Infant Conditions Flashcards
Malformation occurs in ____ tissue.
Deformation occurs in ____ tissue.
Malformation = embryologic. Deformation = normal.
Malformation occurs during ____ (time period).
Deformation occurs during _____.
Mal = first 8 wks of gestation De = after 8 wks of gestation
Cause of malformation
teratologic or genetic
Cause of deformation
mechanical
Anencephaly
lack of brain formation
failure of anterior neural tube closure
Myelomeningocele
failure of posterior neural tube closure
AKA spina bifida
causes of myelomeningocele
low folic acid in pregnancy
myelomeningocele clinical implications
motor/sensory loss (varies depending on degree of severity & level of spinal cord affected).
Positioning, medical equipment & orthotic management, gait or w/c mobility
hypoxic ischemic encephalopathy (HIE)
lack of oxygen at birth
can affect any part of brain
HIE clinical implications & PT Tx
cooling protocol
can lead to CP
varies depending on what part of brain affected.
PT: quality of movement, vary movements with developmental positions, parent education.
Developmental Dysplasia of the Hip (DDH)
abnormal growth/development of hip joint
causes of DDH
mechanical factors in utero
hormone-induced lig laxity
genetics
cultural/environmental factors
risk factors for DDH
breech
small intrauterine space
first born girl
DDH PT Tx
0-9mo: Pavlik harness (worn 24/7).
>9mo: traction & Pavlik harness (if ambulatory, may use ABD orthosis instead of Pavlik)
Surgical tx may be necessary > 9mo.
Pavlik harness maintains what joint positions?
90-100deg flex, ABD, ER
Metatarsus Adductus
Forefoot bent inward (ADD)
Hindfoot & ankle normal (neutral)
Metatarsus Adductus risk factors
breech
DDH
in-toe walking
Metatarsus Adductus PT Tx
Tx depends on rigidity vs. flexibility. Can resolve spontaneously. Improves w stretching. Reverse-Last shoes, cast. Surgery if persists thru 4-6yo
Talipes Calcaneovalgus
Excess Dflex & eversion
Dorsum of foot in contact w/ Tib Ant
Resistance into Pflex & inversion
Talipes Calcaneovalgus risk factors
breech
DDH
Tibial ER
Talipes Calcaneovalgus PT Tx
Tx depends on rigidity vs. flexibility. Can resolve spontaneously. Improves w stretching. Splinting Firm, high-top shoes.
Torticollis
Unilateral shortening of SCM.
Ipsilateral lat flex.
Contralateral rotation.
Infants w/ torticollis are at a higher risk for
facial asymm
plagiocephaly
developmental delay
vision problems
Torticollis PT Tx
Prolonged passive stretch of SCM. Positioning to promote symm. Cervical strengthening & AROM. Symm developmental activities to correct head position. Environmental adaptations.
Cranial molding deformities: Plagiocephaly
asymm flattening
Cranial molding deformities: Plagiocephaly is associated with
Back to Sleep campaign In-utero position Torticollis Prolonged hospitalization Asymm facial features
Cranial molding deformities: Brachycephaly
symm flattening
Cranial molding deformities: Brachycephaly is associated with
Back to Sleep campaign
Hypotonia
Prolonged hospittalization
Osteogenesis imperfecta
disorder of connective tissue
severity varies person to person
lax joints, weak muscles, diffuse osteoporosis
Osteogenesis imperfecta PT Tx
Pt education Environmental adaptation Developmental Post-trauma recovery DME
Arthrogryposis Multiplex Congenita
nonprogressive neuromuscular syndrome
2+ joint contractures at birth
Arthrogryposis Multiplex Congenita clinical considerations
severe jt contractures
muscle weakness & fibrosis
inhibited movement in utero
Arthrogryposis Multiplex Congenita PT Tx
improve alignment (DME or splint)
Strengtthen & stretch
Compensatory strategies
Congenital Limb Deficiencies: Longitudinal Limb Deficiency
reduction or absence of 1 or more elements w/in the long axis of limb.
malformation.
may have typical distal skeletal elements.
Congenital Limb Deficiencies: Proximal Femoral Focal Deficiency
absense or hypoplasia of prox femur.
Varies in degree of involvement of other structures (acetabulum, femoral head, patella, tib, fib, cruciate ligs, foot).
Club Foot (AKA Talipes Equinovarus)
Forefoot ADD
Calcaneal Varus
Supination
Club Foot (AKA Talipes Equinovarus) PT Tx
Taping Casting Stretching Reverse-Last shoes Dennis-Brown bar Surgery
Teratogens
environmental agents causing harm to embryo/fetus
Critical Periods: CNS
throughout embryonic & fetal periods
MOST critical time = 2-8wks
Critical Periods: Heart Defects
3-7wks
Critical Periods: Skeletal System
4-6wks
Teratogens: severity of symptoms depends on…
amount of exposure
timing of exposure
genetic makeup of indiividual
Maternal exposures influencing development: Maternal diseases/conditions
infections
diabetes
malnutrition
Maternal exposures influencing development: Environmental factors
radiation
pesticides
herbicides
Maternal exposures influencing development: Prescription Drugs
opioids narcotics seizure meds psych disorder meds blood thinners antibiotics thyroid meds
Maternal exposures influencing development: Non-Prescription Drugs
pain killers
cold meds
Fetal Alcohol Syndrome characteristics
growth deficiency
CNS dysfunctiion
craniofacial anomalies
Effects of cocaine/tobacco exposure
vasoconstriction BP fluctuations O2 deprivation CNS damage increased risk of SIDS (Sudden Infant Death Syndrome) increased risk of mortality
Neonatal Abstinence Syndrome (NAS) is caused by
maternal substance abuse
Neonatal Abstinence Syndrome (NAS) presentation
may appear immediately or days after birth
excessive crying, diarrhea, sucking, sweating.
increased muscle tone
Neonatal Abstinence Syndrome (NAS) PT considerations
hypERtonica
tremor
severe state regulatiion issues
Cystic Fibrosis (genetic malformation)
impaired CaCl channel & thicker secretions (“salty kiss”)
affects pulmonary, digestive, & reproductive
Cystic Fibrosis (genetic malformation) PT Tx
airway clearance techniques posture - esp chin/shoulder retraction mobility, stretching, strengthening. aerobic training, energy conservation. effecient breathing training
Sickle-Cell Disease PT Tx & considerations
pain management
avoid exercise in extreme hot or cold
Sickle Cell Crisis: “painful event”
Down Syndrome
duplication of chromosome 21
Down Syndrome PT considerations
delayed gross, fine, speech
hypotonia
joint laxity
atlantoaxial instability
Prader-Willi Syndrome (genetic malformation) - what is it & clinical presentation
chromosome microdeletion severe hypOtonia severe feeding problems in infancy excessive eating & obesity in childhood poor fine/gross motor coordination
Prader-Willi Syndrome: average age of sitting
12mo
Prader-Willi Syndrome: average age of walking
24mo
Angelman Syndrome (genetic malformation) - what is it & clinical presentation
deletion of chromosome 25 hypotonia feeding problems developmental delays tremulous movements, hand flapping. distinctive gait pattern. ataxia
Abdominal anomoly: Omphalocele
intestine & other ab organs herniate thru opening WITHIN the sac
Abdominal anomoly: Gastroschisis
intestine & other ab organs herniate thru opening OUTSIDE the sac
Abdominal anomolies: PT considerations
poor ab strength
prolonged supine position
decreased head ctrl due to limited play in prone/sitting
