Final Exam Flashcards
what is myelodysplasia (spina bifida)
birth defect or neural tube and spinal columns when the spinal verbtrea do not close/fuse
when does myelodysplasia occur
fetal period (first 28 days of first trimester)
types of neural tube defects
anencephaly
porencephaly
iniencephaly
encephalocele
anencephaly
brain deformity where parts of brain are missing
porencephaly
brain develops fluid filled cysts
iniencephaly
extreme retroflexion of head
encephalocele
sack like protrusion of brain and membranes through the skull
4 types of myelodysplasia
occulta
closed neural tube defects
meningocele
myelogeningocele
occulta
mildest and most common form
1+ vertebrae malformed
rarely causes disability or symptoms
closed neural tube defects
spine may have malformations of fat, bone, or membranes covering SC
usually requires surgery in childhood causing LE weakness and trouble with bowel/ bladder control
meningocele
sac of spinal fluid protrudes through spine
may have minor symptoms
myelomeningocele
most severe form
part of SC or nerves exposed in sac through opening in spine
need surgical closure in utero or right after birth
changes in brain structure, LE weakness, bowel/ bladder
lower spinal level= less symptoms
causes of myelodysplasia
genetics
exposure to teratogen (alcohol, drugs)
nutritional deficits
overall unknown etiology
what is the most common permanently disabling birth defect in the US
myelodysplasia
how population groups have highest prevalence of myelodysplasia
hispanic women
celtic region
why is the incidence of myelodysplasia decreasing
better nutrition
better screening
better med care
prevention of mylodysplasia
folic acid
counseling for women with a child or siblings with spina bifida
diagnosis of spina bifida prenatally
maternal alphafetoprotein (AFP) test- blood test
ultrasound- look for lemon sign before 24 weeks
amniocentesis- check AFP levels from amniotic fluid
diagnosis of spina bifida post natally
hairy patch of skin or dimple of baby’s back and use imaging
co-occuring conditions with spina bifida
hydrocephalus
Arnold chiari
ortho conditions
bowel and bladder conditions
obesity
precocious puberty
skin breakdown
overuse injuries
medical interventions for spina bifida
fetal surgery (repair)
neurosurgical treatment for hydrocephalus
shunting (VP, VA, ETV)
redirect CSF flow elsewhere
normalize CSF flow and fix pressures in skull
mobility precaution for hydrocephalus neurosurgical treatment
no prolonged head inversion
neurosurgery of hydrocephalus (ETV)
alternative to shunting by creating stoma at based of 3rd ventricle to allow for CSF drainage
longer lasting and more natural but could have serious complications
signs of shunt malfunctions in older kids
headache
blurred vision
drowsiness
LOC
lethargy
signs of shunt malfunction in infants
rapid head growth
bulging soft spot at frontal
swelling/pain along shunt
irritable
nausea and vomitting
crossed eyes/ sunset eyes
apnea
drowsiness
trouble drinking, swallowing, crying
signs of infected shunt
fever
neck stiffness
redness
leakage
abdominal pain
ACM type 1
mild
protrusion of tonsils through foramen magnum
ACM type 2
most severe
protrusion of vermis and brainstem through foramen magnum
ACM most common symptoms
inspiratory stridor
symptoms of ACM in kids with SB
1/3 of individuals
difficulty swallowing
poor feeding
weak cry
stiff arms/hands
selective loss of sensation in hands/ arms
cerebellar symptoms
what to avoid with ACM
excessive neck flexion
what is tethered cord
SC attached to spinal column restricting movement of SC which reduces BF and causes damage
what part of spine does tethered mostly occur in
lumbar spine
symptoms of tethered cord
sensory disturbance, significant muscle weakness, spasticity, increased tone and incontinence
changes in gait
LL or scoliosis
inwards turned feet
tripping
when to watch out for tethered cord
periods of skeletal growth
two conditions that commonly occur with spina bifida
tethered cord and ACM
diagnosis of tethered cord
CT or MRI
clinical signs and symptoms
change in pain, loss of muscle function, gait, bowel/ bladder
ortho conditions often seen with spina bifida
contractures of hip, knee, Ankle
hip dislocation
scoliosis and kyphoscsliosis
gibbous deformity
club feet
what is gibbous deformity
kyphosis with 3+ vertebral segments with sharp angle of spin
who treats kids with spina bifida
interprofeessional team
services for kids with spina bifida
neurosurgical management
urological care
bowel management
ortho care
developmental and neuropsychological educational evals
patient/fam edu
mental health screening
sleep studies
independence training
social work
transition to adult services
3 main reasons for PT exam spina bifida
define current status for program planning
ID potential for developing secondary impairments and make preventative measures
monitor changes in status
infancy age range (SB)
0-11 months
preschool age range (SB)
1-5 yo
school aged range (SB)
6-12 yo
adolescents-adulthood (SB)
13-21 yo
what is grade 0-3/5 iliopsoas associated with
partial or complete reliance on WC mobility
what is grade 4-5/5 iliopsoas strength associated with
community ambulation in most patients
what is grade 4-5/5 glute and anterior tibial associated with
community ambulation without aids or braces
what muscles are most important for forward propulsion
hip extensors and calves
what does mid- lower lumbar levels do during ambulation
shift trunk side to side
things to find out during exam for SB
motor level (MMT) and look at functional movement and sensory level
communicate with fam and medical team
ID challenges and goals
determine need for equipment
PT interventions for spina bifida
direct intervention (clinic, school community)
patient edu/ HEP
collaboration/communication
consider positioning and mobility programs
consult and monitor
what to include in HEP for SB
ROM, strengthening, positioning, facilitate play and gross motor development
prognosis for SB
90% live to be adults
80% full intelligence
75% play sports
prevalence of ASD
1:44
4.2 times more in boys
why is there increased prevalence of ASD
earlier diagnosis
inc awareness
changes in screening
components of diagnostic and statistical manual of mental disorders
persistent deficits in social communication and social interaction across multi contexts
restricted, repeat patterns of behavior, interests/ activities
symptoms present in early development
symptoms cause clinically significant impairment in social, occupational, or other areas of function
disturbances not better explained by intellectual disability or global development delay
3 levels of ASD
level 3: requires very substantial support
level 2: requires substantial support
level 1: requires support
co-occuring conditions with ASD
adhd, communication disorders, epilepsy, GI disorders, intellectual disability, motor planning, dyspraxia, obesity, sleep disorders, toe walking
early detection of ASD
decreased social play
loss of words/ sentences
self injurious / repeat behaviors
sleep difficulties
special skills
seizures
intellectual diability
major concerns for ASD by 12 months
no babbling
no pointing
loss of language or social concerns
red flags for ASD by 12 months
failure to orient to name
lack of nonverbal showing
lack of eye contact
hyperactivity
lack of emotional reeg
poor socialization
outcome measure ASD
M-CHAT
modified checklist for autism in toddlers
age for M-CHAT
16-30 months
scoring MCHAT
low risk: 0-2
medium risk: 3-7
high risk: 8-20
three pathways BS/BF ASD
primary: frontal brain
secondary: brainstem
Tertiary: cerebellar
neuroanatomical changes ASD
macrocephaly- enlarged frontal lobe, amygdala, white matter and underdevelopment of vermis
basal ganglia- dysfunction resulting in saccadic dysfunction and poor feed forward
changes in vestibular development ASD
vestibular processing is different for kids with ASD d/t decreased function of semicircular canal and integration deficits
changes in visual system in ASD
visual hyperacidity
hypermetropia
astigmatism
strabismus
impaired oculomotor function
what is hypermetriopia
images reach retina before focusing on lens
changes in hearing ASD
hyperacusis
resulting in avoiding sounds and covering ears
changes in motor planning ASD
visual feedback and external guidance diminished
difficulty with integration of visual and vestibular system
hypotonia
results of motor planning deficits in kids with ASD
decreased motor performance, postural stability, lack of effective sequencing
etiology theories ASD
refrigerator mother
infections
immunological deficiency
toxins
gastric inflammatory disease
genetic
other systems affected with ASD
GI issuees
food sensitivities
nutritional deficiencies
autoimmunity
metabolic
possible clinical presentation ASD
low proximal tone
delayed postural refelexes
poor integration of reflexes
gross and fine motor delays
speech delays
difficulty crossing midline
difficulty with visual tracking
avoiding gaze
dyspraxia
movement disorder
how is baleen affected ASD
abnormal proprioception
difficulty with eyes closed
gait in kids with ASD
difficulty walking on a line
variability to velocity
postural abnormalities
strides length variability
difficulty using environmental cues
similar to cerebellar ataxia
activity limitations in ASD
decreasd self perception in motor performance ability
what motor performance deficits do kids with ASD have
body schema
time/ space awarness
distance estimation
fear of intimate contact
theories of gross motor deficits ASD
automatization deficit hypothesis
disorder specific learning theory
services for kids with ASD
speech
OT
ABA
psych/ special education
PT
number of hours for services/ week ASD
25+ hours
state EI does 5 hours
acronym for why kids with ASD have behavioral issuse
Sensory
Escape
Attention seeking
Tangible
interventions for gross motor skills ASD
sensory integration- brushing
AIT- introduce different sounds at Dif volumes
vestibular- balance and posture play
brain gym
greenspan- floor time
usual care- functional task
activity-based: yoga, aquatics, strength
meds for ASD
antipsychotics
SSRIs
tricyclics
stimulants
anti anxiety
anti convulsants
devices for ASD
compression vest
foot orthos
communication board
wiggles seat (dynamic disk)
exercise interventions for ASD
dec BMI
inc exercise capcity
increase walking speed
improve eye contact, socialization, and restricted repeat behaviors
vigorous activities
what are outcomes of exercise and ASD
increase self efficacy
decrease fear of balance activities
how do you get cystic fibrosis
hereditary- autosomal recessive from cystic fibrosis transmembrane conductance regulator
airway clerance
cardiopulmonary technique used to pen airways and lessen up secretions from peripheral airways to central airway to promote mucus transport in lungs
exercise testing
evaluate physical limitations and aerobic capacity to make recommendations for individualized exercise programs
FEV1
amount of air forcefully expired in one second during spirometry
inhalation therapy
administration of aerosolized meds with proper breathing technique
PFTs
group of tests to assess how well lungs are working
sweat chloride test
clinical diagnostic test used to detect elevated chloride levels in sweat and make CF diagnosis
main organ systems effected with CF
respiratory and GI
other secondary systems effected with CF
reproductive system, sinuses, sweat glands, exocrine glands blocked
how are the lungs effected with CF
obstruction of mucus secreting exocrine glands and hyper viscous secretions that lead to collapse and decrease transport- blocking lungs and airways
pathophysiology of CF
reconditioning of respiratory muscles and malnutrition
functional limitations of respiratory system
obstruction of small airways and air trapping- ventilation perfusion mismatch causing hypoxemia
what happens to lung volumes with CF over time
reduced Vidal capacity and tidal volume
how is GI tract impacted in CF
viscous secretions obstruct pancreatic duct in utero and periductal inflammation and fibrosis can cause loss of pancreatic exocrine function
what is DIOS
distal instestinal obstruction syndrome- abnormal intestinal secretions
what patients get hepatobillary disease
CF patients with pancreatic insufficiency
how is reproductive system impacted with CF
many men are infertile
most women are fertile
upper respiratory tract and CF
most get chronic pansiusitis and can get lower respiratory tract infections
is sinusitis common with CF
yes
how common is osteopenia with CF
85% of adults
smaller number get osteoporosis
when is CF diagnosed
prenatally if possible
s/s associated with CF diagnosis
history of respiratory illness
early structural changes- will be progressive
infection and inflammation on chest CT
clinical features of CF for diagnosis
history in siblings
positive newborn screening tests
abnormality in CFTR gene/ protein
elevated sodium chloride in sweat test
race/ ethnicity with highest CF prevalence
1 in 3500
median age of survival for CF
41
why is improving life expectancy for CF
surgical advances with lung transplant and improved disease management
what is the primary mode of delivery of specialized health care CF
comphrehensive treatment center
what do CF centers do
proactive approach- EI, health maintenance, preservation of lung function
health care team members for CF
repirologists, gastroenterologists, PT, RT, pharmacists, dietitians, genetic counselors, social workers, psychologists, nursing
medical management for CF
followed every 3-4 months in CF clinic
treatment of lung disease to decrease airway obstruction
antibiotics
inhaled hypertonic saline
nutrition
inhaled steroids to reduce airway edema
bronchodilators before exercise
nebulization with meds
lung transplant
PT for CF
promote airway clearance via
postural drainage, perfusion, positioning, oscillations, coughing, thoracic mobility
CF tests and measures that PT can do
exercise field tests (6mwt)
pre
breathlessness score
pulse ox
HR
RR
sputum qualities
MMT
postural screening and ROM
breathing patterns
examples of interventions for CF
postural drainage and peerecusion for airway clearance
postural exercises
mobility- trunk flex and chest expansion
stretches- pec
swimming and running
inhalation teechniques
energy conservation- positioning, pacing
efficient breathing- pursed lip
inconteinence training
characteristics of asthma
airway inflammation
airway obstruction
bronchial hyperresponsiveneess to stimuli
what does PT need to know about asthma in each case
effect on ability to participate in activities and how to optimize Childs health and PA
prevalence of asthma
1 in 10 kids
double in kids born preterm
which airways does asthma effect
large and small airways
symptoms of asthma
shortness of breath
wheezing
chest tightneess
coughing
pathophysiology of asthma
extrinsic/ allergic stimuli or intrinsic/ nonallergenic stimuli causes hyperresponsiveness which causes inflammatory response and airway remodeling and chronic inflammation and structural changes over time
extrinsic stimuli
pollen, mold, animal dander, smoke, foods, drugs, dust
intrinsic stimuli
viral infections, inhalation of irritating substances, exercise, emotional stress
is asthma genetic
plays a roll but doesnt account for all types and severities
what system do asthma stimuli triggeere
immune system
what are 2 major environmental factors that significantly increase risk of developing asthma
airborne allergens and respiratory infections (RSV)
does exposure to second hand smoke increase risk of asthma
yes
diagnosis of asthma
history
auscultation and plaption
PFTs
wheeling and rhonci sounds
breathing worse at night/ early in morning
hyper expansion of thorax
signs of acute asthma attack
increase RR, expiratory grunting, nasal flaring, coughing, blue lips,
how is asthma classified
by age and clinical symptoms
1- intermittent/ persistent
2- mild persistent
3- mod persistent
4- severe
is asthma obstructive or restrictive
obstructive- inflamed airways trap air and make it hard to exhale
what PFT values will be low with asthma
FEV1 and PEFR
how can asthma bee restrictive
swelling and mucous can restrict ability to inhalee
asthma risk factors
family history
allergies
prematurity
lung abnormalities
smoke exposure
respiratory illness disease
difficulty sleeping
RSV
GERD
sleep dysfunction
rapid weight gain in infancy
childhood obesity
chronic dehyration
low vitamin D
medical management of asthma
short term- manage acute airway obstruction
long term- address triggers causing bronchial hyperresponsiveneess and inflammatory responses
what do schools have for kids with asthma
asthma action plan
Genereal Movement Assessment (GMA) in NICU
quick, non-invasive, cost-effective way to make assessment of infants to ID neuro deviations which can lead to CP or other deficits later
age range for GMA
36 weeks to 4 months
neurobehavioral based tools in the NICU
NBO
TIMP
NIDCAP
NBAS
NNNS
GMA
pain assessment tools for NICU
NIPS
NFCS
N-PASS
CRIES
COMFORT scale
PIPP
gold standard tool in NICU for follow up
Bayley scales of infant and toddler development
PT interventions in NICU
handling
environmental modifications
positioning
massage
kangaroo care
facilitated tucking
PA and ROM
education
principles of positioning in the NICU
provide containment
support self regulation
promote flexion
support functional movements
benefits of massage in NICU
stimulate weight gain
decrease length of stay
increase vagal tone
improve brain and visual development
pain management strategies in the NICU
facilitated tucking
sucrose
skin to skin
sucking
swaddling
disorganized infant state in NICU
pale skin
irregular HR
tremors
extended posture
tone
unpredictable and irritable
attention interaction stress signs in NICU
stress signals of autonomic, motor, and state systems
inability to integrate with other sensory input
state stress signs in NICU
diffuse sleep states
glassy eyed
gaze aversion
staring
panicked look
irritable
motor stress signs
general hypotnia
frantic flailing movements
finger splaying
hyperextension
autonomic stress signs
color changes in skin
changes in vital signs
visceral responses
sneezing
yawning
precautions in NICU
determine readiness to begin
light
sound
lungs and brain will be immature
underdeveloped sensory and MSK systems
