Examination & Eval of Atypical Development Flashcards
Atypical Development
-can start out normal with some components missing
-babies compensate for missing components
-compensations become abnormal movement postures
-Must take Hx
Planning an Exam
-child’s age
-appropriate toes
-diagnosis
-Primary concern
-Clinical Picture
Exam: Patient Hx
-demographics
-prenatal development/Birth
-atypical development
-employment (school or play)
-social hx and environment
-Past Medical Hx
-family Hx
-Meds
-Functional Status
-Chronilogical/adjusted age
-Milestones
Exam: Systems Review
-cardiopulm
-integ
-msk
-neuro
-Vision, hearing, cognition
-Communication skills
-affect
-language
-learning style
Exam: Tests & Measures
-Joint exam*
-Muscle tests (strength/tone)*
-Reflexes*
-Movement control (gait, balance, symmetry)*
-Functional skills (ADLs, motor function)*
-Skin & Sensation
-Equipment
-Observations
-Pain*
-Posture*
*Essential
Functional Skills
-Milestones
-Methods of play
-ADLs
-AROM
-Gait
Patterns of Immature Movement
-inconsistent performance
-limited plans of motion
-extraneous movement
-asymmetry
High-Level Balance Skills to Assess
-SLS
-walking on toes/heels
-running
-hopping
-galloping
-kicking
-Jumping
-Stair climbing
-skipping
-curb ascending and descending
Hand/Eye Coordination
-catching
-throwing
-striking with bat
usually associated with dominance
Eye Dominance
-3 to 4 years
-by 6 it’s clear
Hand Dominance
-3 to 4 years
-by 4-6 it’s clear
Leg Dominance
-around 3 years
-by 6 years it’s clear
Patterns of an Immature Moor System
-loss of dynamic balance
-falling after task
-inability to control force
-inability to maintain rhythm
-inappropriate motor planning
-lack or decreased transverse plane
Assessing PROM
-supine
-try to relax and distract child
Assessing Tone/Neurological
-determine Normal, Hypo, hyper
-MAS, tardieu, R1 vs R2
-Clonus 0-3
-Reflexes 0-4
-Spasticity/Dystonia/Rigidity
Modified Ashworth Scale
-MAS
-measures spasticity/tone in reference to ROM
-0-4
0: No increase in ttone
1: Slight increase with a catch and release
1+: Slight increase with catch followed by slight resistance throughout
2: More tone through most ROM, but can still move easily
3: More tone, passive movement is difficult
4: Rigidity
Assessing Alignment
-leg length discrepancy: Galeazzi
-Scoliosis
-Lordosis
-Kyphosis
-Atypical postures and asymmetries
-foot deformities
Assessing Strength
-8 years
-similar to adults with less force
-test through functional movements
Assessing Pain
-FLACC Observation scale
-Wong-Baker Faces Pain Rating Scale (3 and older)
-Verbal Analog Scale (10+ years, 0-10 scale)
FLACC Pain Observation Scale
-face, legs, activity, cry, consolability
Rotational Profile Components
-Foot Progression angle
-Medial/Lateral Hip rotation
-Ryder’s/Craig’s Test
-Thigh-Foot Angle
-Transmalleolar Axis-Thigh angle
-Foot Configuration
Foot Progression Angle
-watch gait for step length, foot contact, intowing or outowing
Medial/Lateral Hip Rotation
-done in prone
Craig’s Test
-hip anteversion
-check greater trochanter
Adults: 10-15 deg of anteversion
Thigh Foot Angle
-Tibial Torsion
-angle between thigh and foot
Transmalleolar Axis-Thigh Angle
-Tibial torsion
-Angle between malleoli and heel
Foot Configuration
-look at foot for metatarsus adductus
Newborn Torsional Profile
Anteversion: 40 deg
Transmalleolar Axis: 0 deg
Thigh-Foot Angle: 5-10 deg
2 Year Torsion Profile
Anteversion: 26-40 deg
Transmalleolar Axis: 10-15 deg
5 Year Torsional Profile
Anteversion: 23-26 deg
Transmalleolar Axis: 20-30 deg
Thigh-Foot Angle: 10 deg
8 Year Torsional Profile
Anteversion: 20 deg
Transmalleolar Axis: 20-30 deg
15+ Year Torsional Profile
Anteversion: 10-15 deg
Transmalleolar Axis: 20-30 deg
Thigh-Foot Angle: 12-30 deg
Q-Angle Increases
-Anteversion and Tibial ER
->20 deg
Q-Angle Decreases
-Retroversion and Tibial IR
-<15 deg
Miserable Malignment
-Anterversion and Tibial ER
-Squinting Patella: can appear like valgus
-common in CP
