Final part 1 Flashcards
The five red flags for language delay?
- no babbling by 12 months
- no back and forth gestures (pointing, showing, reaching, waving) by 12 months
- no words by 16 months
- no 2-word meaningful phrases by 24 months (imitation and repetition don’t count)
- ANY loss of speech, babbling, or social skills at ANY age
Autism is a big thing in peds, need to know these language delays – a lot of us forgot that any child who losing a language = RED FLAG
How many minutes do they need to be in prone?
81
Listing the features of hypotonia?
● decreased strength ● delayed motor skill development ● poor attention/motivation ● decreased activity tolerance ● hypermobile joints: increased flexibility ● lean on supports: rounded shoulders
. Stair climbing (What the age range of alternating up with the rail, alternating up without the rail – know up and down)
● alternating up with rail: 24-28 months
● alternating up without rail: 36 months
● alternating down with rail: 35 months
● alternating down without rail: 48 months
alternating up with rail:
24-28 months
alternating up without rail:
36 months
alternating down with rail:
36 months
alternating down without rail:
48 months
When you have a child that has a hard time lifting head in supine, not be cause of lack of tummy time but lack of their flexors
When you have a child that has a hard time lifting head in supine, not be cause of lack of tummy time but lack of their flexors
Tummy times is prone skills = extension
Sea saw – bottom goes down, head comes up
Hemophelia
what joints are affected
a. Elbow
b. Knee
c. Ankle
Hemophelia: muscles most affected
a. Illiopsoas
b. Gastrocnemius
c. Forearm flexor compartment
Hemophelia: nerves compressed
femoral, sciatic, peroneal
?, ulnar nerve, median
Hemophelia: appropriate recreational activities for these kids
swimming, golf, walk, bike+helmet pads
OI: skeletal deformities
a. bowing of femur and tibia, anterolaterally; humerus
b. coxa vara, acetabular protrusion
c. apparent knee flexion contracture due to angulation of femur and tibia
OI: deformities
a. Ligamentous laxity
b. Fragile bone
c. Spinal deformities
d. Patella femoral dislocation
OI: deformities
- Skeletal Deformities
- –bowing of femur and tibia, anterolaterally; humerus
- –coxa vara, acetabular protrusion
- –apparent knee flexion contracture due to angulation of femur and tibia - ligamentous laxity
- fragile bones: can develop osteoporosis from fracture immobilization
- spinal deformities
- –scoliosis
- –kyphosis - patello-femoral deformities: joint dislocation
OI:
Contra-indications to PROM
—AROM and functional ROM only: hands to mouth, midline, top of head
—defer goniometry if fractures
Arthrogryposis Multiplex Congenita
Definition:
congenital, non-progressive neuromuscular syndrome
there are contractures in at least 2 body areas
Arthrogryposis Multiplex Congenita
Body Parts Affected Type 1
Flexed hips extended knees clubfeet IR shoulders flexed elbows flexed/ulnar deviated wrists
Arthrogryposis Multiplex Congenita
Body Parts affected type 2
Abducted and ER hips Flexed knees clubfeet IR shoulders extended elbows flexed/ ulnar deviated wrists
Downs Syndrome
Ortho considerations in downs
- Hypotonia
- Joint ligament laxity
- Cervical Spine Instability: AO joint instability*
- Scoliosis
5. Hip instability (Sankar, Millis, & Kim, 2011) ---Osteoarthritis ---Dislocation ---Fracture
- Patellar instability
- Pes Planus/Metatarsus varus
Notes on Downs Syndrome
- orthopedic considerations in DS
- leukemia common
- kids with downs are very stubborn
Is leukemia common in Downs?
YES
A personality trait common in children with downs?
Stubborn
CF: most important PT intervention
a. chest PT: percussion, vibration, postural drainage, counter rotation, forced expiration technique/active cycle of breathing, autogenic drainage
b. breathing exercises: singing songs, prolonged phonation, blowing bubbles, blowing out candles, balloons,
c. chest mobility: ball skills (throwing, catching, dribbling), hitting ball with bat, rolling on a physioball, crawling, prone activities, reaching, yoga
Juvenile Idiopathic RA:
What assessment tool is only used in this condition
JAFAS: juvenile arthritis functional assessment
scale: Measure the child’s performance
Only tool that measures the child with JIA’s
actual performance
Juvenile Idiopathic RA:
appropriate activities
a. low impact activities (swimming, pilates, cycling)
Doubles tennis, swimming, horseshoes, sailing, cycling,
bowling, golf
high impact activties are contraindicated
Spinal Muscular Atrophy
- pattern of weakness:
a. PROXIMAL MORE THAN DISTAL: quad weakness
b. absent DTRs, hyporeflexia
c. respiratory weakness
Spinal Muscular Atrophy
orthopedic impairment
a. contractures: knee flexion, plantar flexion, elbow flexion, wrist
b. kyphoscoliosis: spinal fusion
c. fractures
d. hip dislocation
Spinal Muscular Atrophy
mortality
aspiration pneumonia
Spinal Muscular Atrophy
Common orthopedic impairment
Scoliosis
Spinal Muscular Atrophy
Motor Scale
Modified Hammersmith Functional Motor Scale –SMA specific
Spinal Muscular Atrophy
Musculoskeletal vulnerabilities
- Proximal weakness especially in quadriceps
- Contracture formation - knee flexion, plantar flexion, elbow flexion
and wrist most common ( need night splints) - Kyphoscoliosis - spinal fusions - custom molded seating support
- Fractures, hip dislocations
Walks Upstairs with ONE HAND HELD
17-19 Months
a yr and 5 months to a yr and 7 months
Walks UPSTAIRS holding RAIL both feet on each step
18 months
Walks DOWNSTAIRS holding RAIL
18 months
Clinical signs or red flags exist to help identify children at risk for language delays and or ASD
- no babbling by 12 MONTHS
- no back/forth gestures as pointing/showing/reaching/waving by 12 MONTHS
- no WORDS by 16 MONTHS
- no TWO-WORD meaningful phrases (doesnt include imitation/repetition) by 24MONTHS
- ANY loss `of speech, babbling, or social skills at ANY age
Part C
EI
0-3 years
EI = early intervention
Document: IFSP (review every 6 months)
not classified
12 months delay or 33% delay or a score at least 2SD from mean in one area of development (2.14 percentile)
or 25% delay in two areas
or at least 1.5 SD below the mean in 2 areas (7 percentile)
Part B
CPSE
3-5 years
(need to set up meeting 6 months before 3rd bday)
section 4410 of Education Law
write an IEP
Classified: “Preschooler with a Disability”
Part B
CSE
5-21 years
Classified: federal classification system:
autism, deaf/blindness, hearing impaired, speech or language impaired, visually impaired, intellectual disability, other health impairments, multiple disabilities, TBI, emotional disturbance, learning disability, orthopedic impairment
How often is the IFSP and IEP reviewed?
When does IEP testing need to be done
IFSP: every 6 months
IEP: quarterly check goals, every year review, retest every 3 years for eligibility
what need to show to get ESY
regression
take longer than 6 weeks to get the skill back (recoupment)
- -degree of preogress
- -emerging skill, breakthrough opportunity
- -interfering behaviors
- -special circumstances
Who gets 504
students not eligible under IDEA because do not need special education but still need some assistance to participate fully in regular school (not federal fun)
