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7 Pediatrics > L4 CP/Down Syndrome > Flashcards

L4 CP/Down Syndrome Flashcards

1
Q

Cerebral Palsy

A

motor disability related to early damage of brain in areas controlling motor behaviors

early brain damage in utero, during birth, or shortly after birth

presentation is impacted by etiology, location, and extent of injury

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2
Q

CP of Cerebral Palsy

A

muscle weakness
dysfunction in motor recruitment
decreased balance
decreased endurance
intellectual impairments
dysfunction in sensory integration

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3
Q

Functional impacts of CP

A
  • ADLs
  • delayed developmental milestones
  • challenges walking distances
  • decreased activity tolerance
  • decreased ability to maintain sustaiined active play
  • participation in organized sports and recreational activities
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4
Q

Distribution of Involvement

A

Quadriplegia
Hemiplegia
Diplegia

difficult to classify due to subtle involvement in all extremities, as well as asymmetries with presentation

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5
Q

Displegia

A

primarily LE involvement

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6
Q

Classifications of CP

A

Distribution of involvement
Muscle tone or motor control
Degree

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7
Q

Muscle Tone Classification

A

spastic
Dyskinetic
Ataxic
Mixed

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8
Q

Degree classification

A

mild
moderate
severe

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9
Q

Dystonia

A

involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements and/or postures

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10
Q

Chorea

A

on going, random appearing sequence of one or more discreate movements or movement fragments varying in timing, duration, direction, body location

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11
Q

Athetosis

A

slow, continuous, involuntary writhing movement that prevents maintenace of stable posture; characterized by smooth continous random movements not composed of identifiable fragments of movement

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12
Q

Tremor

A

rhythmic back and forth or oscillating involntary movement about a joint axis, rhythmic alternatic movement with relative symmetry in speed

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13
Q

Ataxia

A

gross lack of coordinated movements

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14
Q

Pelvis and Hip in CP

A
  • may have bony involvement, either due to shape/muscle involvement/length
  • pelvic obliquity or leg length discrepancy
  • pelvic tilt
  • W sitting
  • hip sublux, dislocation, instability
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15
Q

Foot and Ankle in CP

A
  • shortened gastroc
  • reduced DF ROM associated with PF position during WB
  • breakdown of longitudinal arch with difficulty stabilizing foot (flatfoot)
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16
Q

Spine and CP

A
  • may develop scoliosis and/or thoracic kyphosis
  • leg length discrpancy contributes to pelvic asymmetry and compensation in spine
  • may stand on toes, knees extended, hips adducted, hips IR, pelvis anteriorly tilted
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17
Q

Intervention for CP MSK

A
  • WB to mold bones
  • stretching before and after exercise
  • night splinting
  • orthotics
  • surgery
  • strength training
  • functional training
18
Q

Gross Motor Function Classification System (GMFCS)

A
  • classification system of gross motor function of kids with CP
  • 5 point scale describing functional abilities in sitting, walking, wheeled mobility
  • used before 2nd bday, between 2-4, 4-6, 6-12, 12-18
19
Q

Level 1 of GMFCS

A

walks without limitations

can run, jump, skip
participates in age appropriate activities

20
Q

Level 2 GMFCS

A

walks with limitations

difficulty walking long distances
may need min assist
struggles with different environments

21
Q

Level 3 GMFCS

A

walks using a hand-held mobility device

uses AD in home and community
STS needs min assist
w/c for long distances

22
Q

Level 4 GMFCS

A

self-mobility with limitations, possible use of powered mobility

requires AD for most to all settings
adaptive seating
needs help with transfers

23
Q

Level 5 GMFCS

A

transported in manual w/c

may crawl, roll, creep for short distances
powered or manual w/c
needs seat belt for positioning

24
Q

Manual Ability Classification System (MACS)

A
  • how children with CP use thier hands in daily activities
  • levels based on child’s need for assistance for activities in most settings
  • 5 levels
  • good correlation between GMFCS and MACS
25
Q

Levels for MACS

A

Level 1 = handles objects easily and successfully
Level 5 = child does not handle objects and challenged with simple tasks

26
Q

Communication Function Classification System

A
  • determine communication abilities of kids with CP
  • based on ability to speak, receive, pace, adapting to different context
  • 5 levels, with level 1 being the most competent
27
Q

Interventions for CP

A
  • Medical: botox, oral meds
  • surgery
  • nutritional management with g tube
  • posture
  • alignment
  • ROM
  • strength
  • activities
  • participation
28
Q

What categories does the GMFCS test?

A

lying and rolling
sitting
crawling/kneeling
standing
walking, running, jumping

29
Q

Down Syndrome

A

Genetic disorder in which majority of individuals have extra 21st chromosome

non disjunction of two homologos chromosomes during first or second meiotic division

30
Q

CP of down syndrome

A

generalized low muscle tone
muscle weakness
slow postural reactions
joint laxity
intellectual disabilites
increased BMI

31
Q

Functional Impacts of Down Syndrome

A
  • delay of developmental milestones
  • decreased ability to maintain sustained active play with peers or family
  • decreased participation in organized sports and active recreation activities
  • surgery to correct any congenital heart defects
32
Q

Interventions for Down Syndrome

A
  • early focus on developmental milestones
  • strengthening with resistance
  • balance
  • treadmill/gait training
  • orthotics
  • aerobic conditioning
  • wellness plans and programs
  • incorporation of technology
33
Q

Atlantoaxial instability

A

enlarged space between first and second cervical vertebrae

present in 15% of individuals with Down Syndrome

risk of excessive motion and spinal cord compresison

34
Q

Things to avoid with AA instability

A

tumbling
boxing
diving
horseback riding
gymnastics

things that cause excessive neck flexion or extension

35
Q

When should initial radiographs be taken for AA instability?

A

3-5 years and repeated screening is not indicated

special olympics requires screening

36
Q

Examples of adaptive equipment

A
  • w/c
  • go baby go
  • strollers
  • walkers
  • gait trainers
  • standers
  • adaptive seating
  • orthotics
  • adaptive cycles
  • toilet and bath chairs
  • car seats
  • communcation tablet
  • beds, hoyer lift, ramps
37
Q

Justification of medical necesity

A

work with family and equipment vendor to determine need

38
Q

Chromosome Disoders Types

A

Structural
Numerical

39
Q

Structural abnormalities

A

deletion
translocation
inversion
other

40
Q

Numerical abnormalities

A

addition
deletion

41
Q
A

7 Pediatrics (10 decks)

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