Lec 6 Management of Neurologic and MSK conditions Flashcards
how is the MACS assessment normally preformed? (Manual ability classification system)
By asking someone who knows the child and how that child typically performs
(not by direct observation)
What kind of assessment can categorize a 4-18 year old with CPs ability to handle objects in everyday activities
MACS- Manual Ability Classification System
Child handles objects easily and successfully, maybe has some limitation of speed and accuracy but does not restrict independence
MACS 1
What is the distinction between MACS 1 and MACS 2
MACS 1 children might have speed/accuracy difficulty with small/heavy/fragile objects…
MACS 2 have speed/accuracy difficulties with all objects - these children try to simplify handling of objects (example: use surface for support instead of using 2 hands to handle the object)
Child handles most objects but with reduced quality or speed of movement
MACS 2
Child handles objects w/ difficulty and needs help to prepare or modify activity
MACS 3
What is the distinction between MACS 2 and MACS 3
MACS 3 cannot preform certain activities bc their degree of dependence is related to environmental context
Child handles a limited selection of easily managed objects in adapted situations
MACS 4
Child does not handle objects and is severely limited to preform even simple actions
MACS 5
What is the distinction between MACS 4 and MACS 5
Children at level 4 may preform part of an activity with continuous assistance
children at level 5 might at best only be able to do a simple movement in special situations like pushing a button
What measure is designed to describe functional mobility in children with CP between the ages of 4-18
FMS Functional Mobility Scale
What is unique about the FMS?
Gives you the freedom to score mobility across 3 different distances (mobility in home, mobility at school, mobility in wider community)
FMS scores:
6: Independent on all surfaces
5:independent on level surfaces
4: uses sticks (1 or 2)
3: Uses crutches
2: uses walker or frame
1: uses wheelchair
C: Crawls
N: Does not apply
FMS score 5
Independent on level surfaces
FMS score 2
Uses walker or frame
FMS Score 3
Uses crutches
FMS score 1
Uses wheelchair
the GMFM-88(Original) is valid for what ages?
What about the new GMFM-66?
5 months to 16 years
5 years to 16 years
T or F: The GMFM has been validated for not only CP, but also downsyndrome
T
note: emerging evidence to use it for TBI, SMA, OI, and other diagnosis
What dimensions are included in the GMFM?
How is it scored?
Lying+rolling
Sitting
Crawling/kneeling
standing
walking/running/jumping
Scores:
0: does not initiate task
1: initiates task
2: partially completes task
3: Completes task
NT: not tested
The GMFM is appropriate for those with motor skills at or below ______________________
at or below those of a 5 year old child without any motor disability
So even though it’s valid for up to 16 years, you should only use it for children w/ skills of a 5 year old
What equipment do you need for the GMFM
Mat, Bench, Access to stairs (at least 5 steps)
and space for a 4.5 meter run
Which should be used for testing children that are using ambulatory aids/ orthosis/shoes: GMFM-66 or GMFM 88
GMFM- 88,
the GMFM-66 is only for barefoot
Which is quicker to administer: GMFM-66 or GMFM-88
GMFM-66 is shorter and it doesn’t require all items to be assessed to get accurate score
Between the GMFM-66 and the GMFM-88, which is better for documenting change over time
GMFM-66 because the items are ordered by level of difficulty
How long does it take to administer the GMFM-88
45-60 minutes
Spina Bifida precautions
Latex allergy
Hydrocephalus
Knowledge of shunt malfunctions
Knowledge of tethered cord
Be aware of sudden changes in foot posture or bowel/bladder function
myelomeningocele precautions
monitor for scoliosis
d/c strength/sensation
impaired B/B
Poor motor control
dc mobility
deficits dependent on level of injury
Pt w/ Spina Bifida is experiencing headaches, vomiting, lethargy, and irritability
possible shunt malfunction
Pt w/ spina bifida is experiencing vision changes, decreased school performance, and cognitive changes
possible shunt malfunction
What is the incidence of shunt malfunction?
15%
What are signs of tethered cord syndrome
weakness/numbness
tremors or spasms in leg muscles
changes in way the feet look
loss of B/B control
For children with down syndrome, radiographs should be taken _____________
between 3-5 years old to look for OA instability (present in 15%)
Downsyndrome complications
Cardiac, Endocrine (mainly hypothyroid) issues
Heart defects
Cervical instability
OA instability
What is Part B of the Individuals with Disability Education Improvement Act
Established school aged services for students 3-21 with disabilities
What is the IEP for a student under Part B of the IDEA act
IEP= individualized education program, legally binding document developed annually for students
note: Also the PTE- permission to evaluate, and the NOREP: notice of recommended education placement (which outlines the type of classroom and programming the student will receive)
Which part of the IDEA act is for birth-3 years old
Part C, develops early intervention for infants and toddlers with disabilities
What is the IFSP from the IDEA part C
how often is it reviewed
Individualized family service plan for those receiving early intervention
educated atleast once per year and reviewed every 6 months
What is the Individuals with Disabilities Education Improvement Act (2004)
Federal law provides financial assistance to states to implement early intervention program
What does section 504 of the rehabilitation act of 1973 say
Provides students, who do not require special education, services like physical therapy if they are considered to have a disability
What does the ADA act do?
Federal law prohibits discrimination against those with disabilities
T or F: you can use diagnostic ultrasound on Epiphysial plates
T
NOT therapeutic ultrasound
What is developmental biomechanics
Effects of forces on MSK system throughout lifespan
What are the 3 key tissues of growth
connective tissue
bones
muscles
What are the 2 types of connective tissue:
Dense ordinary CT- tendons and ligaments
Cartilage- found at the site of articulating joints
a common complication of tendon regeneration is the development of _______________ between the tendon and the surrounding tissue
fibrous adhesions
Bones, cartilage, and muscle are derived from the ______ layer of embryonic development
mesoderm layer
Epiphysial plates vs epiphysial lines:
Lines occur when the plates have fused and come together, growth no longer possible
What is heuter-volkman principle
growth plates produce increased growth in response to tension, decreased growth in response to excessive compression
How is skeletal maturity measured
SMI (skeletal maturity indicators), done by taking an xray of the left wrist, hand and fingers
what is Risser sign?
Percent of ossification of the iliac epiphysis
indicates how much growth you have left
example: can be used to see what kind of treatment is appropriate for a childs scoliosis by deciding how much conservative therapy can help
The posterior fontanelle closes:
The anterior fontanelle closes:
1-2 months
7-18 months (cranial orthosis wont work past 18 months)
What is OI?
Osteogenesis Imperfecta- Genetic disorder characterized by bones that break easy
How should we educate parents for handling infants with OI?
Carry with widespread hands over head, shoulders, and bottom
diaper change done by lifting buttocks, NOT ANKLES
No twisting or pulling on bodyparts (caution with shoes and braces)
Should you MMT a child with OI?
May not be possible, you can do it they can tolerate it
If they can tolerate: do on the mid-shaft of the bone NOT at the end!
NO isolated trunk extension/flexion to assess core strength
A child with OI has a joint contracture, should we develop an orthosis with an aggressive stretch?
F, need extreme caution when dealing with contractures for pts with OI
OI type 1
OI type 2
Mildest type
OI type 2: intrauterine fractures and infant death
OI type 3:
OI type 4:
3: Severe! fractures at birth, causes short stature.
4: mild to moderate severity
What kind of drug do patients with OI take to prevent bone loss
biphosphonates
What symptoms of hydrocephalus are unique to children
Rapid head growth (fontanelles not closed yet)
Bulging fontanelles (if they are not closed)
Developmental delays
What are the clinical characteristics of Osteogenesis imperfecta
Hyperlaxity of ligaments
Fragile skin
Poor thermoregulation
Blue sclerae
Issues with teeth (dentinogenesis imperfecta)
Symptoms of hydrocephalus in infants
Bulging/tense soft spots, downward looking eyes, enlarged head, high pitched crying, seizures, problems w/ feedings
Symptoms of hydrocephalus in children/adults
Headache, vision changes, B/B, balance, Nausea and vomiting, decline in job or school performance, poor coordination, difficulty sleeping
Symptoms of hydrocephalus in older adults
Difficulty walking, slow shuffling, memory problems, dementia, tremor, balance
What is hydromyelia
Condition where the central canal of spinal cord is abnormally widened, creating a cavity filled with CSF
What are symptoms of hydromyelia
Headache
Loss of temperature sensitivity
Muscle stiffness
Scoliosis
Weakness in arms and leg
Sensory loss/ severe pain in neck/arms
What percent ossified is a grade 3 Riser sign?
50-75%
