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Peds Neuro > HOP-FA > Flashcards

HOP-FA Flashcards

1
Q

Definition of HOP-FA

A

clinical framework designed to guide students and novice clinicians through the clinical reasoning process in pediatric physical therapy practice

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2
Q

what does HOP-FA stand for?

A

Hypothesis-Oriented Pediatric Focused Algorithm

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3
Q

What really is the HOP-FA and what does it do?

A
  • A systematic, step-wise guide to the patient/client management process
  • Assists physical therapist students in developing pediatric clinical reasoning skills
  • Promotes a child-and family-centered approach to pediatric physical therapist practice
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4
Q

is the HOP-FA intended to provide specific guidelines for pediatric physical therapy practice?

A

nope

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5
Q

is the HOP-FA built upon a specific therapeutic examination or intervention philosophy?

A

nope

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6
Q

Definition of Cerebral Palsy:

A
  • Disorder of the development of movement and posture causing activity limitation
  • Attributed to non-progressive disturbances that occurred in the developing brain
  • Motor disturbances
  • Disturbances in sensation, perception, cognition, communication, behavior, epilepsy
  • Secondary musculoskeletal problems
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7
Q

Antenatal Pathophysiology of CP

A
  • Prematurity and low birth weight
  • intrauterine infections
  • multiple gestation
  • pregnancy complications
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8
Q

Perinatal Pathophysiology of CP

A
  • birth asphyxia
  • complicated labor and delivery
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9
Q

Postnatal Pathophysiology of CP

A
  • Non-accidental injury
  • Head trauma
  • Meningitis/ Encephalitis
  • Cardiopulmonary arrest
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10
Q

Periventricular Leukomalacia

A
  • Ischemic necrosis to periventricular white matter
  • Causes bilateral cystic lesions (myelin doesn’t form)
  • distal > proximal
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11
Q

Periventricular Hemorrhagic Infarction

A
  • Hemorrhage into germinal matrix and ventricles
  • Unilateral
  • Caused by an increase in cerebral blood pressure
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12
Q

pathophysiology - preterm infant

A

*Periventricular leukomalacia (PVL)
*Periventricular hemorrhagic infarction
*Affects ascending/descending axons
*Topographic and size relationship

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13
Q

Pathophysiology - Term Infant

A

*Infarction in parasagittal watershed area, MCA stroke
*Basal ganglia & thalamic injury

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14
Q

Term Infant- Infarction in parasagittal watershed area, MCA stroke

A

Cortical and deep gray matter lesion

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15
Q

Basal ganglia & thalamic injury

A
  • Athetosis, chorea
  • Seizures and cognitive impairments
  • Hemiplegia > Diplegia
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16
Q

Classification of CP - Movement Disorder

A
  • Hypertonia –spasticity, dystonia, rigidity
  • Hyperkinetic –athetosis, chorea, dystonia, myoclonus, tics, tremor
  • Negative –ataxia, weakness, decreased selective motor control
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17
Q

Classification of CP- Anatomic Distribution

A
  • Hemiplegia
  • Diplegia
  • Triplegia
  • Quadriplegia –involvement of head and neck
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18
Q

GMFCS - Level I

A
  • Walks without limitation
19
Q

GMFCS - Level II

A
  • Walks with Limitations
  • Climb stairs holding onto a railing
  • difficulty walking long distances or uneven terrain
  • May walk with physical assistance, a hand-held mobility device or wheelchair over long distances
  • Minimal ability to perform gross motor skills such as running and jumping
20
Q

GMFCS - Level III

A
  • Walks using a hand-held mobility device in most indoor settings
  • May climb stairs holding onto a railing with supervision or assistance
  • Wheeled mobility when traveling long distances and may self-propel for shorter distances
21
Q

GMFCS - Level IV

A
  • Self-Mobility with Limitations; may use powered mobility
  • May walk short distances at home with physical assistance or use powered mobility or a body support walker when positioned
  • At school, in community, or outdoors, children are transported in a manual wheelchair or powered mobility
22
Q

GMFCS - Level V

A
  • Transported in a manual wheelchair in all settings
  • Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
23
Q

Twelve Steps of the HOP-FA

A
  1. Initial Hypothesis
  2. Initial Data Collection
  3. Problem Statement
  4. Hypothesize Goals
  5. Examination Planning
  6. Examination
  7. Evaluation
  8. Diagnosis and Prognosis
  9. General Intervention Planning
  10. Intervention Session Planning
  11. Reflection
  12. Formal Re-examination
24
Q

Initial Hypothesis - 1a

A
  • Question: What is the child’s
    chronological age?
  • Build a mental image of the child at this
    age….
  • Gross Motor Function
  • Social
  • Educational
  • Family Activities
25
Q

Initial Hypothesis - 1b

A
  • Question: What are the primary and
    secondary impairments associated with
    the child’s medical diagnosis?

Assists with:
* Foundational aspects of examination
* Building a mental image of the child

26
Q

Initial Data Collection

A
  • Review of records (Medical, Educational)
  • Interview with family
  • Observe the child during the interview
    process
  • What is the lived reality and environment of the child and family?
  • Why are the child/family seeking PT?
  • What are their desired goals/outcomes
    from PT?
27
Q

what is the information collected during initial data collection for?

A

This information assists the PT to further
develop an initial impression of the child’s
functional capabilities/status

28
Q

Measures to assist with goal setting

A
  • Canadian Occupational Performance Measure (COPM)
  • Perceived Efficacy and Goal Setting System
29
Q

Problem statement

A

*Statement that specifically describes why the child/family are seeking PT
*The foundation of family-centered care –> Ensures that the child’s and family’s goals and expected outcomes are well understood and delineated prior to examination

30
Q

Problem statement to fill in:

A

“The family/child are seeking physical therapy to be able to…”

31
Q

Hypothesize goals

A

*Propose short and long-term functional goals that will direct the examination process
*Ensure that these goals are consistent with the child’s/family’s desired outcomes –> Encourages family involvement in the examination process

32
Q

What is important to note when hypothesizing goals

A

These goals might not be the definitive goals established for the plan of care –> These initial goals are tools to help prioritize the tests and measures used in the examination

33
Q

tests and measures identified based on:

A
  • The PT’s mental image of the child
  • The problem statement
  • The hypothesized goals
  • The information gathered through the initial data collection process
  • The PT’s knowledge of available tests and measures
34
Q

what is extremely important during examination planning?

A

ICF

35
Q

examination

A

*Administer tests and measures
*You will find that measures of Activity and Participation are not routinely employed in clinical settings –> Good for tracking progression over time, measuring effectiveness of interventions

36
Q

measures of examination should be:

A
  • Valid
  • Reliable
  • Feasible
  • Able to detect clinically-relevant changes
37
Q

Evaluation

A

*Synthesis of examination findings
*Facilitates the inclusion of contextual factors during the synthesis of
examination findings

38
Q

Questions to consider during evaluation?

A
  • What are this child’s specific strengths?
  • What are the physical therapy problem areas (impairments, functional limitations, and activity or participation restrictions), and how do
    these problem areas impact this child’s function?
  • In what ways do the identified physical therapy problem areas restrict the child’s ability to fully participate in activities that are
    appropriate for the child’s age?
  • Do any of the identified physical therapy problem areas have the potential to lead to the development of further problem areas? Can
    these future problems be prevented? How?
  • Are there any changes coming up for this child and family in the next year? How might these anticipated changes affect the child and
    the family?
  • What is the child’s anticipated level of function in 1 year? 5 years? What needs to be done now to maximize the child’s future independence and function?
39
Q

diagnosis and prognosis

A

*Identify the primary 1-2 physical therapy problem areas that are most limiting the child’s functional activity level (Prioritize problem areas and Assist in focusing the physical therapy plan of care)
*Helps drive intervention strategies
*Are additional referrals necessary?
*Refine mental image of child based on examination/evaluation

40
Q

general intervention planning

A

*Physical therapy interventions based on plan of care (Coordination, Communication, Documentation)
*Procedural interventions
*Patient/client and family-centered instruction (Home program)

41
Q

Intervention Session Planning

A
  • Base interventions for individual sessions on a specific functional goal
  • Specific activities (Preparation, Motor, Links to the next session)
  • Consider: Motivational factors, Play, Feedback mechanisms, How to increase/decrease level of difficulty
42
Q

Reflection - Continue monitoring:

A
  • Was the intervention successful?
  • Are we progressing toward the short-and long-term goals?
43
Q

formal re-examination

A

*Re-administration of examination tests and measures to modify/redirect
interventions

Peds Neuro (19 decks)

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