Lecture 3 Atypical Flashcards
What muscles are affected by torticollis?
SCM, Scalene, Trap, Levator Scap
Can atypical development start out as typical?
Yes
When many components from normal development are missing, babies learn to compensate, these compensations lead to __________
pathologies that cause atypical movement postures and patterns
If a child is toe walking, what do you need to know in their history? (Some questions are the same as any other atypical development question)
Has this happened before?
What is their developmental history?
note: new toe walking is a red flag for neurological changes
Idiopathic toe walking is toe walking beyond _______
persistent idiopathic toe walking is beyond _______
24 months
36 months
Delays in what domains are associated with idiopathic toe walking?
Language and sensory
Does a child with torticollis have atypical muscle tone?
Usually no, unless the torticollis is caused by the CNS
What is the key indicator in the examination for how we will treat toe walking
PROM measurements and muscle tone
How much does eye dominance, hand dominance, and leg dominance correlate?
they aren’t directly related but significantly associated
When is eye dominance established?
emerges 3-4 years, by 6 it is typically established
When is hand dominance established
emerges 3-4 , by the age of 4-6 hand dominance is usually established
When is leg dominance established
emerges around 3 years, by 6 years it is typically established
how can you test a child’s eye dominance
ask them to look through something
Patterns of an immature motor system
Loss of dynamic balance
Falling after finishing motor task
inability to control force
inability to maintain rhythm
inappropriate motor planning
lack or decreased transverse plane movement
How do we assess pain in an infant?
FLACC observation scale
Face Legs Activity Cry Consolability
The wong baker pain scale is approved for use in kids how old?
3-10
At what age is the verbal analog scale suggested to use for pain
10+
What are the two general types of diagnoses of atypical development
MSK
and
Neuromuscular
What do we need to rule out when assessing torticollis?
non-muscular torticollis must be ruled out
What can be potential causes of non-muscular torticollis?
Cervical rib
cataract
brachial plexus injury
posterior fossa tumor
Right torticollis has what 2 components at the neck?
Right lateral flexion and Left rotation
(named for the side of the flexion)
Asymmetries of ___ to ___ degrees in hip _______ may indicate hip dysplasia
5-10 degrees
hip abduction
What is plagiocephaly?
Misshapen skull
at what age is prognosis for torticollis considered better for conservative treatment
before the age of 1
What is the key to a conservative treatment of torticollis?
comprehensive home program
what is typically perscribed to help with plagiocephaly
cranial orthosis
the posterior fontanelle closes by _________
the anterior fontanelle closed by ___________-
1-2 months
7-18 months
9 specific health factors to know for infants with torticollis
Age of initial visit
age of symptom onset
pregnancy history
delivery history
head/posture preference
family history of CMT
other known or suspected medical conditions
developmental milestones
Torticollis patients must be screened for
hip dysplasia and spine/vertebral asymmetry
pain and discomfort at rest and during passive/active movement
skin integrity and symmetry of neck and hip skin folds
Palpate SCM
Craniofacial assymetries
Head/skull shape
What is the most consistent clinical sign of hip dysplagia in neonates
hip abduction limitation or asymmetry
What is a Pavlik Harness
At what age can it be used
Harness used to help fix DDH by holding hip in proper position
* restricts hip extension and adduction
up to 3 months
For babies 3-6 months, what are the options for DDH
brief 3 week trial of Pavlik harness, if not successful they receive closed reduction and spica cast
For dislocated hips dx’d between 6-18 months of age, ____ is usually required
Surgical tx.
Dx of hip dislocation in a child at the age of ___________ is generally considered to be mandated for an open reduction surgery to fix DDH
2 years or older
Older children with continuing acetabular dysplasia may benefit from ____________
pelvic osteotomy
Club foot is associated with what gait deviation
early heel rise (theyre stuck in plantarflexion)
T or F: At no point should Internal rotation be typical in gait
true
The Barlow and orlotani test are typically done until what age?
6 months
The pavlik harness holds a baby in what position
What movements does it restrict
Flexion and abduction
Restricts adduction and extension
