Final Review Flashcards
Developmental Progression
Prone → ? → ? → ? → Standing
Prone
- Prone lying, Prone on elbows/forearms, Prone on extended arms, Pivot Prone, Quadruped, Locomotion in prone (crawling, creeping)
Supine
- Supine lying, pull to sitting, hands to knees and feet, feet to mouth
Rolling
- Non-segmental (log rolling) to segmental
Prone to supine & supine to prone
Sitting
- Supported sitting, prop sitting, ring sitting, weight shifting in independent sitting, reaching with trunk rotation, side-sit to play
Standing
- Supported standing, pull to stand, independent standing, cruising, independent Bipedal Locomotion
Developmental Directions
- Child moves _ ? _ first
10 total
Developmental Directions:
- Child moves reflexively first
- Total response before local
- Proximal control then distal
- Medial then lateral
- Head (cephalic) control before LE (caudal)
- Cervical control to rostral
- Gross motor before fine motor
- Flexor muscle tone before extensor
- Extensor anti-gravity before flexor anti-gravity
- Weight bearing on flexed arms before extended
Developmental Theories
- Maturational Theories = ?
- Behavioral Theories = ?
- Ecological Systems Theory = ?
- Dynamic Systems = ?
- Psychodynamics/Psychoanalytical Theory = ?
Developmental Theories:
- Maturational Theories (Gesell, Bobath) - A normal developmental sequence common in all child development.
- Behavioral Theories (Skinner) -we can condition behavior through a stimulus response.
- Ecological Systems Theory (Bronfenbrenner) – Believes that we encounter different environments throughout our lifespan that influence our behavior in varying degrees.
- Dynamic Systems (Bernstein, Thelen) - many factors influence development including genetics, nutrition, exposure to toxins, race, ethnicity, prenatal care, childrearing practices, socioeconomic level, disease, trauma, opportunity, level of stimulation, motivation.
- Psychodynamics/Psychoanalytical Theory (Freud) – Biologically-determined drives and unconscious conflict cause behaviors.
How to facilitate movement in…
- Prone on elbows (POE) = ?
- Prone on extended arms (POH) = ?
- Quadruped = ?
- Rolling = ?
- Pull to stand = ?
- Standing = ?
- Walking = ?
Facilitating movement through the developmental progression:
- Prone on elbows (POE): towel roll under chest, use of vision to stimulate cervical extension, modifying on an incline, chest to chest.
- Prone on extended arms (POH): lying across your lap, prop sitting for UE extension.
- Quadruped: rocking, reaching with either UE, utilize supports.
- Crawling vs. creeping
- Supine; hands to feet/mouth, pull to sit (at arms or shoulders).
- Rolling: facilitation using cervical rotation followed by trunk rotation.
- Pull to stand: use of UE vs. ½ kneel transition.
- Standing: start with bilat UE support and reduce support.
- Walking: Use of push toy, walk on knees,walk with support around trunk before using HHA.
AIMS
- Performance-based assessment of for children birth to ?
- Observation of spontaneous movement in four positions, they are ?
- In each of the four positions, the ? and ? items are marked as “Observed”.
AIMS (Alberta Infant Motor Scale)
- Performance-based assessment of for children birth to 18 months
- Observation of spontaneous movement in four positions: prone, supine, sitting and standing
- Each item is observed for weight bearing, posture and antigravity movement
- In each of the four positions, the least mature and most mature items are marked as “Observed”
- Items within the window are then marked “observed” or “not observed”
- All items prior to the start of the window are scored as 1 point each
- Know how to interpret percentile rankings
- Adjustment for prematurity
PT in the Medical Setting
Pain Assessments = ?
Pain Assessments:
- Visual Analog Scale (children 8 years and older)
- FACES scale (children 3 years and older)
- FLACC (2 months to 7 years) and r-FLACC (children with developmental delay)
- IPS and NPASS (preemies and infants)
PT in the Medical Setting
- Coma = ?
- Cognitive and behavior function = ?
- Balance = ?
- Tone = ?
- Function = ?
Tests
- Coma: Glasgow Coma Scale (GCS), Pediatric Coma scale (PCS), Coma Recovery Scale – Revised (CRS-R)
- Cognitive and behavior function: Rancho Scale, Children’s Orientation and Amnesia Test (COAT)
- Balance: Pediatric Berg Balance Scale
- Tone: Ashworth Scale or Modified Ashworth scale, modified Tardieu scale and Barry-Albright dystonia scale (BAD scale)
- Function: Pediatric Evaluation of Disability Inventory (PEDI), PEDI-CAT and WeeFIM II
PT in the Medical Setting
- Goal of Acute Care = ?
- Goal of Inpatient Rehab = ?
- Goal of Outpatient/Day Rehab = ?
Goal of Acute Care:
- Goal to medically stabilize the child and then begin the process of rehabilitation
- Physical therapy is not the main reason the child was admitted to the hospital
- Goal is to maintain or minimize loss of function during inpatient stay
Goal of Inpatient Rehab:
- Intensive functional rehabilitation of a patient after illness or injury
- Is the patient:
- Medically stable?
- Has not reached full potential for independence?
- Has potential to benefit from therapy services?
- Able to participate in 3 hours of therapy a day?
- In need of more than one rehab service
Goal of Outpatient/Day Rehab:
- Typically less intensive than an inpatient approach
- Directed at a specific activity limitation for a defined episode of care
Assessment and Testing of the Infant and Child
- Screening (2) = ?
- Test of motor function (5) = ?
- Comprehensive developmental scales (3) = ?
- Functional assessments (3) = ?
- Outcome and health-related quality of life (2) = ?
Screening:
- HINT (2.5-12.5 months)
- Bayley infant screener (3-24 months)
Test of motor function:
- TIMP (34 weeker-4 months)
- AIMS (0-18 months)
- GMFM and GMFCS (skill level under age 5, CP)
- PDMS-2 (0-72 months)
- BOT (4-21)
Comprehensive developmental scales:
- Bayley scales of development (16 days-42 months)
- Battelle (0-7 years/11 months)
- HELP (0-6 years)
Functional assessments:
- Pedi-CAT (birth-20 years)
- Wee-FIM (6 months-7 years)
- School function assessment (K-6th grade)
Outcome and health-related quality of life
- Peds-QL
- Pediatrics outcome data collection
State Differentiation
- = ?
- = ?
- = ?
- = ?
- = ?
- = ?
State Differentiation
- 1 – Deep Sleep: Eyes closed, regular respiration, no active movement
- 2 – Light Sleep: Eyes closed, small motor movements, no gross body movement
- 3 - Drowsy: Eyes open/close, quiet, some facial movements, no gross motor movements
- 4 - Alert: Eyes open, gross motor movement, not crying, able to focus on stimulation
- 5 – Active alert: Eyes open/closed, fussy, but not crying, not taking in information
- 6 - Crying: Intense cry
Typical Developing Gait
- 9-15 months = ?
- 18-24 months = ?
- 3-3 ½ = ?
- 6-7 year old = ?
- 9-15 months: Cruising (hip abd strength),onset of walking, “stepping”, high COM, head moving, head moving out of BOS=LOB, decreased ant/post stability, walks by falling, Gait characteristics:
- 18-24 months: LE position in standing, Gait characteristics, heel strike at IC, uneven surfaces and obstacles
- 3-3 ½: valgus knees, COM lower, gait characteristics
- 6-7 year old: full mature gait by 7, calcaneus neutral by 7, visual/vestibular/proprioceptive systems still evolving.
Typical Developing Gait
- Birth-6 months = ?
- Birth-9 months = ?
- Birth-6 months: reciprocal kicking, foot to foot contact, plantigrade feet in WB
- Birth-9 months: higher body fat, LE position in WB, strength increasing at the hips
Levels of NICU
- Level I = ?
- Level II = ?
- Level III = ?
- Level IV = ?
Levels of NICU
- Level I: Basic care facility for healthy newborns
- Level II - In addition to level I capabilities provides: Care for infants > or = 32 weeks gestation, and > or = 1500g who are not anticipated to need subspecialty care urgently.
- Level III - In addition to level II capabilities provides: Sustained life support using full range of respiratory support including conventional and high-frequency ventilation, ECMO and inhaled nitric oxide.
- Level IV (highest level) - In addition to level III capabilities provides: Surgery for complex congenital and acquired conditions
PT in the NICU - Diagnoses
- Bronchopulmonary Dysplasia (BPD) = ?
- Intraventricular Hemorrhage (IVH) = ?
Bronchopulmonary Dysplasia (BPD):
- Most common chronic lung disease associated with prematurity
- Greatest contributing factor is under-developed lungs
- Fibrosis of lung tissue
- Symptoms: bluish skin, rapid breathing (tachypnea), shortness of breath
Intraventricular Hemorrhage (IVH):
- Most common type of brain lesion in premature infants
- Occurs in 35-50% of infants less than 1500 grams or less than 32 weeks gestation
- Diagnosed by cranial US
- Classified by severity, grade I-IV
- Damage can extend into the periventricular white matter, resulting in significant neurologic issues, including cerebral palsy, cognitive delay and seizures.
PT in the NICU - Diagnoses
- Congenital Diaphragmatic Hernia (CDH) = ?
- Arthrogryposis = ?
- Congenital Hip Dysplasia = ?
Congenital Diaphragmatic Hernia (CDH):
- Congenital malformation of the diaphragm.
Arthrogryposis:
- Describes congenital joint contractures in two or more areas of the body.
Congenital Hip Dysplasia:
- Child is born with an unstable hip due to abnormal formation of the hip joint during early stages of fetal development
Describe the germ Layers and what they develop into
- Ectoderm: Hairs, nales, skin, brain, spinal cord
- Mesoderm: Muscles, heart, blood vessels
- Endoderm: GI & respiratory tracts,
Embryo development
- During ovualation, egg released into ?
- Travels down ? in which fertilization occurs
- At conception in fallopian tube, maternal and paternal genetic material join to form ?
Embryo development (ovulation to embryo)
- Ovulation: egg released into the peritoneal cavity
- Travels down fallopian tube in which fertilization occurs
- At conception in fallopian tube, maternal and paternal genetic material join to form a new human life (zygote)
- Cell division occurs with travel down the tube and into the uterus
- The daughter cells are called blastomeres
- Morula: the solid cluster of 12-16 blastomeres at about 72 hours
-
Day 4: late 60 cell morula enters uterus, taking up fluid becoming blastocyst
Implantation occurs around day 7
Three phases of swallow = ?
Three phases of swallow
(1) Oral: sucking, chewing, and moving food or liquid into the throat
(2) Pharyngeal: starting the swallow and squeezing food down the throat. You need to close off your airway to keep food or liquid out. Food going into the airway can cause coughing and choking.
(3) Esophageal: opening and closing the esophagus. The esophagus squeezes food down to the stomach.
