Final Exam!!!! Flashcards
Child 1: 5-year-old male diagnosed with arthrogryposis
General info
Joint deformity of the extremities (typically at least 2 joints)
Joints are typically affected in a symmetrical pattern in the extremities with greater distal than proximal involvement
In classic AMC, all of the joints of the extremities are affected
Cylindrical extremities with few features and no skin creases across joint surfaces.
Skin is thin with little subcutaneous tissue
Joint rigidity and hips may be dislocated or subluxed
Muscle atrophy is common with absence of some muscles or muscle groups
SENSATION IS INTACT
Normal intelligence and speech
Child 1: 5-year-old male diagnosed with arthrogryposis
Assessments
PEDI (self-care, mobility, social/cognitive skills) and Peabody, M-FUN, or BOT (FM subset), ETCH
Child 1: 5-year-old male diagnosed with arthrogryposis
Treatment goals
Early PROM to support active movement and prevent further muscle atrophy
Promote independence in self-care, play, and fine motor skills through use of adaptive equipment
Maximize participation at home and in school and community events
Child 1: 5-year-old male diagnosed with arthrogryposis
Treatment activities
PROM exercises – best if started in the first year of life and before 3 years of age
Positioning to decrease deformity and increase function (splinting and serial casting as needed to increase joint ROM to improve hand functioning)
Assist in determining the need for orthotics and assistive devices (need to be as lightweight as possible to facilitate use and increase compliance)
Facilitate normal movement against gravity and postural reactions in trunk
Promote functional hand use and innovative ways to hold utensils and writing implements
Adapt clothing to increase independence (velcro vs. buttons)
Promote weightbearing in bilateral LE to reduce possible hip dislocation and promote strengthening needed for ambulation
Maximize opportunities for cognitive and social development.
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - fine motor
Can cut with scissors and turn paper with helping hand
Copy simple lined shapes, draw stick figures, write name
Manipulate fork and spoon to feed
Complete simple puzzles
Copy capital letters, color within the lines
Uses a dynamic tripod grasp – fine finger movements facilitate movement of writing utensil
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - self care
Grooming: brush teeth and hair, wash hands, bathe self with S
Feeding: drink from cup, self feed with utensils, use napkin to wipe hands and face, can open most food containers
Dressing: can dress/undress by themselves (buckle shoes, zip zipper, unbutton large buttons), take off and put on shoes, choose weather appropriate clothing
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - gross motor
Hop and stand on one foot
Skip
Climb stairs with alternating foot pattern
Ride a bike
Child 2: 12-year-old girl diagnosed with Down Syndrome
general characteristics
Generalized hypotonia
Atlanto-axial instability/dislocation
Short and stocky stature
Small head with shortened oral cavity
Protruding tongue
Epicanthal eye folds, upward slanting eyes
Low-set ears
Flat nose, wide set eyes with flat bridge
Extremities are shorter
Fingers and toes are broader and shorter
Increased risk for visual acuity problems
Related health problems: cardiovascular abnormalities, obesity, increased risk for respiratory infections, immune system insufficiency, thyroid deficiencies, gastrointestinal problems, increased risk for leukemia
Child 2: 12-year-old girl diagnosed with Down Syndrome
characteristics that affect FM skills
Hypotonia – poor joint stability and poor proximal stability
Ligament and joint laxity – ligaments supporting joints are loose leading to greater risk of subluxation or dislocation
Shorter limbs – affect success with tasks requiring further reaching such as dressing and putting on shoes
Medical conditions – heart problems can decrease endurance
Cognitive level – FM and cognitive skills go hand-in-hand
Sensory registration
Hand characteristics: single simian crease, small hands, wrist bones, curved 5th finger
Child 2: 12-year-old girl diagnosed with Down Syndrome
assessments
PEDI (but at this age it is not norm referenced), BOT, Sensory Profile 2 or SPM
Child 2: 12-year-old girl diagnosed with Down Syndrome
treatment tips
Build a good foundation: Stability, bilateral coordination, and sensation come first; followed by dexterity; then success in daily living skills.
Be functionally focused! Improve functional components while using new abilities to create a bridge with actual participation in age appropriate activities
Active participation
Use a multi-sensory approach
Work on proximal stability and developing controlled movement in midranges
Provide home programs to enhance the child’s daily learning environments. Talk to the family about independence in basic self-care and challenge families to help their child work on independence.
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: fine motor
Dynamic tripod grasp
Refined FM skills: arts and crafts, writing, play, instruments, computers and video games, baking
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: gross motor
Refinement of previously learned skills
Participate in social interaction (sports) and to express themselves (dance)
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: self care
Eating/drinking: more advanced meal prep using other household supplies
Grooming skills with puberty fully present
Child 3: 3.5-year-old child diagnosed with autism
general characteristics
Impairment in reciprocal social interactions
Impairment in verbal and non-verbal communications and imaginative play
Markedly restricted repertoire of activities and interest (stereotypic behaviors)
Disturbances in sensory and perceptual processing and associated impairments
