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Paediatrics > Introduction > Flashcards

Introduction Flashcards

1
Q

What is diagnosis ?

A

The process of identifying a health issue which requires clinical exam and assessment, lab tests, medical imaging, clinical reasoning, etc.

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2
Q

What is a diagnosis ?

A

The classification or taxonomy of a health issue that distinguishes it from other health issues.

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3
Q

What are ICD codes ?

A

Universally accepted diseases’ names, published by WHO.

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4
Q

Which factors can help the physiotherapist determine the dosage of treatment ?

A
  • guidelines
  • patient’s disability assessment
  • patient’s degree of fatigue
  • re-assessment timing, etc.
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5
Q

Which factors can increase compliance to therapy ?

A
  • Written instructions
  • Demonstration by physio and patient
  • No more than 3 activities to do (more than 3 reduces compliance)
  • Access to resources required for prescribed exercice
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6
Q

What is a neonate ?

A

A baby aged between 0 days and 28 days.

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7
Q

What is a pre-term baby ?

A

A baby born before the end of the 37th week of gestation.

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8
Q

What is the normal duration of gestation in human ?

A

From 37 to 40 weeks.

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9
Q

What are the risk factors for prematurity?

A
  • woman less than 5’
  • multiple attempts of pregnancy
  • using fertility clinics
  • carrying more than 1 fœtus
  • narcotics and drugs
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10
Q

How to calculate the corrected age of a premature ?

A

Chronological age - Prematurity

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11
Q

What are the primitive reflexes (listing and general definition).

A

They are involuntary motor responses present after birth in early child development that facilitate survival including:
- sucking, rooting and snout oral reflexes
- palmomental reflex
- glabellar tap reflex
- asymmetric tonic neck reflex
- Moro reflex
- grasping reflex
- Babinski reflex

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12
Q

Describe the sucking, snouting and rooting reflexes.

A
  • Sucking: coordination of breathing with swallowing when the oral region is stimulated or when an object is inserted into the mouth.
  • Snout reflex: when the lips pucker after pressure on the upper lip.
  • rooting reflex: when the mouth is turning toward an object when the cheek is stroked or when an object is in the baby’s visual field.
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13
Q

Describe the palmomental reflex.

A

Puckering of the skin on the ipsilateral side and brief contraction of the mentalis muscle after brisk stroking of the baby’s palm.

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14
Q

Describe the glabellar tap reflex.

A

Occurs in response to repeated tapping of the patient’s head between eyebrow which elicits blinking that normally would disappear after 4 to 5 taps.

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15
Q

Describe the asymmetric tonic neck reflex.

A

When rolled to one side the baby will extend its arm to the side of the rotated face and flex the contralateral arm.

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16
Q

Describe the Moro reflex.

A

It is a protective response to the abrupt disruption of balance: the baby will abduction the shoulder and extend the elbows and spread the fingers, followed by immediate flexion of the upper extremities and an audible cry.

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17
Q

Describe the grasping reflex.

A

It is elicited by providing sustained pressure on the palmar aspect of the hand, resulting in flexion of the baby’s fingers grasping the object providing the pressure.

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18
Q

Give the timing of the Moro reflex.

A

Starts after the 28th week of gestation and fully developed at 34th week of gestation.
Ends 3 months after birth.
Is replaced by startled reaction.

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19
Q

Give the timing of the sucking reflex.

A

Starts after 3 months of gestation.
Ends by 12 months after birth.

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20
Q

Give the timing of the rooting reflex.

A

Starts at about 28 weeks of gestation.
Ends about 4 to 6months.

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21
Q

What is the timing of snout reflex ?

A

Ends after 4 to 6 months.

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22
Q

What is the timing of the grasping reflex ?

A

Ends about 5 to 6 months after birth.

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23
Q

What are the roles of the physiotherapist in neonatal intensive care unit ? Give examples.

A

Contribute to managing parental distress.
Advise on positioning and handling:
- curled up position by nesting and swaddling
- maintain body symmetry
- prevent plagiocephaly
- encourage midline limb movements
Assess and treat:
- respiratory complications
- congenital defects (such as torticolis)

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24
Q

What is the best position for newborn when awake ?

A

Prone

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25
Q

What are the stages of cognitive development according to Jean PIAGET ?

A
  • From 0 to 2 yo: sensory motor stage (= cause and effect; object permanence starting from 6 mo);
  • From 2 to 7 yo: pre-operational stage (= imagination; symbolic; pretend play);
  • From 7 to 11 yo: concrete operational stage (= logical and inductive reasoning; mastery of conservation; problem solving);
  • 12+ yo: formal operational stage (= understanding of theory; hypothetical and abstract discourse; can question societal norm based on logic).
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26
Q

What is object permanence in babies ?

A

The baby is able to find a toy hidden by following the hand motion of an adult taking the toy to the final hiding destination.

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27
Q

What is language ?

A

The words and sounds that we use and how we use them to understand and share ideas.

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28
Q

What is the normal speech and language development from 0 to 3 months ?

A
  • startle at loud sounds
  • recognize familiar voices
  • coo and make pleasure sounds
  • specific cry for each need
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29
Q

What is the normal speech and language development from 4 to 6 months ?

A
  • track sounds with eyes
  • react to changes in tone of voice
  • eye focus on toys that make sound
  • babble to self with sounds beginning by b, p, m
  • laugh
30
Q

What is the normal speech and language development from 7 to 12 months ?

A
  • look in the direction of sounds
  • give attention (listen) when spoken to
  • understand common words (eg: cup, shoe, juice)
  • respond to simple instructions
  • babbles to get attention
  • imitates the speech of people
  • able to say 2 words (at 12 months) such as papa, mama, dog.
31
Q

What is the normal speech and language development from 1 to 2 yo ?

A
  • can point to some parts of the body when asked
  • recognizes objects in books
  • asks questions with one or two words
  • makes requests with two words
32
Q

What is the normal speech and language development from 2 to 3 yo ?

A
  • has a word for most things encountered
  • makes sentences with 3 words
  • able to make sounds containing, g, k, f, t, d, n
  • speech is understood by family members (but strangers may have difficulties understanding the child)
  • name objects or point to objects to make requests
33
Q

What is the normal speech and language development from 3 to 4 yo ?

A
  • responds to name when called from another room
  • answers simple questions when asked, where, why, who, what
  • able to discuss how day was spent
  • make sentences with 4 words
  • speech is fluent and understood by strangers
34
Q

What is the normal speech and language development from 4 to 5 yo ?

A
  • can answer questions based on a short story
  • make complex and detailed sentences
  • narrates events and stories coherently
  • able to play rhyming words game, including vowels and consonants
  • recognizes and name some letters of the alphabet and some numbers
  • uses adult level grammar
35
Q

What are fine motor skills ?

A

Movements involving the use of small muscles of the hand to manipulate small objects.

36
Q

List the normal fine motor development (Bayley) from 0 to 3,5 monts

A
  • hand fisted
  • reflex palmar grasp
  • cannot release grasp voluntarily
  • no thumb opposition
  • does not reach for toy
37
Q

List the normal fine motor development (Bayley) from 3,5 to 6 monts

A
  • hands open when not attempting manual task (fisting mustn’t be the default posture anymore)
  • voluntary grasp replaces reflex palmar grasp
  • can release grasp voluntarily
  • no thumb opposition
  • active carpal pronation/supination
  • reaches for toy
  • hand to mouth (to midline)
38
Q

List the normal fine motor development (Bayley) from 6,5 to 9 months

A
  • partial thumb opposition when grasping
  • beginning of power grip
  • hands cross midline
39
Q

List the normal fine motor development (Bayley) from 9 to 11 months

A
  • transfer small toy between left and right hand
40
Q

List the normal fine motor development (Bayley) from 16,5 to 19,5 months

A
  • index finger isolation when pointing
  • palmar grip for crayon
41
Q

List the normal fine motor development (Bayley) from 28 to 33 months

A
  • static tripod/ static quadripod grip for crayons
42
Q

List the normal fine motor development (Bayley) from 33 to 39 months

A
  • hold paper in place with one hand while writing with the other hand
43
Q

List the normal fine motor development (Bayley) from 39 to 42,5 months

A
  • can put back together toys with 3 simple interconnected parts
  • can imitate hand posture (eg: thumb up/down)
  • can use scissors to cut paper
  • can do/undo buttons on clothes
44
Q

What are gross motor skills ?

A

They involve the use of large muscles to maintain or change static and dynamic postures.

45
Q

At what age is head control achieved ?

A

From 3 months to 6 months

46
Q

At what age can a baby roll from prone to supine ?

A

From 4 to 5 months

47
Q

At what age can a baby sit from prone or supine ?

A

From 7 to 9 months

48
Q

At what age will babies pull to stand ?

A

From 7 to 12 months

49
Q

According to De Onis what are the six gross motor development milestones and when do they happen ?

A
  • sitting without support: 3,7 to 9,4 months
  • standing with assistance: 4,7 to 11,7 months
  • hands and knees crawling: 5,2 to 13,9 months
  • walking with assistance: 5,8 to 14,1 months
  • standing alone: 6,7 to 17,4 months
  • walking alone: 8 to 18 months
50
Q

What are the theories of Motor development ?

A
  • Dynamic system theory
  • McGraw’s theory
  • Central pattern generator
  • Hierarchical theory
  • Neuro maturational theory
  • Neuronal group selection theory
51
Q

What is the principle of Dynamic Systems theory, how to apply it clinically ?

A

A behavior occurs as a confluence resulting from interactions of the characteristics of the individual, environment and task.

Individual constraints examples: height, weight, disabilities
Environment constraints examples: assistive device, being watched during task performance
Task constraint example: sequence of actions required to use an equipment

We must destabilize extant skill to trigger the creation of new skills.

52
Q

Explain the neuronal group selection theory.

A

Neuronal development happens in 3 stages:
1) Primary neuronal repertoires (present before birth, determined by evolution, variable activities).
2) Selection of PNR to reduce variability and refine their activities by increasing strength of synaptic transmission (made possible by sensory information acquired through experience).
3) Re-appearance of variability in the function of PNRs because each PNRs are exposed to variable environments and tasks.

53
Q

What are the assumptions underpinning, neuronal group selection theory ?

A

The CNS is dynamically organized into variable networks.
The function and structure of each network are selected by development and behavior.
The units of selection are collections of hundreds to thousands of strongly interconnected neurons called neuronal groups which act as functional units.

54
Q

Explain primary variability (NGST).

A

Primary neuronal repertoire: movement is determined by genetics and primary neural pathways. Fœtus and newborn perform all movements with great variation but without coordination.

55
Q

Explain selection (NGST).

A

Baby experiments with movement patterns and selects the most effective movements by multiple repetitions to strengthen the new neural pathways (synaptic pathways). Variation is reduced.

56
Q

Explain secondary and adaptative variability (NGST).

A

Secondary neuronal repertoire: Multiple associated neural pathways are created by the selection phase to create a secondary neural repertoire. Mature movements adaptable to changes in task and environment. Variations increased again.

57
Q

Explain the Central Pattern Generator theory.

A

They are neuronal circuits that when activated can produce rhythmic motor patterns such as walking, breathing, crawling and swimming in the absence of sensory or descending inputs that carry specific timing information. The exact location of CPG in the human body is unknown. It is believed to be located in the lumbar spinal cord.

58
Q

What are the properties of Central Pattern Generators ?

A

Their rhythmic oscillatory activity is controlled by either a pacemaker (eg: respiratory center and sinoatrial node) or the synaptic connections between associated neurons (neuronal network with 2 half-centers which inhibits each others reciprocally). Some CPG are active for the life span while others require activation for a specific function (eg: walking). Neuromodulators can alter CPGs (eg: serotonin, dopamine, acetyl-choline, GABA).

59
Q

What is an evidence of the presence of Central Pattern Generators in human ?

A

Stepping reflex in babies present from birth to 8 weeks. If baby gains weight too fast, it won’t be able to walk anymore due to the weight of limbs. However, if feet are put on a treadmill, reflex can still be activated.

60
Q

Describe the concept of General Movements ?

A

General movements are a type of spontaneous movement which involve all body segments (arms, legs, neck and trunk) in a sequence that is variable in intensity, force and speed. It is a sequential, fluid body movement looking like breakdance. There are 2 types of general movements:
- Foetal and preterm + writhing movements
- Fidgety movements

61
Q

Describe the pre-term general movement

A
  • take place from 9th week post menstrual to birth (premature babies will continue to have pre-term GM according to their gestational age at birth.
  • large amplitude and fast speed.
  • no ellipsoïdal motion.
  • intermittent.
62
Q

Describe writhing movement (general movement)

A
  • present from birth to 9th week postnatal
  • small amplitude (occasionally moderate) and slow speed
  • ellipsoïdal motion
  • phasic: only present when baby is awake
  • assess supine through video recording (up to 60mn recording may be necessary)
63
Q

Describe fidgety movements (general movement)

A
  • present from 9 weeks post natal to 20 weeks postnatal (may continue up to 26 weeks)
  • small amplitude (occasionally moderate), slower than pre-term GM
  • initially phasic but later becomes present at all times when baby is awake but not upset.
  • assess in supine with 10mn video recording
64
Q

What is the prognosis for absence of fidgety movements from 9th to 20th week post term?

A

Highly predictive of spastic and dyskinetic cerebral palsy.

65
Q

What is the prognosis for cramped synchronized general movements from 9th week to 20th week post term?

A

Highly predictive of spastic cerebral palsy.

66
Q

What are poor repertoire general movements ?

A

Monotonous movements, lacking normal variability in speed, range of motion and intensity.

67
Q

List movements and postures that may look like general movements but are not.

A
  • predominant hand swipes
  • predominant saccadic arm movements
  • monotonous kicking (same pettern and direction)
  • no movements toward the midline
  • repetitive tongue protrusion for unusual long time
  • repetitive head rotation
  • foot contact on the tibial side
  • legs predominantly lift with knee extension (stiffness)
  • prolonged trunk arching
  • head is always posed laterally
  • posture is never symmetrical
  • spontaneous ATNR cannot be overcome by flexion of the facing arm.
68
Q

Describe AF

A

Abnormal fidgety movements.
Very rare.
Observable from 9th to 20th week post term.
They look like normal fidgety movements, but they are jerky with exaggerated amplitude and speed.
Low predictive value for CP.

69
Q

Describe Ch GM

A

Chaotic general movements.
Very rare.
Observable from pre-term to early post term.
Movements are still large in amplitude but not smooth.
Usually replaced by cramped synchronized movement when normal fidgety movements are expected to be present.
Low predictive value for CP.

70
Q

Describe CS

A

Cramped synchronized general movements.
Observable from 9th to 20th week post term.
Absence of smooth sequential movements of body segments. Eg: upper limbs and lower limbs and trunk muscles contract and relax concurrently.
Highly predictive of spastic CP.

Paediatrics (4 decks)

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