lecture 4: the plan of care for childern with neuromuslcar diagnoses Flashcards
the POC is based on watch 5 things
Diagnosis
Clinical picture
Evaluation results
Reason for referral
Patient/family goals
PT rely on a working knowledge of what 3 things
- limitations in body structures and functions
- principles of motor development , motor contrl and motor learning
- existing evidence for pediatric neurological interventions
what principles do u apply when developing a POC
motor development , motor learning and motor control to a dream work for activity focused interventions
what are the 3 components of intervention that should be included in a POC
- communcation and coordination with parents
- instructions to family
- procedural interventions - “hands on”
the theories of motor control are used as the conceptual framework for what
“hypothesis oriented clinical practice”
t/f: None of these theories hold the
complete theoretical position to explain
how humans control and learn
movement
true
what are the early theories of motor control theories
reflex and hierarchical theory
what is the reflex theory
sensory (afferent) input causes motor (efferent) output between the peripheral
Reflex is the basic unit of movement
what is the hierarchical theory
considers teh reflex a primitive behavior
primitive reflexes were thought to be suppressed with the development of higher control
what did the main neuro facilitation approached originate from
from the early theories of motor control (reflex and hierarchical theories)
what are the main neurofacilitation approached
- neuro developmental treatment (NDT)
- proprioceptive neuromuscular facilitation (PNF)
- sensory intergration therapy (SI)
More complex programs developed at
the cortex level result from ___
learning and are used to simplify the
production of movement
motor
Networks of neurons within the spinal cord-
____ ____ _____
work together as a whole to produce
rhythmic, patterned motor commands, such as
commands for repetitive stepping
(locomotion)
central pattern generators (CPGs) –
what was the systems theories originally known as
distributive theory
the systems theories emphasizes the constraints of the ____ system and the ____ on movement
MSK
environment
how is the ankle strategy coordinated
distal to proximal pattern
- gastroc ,hammy , paraspinals
how is the hip strategy activated
proximal to distal
- abs , quads, tib ant
what is considered an essential component of motor development for the dynamic systems theory
variability within and between individuals
why is the concept of control parameters important for clinical interventions
bc it suggest that the therapist identify what factors , internal or external, are likely to promote change in the movements produced
can the control parameters for the dynamic systems theory be intrinsic or extrinsic to the individual
yes
what is the idea of “triad of constraints”
-person
-environment
-task
what is the action
invovled the accomplishment of a task , the intention to realize a functional goal and a strategy to achieve a goal
what does chagne at the movement level involve
change at the movement level involved the coordination of movement patterns which allows the action goal to be achieved
is change at the movement level alone sufficient for the action
no
what is a task required to give
a meaning and a goal strucutre to the movement pattern
what is the different between qualitative change and quantitative change
qual: palmar grasp vs pincer grasp
quant: speed, timing, magnitude
what are the 2 major perspectives that have guided the research on motor learning and development
◦ dynamic systems perspective, and
◦ information processing
perspective
what are the difference int he dynamic systesm perspective on motor learning compared to the information processing perspective
the dynamic systems provides more of a theoretical framework for how movement behavior is organized and how it changed with activity focused intervention
while the information addresses cognitive systems and their role in motor learning
Information-Processing Perspective emphasizes the ____ processes associated with learning motor skills
cognitive
Information processing is essential to
___ ____
motor learning
what are teh 3 stages of information processing
stimulus identification
response selection
response programming
what is stimulus identification
selectively attending to and integrating relevant stimulus from environment
The stages of information processing
interact with 2 other elements of the
information processing perspective.. what are they
memory and attention
t/f: Time to process information is age
related
true
The memory representation of a
movement that can be retrieved when
needed for a functional action is called a
motor program
what is responsible for
determining the major events in the
movement pattern
motor program
____ of the motor program are
the variant or changeable
features of the motor program
Parameters
what is performance as a motor learning principle
change may not be permanent
what is learning as a motor learning principle
permanent change
what is learning as a motor learning principle
permanent change
what is attention as a motor learning principle
allocation and confusing of information processing resources
The concept of divided attention has
applications to ____ and ___ in
children
balance adn gait
what are the 3 strategies for attention
- taking the child to a high level of primary task performance before introducing competing task
- using dual task to evaluate level of learning of a primary task or development
- practicing functional task in the natural environment
It is believed that Infants who play in the
prone for a total of ___ minutes (not all at
once) per day decrease the negative
effects of the back to sleep program
60
what CMT classification is “infant between 7 and 12 months with mm tightness of > 15”
grade 6- late severe
what CMT classification is “infants between 10 and 12 months with one postural or mm tightness <15 “
grade 5- late moderate
what is the grade 3- early severe for CMT classification
infants between 4 and 6 months of age with mm tightness of > 30° or SCM mass
what is the grade 2 early moderate for CMT classification
infants between 4 and 6 months of age with mm tightness of 15°-30°
what is the grade 1- early mild for CMT classification
infants in first 3 months of life with only postural or mm tightness < 15°
what grade and severity is it on the CMT classification for an infant between 7 and 9 months wiht only postural or mm tightness < 15°
grade 4- late mild
what is grade 7 - late extreme on the CMT classification scale
infants after 7 months of age with SCM mass or after 12 months of age wiht mm tightness of > 30°, presence of SCM mass or referred after 12 months of age
what kind of treatment does children with ITW respond well to
conservative treatment
At 2 years of age what should we see
when a child’s ambulates?
heel strike
reciprocal arm swing
Persistent toe-walking past the age of 2,
without any signs of any pathologies or
conditions is considered what
idiopathic toe walking or intermittent periods of toe wlkaing past the age of 3
what is the conservative treatment plane for ITW
stretch the gastroc and soleus
strengthening the DF and PF (PF are not strong in tow walkers)
t/f: There is as association between ITW and Language delays
true
do kids with ITW need to have their peach and language milestone e3xamined
yes
t/f: Children with Autism often exhibit toe-walking
true
should u screen toe walkers for sensory integration disorders
yes
what is Autosomal dominant pattern
when there is a family hx of ITW
what is increased resistance to
passive movement about a joint
hypertonicity
what is spasticity
resistance to passive movement , which increases with increasing speed of stretch
what is dystonia
a movemtn disorder in which involuntary sustain or intermittent mm contractions cuase twisting and repetitive movements
what is hypotonicity
excessively low resistance to passive stretch
what is on-going, random-appearing
sequence of one or more discrete movements
or movement fragments varying in timing,
duration, direction and body location
chorea
what is slow, continuous, involuntary
writhing that prevents maintenance of a stable
posture
athetosis
what is rhythmic back-and-forth or
oscillating involuntary movement about a joint
axis
tremor
what refers to a gross lack of coordinated
movements that generally originates from
damage to the cerebellum
ataxia
Coordination
Tripping and falling
Emerging vs. mature mvt. pattern
Reciprocal & Disassociated mvt.
Isolated joint control
Trunk rotation
these are all examples of what kind of movements
voluntary
what is the degrees of freedom
all of th possible independent planes of motion in the joints in the body to coordinate efficient movement
Baby must develop ____ to achieve
movement goals
compensations
what assist in setting the atypical motor development process
blocks and compensations
what mm activity may be strong in :blocks:
extensor
what kind of postural tone do babies with “blocks” have even if they have a strong extensor muscles
hypotonic
As ____ is used more frequently it prevents or
“blocks” the typical movement process
fixing
where are the 4 common blocks at and what are they called
neck , shoulder girdle , pelvis and hips
neck block
shoulder block
pelvic hip block (anterior pelvic tilt)
pelvic hip block (posterior pelvic tilt)
how will the neck of a baby look if they have a neck block and what will they lack
neck hyperextension
lack of midline , lack of tucking
how will a baby with a neck block compensate
by elevating shoulders to stabilize head
what are the consequences of a neck block
compensations are compounded
in sitting, typical development of scapula is
blocked, affects UE and oral motor
development
a neck block, Blocks bilateral ____ development, bilateral ___ development, spine rotates in
___ of head, emphasizes spinal
extension
UE
ocular
direction
what does not develop if a baby has a shoulder block
scapula stability
what are the consequences of the shoulder block
UE development is blocked
what is tight for a anterior pelvic tilt
lumbar extensors and hip flexors
for a pelvic hip block-anterior tilt how is the baby positioned in prone
frog leg position maintained
what does the pelvic hip block-anterior tilt cause
increased hip flexion , abduction , external rotation further increasing anterior pelvic tilt and lumbar extension
what does pelvic hip block - anterior tilt block >
lateral weight shifts , righting reactions
what is usually tight in the pelvic hip block - posterior tilt
hip extensors tight
what is inactive and tight while sitting with a Pelvic-Hip Block – Posterior Tilt
inactive abs , tight HE
is a baby with Pelvic-Hip Block – Posterior Tilt able to lateral weight shift
no
with a pelvic hip bloc how does the baby stand/walk
adduction , scissoring
what is x Any change in the nervous system that is
not periodic and lasts more than a few
seconds
neural plasticity
what is the basis for learning in the intact brain and relearning after brain damage
neural plasticity
what are the 10 principles of plasticity
- Use it or Lose it
- Use it and Improve it
- Specificity
- Repetition
- Training Intensity
- Time
- Salience
- Age
- Transference
- Interference
what integrates the best research
evidence with the therapist’s clinical
expertise and the individuals
circumstances of the patient and
family
evidence based practice
Current approaches to PT for children
with neurological conditions can generally
be characterized as ____ ____ or
activity focused
task-oriented
in the activity focused interventions they focus on practice of meaningful functional tasks and
assume that the child is an active participant in a learning process, motivated by the ___ to accomplish a specific tas
goal
what interventions Involve structured practice and repetition of functional actions with consideration
of the constraints of the task, the environment, and the individual that influence motor behavio
activity focused interventions
what is constraint induced therapy
an intervention that emphasizes functional practice to improve function
what are the 3 steps from activity focused interactions
Develop activity-related goals and
objectives
Plan activity-focused interventions
Integrate impairment-focused
interventions
what is an important feature of the activity focused model
the integration of impairment focused interventions with the functional practice
what interventions attempt to ameliorate the effects of impairments through practice of a meaningful functional task or developmental activity
active impairment focused interventions
Impairment-focused interventions are
divided into 2 major categories:
active and passive
Hippotherapy
Aquatic therapy
Manual guidance
Biofeedback
Partial weight-bearing treadmill training
Proprioceptive Neuromuscular Facilitation (PNF)
these are examples of what type of interventions
active impairment focused
passive ROM
application of nighttime orthoses
these are examples of what kind of interventions
passive ROM
application of nighttime orthoses
what Emphasizes skillful handling by the therapist to
reduce the effects of atypical tone and encourage
the emergence of typical postural components as
the basis for typical movement
Neurodevelopmental Treatment (NDT)
NDT includes preparatory interventions to reduce what
the effects of impairments in mm tone and some soft tissue restrictions
sensorimotor approach is relied heavily on what
neuro anatomical basis for treatment
what are the 4 stages of development of motor control
◦ Reciprocal Innervation
◦ Co-contraction
◦ Stability superimposed on mobility
◦ Mobility superimposed on stability
what does the sensory integration approach address
the sensory processing and the motor and perceptual impairments of children
t/f: is conductive education a therapy system designed for physical or OT
no false
what is a System of education that aims to teach
children to be active and self-reliant
participant in the world
conductive education - holistic approach
