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Pediatrics > L7: Peds Exam > Flashcards

L7: Peds Exam Flashcards

1
Q

Where do you start?

A
  • 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
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2
Q

Exam/impairment lvl

Things to remember***

A

NEVER assume pt will be able to comply w/ testing

Formal testing often cannot be conducted due to pts age, cog, compliance

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3
Q

Exam/Impairment Lvl

MSK

A
  • ROM/Strength
    • Strength→ MMT usually becomes accurate around age 3******
  • Posture and Alignment
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4
Q

How and when does one formally assess strength in the absence of MMT?

A
  • 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
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5
Q

Exam/Impair. Lvl

Neurological

A
  • Reflexes
  • Tone/Spasticity
  • Motor Control
  • Coord
  • Balance
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6
Q

Exam/Impair LVL

Neuro→ Tone/Spasticity

A
  • 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
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7
Q

When ______ is NOT present, _____ cannot be conducted and should not be

A

Isolated mvmt; MMT

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8
Q

Motor Control Assessment

(Older children)

A

Qualifies strength

*narrative that breaks down mvmt of limbs by joint→ describes quality of that mvmt

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9
Q

Coordination note:

A
  • finger to nose
  • itsy bitsy spider
  • Dysdiadochokinesia (patty cake)
    • OR coord assess→ jumping jacks/catching ball
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10
Q

Balance tests to note

A

Peds functional reach

TUG for children

Pediatric BERG

*No predictive values for these tests for children!!!

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11
Q

Balance must be reported HOW?

A

Objective and reproducible way NOT just good, fair, poor

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12
Q

Exam/Impair Lvl

Cardio.

HR trends

A
  • Fetal→ 8-10yo=== Avg HR SLOWS as we get older
  • 12yrs→14yrs=== Females HIGHER vs males BUT same thing, slows as we age
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13
Q

Exam/Impair Lvl

Cardiovascular→ BP

A

BOTH systolic and diastolic BP gets HIGHER as we age

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14
Q

Exam/Impair Lvl

Cardiovascular → RR

A

RR gets LOWER as we age

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15
Q

Exam/Impair Lvl

Cardiovascular→ Lung capacity/Wall expansion

things to use

A

Inspirometer, bubbles, tape measure, tissue blow, cough strength

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16
Q

Exam/Impair Lvl

Cardiovascular → Endurance

Tests to use

A
  • Step up test
  • 6min Walk Test
  • RPE (peds graph)
  • time playing
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17
Q

Exam/Impair Lvl

Sensation

Things to look @

A
  • Lt touch/proprio
  • Vision
  • Hearing
  • Processing→ thru observation of behavior/parent report
  • Pain
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18
Q

Pain scales to use w/ Peds

A

FLACC Scale (nonverbal children/cog. impaired)

Wong Baker FACES Scale

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19
Q

Exam/Impair Lvl

Cognitive/Social

IMPORTANT THINGS TO NOTE***

A

Make eye contact?

Have age approp. play skills?

*if old enough, questions related to self-efficacy, overall perception of health, QoL measures→ PEDS-QL

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20
Q

Exam/Impair Lvl

Integumentary

A
  • skin integrity
  • Skin risks***→ important for certain pops like spina bifida
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21
Q

Functional/Activity Limits.

A

Transfers

Mobility: amb, W/C mobiltiy

Stairs

Changes in environ.

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22
Q

Function/Activity/Participation Restricts:

A

MANY measures

MOST function on functional mobility, motor skills vs peers, participation capability

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23
Q

There are 2 types of measures

A
  1. Criterion Referenced
    1. pts scored for aspects or components of mvmt: changes over time
    2. cannot compare to peers
  2. Norm-Referenced
    1. Standardized or norm (typical) children and are used to provide a measure of childs function in compare to age matched peers
    2. not as resp. to change over time***
24
Q

***Test of Infant Motor Performance (TIMP)

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
25
Q

***Bailey Scales of Infant Development (BSID-2): Norm ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 1-42mos
  • Developmental delay & monitor progress (lang, gross/fine motor, behavior, perceptual)
  • Activity category: Developmental Screening
26
Q

***Denver II→ Norm ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 1wk→ 6.6yrs
  • Developmental problems (behavior, self-care, fine/gross motor, lang.)
  • Participation category:
27
Q

***Batelle Developmental Inventory (BDI)→ Norm ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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

*

28
Q

***Movement Assessment of Infants (MAI)→ Norm ref’d and Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
29
Q

Alberta Infant Motor Scale (AIMS)→ Standardized

Age group:

Looks @/Dx:

Category ICF:

A
  • Birth→ 18mos
  • Gross motor delay and changes over time
  • Activity category: Gross motor
30
Q

Peabody Developmental Motor Scale (PDMS-2)→ Norm ref’d and Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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!!!
31
Q

This FOM especially used for CP and Down Syndrome******

KNOW THIS!!!

A

Gross Motor Function Measure (GMFM)

32
Q

GMFM what should you memorize???

A

CP and Downs!!!

33
Q

***Gross Motor Function Measure→ Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
34
Q

GOLD STANDARD FOR CP AND DOWN SYNDROME

A

GMFM

35
Q

Test for Gross Motor Development-2 (TGMD-2)→ Norm ref’d and Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • Norm ref’d for 3→ 10yo
  • Criterion ref’d
    • Determine acquisition of gross motor skills (locomotion, obj. control)
  • Activity category: Gross Motor
36
Q

School Function Assessment (SFA)→ Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • K-6 children w/ disabilities***
  • assess function & guide program planning w/in school (Participation, task support, activity performance, phys. tasks, cog/behavioral)
  • Participation category:
37
Q

Movement Assessment Battery for Children (Movement-ABC)→ Norm ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
38
Q

Bruininks Oseretsky Test of Motor Proficiency (BOT-2)→ Norm ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
39
Q

Pediatric Evaluation of Disability (PEDI)→ Norm ref’d and criterion ref’d (older kids)

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
40
Q

Functional Independence Measure for Children (Wee-Fim)→ Criterion ref’d

Age group:

Looks @/Dx:

Category ICF:

A
  • 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
41
Q

Knowing Normal Dev. importance

A
  • Need to know norm for abnorm ID
  • Be aware red flags
  • Any regression or loss of previously acquired skills is cause for concern!!!
42
Q

PT Eval

A
  • 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.
43
Q

Goal Writing

ABCD!!!

A
  • Functional (why important, function pt unable to perform?
  • Measurable
  • Meaningful
  • Realistic
  • Time Frame
  • Take normal dev. into acct
    • age approp?
44
Q

Discharge planning

Setting and type of Dx

A
  • 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
45
Q

Class. of tests under ICF Cats:

Body Structure/Function

Pain

A
  • FLACC
  • Wong-Baker FACES
  • VAS
46
Q

Class. of tests under ICF Cats:

Body Structure/Function

Posture/Balance

A
  • MAI (Movement Assessment of Infants)
  • Ryders
47
Q

Class. of tests under ICF Cats:

Body Structure/Function

Spasticity

A

Mod. Ashworth

Mod Tardieu (R1/R2)

48
Q

Class. of tests under ICF Cats:

Body Structure/Function subcats:

A

Pain

Posture/Balance

Spasticity

49
Q

Class. of tests under ICF Cats:

Activity subcats:

A

Gross Motor

Fine Motor

Multidomain

50
Q

Class. of tests under ICF Cats:

Activity

Gross Motor

A
  • BOT-2
  • Peabody-2, AIMS
  • GMFM*** (CP and Downs****)
  • TIMP
  • TGMD-2
51
Q

Class. of tests under ICF Cats:

Activity

Fine Motor

A
  • BOT-2
  • Peabody-2
52
Q

Class. of tests under ICF Cats:

Activity

Multidomain

A
  • BSID-2
  • BDI
  • SFA
  • Movement-ABC
  • PEDI
  • Wee-FIM
  • Denver-II
53
Q

Class. of tests under ICF Cats:

Participation

A

SFA

54
Q

Goal Writing:

ABCDF

A
  • 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.
55
Q

Goal Writing Ex’s

A
  1. 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
  2. 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
  3. 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

Pediatrics (27 decks)

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