in intestinal mucosal ulceration, hemorrhage, and necrosis
(2) can cause short gut syndrome, which is inability for the baby to get all of the nutrition required and can result in a permanent feeding pump
what is retinopathy of prematurity (ROP)?
abnormal growth of blood vessels in immature part of the retina due to high levels of supplemental O2; leads to all kinds of sight problems and could cause blindness
what is hyperbilirubinemia? how is it treated?
(1) also known as jaundice; occurs with excessive amounts of bilirubin in the blood; if untreated can cause brain damage to the basal ganglia
(2) treated with phototherapy (UV light)
what are normal vitals for newborns?
(1) HR: 120-180 bpm
(2) RR: 40-60 breaths per minute
(3) O2: 96-98%
is clonus in a newborn normal?
4 beat clonus in a newborn is normal; anything more is abnormal
what causes JIA?
it’s unknown, but it’s thought the child has a genetic tendency and then an environmental factor induces it (virus, trauma, etc.)
what is both a primary and secondary impairment observed with JIA?
gait deviations
what are some signs and symptoms of JIA?
(1) joint swelling, pain and stiffness
(2) morning stiffness
(3) muscle atrophy or weakness
what are the 3 types of JIA?
(1) systemic arthritis
(2) oligoarthritis
(3) polyarticular arthritis
what is the most common form of JIA?
oligoarthritis
how does oligoarthritis present?
(1) affects 4 or less joints
(2) asymmetrical
(3) most commonly affects the knees, ankles, and elbows
(4) best prognosis
(5) age of onset: early childhood
what is the most painful and most debilitating form of JIA?
systemic arthritis
how does systemic JIA present?
(1) onset accompanied by a fever for >2 weeks
(2) symmetrical joint involvement
(3) typically starts with a rash or fever
(4) age of onset: throughout childhood
what are the two sub types of polyarticular JIA?
(1) rheumatoid factor-positive
(2) rheumatoid factor-negative
how does polyarticular JIA present?
(1) affects 5 or more joints
(2) symmetrical involvement
(3) affects large and small joints
(4) may progress to severe and deforming arthritis
what does polyarticular JIA present with that no other form of JIA presents with?
it may present with rheumatic nodules (elbows, tibial crests, fingers)
what does morning stiffness due to JIA put the child at an increased risk for?
increased risk for falls
what is a child with JIA at an increased risk for due to swelling? (2)
(1) contractures
(2) DVT
what modality should be avoided in patients with JIA and why?
heat modalities due to the inflammation
what is the most common type of OI?
type I
how does OI type I present?
(1) blue sclera
(2) weight and lengths at birth are normal
(3) short stature postnatally
(4) conductive hearing loss
(5) bone fragility / joint hyper laxity
how does OI type II present?
not compatible with life
how does OI type III present?
(1) severe form
(2) progressive deformation of long bones
(3) very short stature
(4) severe kyphoscoliosis leading to respiratory compromise
how does OI type IV present?
(1) mild to moderate deformity
(2) post natal short stature
(3) dentinogensis imperfecta
(4) ambulators
what should the PT intervention for OI be focused on?
(1) weight bearing should be encouraged to stimulate bone growth
(2) aquatic therapy
what is a contraindicated treatment for OI?
NO PASSIVE STRETCHING
what are some considerations for OI?
(1) no force across long bones
(2) head and trunk should be supported
(3) position in neutral
(4) don’t over dress (this population has problems with temperature regulation causing excessive sweating)
what is the clinical presentation of patients with AMC?
(1) non-progressive neuromuscular disorder (primary impairments don’t worsen overtime)
(2) severe joint contractures
(3) muscle weakness and fibrosis
(4) normal sensation but may have decreased DTRs and myotomes
how does frog-like AMC present?
(1) hips abducted and ER
(2) knees flexed
(3) shoulders IR
(4) elbows extended
(5) wrists flexed and ulnar deviation
how does jackknifed AMC present?
(1) hips flexed
(2) knees extended
(3) clubfeet
(4) shoulder IR
(5) elbows flexed
(6) wrists flexed and ulnar deviation
what conditions is a Pavlik harness contraindicated?
(1) CP
(2) neurological conditions
(3) spina bifida
for DDH, what is the Barlow test for?
a stress test that dislocates the hip (you will feel a clunk)
for DDH, what is the Ortolani test for?
reduction test that relcoates the femur into the acetabulum (you will feel a clunk)
