Examination and Documentation of the Pediatric Client Flashcards
What is the international classification of functioning, disability, and health?
Unified/standard language and a framework set forth by the World health Organization.
Shifts emphasis from disability and focuses on abilities of the individual.
ICF organizes info into 2 parts: part 1 is functioning and disability and part 2 is contextual factors
There is a child and youth version
What are the 6 categories of the ICF?
Body functions: physiologic and psychologic functions of the body (e.g. functions of the joints and bones, muscle functions, reflexes, voluntary movement, gait)
Body structures: organs, limbs, trunk and components
Activity: performance of task or action
Participation: involvement in life situations- home, school, community activities, social relationships
Environmental: physical, social, and environment in which people conduct their lives
Personal: background of person’s life and living that is not part of the health condition e.g. lifestyle, habits, coping styles
What are components of the PT examination?
History: systematic gathering of data to determine why client is seeking services, interview
Systems review: record review, collaboration with other team members, brief or limited examination of anatomical/physiological status of CV/pulm, integumentary, MS, and NM systems and communication, affect, cognition, language, learning style
Tests and Measures: used to investigate diagnostic hypotheses generated during the history and systems review
Observation
What are the parts of the subjective for pediatric exams?
Birth/Medical history
Developmental history
Social history, functional status/activity level (including self care, behavior)
Communication abilities
Cognition
Home/childcare/school environment
Current complaints/concerns (school, childcare, home)
What are parts of the history/medical status during pediatric exam?
GA at birth/birth weight
Current age
Medical complications, if any
Ongoing medical concerns, including diagnoses/conditions and medications
What tests and measures may be used during pediatric exam?
Assistive device, orthotics, gait/locomotion/balance/mobility, motor function, posture, ROM, self care, ventilation/respiration, home/school/play, pain, arousal/attention/cognition
Specific tests: anthropometrics, ADL, strength, functional ROM, reflexes, balance assessments, standardized assessment
What is ROM like in full term newborns?
Limited hip and knee extension and greater dorsiflexion when compared to adults
Can ROM be reliably used in children?
Reliably tested in healthy children, but reliability varies with pathology
Change in ROM measurements may not signify a meaningful, functional change
Can MMT be used in children?
Yes. Child must be able to follow instructions
What is MMT reliability?
Reliable with DMD and Down syndrome Not reliable in children with CP Hand held dynamometers reliable as young as 2 years with hand held Isokinetics reliable as young as 6 years Functional strength based on milestones
List the ways you must evaluate exam findings in pediatric clients?
Identify strengths
Identify barriers to movement/function
Prioritize movement problems
Hypothesize relationship of each of these factors to activity/participation limitations
Develop goals/intervention plan accordingly
Use findings of tests and measures to determine impairments of body function and structures
Use findings of observation, mobility assessments and/or standardized assessments to determine activity limitations
Use findings of observation and interview and to determine restrictions in participation
What are special things you must consider when examining an infant?
Time of day (feeding and nap time) Parent's schedules Natural environment Naturalistic observation Examination may be in random order based on desires/needs of infant
What are special things you must consider when examining a young child?
Time of day (nap time) One or both parent's schedules Natural environment Naturalistic observation Comprehensive developmental assessment- cognitive, motor, social, speech language and self help in natural environment (arena assessment)
What are special considerations for examining a preschooler or school aged child?
Schedule Natural environment Naturalistic observation Team approach Comprehensive developmental assessment- cognitive, motor, social, speech language and self help in natural environment (arena assessment)
What are intervention strategies for children?
Gross motor activities in a functional context: play Play based therapy from infants and young kids Incorporate toys and games Stretching exercises Strengthening Balance activities Natural environment Group with another child if possible
What are types of stretching, balance, and strengthening exercises?
Stretching: PROM, animal poses, yoga
Strengthening: core, tummy time, squatting games, upper and lower extremity weight bearing activities
Balance: kicking, squatting, stepping over, mini trampoline, different surfaces, therapy ball, obstacle course
What are types of toy and gam activities?
Gross motor games
scooters, twister, hula hoops, bubbles, tunnels, hopscotch, ball activities, rocker board, bean bag, music games, mirrors, scooter soccer, made up games
Goals and outcomes for pediatric clients should be..
Determined with help from child, parent, teacher, etc.
Related to functional skills
Focused on participation and activities
Realistic and achievable
Easily understood and free of professional jargon
Goals not intervention
What should goals/objectives include with pediatric clients?
Statement of behavior to be achieved (who, what)
When and under what conditions the behavior will be achieved (specific details, context)
Measurement criteria used to determine achievement (level of assist, # of attempts)
What is an example of a goal for clients?
Who, What, Under What condition, Criteria for Success, By when
What does SMART and ROUTINE stand for in regards to goals/objectives and strategies to achieve them?
Specific, Measurable, Attainable, Routine-based, Tied to functional priority
Routine based, Outcome related, Understandable, Transdisciplinary, Implemented by teacher/family, Non judgmental, Evidence based
What does frequency and duration of therapy depend on in pediatric clients?
Depends on setting:
Outpatient, acute care, special programs
Early intervention services: individualized family service plan, regulated by individuals with disabilities act
School based therapy: individualized education plan, regulated by individuals with disabilities act
What is documentation like for pediatric clients?
Depends on setting
Evaluation report, daily note, progress report, discharge summary
What is terminology for NICU?
Special care nursery (SCN)
Neonate- newborn
Premature birth (less than 37 weeks GA)
What are NICU birth weights?
Low birth weight- LBW (less than 2500 g)
Very low birth weight- VLBW (less than 1500 g)
Extremely low birth weight- ELBW (less than 1000g)
Small for gestational age- SMA (less than 10th percentile in weight)
In what instances does PT get referred for NICU?
Infants who show signs of CNS impairment
Specific neuromuscular or orthopedic problems
Multiple medical or genetic problems
Other symptoms that put infant at risk for developmental problems
What is purpose of exam/eval for NICU?
Identify participation restrictions, particularly barriers to normal development.
Identify activity limitations, particularly in terms of parent child interaction.
Identify body structure/function impairments that require intervention
Identify methods of positioning and handling and ways to adapt the environment to optimize development
What are parts of examination for NICU?:
History (birth and medical) including current medical status
Systems review
Tests and measures: precautions/contraindications, behavioral state/alertness, active movements/strength, muscle tone/reflexes, feeding, standardized assessment
What are parts of NICU history/medical status>?
GA at birth/birthweight APGAR Current post menstrual age Medical complications Ongoing medical concerns, including diagnoses/conditions and medications
What does APGAR stand for?
Activity Pulse Grimace Appearance Respirations
What are the signs they look for in a newborn/NICU?
HR, respiration, muscle tone, grimace, color
What are the APGAR scores?
0: absent HR, absent respiration, limp muscle tone, no grimace response, blue, pale
1: HR 100 bpm, good respirations, crying, active movement, cough or sneeze, completely pink
When are APGAR scores taken?
at 1 min and 5 min
What are normal APGAR scores? Abnormal?
Normal: 8-10 at 1 min are normal
Abnormal: 0-3 at 1 and 5 minutes indicate risk of neonatal death
What are complications of prematurity?
Compromised respiration: respiratory distress syndrome Bronchopulmonary dysplasia Chronic lung disease Feeding problems Seizures Amniotic band syndrome Myelomeningocele Microcephaly Intraventricular hemorrhage (IVH, grades 1-4) Periventricular leukomalacia (PVL)
What tests and measures are done in the NICU?
Active movements and posture Muscle tone Reflexes Feeding Standardized assessments
What are active movements/strength we look at in the NICU?
Are movements smooth/symmetrical Antigravity movements Active movements: hands to midline, hands to face/mouth, pulling tube, LE extension to push against bed Prone Supported sitting
What type of tone assessment do we do in the NICU?
Resistance to passive movement
Tone is generally decreased in preemies and ill full term infants
No opportunity to develop physiological flexion, inability to overcome effects of gravity
What reflexes are tested in the NICU?
ATNR, Moro, rooting, palmar grasp, traction, galant, plantar grasp, placing, stepping
What are standardized assessments done in the NICU?
Neurobehavioral assessment of premature infants Test of infant motor performance Neonatal neurobehavioral exam Neonatal behavioral assessment scale Preemie-neuro
What is developmentally supportive care?
Caregiving guided by infant’s physiological reactions, behavioral cues, and stress signs.
Promotes optimal recovery, rest, and supports the infant in achieving developmental tasks.
Decreased sensory stimulation.
Neonatal Individualize developmental care and assessment program
Kangaroo care
What are precautions/contraindications for PT exam in the NICU?
Tolerance to handling (including change in O2 sats, RR, HR, BP in response to handling)
Exam should be cancelled/stopped if there are any signs of physiological instability.
Follow a conservative approach to assessment of the premature infant
What are physiological neonatal signs of distress?
Increased/decreased HR Decreased RR Increased BP Decreased O2 sats Apnea Bradycardia Skin color change
What are behavioral neonatal signs of distress?
Gaze aversion Finger splays Trunk extension Facial grimace Leg extension Drowsiness Hyper alertness
What are neonatal coping methods?
Self calming: hand to mouth, sucking, flexed posture, drowsy state, hands/feet to midline, closing eyes/gaze aversion
Assisted calming: nesting, holding in flexion, rocking, swaddling, quiet voice
What is evaluation and intervention planning in the NICU?
Promote normal newborn flexion (vital to development of body movement control in an environment challenged by gravity)
Hand to mouth activity facilitation
Midline position and symmetrical positioning facilitation
Support posture and movement
Optimize skeletal development and alignment
Promote calm state
Prevent head deformities and torticollis
Positioning/handling needs
Need for follow up care, early intervention services, other services
Discharge recommendations
