Final Study Guide Flashcards
Causes of JIA?
Genetic predisposition with external trigger
Systemic JIA
4-17%
Male=female
**Fever! 1-2x/day (at least 2 weeks)
Rash
Systemic signs
Polyarticular JIA
2-28%
>= 5 joints
-large and small joints
- symmetrical
- swollen +warm
- female > male (rarely red)
Two types RF + and RF -
RF+
Onset= 2-4 and 6-12
Nodules on
Elbows, tibial crest and fingers
RF-
Late childhood ; adolescence
Most common type of jIA
Oligoarticular
Oligoarticular JIA
27-56% most common
Less than or equal 4 joints
- female> male
- swollen + warm: not always painful
- systemic signs uncommon
Primary issues of JIA
Swelling
Pain
Weakness
Systemic
Secondary issues of JIA
Contracture Fatigue Aerobic Osteopenia Participation restriction
JIA joint issues in acute
Inflammation
effusion
Lig laxity
Instability
Joint issues in JIA in subacute +chronic
Synovial hypertrophy
Joint erosion
Loss of alignment
OI Type 1 presentation
Mild-mod bone fragility Few-several fx before puberty No bone malformation Normal height/weight Lift avg lifespan: Blue sclera, triangle face, hearing loss (20-30)
OI Type 2 presentation
Perinatal fatal Extreme fragility Long bones =crumbled Small+short Curved Deformed
OI Type 3 presentation
Autosomal dominant usually Short Progressive deformity Severe fagility 10s-100s of fx. Blue sclera (lessens with age)
OI Type 4 presentation
Mild- mod deformity Short (after birth) Dentiogenesis (teeth) Variable hearing loss Ambulation potential =excellent
OI Type 5 presentation
Autosomal dominant Hypertrophic calcification Surgical osteotomies Limited supination+pronation -$calcification of IM
OI Type 6 presentation
Autosomal recessive
- RARE
- mod -severe deformity
OI Type 7 presentation
Autosomal recessive
—issue =translation of collagen
- mod-severe fragility
- humerus+femur short
OI Type 8 presentation
Autosomal recessive
—issue =translation of colagen
-flattened long bones
- skinny ribs
- small head
- growth deficiency (teenage survivors)
What should be included in exam of OI?
- Pain: FLACC
- caregiver handling
- AROM — never PROM
- strength - via observation
Gross motor- PDMS-2, PEDI, Bayley
Sitting @10 mo in OI
Good predictor for future walking
Contraindication of OI
pROM Baby walkers Jumping seats Pull to sit Grabbing by arms/legs
PT intervention of OI infants
Education on proper handling/positioning -avoid forces to long bones -loose clothing -bathe in padded plastic bin -infant carrier for household mobility -may need car bed Aquatic therapy more than or equal 6mo
Pt positioning in OI infants
Sidelying= support with towels Prone=initiate with infant on caregivers chest Supine= arms+knees supported Change position frequently —dont restrict natural movement Prevent contractures +deformity
Pt intervention in OI preschool kids
Protected WB. :LE fx more common than UE
-self mobility:scooters, orthotics, walker+padded pommel
- strengthen: hip extensors, hip abductors. Use bolsters
- aquatic tx:20-30 min MAx. Heat
- car: rear-facing seat as LONG as possible
Pt intervention for school aged kids with OI
$strengthen mm
- aerobic
- protected ambulation
- enhance lifelong health
- power or manual w/c for life
What is PFFD?
Proximal femoral focal deficiency -most common LE deficiency -absence/small proximal femur — most also have total longitudinal deficiency of fibula -U/L or B/L -severe leg length discrepancy
Mild PFFD tx
Limb lengthening sx
Severe PFFD tx
Amputation
-prosthetics: symes, boyd
Short leg position
Flexion
Abduction
ER
Classification of congenital limb deficiencies
Failure of formation Failure of differentiation Duplication Overgrowth Undergrowth Skeletal deformities Congenital constriction band syndrome
Transverse limb dificiency
Normal until certain level, then absent
- usually U/L
- most common= below elbow BE
Longitudinal limb dificiency
Issues along long axis
Skeletal elements exist beyond affected area
What is rotational plasty and who is it used for?
For proximal tibis or distal femur
Backwards ankle=knee
- DF =flexion
- PF=extension
What conditions influence overuse injuries in kids
Rising incidence in pediatrics. Est at >50%of injuries
- inc sport participation: early specialization, higher complexity,longer duration
- high stress on growing body
- lack of appropriate coaching and skill training
Risk factors of overuse injuries
Training error Muscle-tenson imbalance Anatomical malalignment Improper footwear or playing surface Associated disease states Growth factors
Hydration needs of kids
Pre-hydration of 3 to 12 oz one hour prior to activity
- 3 to 6 oz just prior to activity
- 3 to 9oz every 10 to 20 mins
-16 oz for every pound of weight lost in 2 to 4 hours following activity
Stage 1 return to activity post concussion
No physical activity. Maximum rest
Progress when: symptom free for a min of 24hrs
Stage 2 return to activity post concussion
Light aerobic activity
-10-15 min of light exercise with no resistance. Walking stationary bike, or swimming. Quite play time alone or with parent
Progress when: symptom free for 24 hrs. If symptoms reemerge with this level of exertion. Return to stage 1
Stage 3 return to activity post concussion
Sport specific exercise
Running drills for up to 30 mins, nut no contact. Play must be supervised and activities low risk
Progress when: symptom free for 24 hours. If symptoms reemerge with this level of exertion, return to stage 3
Stage 4 post concussion
No contact
Complex training
Running jumping
Resistance
Stage 5 return to activity post concussion
-full -check ntact practice
Medical clearance. Normal training activities with full exertion. Have parent or adult supervision.
Progress when: symptom free for 24 hrs. If symptoms reemerge with this level of exertion return to stage 4
Stage 6 return to activity post concussion
Return to activity. Mormal game play
Next step: no restriction
Erb’s palsy:
Most common 52%. Injury to C5 and C6 nerve roots
Shoulder rests in extension IR and AD, elbow extension, forearm pronation and the hand and fingers held in flexion
Paralysis of C5-6 muscles. Rhomboids, levator, serratus, subscap, deltoid, infraspinatus, biceps, brachialis, supinator, brachioradialisand fingerand thumb extensor
Klumpke’s palsy
Rare. Breech delivery with the arm overhead
-C7-T1 nerve roots
Shoulder and elbow intacct
-resting position. Forearm supination and elbow flexion.
Paralysis: of C7-T1 muscles. Wrist flexors and extensors hand intrinsics
Erb-klumpke palsy:
Combo of C5-6 and C7-T1
Total arm paralysis and loss of sensation
Horners syndrome
Avulsion of T1 roots Deficient sweating(anhydrosis) Recssion of the eyeball Miosis Ptosis Irises of different colors
-70% of full recovery. Some have spont recovery within a few weeks. Recovery in shoulder ER. Accurately predict full recovery
OBPI initial intervention after birth
Initial rest period 7-10 days after birth
NoROM
Limb is positioned across the abdomen. Avoid lying on limb
OBPI PT intervention after rest period
HEP with ROM
Parent education on risk of dislocation and sensory loss issues
-strengthening activities through play
OBPI PT intervention for active movement
$faciliatate normal movement patterns. Inhibit substitutions during reaching and WB. Watch scapula. Can manually support and align
- use functional tasks. Hand to mouth, transferring objects, weight shift or propped UE and creeping
- sidelyng on uninvolved arm. Free involved arm to work on reaching
-pushing up to sitting from involved side
$bilateral activities
OBPI Pt intervention ROM
Avoid over stretching unstable joint
- does not pick child up under axilla
- stretch scapulohumeral muscles. Scapula can be stabilized in first 30 deg of abduction. Beyond 30 deg, scapula must rotate. Avoid impingement
-improve elbow extension. Botox and casting. Requires more research
OBPI PT intervention for sensory awareness
Can lead to neglect self-mutilation
- find way to make imapired arm seem purposeful and part of self
- incorporate variety and creativity
OBPI PT intervention for positioning and splinting
Sleeping: Abd, ER, elbow flexion,supination
Wrist splints. Prevent contractures.
Constrain uninvolved arms for short periods of time
E-stim requires more research
OBPI pathophysiology
- forceful traction injury during birthing process
- damage to any rootlets, roots, ,trunks, divisions, cords, peripheral nerve
risk factors for brachial plexus injury
- > 3500
- long labor
- difficulty w/deliver
- maternal DM
- sedated/hypotonic infant
- breech
neurapraxia
- least severe
- temporary nerve block
axonotmesis
- disruption of axon
- sheath is intact
neurotemesis
- most severe
- complete rupture
nerve regrowth
- -4-6 mo in upper arm (up to 2 years)
- 7-9 mo in lower arm (up to 4 years)
** distal takes longer than proximal
what are the types of CP? and associated lesions
- spastic= motor cortex
- Dyskinesia= BG
- ataxic= cerebellum
- mixed = MC +BG COmbo of spastic and dykinesia
How is CP diagnosed?
- clinical diagnosis
- abnormal muscle tone
- abnormal movement patterns
- useful tests:
- —-best sensitivity +specificity for EARLY mo. GM
- —best sensitivity +specificity for OLDER infants. AIMS, NSMDA
in CP what early skills are predictive for future ambulation?
- Best predictor for amb 15m by 8 yr
- ** independent sitting by 24 mo
- -if not by age 3 likelihood of functional walking very low
CP quadriplegia
- all four limbs are involved “tetraplegia”
CP diplegia
- all four limbs are involved. both legs are more severely affected than the arms
CP hemiplegia
-one side of the body is affected. the arm is usually more involved than the leg.
CP triplegia
- three limbs are involved, usually both arms and a leg
CP monoplegia
- only one limb is affected, usually an arm
GMFCS level in general
- Level 1: walks w/o limitation
- Level 2: walks with limiattaion
- Level 3: walks using a hand-held mobility device
- Level 4: self-mobility with limitations, may use powered mobility
- Level 5: transported in a manual wheelchair
CP common impairments
- hypertonia and hypoextensibility
- contrcatures
- diminished strength. weak distal >proximal , concentric > eccentric, fast >slow
CP progressive resistance training
- 4-12 week duration
- 3x/day
- 80-90% max load
IDEA Part C
-EI
- Age 0-3
- eligible: disability or medical diagnosis high probability of developmental delay
- –FM/GM, speech , adaptive, cognitive, social/emotional.
EI— agency
- CA= regional center
- 0-36 mo… 33% delay
- one low incidence condition. blind, death, orthopedically handicapped
- must use private insurance first
-child find: referral system
EI–Purpose
- meet developmental needs of infant
- resources to family
- provide child everyday learning opportunities
- natural environment
tests for IDEA Part C EI
- Bayler
- DAYC-2
- PDMS- 2
IDEA Part B
eligibility catgeories
- school district: Age 3-21
- autism
- deaf
- ID
- orthopedic CP
- speech/language
- TBI
IDEA Part B
-individualized education Plan HEP
- academic and functional performance
- initial eval w/in 60 days
- re-eval at least every 3 years, and max 1/year
IDEA Part B test
- PDMS-2
- BOT
- GMFM
how can a child obtain PT services through the school if they do not require special education?
- section 504
- -general school funding (does not NOT receive govt funding) Does not need IEP
–substantial physical/mental impairments
How is cystic fibrosis inherited?
- chromosome 7
- > 15000 mutations found that cause CF
- Problem = exocrine gland ion transport NaCl
- ** CFTR protein
- viscous secretions build up outside of cell
- impaired secretion clearance
- autosomal recessive- Both parents must be carriers
- most common inherited life-shortening illness in white population
What organs does CF affect? in respiration
- Lungs
- -chronic cough +sputum, incr risk of infection, less O2 –> cyanosis +hypoxia
What organs does CF affect
- digestive
- Pancreas: issues with fats +proteins. signs of malnutrition
- meconium ileus: unable to poop 1st few days after birth
what organs does CF affect? in reproductive system
- MALE only
- 98% = infertile
- -vas deferens blocked
What is clinical manifestation of cystic fibrosis?
- muscle pain
- decr bone mineral density
- hypetrophic pulmonary OA: causes clubbing of fingers +toes. increases with age
CF intervention in infancy
- emphasis on prevention of respiratory impairments
- imporves adherence with tx
- tx:
- -postural drainage
- -precussion
- -manual vibration
- -positive expiratory pressure (preferred)
- breathing games
- developmental milestones yp improve chest wall mobility, LE strengthening, endurance
CF intervention in pre-school and school age kids main goals
- improve exercise tolerance
- secretion clearance
- posture
- self- efficacy +independence
- promote adherence
CF intervention in preschool and school age LEAST adhered to…
- percussion
- vibration
- postural drainage
CF intervention HFCWO
- vest tat helps with secretion clearance
CF intervention for adolescence
- PEP
- active cycle of breathing
- ex program +strengthening
- diet
- autogenic drainage
- ball therapy
- posture (breathing mechnaics, hyperinflated lungs)
autogenic drainage
- 1st= unstick in distal
- 2nd= collect in middle
- 3rd= evacuate from central airways
- -PROS: no equipment can do in sitting
- -CONS: hard to teach/learn
COmmon signs of child abuse and neglect
- enuresis
- nightmares
- academic decline
- helpless behaviors
- secretiveness
- bruising
What is a PT role as a mandatory reporter?
- ADA: must report suspected abuse
- Physical or sexual abuse and neglect
Common extrinsic asthma triggers?
- extrinsic= allergic
- pollen
- mold
- pet dander
- dust mites
- chemicals/pollutants
- strong odors
- smoke
strategies to prevent acute attack with exercise induced asthma?
- long warm-up
- timing of medication
- hydration
- breathing control techniques
- neuromuscular: facilitate DSS for improved stabilization+ breathing patterns
- musculoskeletal: rib cage mobilization, stretching , strnegthening
Type I SMA
- primary impairment
- acute childhood SMA
- loss on anterior horn cells
- muscle weakness at birth. abdominal weakness = respiratory issues. POE= not usually attained
- supported sitting only for short periods b/c fatigue
-avg life span: 6 mo range= 1-21 mo
- contrcatures.
- CN involvement variable
Type I SMA
-secondary impairments
- contrcatures
- scoliosis
Type II SMA
-primary imapirments
- chronic childhood SMA
- proximal muscle weakness. poor sitting posture. pulmonary compromise. fatigue easily. hip dislocations +contrcatures
- **intelligence RARELY affected
Type II SMA- severe
- never able to sit independently
- sig reduced respiratory capacity
Type II SMA- intermediate
- able to sit independently
- will never walk
- FVC down to 45% by 10 y.o
Type II SMA- mild
- able to walk independently
- BUT 50% lose ability by 10.yo
Type III SMA
- primary and secondary impairments
- juvenile onset SMA
- onset = end of 1st decade
- primary: proximal LE weakness
- secondary: postura; compensations- L/S lordosis, trendelenberg gait. contractures PF= common, scoliosis
Presentation of angelman syndrome?
- SEVERE learning difficulties
- ataxia
- jerky movements
- puppet-like gait
- seizures
- sleep issues
- expressive speech = RARE
- inappropriately timed laughter
facial characteristics of Cri-duchat?
- microcephaly
- small jaw
- wide-set eyes
- downward slopin palpebral fissures
- epicanthal folds
- strabismus
- low-set ears
- broad nasal bridge
facial characteristics of Prader-willi
- decreased pigmentation of eyes+ skin
- often overweight b/c no sense to stop eating
facial characteristics of angelman syndrome
- SUBTLE
- wide smiley mouth
- small maxilla +prominent chin
- pale blue, deep-set eyes
facial characteristics Fragile X
- long face
- large ears
- prominent mandible
facial characteristics rett syndrome
- microcephaly
down syndrome MSK characteristics
- diastasis recti
- hypoplasia of middle phalanx
- hypermobility
- hypotone
- shallow acetabular angle
- atlantoaxial instability
- wide toe gap between 1 and 2
- single palmar crease
DS cardiovascular
- ventricular septal defect
- patent ductus arteriosus
- tetralogy of fallot: pulmonary valve stenosis, VSD, malposition of aorta, R ventricle hypertrophy
DS GI characteristics
- duodenal stenosis
- imperforate anus
- hirschsprung’s disease
DS immunologic characteristics
- leukemia
- chronic rhinitis
- chronic conjunctivitis
- fluid in middle ear
DS neurologic characteristics
- mild microcephaly
- hypotonia
- intellectual disability
- developmental delay
- early onset Alzheimer’s ~35yo
- small cerebellum/brainstem
DS gait pattern characteristics
- small step length
- increased knee flexion at IC
- hyperextension in stance- secondary to weakness
- decr single limb support
- incr hip flexion posture
DS interventions
- Monitor delays
- Promote WB
- facilitate antigravity muscles: trunk extensors
- midline orientation
- righting response
- cognition, kanguage, socialization
DS precautions
- ligament laxity: trauma, joint protection AA- avoid extremes of ROM
CMT first sign
- mild preference for rotation/ tilt
- named for the side of the tilt
- reinforced by positioning
CMT presentation of SCM
- unilateral fibrosis of SCM
- 2/3 have palpable tumor
Possible causes of CMT in utero/birthing process
- ischemic injury
- positioning/ constraint
- multiple births
- BAby A position (lower baby)
CMT facial deformities
- unlevel ears
- plagiocephaly
- ear cupping
- asymmetric cheeks, eyes, neck creases
CMT tx GOal
- ind w/ HEP
- full cervical AROM/PROM
- age appropriate postural control and motor milestones. midline control of head, neck and body
- symmetrical movement pattern
- monitor for regression!!
CMT intervention
- stretching (HEP)
- can desensitize first with heat or massage
- teach parents to be gentle yet firm
- -infants will not like stretching. teach play/distraction techniques
- positioning, stretching, handling
- postural control, motor milestones. improve prone skills with tummy time
CMT failure to treat
- persistent neck tilt and contracture. SCM and surrounding soft tissues may not grow w/ child.
- plagiocephaly (flattened cranium). most common cranial deformity
-delayed and/or asymmetrical motor skills. R CMT -> R sided preference. Lead transitions w/ ext not flex
- scoliosis
- decr midline postural stability. disorganized postural responses. esp post displacement
-craniofacial deformities. asymmetrical orbital fissures. mandibular asymmetry. muscle growth asymmetry
SI sign of under registration
- pay little attention or fail to notice things
- toys , people, sounds
- falling or bumping into objects. do not appear to feel pain unless intense
SI sign of over registration
- unable to tune out
- cont or steady sounds
- overly sensitive to textures
- respond well to deep pressure
SI intervention for gravitational insecurity
- excessive emotional response to vestibular movement
- extremely cautious: manipulates environment to avoid distress. seen as bossy/obstinate
SI intervention tactile defensiveness
- negative and emotional response to touch. fidgeting due to clothing. avoid glue, sand, paint food…
- may avoid or seek out comfortable stimuli. blanket, stuffed animals
- needs more touch. but cannot modulate it.
- deep pressure can modulate
SI underactive vestibular disorder
- may not become dizzy w/ spinning
- typical movements do NOT provide enough stimulation
- will seek out input
SI bilateral vestibular disorder
- may be undiagnosed if subtle. appears to have dyslexia/attention problems
- difficulty w/ postural responses
- poor integration of R and L
SI overactive vestibular disorder
- gravitational/postural insecurity. excessive emotional response to vestibular movement. extremely cautious.
- manipulates environement to avoid distress
- easily car motion sick
- long post rotary nystagmus
diagnostic criteria of autism
- Asperger’s
- childhood disintegrative disorder
- PDD-NOS: pervasive developmental disorders
- not otherwise specified
- symptoms MUST be present from early childhood!.
- deficits in childhood
- deficits social interactions
early signs of autism
- no babbling by 1 year
- no words by 16 mo
- no 2-word phrases by 2 years
- no response to name
- loss of previously acquired language
- poor eye contact
- no smiling
- poor social responsiveness
- excessive lining up objects
autism motor function
- motor delay in 2nd + 3rd years. delayed onset of walking. abnormal movement patterns
- poor coordination. usually B/L, UEs, LEs
gait characteristics of autism
- instability
- reduced ankle ROM
- incr wariable stride length
- postural asymmetry
- abnormal muscle tone
Now do
Cp
Dcd
Assessments
Milestones
