Lec 6 Management of Neurologic and MSK conditions Flashcards

1
Q

how is the MACS assessment normally preformed? (Manual ability classification system)

A

By asking someone who knows the child and how that child typically performs

(not by direct observation)

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2
Q

What kind of assessment can categorize a 4-18 year old with CPs ability to handle objects in everyday activities

A

MACS- Manual Ability Classification System

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3
Q

Child handles objects easily and successfully, maybe has some limitation of speed and accuracy but does not restrict independence

A

MACS 1

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4
Q

What is the distinction between MACS 1 and MACS 2

A

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)

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5
Q

Child handles most objects but with reduced quality or speed of movement

A

MACS 2

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6
Q

Child handles objects w/ difficulty and needs help to prepare or modify activity

A

MACS 3

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7
Q

What is the distinction between MACS 2 and MACS 3

A

MACS 3 cannot preform certain activities bc their degree of dependence is related to environmental context

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8
Q

Child handles a limited selection of easily managed objects in adapted situations

A

MACS 4

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9
Q

Child does not handle objects and is severely limited to preform even simple actions

A

MACS 5

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10
Q

What is the distinction between MACS 4 and MACS 5

A

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

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11
Q

What measure is designed to describe functional mobility in children with CP between the ages of 4-18

A

FMS Functional Mobility Scale

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12
Q

What is unique about the FMS?

A

Gives you the freedom to score mobility across 3 different distances (mobility in home, mobility at school, mobility in wider community)

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13
Q

FMS scores:

A

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

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14
Q

FMS score 5

A

Independent on level surfaces

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15
Q

FMS score 2

A

Uses walker or frame

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16
Q

FMS Score 3

A

Uses crutches

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17
Q

FMS score 1

A

Uses wheelchair

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18
Q

the GMFM-88(Original) is valid for what ages?

What about the new GMFM-66?

A

5 months to 16 years
5 years to 16 years

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19
Q

T or F: The GMFM has been validated for not only CP, but also downsyndrome

A

T

note: emerging evidence to use it for TBI, SMA, OI, and other diagnosis

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20
Q

What dimensions are included in the GMFM?

How is it scored?

A

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

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21
Q

The GMFM is appropriate for those with motor skills at or below ______________________

A

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

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22
Q

What equipment do you need for the GMFM

A

Mat, Bench, Access to stairs (at least 5 steps)

and space for a 4.5 meter run

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23
Q

Which should be used for testing children that are using ambulatory aids/ orthosis/shoes: GMFM-66 or GMFM 88

A

GMFM- 88,

the GMFM-66 is only for barefoot

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24
Q

Which is quicker to administer: GMFM-66 or GMFM-88

A

GMFM-66 is shorter and it doesn’t require all items to be assessed to get accurate score

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25
Q

Between the GMFM-66 and the GMFM-88, which is better for documenting change over time

A

GMFM-66 because the items are ordered by level of difficulty

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26
Q

How long does it take to administer the GMFM-88

A

45-60 minutes

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27
Q

Spina Bifida precautions

A

Latex allergy

Hydrocephalus

Knowledge of shunt malfunctions

Knowledge of tethered cord

Be aware of sudden changes in foot posture or bowel/bladder function

28
Q

myelomeningocele precautions

A

monitor for scoliosis

d/c strength/sensation
impaired B/B
Poor motor control
dc mobility

deficits dependent on level of injury

29
Q

Pt w/ Spina Bifida is experiencing headaches, vomiting, lethargy, and irritability

A

possible shunt malfunction

30
Q

Pt w/ spina bifida is experiencing vision changes, decreased school performance, and cognitive changes

A

possible shunt malfunction

31
Q

What is the incidence of shunt malfunction?

32
Q

What are signs of tethered cord syndrome

A

weakness/numbness

tremors or spasms in leg muscles

changes in way the feet look

loss of B/B control

33
Q

For children with down syndrome, radiographs should be taken _____________

A

between 3-5 years old to look for OA instability (present in 15%)

34
Q

Downsyndrome complications

A

Cardiac, Endocrine (mainly hypothyroid) issues

Heart defects

Cervical instability

OA instability

35
Q

What is Part B of the Individuals with Disability Education Improvement Act

A

Established school aged services for students 3-21 with disabilities

36
Q

What is the IEP for a student under Part B of the IDEA act

A

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)

37
Q

Which part of the IDEA act is for birth-3 years old

A

Part C, develops early intervention for infants and toddlers with disabilities

38
Q

What is the IFSP from the IDEA part C

how often is it reviewed

A

Individualized family service plan for those receiving early intervention

educated atleast once per year and reviewed every 6 months

39
Q

What is the Individuals with Disabilities Education Improvement Act (2004)

A

Federal law provides financial assistance to states to implement early intervention program

40
Q

What does section 504 of the rehabilitation act of 1973 say

A

Provides students who do not require special education services like physical therapy if they are considered to have a disability

41
Q

What does the ADA act do?

A

Federal law prohibits discrimination against those with disabilities

42
Q

T or F: you can use diagnostic ultrasound on Epiphysial plates

A

T

NOT therapeutic ultrasound

43
Q

What is developmental biomechanics

A

Effects of forces on MSK system throughout lifespan

44
Q

What are the 3 key tissues of growth

A

connective tissue

bones

muscles

45
Q

What are the 2 types of connective tissue:

A

Dense ordinary CT- tendons and ligaments

Cartilage- found at the site of articulating joints

46
Q

a common complication of tendon regeneration is the development of _______________ between the tendon and the surrounding tissue

A

fibrous adhesions

47
Q

Bones, cartilage, and muscle are derived from the ______ layer of embryonic development

A

mesoderm layer

48
Q

Epiphysial plates vs epiphysial lines:

A

Lines occur when the plates have fused and come together, growth no longer possible

49
Q

What is heuter-volkman principle

A

growth plates produce increased growth in response to tension, decreased growth in response to excessive compression

50
Q

How is skeletal maturity measured

A

SMI (skeletal maturity indicators), done by taking an xray of the left wrist, hand and fingers

51
Q

what is Risser sign?

A

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

52
Q

The posterior fontanelle closes:

The anterior fontanelle closes:

A

1-2 months

7-18 months (cranial orthosis wont work past 18 months)

53
Q

What is OI?

A

Osteogenesis Imperfecta- Genetic disorder characterized by bones that break easy

54
Q

How should we educate parents for handling infants with OI?

A

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)

55
Q

Should you MMT a child with OI?

A

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

56
Q

A child with OI has a joint contracture, should we develop an orthosis with an aggressive stretch?

A

F, need extreme caution when dealing with contractures for pts with OI

57
Q

OI type 1

OI type 2

A

Mildest type

OI type 2: intrauterine fractures and infant death

58
Q

OI type 3:

OI type 4:

A

3: Severe! fractures at birth, causes short stature.

4: mild to moderate severity

59
Q

What kind of drug do patients with OI take to prevent bone loss

A

biphosphonates

60
Q

What symptoms of hydrocephalus are unique to children

A

Rapid head growth (fontanelles not closed yet)

Bulging fontanelles (if they are not closed)

Developmental delays

61
Q

What are the clinical characteristics of Osteogenesis imperfecta

A

Hyperlaxity of ligaments

Fragile skin

Poor thermoregulation

Blue sclerae

Issues with teeth (dentinogenesis imperfecta)

62
Q

Symptoms of hydrocephalus in infants

A

Bulging/tense soft spots, downward looking eyes, enlarged head, high pitched crying, seizures, problems w/ feedings

63
Q

Symptoms of hydrocephalus in children/adults

A

Headache, vision changes, B/B, balance, Nausea and vomiting, decline in job or school performance, poor coordination, difficulty sleeping

64
Q

Symptoms of hydrocephalus in older adults

A

Difficulty walking, slow shuffling, memory problems, dementia, tremor, balance

65
Q

What is hydromyelia

A

Condition where the central canal of spinal cord is abnormally widened, creating a cavity filled with CSF

66
Q

What are symptoms of hydromyelia

A

Headache
Loss of temperature sensitivity
Muscle stiffness
Scoliosis
Weakness in arms and leg
Sensory loss/ severe pain in neck/arms

67
Q

What percent ossified is a grade 3 Riser sign?