lecture 3: atypical development Flashcards
What gait thing happens at age 2 years old?
ARM SWING
Heel strike!
If you have persistent toe walking past the age of ___, this indicates
past the age of 2: indicates ATYPICAL gait
possibly ITW
if you have inconsistent toe walking (ITW) past the age of ____,
3, indicates ATYPICAL development
ITW is a diagnosis of
exclusion
delays in which domains have been associated with ITW?
language
sensory processing
atypical development may start out just like typical development, but _____
many typical components are missing!
*babies learn to compensate
*compensations become pathological, cause ABNORMAL or atypical movement postures/patterns
What is important to get during atypical development exam subjective?
developmental history!
a 4 month old infant presents with severe L CMT. What mm would be tight?
SCM, scalenes, upper trap, levator scap
left lateral trunk
Would Apgar be the same as typical baby with 4 month old baby with torticollis?
yes, probably! Just typical components are missing
babies learn to compensate, which become pathological
What is key question to ask with ITW subjective?
did kid always walk like this since starting walking?
*if it is new –> RED FLAG, may be something else
When is eye dominance established?
range __ to ___, but by ___ is established
range: 3-4 years
by 6 years eye dominance established
When is hand dominance established?
range 3-4 years
by 4-6 years CLEAR DOMINANCE usually established
leg dominance is established when?
range: around 3 years
by 6 years a leg dominance is established
__% of people are right handed
__% of people are right eye dominant
90% right handed
67% right eye dominant
How can you test a kid’s eye dominance?
ask them to look through a camera, kaleidoscope, toilet paper tube
(usually will place object up to dominant eye
before exam starts: what should you know?
child’s age
diagnosis
primary concern
CHART REVIEW! for CLINICAL PICTURE
what should you include in kid examination for past medical history? EXTRAS not in adult exam
*maternal pregnancy and birth history
key questions for developmental history:
what age did they sit
what age did they walk
know: chronological age, adjusted age, observed LOF
functional skills exam:
developmental milestones
methods of play
ADLs
AROM assessed through play
gait
What are patterns of an immature motor system?
- loss of dynamic balance
- falling after doing a motor task
- inability to control force
- inability to maintain rhythm
- inappropriate motor planning
- lack of/decreased TRANSVERSE PLANE MVMT
With orthotics, when can you get a new pair?
typically every year
little ones: maybe every 6 months
*write down equipment and how old it its
AIMS test is ___ based
observation based
Modified Ashworth Scale (MAS): list the grades
0: normal
1: slight increase in tone: catch & release or minimal resistance at end of ROM
1+ : slight increased tone, CATCH followed by minimal resistance through remainder (less than half) of ROM
2: more increased mm tone through most ROM, but affected parts easily moved
3: considerable increase in mm tone–> passive movements difficult
- affected part RIGID in flexion/extension
Clonus grades
0: absent
1: unsustained (few beats)
2. sustained (continuous)
3: SPONTANEOUS/light touch provoked and sustained
DTR grades
0: none
1: lower than normal
2: normal
3: higher
4: exaggerated with clonus
patterns of immature movement:
inconsistency of performance
limited planes of motion
perseveration: can’t stop activity when appropriate
extraneous mvmts
asymmetry, difficulty with bilateral coordination
What is the FLACC observation scale?
For infants, preschoolers, nonverbal children
F: face
L: legs
A: activity
C: cry
C: ability to console
score 0-2, resulting in total score between 0-10
What are 3 pain assessment scales?
FLACC
Wong-Baker Faces PRS (3+) –> 0, 2, 4, 6, 8, 10
Verbal Analog Scale (10+)
atypical infant development: W sitting is an example of
fixing/limiting DOF due to poor underlying control
What are 2 BROAD general types of diagnoses?
MSK
Neuromuscular
before initiating PT for CMT, need to rule out ____
NON-MUSCULAR causes of TORTICOLLIS
*baby could have CP, cataract, etc.
What are non-muscular causes of torticollis?
- cervical rib (cervical skeletal malformation)–> should NOT STRETCH
- posterior fossa tumor
- Sandifer’s syndrome (gastroesoph. reflux)
- sublux of cervical vertebrae
- extraocular mm paresis
- CATARACT (ocular strabismus or nystagmus)
- Klippel-Feil syndrome, Sprengel’s deformity
- Brachial Plexus Injury/ clavicular injury during forceful birth
__% of all torticollis is NON-MUSCULAR TORTICOLLIS
18%
All CMT should screen for ___ and ___
DDH (10-20% association)
plagiocephaly (asymmetry of ears and eyes)
feeding, vision, hearing
contractures
AROM/PROM cervical spine
gross motor skills
definition of plagiocephaly
misshapen head
can have uneven eyes, ears, etc.
definition of cranial orthosis
NOT A HELMET
may only need to wear 2-3 months
brachycephaly
flat head
*can have brachycephaly and plagiocephaly
what is scaphocephaly?
elongated head
The posterior fontanelle usually closes by age
1-2 months
the anterior fontanelle usually closes withing
7-18 months
When can cranial orthosis no longer help the child?
18 months
earlier the better, especially bc it takes a few months to get it
review Torticollis CPG
- neck PROM
- neck + trunk AROM (also screen UE/LE for hip dysplasia, spine asymmetry)
- symmetry (skin, folds, SCM, hips)
- environmental adaptations
- caregiver education
What is a Pavlik Harness?
Treatment for DDH infant less than 3 months old: hip is in flexion and abduction (good for hip development)
If older child, DDH intervention is
surgery + spica cast 3-6 months if brief 3 week trial of pavlik harness doesn’t work
What should you monitor children wearing pavlik harness for???
avascular necrosis
femoral nerve palsy
inferior dislocation
infants over 9 months of age may need to have….
a closed hip reduction and hip spica cast
for dysplasia with/without subluxation, infants more than 9 months old ambulatory can use a
hip abduction orthosis for ambulation
*if dislocated between 6-18 months of age, need surgery
When do you need surgery for DDH?
2+ (mandate open reduction)
