L7: Peds Exam Flashcards
Where do you start?
- Hx/chart review
- med, fam sx hx
- dev. hx including age of acquisition for motor milestones, APGAR**
- family dynamics, school placement, day-day routine
- ADs/PLOF
- Current LOF/condition, reason for PT
- MEds
- *anti-epilectics, spasticity, attn defs
- allergies
- imaging
- precautions/contraind’s
Exam/impairment lvl
Things to remember***
NEVER assume pt will be able to comply w/ testing
Formal testing often cannot be conducted due to pts age, cog, compliance
Exam/Impairment Lvl
MSK
- ROM/Strength
- Strength→ MMT usually becomes accurate around age 3******
- Posture and Alignment
How and when does one formally assess strength in the absence of MMT?
- Younger than 3, poor cog, lack of isolated mvmt
- Use observation of and description of motor skill abilities OR lack of abilities
- OFten described as “developmental assessment” for younger children
- described as “motor control assessment” in older children
- Use observation of and description of motor skill abilities OR lack of abilities
Exam/Impair. Lvl
Neurological
- Reflexes
- Tone/Spasticity
- Motor Control
- Coord
- Balance
Exam/Impair LVL
Neuro→ Tone/Spasticity
-
HypERtonicity
- Ashworth Scale
- Modified Tardieu (R1/R2)
-
HypOtonicity
- no assess’s
-
Dystonia
- fluctuations in tone
-
Barry Albright Dystonia Scale
- 8 body regions → HIGHER= more severe dystonia
When ______ is NOT present, _____ cannot be conducted and should not be
Isolated mvmt; MMT
Motor Control Assessment
(Older children)
Qualifies strength
*narrative that breaks down mvmt of limbs by joint→ describes quality of that mvmt
Coordination note:
- finger to nose
- itsy bitsy spider
- Dysdiadochokinesia (patty cake)
- OR coord assess→ jumping jacks/catching ball
Balance tests to note
Peds functional reach
TUG for children
Pediatric BERG
*No predictive values for these tests for children!!!
Balance must be reported HOW?
Objective and reproducible way NOT just good, fair, poor
Exam/Impair Lvl
Cardio.
HR trends
- Fetal→ 8-10yo=== Avg HR SLOWS as we get older
- 12yrs→14yrs=== Females HIGHER vs males BUT same thing, slows as we age
Exam/Impair Lvl
Cardiovascular→ BP
BOTH systolic and diastolic BP gets HIGHER as we age
Exam/Impair Lvl
Cardiovascular → RR
RR gets LOWER as we age
Exam/Impair Lvl
Cardiovascular→ Lung capacity/Wall expansion
things to use
Inspirometer, bubbles, tape measure, tissue blow, cough strength
Exam/Impair Lvl
Cardiovascular → Endurance
Tests to use
- Step up test
- 6min Walk Test
- RPE (peds graph)
- time playing
Exam/Impair Lvl
Sensation
Things to look @
- Lt touch/proprio
- Vision
- Hearing
- Processing→ thru observation of behavior/parent report
- Pain
Pain scales to use w/ Peds
FLACC Scale (nonverbal children/cog. impaired)
Wong Baker FACES Scale
Exam/Impair Lvl
Cognitive/Social
IMPORTANT THINGS TO NOTE***
Make eye contact?
Have age approp. play skills?
*if old enough, questions related to self-efficacy, overall perception of health, QoL measures→ PEDS-QL
Exam/Impair Lvl
Integumentary
- skin integrity
- Skin risks***→ important for certain pops like spina bifida
Functional/Activity Limits.
Transfers
Mobility: amb, W/C mobiltiy
Stairs
Changes in environ.
Function/Activity/Participation Restricts:
MANY measures
MOST function on functional mobility, motor skills vs peers, participation capability
There are 2 types of measures
-
Criterion Referenced
- pts scored for aspects or components of mvmt: changes over time
- cannot compare to peers
-
Norm-Referenced
- Standardized or norm (typical) children and are used to provide a measure of childs function in compare to age matched peers
- not as resp. to change over time***
***Test of Infant Motor Performance (TIMP)
Age group:
Looks @/Dx:
Category ICF:
- 32wks→ 4mos
- Functional motor activities for very young child diff pos’s
- @risk children in NICU***
- Great to eval infants <4mos w/ torticollis***
- Activity category: Gross Motor
***Bailey Scales of Infant Development (BSID-2): Norm ref’d
Age group:
Looks @/Dx:
Category ICF:
- 1-42mos
- Developmental delay & monitor progress (lang, gross/fine motor, behavior, perceptual)
- Activity category: Developmental Screening
***Denver II→ Norm ref’d
Age group:
Looks @/Dx:
Category ICF:
- 1wk→ 6.6yrs
- Developmental problems (behavior, self-care, fine/gross motor, lang.)
- Participation category:
***Batelle Developmental Inventory (BDI)→ Norm ref’d
Age group:
Looks @/Dx:
Category ICF:
- Birth→ 8yrs
- Developmental lvl→ plan intervention/assess effects (personal-social, adaptive, motor, communication, cognition)
- *looks @ all areas where you can justify rehab
- Activity category: Multidomain
*
***Movement Assessment of Infants (MAI)→ Norm ref’d and Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- 4→ 8mos: Norm referenced; Birth→ 12mos: Criterion referenced
- ID motor dysf in high risk infants, monitor PT effects (mm tone, reflexes, automatic rxns, volitional mvmt)
- Body structure/function category: Reflexes
Alberta Infant Motor Scale (AIMS)→ Standardized
Age group:
Looks @/Dx:
Category ICF:
- Birth→ 18mos
- Gross motor delay and changes over time
- Activity category: Gross motor
Peabody Developmental Motor Scale (PDMS-2)→ Norm ref’d and Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- 1→ 72mos
- Known disabilities: Criterion
- Determine lvl of motor skill acquisition/delay (Gross motor, reflex, stationary, locomotion, object manip, grasp, visual motor integration)
- Activity category: Fine Motor
- *MOST commonly used in research/Gold Standard!!!
This FOM especially used for CP and Down Syndrome******
KNOW THIS!!!
Gross Motor Function Measure (GMFM)
GMFM what should you memorize???
CP and Downs!!!
***Gross Motor Function Measure→ Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- 5mos→ 16yrs
- **CP and Downs!!!
- Change in gross motor skills over time→ current lvl & determine goals (lying, rolling, crawling, sitting, standing, walking, running, jumping)
- Activity category: Gross Motor
GOLD STANDARD FOR CP AND DOWN SYNDROME
GMFM
Test for Gross Motor Development-2 (TGMD-2)→ Norm ref’d and Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- Norm ref’d for 3→ 10yo
- Criterion ref’d
- Determine acquisition of gross motor skills (locomotion, obj. control)
- Activity category: Gross Motor
School Function Assessment (SFA)→ Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- K-6 children w/ disabilities***
- assess function & guide program planning w/in school (Participation, task support, activity performance, phys. tasks, cog/behavioral)
- Participation category:
Movement Assessment Battery for Children (Movement-ABC)→ Norm ref’d
Age group:
Looks @/Dx:
Category ICF:
- 3→ 16yo
- *Best for coord. dx (ADHD, ASD)
- Impairments of motor coordination (DCD, ADHD, ASD)
- Manual dexterity, ball skills, static/dynamic balance
- Activity category: Multidomain
Bruininks Oseretsky Test of Motor Proficiency (BOT-2)→ Norm ref’d
Age group:
Looks @/Dx:
Category ICF:
- 4→ 20yo
- Assess motor skills in children
- Balance, coord, speed/agility, strength, visual motor control, dexterity
- Looks @ high lvl skills (sit-ups, push-ups, wall-sits, agility)→ NOT good option for neuro pop.****
- Activity category: Fine Motor and Gross Motor
Pediatric Evaluation of Disability (PEDI)→ Norm ref’d and criterion ref’d (older kids)
Age group:
Looks @/Dx:
Category ICF:
- 6mos → 7.6yo
- Older children w/ lower functional/cog abilities→ criterion ref’d
- Looks @ functional capabilities/performance, monitor progress in functional skill performance and eval outcomes
- interview format
- Activity category: Multidomain
Functional Independence Measure for Children (Wee-Fim)→ Criterion ref’d
Age group:
Looks @/Dx:
Category ICF:
- Criterion for:
- Children w/OUT disabilites 6mo→ 8yrs
- Children w/ disabilities 6mo→ 12yrs
- Children w/ disabilities and mental age <7yrs
- Determine severity of disability, caregiver assist, outcomes of rehab stay
- self care, sphincter control, transfers, locomotion, communication, social cog
- Activity category: Multidomain
Knowing Normal Dev. importance
- Need to know norm for abnorm ID
- Be aware red flags
- Any regression or loss of previously acquired skills is cause for concern!!!
PT Eval
- Based on Exam findings
- Dx
- Prognosis: det’d/predicted outcome lvl
- POC: purposed interventions, freq/duration, goals/outcomes, discharge plans
- Eval is summary of clinical findings and how they impact function/development.
Goal Writing
ABCD!!!
- Functional (why important, function pt unable to perform?
- Measurable
- Meaningful
- Realistic
- Time Frame
- Take normal dev. into acct
- age approp?
Discharge planning
Setting and type of Dx
- Acute→ likely d/c to home
- Early Intervention→ d/c to school program
- OPPT→ possible d/c to HEP, break in services, back to PCP, community activities
- NOTE most children we treat have lifelong PT needs→ planning how/when to take breaks is reqd
Class. of tests under ICF Cats:
Body Structure/Function
Pain
- FLACC
- Wong-Baker FACES
- VAS
Class. of tests under ICF Cats:
Body Structure/Function
Posture/Balance
- MAI (Movement Assessment of Infants)
- Ryders
Class. of tests under ICF Cats:
Body Structure/Function
Spasticity
Mod. Ashworth
Mod Tardieu (R1/R2)
Class. of tests under ICF Cats:
Body Structure/Function subcats:
Pain
Posture/Balance
Spasticity
Class. of tests under ICF Cats:
Activity subcats:
Gross Motor
Fine Motor
Multidomain
Class. of tests under ICF Cats:
Activity
Gross Motor
- BOT-2
- Peabody-2, AIMS
- GMFM*** (CP and Downs****)
- TIMP
- TGMD-2
Class. of tests under ICF Cats:
Activity
Fine Motor
- BOT-2
- Peabody-2
Class. of tests under ICF Cats:
Activity
Multidomain
- BSID-2
- BDI
- SFA
- Movement-ABC
- PEDI
- Wee-FIM
- Denver-II
Class. of tests under ICF Cats:
Participation
SFA
Goal Writing:
ABCDF
- AUDIENCE: who goal directed towards (pt, caregiver, sibling, teacher)
- BEHAVIOR: what do you want child to do (walk, crawl, etc.)
- CONDITION: how you want it to be done (walker, w/out abd sagging, etc.)
- DEGREE: how far (x150ft, x10ft, 80% of time, etc)
- FUNCTION: to be able to walk into bathroom at home, etc.
Goal Writing Ex’s
- In 4 wks, Ashley will ind. negotiate 12 stairs reciprocally w/ 1 HR while wearing her backpack ⅔ trials in order to improve her ability to negotiate school hallways safely
- In 4wks, Ashley will demonstrate an active heel strike 50% of the time over 100 feet of amb w/out verbal cueing ⅔ trials in order to improve gait mechanics and dec tripping incidence
- In 4wks, Ashley will maintain SLS on either foot for at least 20s w/out excessive sway ⅔ trials in order to improve her ability to participate w/ peers on playground
