lecture 6: common neuro conditions Flashcards
Which of the following is not a PRECAUTION for PT session w/ child with spina bifida?
-latex
-hip dislocation
-fracture risk
-fragile skin
-decreased endurance
-thermoregulation
-UTI
UTI
(not a precaution, just something to be aware of…incontinence IS a precaution and related to UTI)
list all the 9 precautions for Spina Bifida during PT
- decreased endurance
- fracture risk
- hip dislocation
- fragile skin
- latex allergies
- incontinence
- thermoregulation
- fall risk
- spasticity increase
list all the COMPLICATIONS of Spina Bifida interfering with PT
-UTI
-spasticity
-Arnold Chiari malformation
- fracture
- pressure sore
- tethered cord
-VP shunt failure
-symptomatic hydromelia
-symptomatic hydrocephalus
A child with spastic diplegic CP functions at GMFCS level 3 has
What is the FMS?
MACS is what
GMFCS scale for the UE
an important feature of the activity-focused model is the integration of ______ with ________
impairment-focused interventions WITH functional practice
What are the 3 classification systems, not assessment tools, for cerebral palsy?
GMFCS -mobility level
FMS - mobility
MACS - UE function
GMFCS level 1
GMFCS level II
GMFCS level III
GMFCS level IV
What is the MACS and what is it for?
Manual Ability Classification System:
ability 4-18 years with CP to handle objects in daily activities, categorized into 5 levels
1: good, 5: bad
What is the FMS and how does it work?
describes functional mobility in children with CP, 4-18 years (scored over 3 distances)
how do they walk for 5 meters? (house)
how do they walk for 50 meters? (classroom)
how do they walk for 100 meters? (community)
Ratings 1-6 for FMS and rating C and N
Describe these:
GMFM is what?
standardized, criterion referenced, observational ASSESSMENT (measure changes over time) for children with CP
*GMFM-66, GMFM-88
What is a dorsal rhizotomy
cut dorsal nerve rootlets
to decrease spasticity for children with CP
GMFM is validated for children with
CP and also been validated for children with Downs Syndrome
GMFM-88 original is for children ___ years of age
5 months - 16 years
GMFM-66 newer is validated for ages _____
5 years to 16 years
GMFM includes what 5 dimensions?
- lying and rolling
- sitting
- crawling and kneeling
- standing
- walking, run, jumping
GMFM scored how?
NT: not tested
0 = does not initiate
1 = initiates task
2 = partial complete task
3 = COMPLETES TASK
GMFM items are appropriate for children with motor skills at or below those of _____
at or below those of a 5 year old child without any motor disability
GMFM-88 is evidenced for use in children with ______
TBI
spinal muscular atrophy
osteogenesis imperfecta
hereditary spastic paresis
acute lymphoblastic leukemia
GMFM equipment and space needed
mat, bench, stairs (5 steps)
space for 4.5 meter run
*any differences should be documented for consistency to measure change over time
The GMFM-88 vs -66
-88:
more descriptive for complex or very young children
-88: use if evaluating kid with ambulatory aids and/or orthoses/shoes
-66: barefoot, teaks less time, more meaningful assessment of change bc items ordered by level of difficulty
Administering GMFM-88 takes about -__ to ___ minutes for someone familiar with the measure
45-60 minutes
GMFM-66 takes about ___ min
20-30 minutes
precautions for children with spastic diplegic CP
lever arm dysfunction, midfoot breakdown
What are precautions for children with CP at age 8?
be aware of growth spurt
*extra affected due to tight gastroc/spastic diplegic CP
*MSK is progressive, so weakness with age and tightness as they grow
Spina Bifida case study: myelominengocele presentation
▪ Diminished or absent trunk or lower extremity
strength and sensation
▪ Impaired bowel and bladder
▪ Possible poor motor control
▪ Changes in posture and alignment
▪ Decreased mobility and activity tolerance
▪ Deficits depend on level of injury
▪ Monitor for Scoliosis***
Shunt malfunction signs:
▪ Headaches
▪ Vomiting
▪ Lethargy
▪ Irritability
▪ Vision issues or changes
▪ Decreased school performance
▪ Cognitive challenges/mild dementia.
▪ Periods of confusion
▪ Seizures
▪ Difficulty walking/gait disturbances
▪ Urinary urgency or incontinence
▪ Fever (sign of shunt failure or infection)
▪ Redness or swelling along shunt tract
VP shunt as mainstay of treatment for ____ in both adult and pediatric patients
hydrocephalus
signs of tethered cord syndrome
Weakness, numbness or problems with muscle function
in the legs.
▪ Tremors or spasms in the leg muscles.
▪ Changes in the way the feet look, like higher arches or
curled toes.
▪ Loss or change of bladder or bowel control that gets
worse
What is the 1 year failure rate for VP shunts?
40-50% of pediatric patients until few decades ago….shunt malfunctions are found to be approx 15%
PT interventions for SB includes…
-risk for obesity, osteoporosis, UTIs,
functional mobility training, what life will look like…
-exercises
symptoms of hydrocephalus in infants
- enlarged head
- bulging/tense soft spot on top of head
- downward looking eyes
- high pitched cry
- problems sucking/feeding
- recurrent vomiting
- seizures
symptoms of hydrocephalus in children/adults
- headaches
- blurred/double vision
- loss of bladder control
- nausea/vomiting
- problems with balance
- vision problems
- decline in school or job performance
- poor coordination
- sleepiness or hard time waking up
- irritability
symptoms of hydrocephalus in older adults
difficulty walking or slow shuffling
memory problems, dementia
problems with balance, coordination
tremor or shaking
Initial radiographs for children with down syndrome should be taken when?
between 3-5 years of age
*atlanto-axial instability
*possible cervical instability
children with DS have higher incidence of ________
cardiac (heart defects)
hearing
endocrine
developmental
dental defects/health issues
*cervical instability
*AA instability in about 15%
IDEA PART B is what?
federal legislation for school-aged services for students 3-21 years with disabilities
What is the IEP?
legally binding document developed annually for students
IDEA PART C
federal legislation establishes early intervention services for infants and toddlers (birth to 3 years) with disabilities
What is IFSP?
Individualized family service plan for those receiving early intervention. Educated at least 1x/year and reviewed at least every 6 months
Section 504 of the rehabiliation Act of 1973:
Federal legislation that makes discrimination against individuals
with disabilities illegal
▪ Section 504 provides that students who do not require specially
designed instruction may receive accommodations and services
including physical therapy if they are considered to have a
disability that impacts a major life function
Americans with Disabilities Act of 1990 (ADA)
▪ Federal civil rights legislation that prohibits discrimination against
individuals with disabilities in employment, transpiration, public
accommodations communications, and governmental activities
▪ Treating across life-span and education families
Are children tiny adults?
NO! growth plates!
-physiologically: young children under 4 yrs have an unreliable thermoreg system
-risk of hypothermia is higher in children as they are less efficient in generating heat, lose heat more readily
CANNOT DO THERAPEUTIC ULTRASOUND OVER GROWTH PLATES, OK?
epiphyseal plates!!!
*you CAN do diagnostic ultrasound, they do this for hip dysplasia dx
What influences body structures (connective tissues, bone, mm)?
force
shape
genes
nutrition
drugs
hormones
actiivites/lack of
bone, cartilage and mm are derived from what embryonic layer?
mesoderm
growth plates
produce increase growth in response to
tension and decreased growth in response to
excessive compression
What principle is this?
Hueter-Volkman Principle
What is Bone age?
helps docs estimate skeletal maturity
take single x ray of left hand, wrist, fingers
scoliosis: x ray of iliac crest to see how much bone growth is left
What is this called?
RISSER SIGN
1: 25 (lot of ossificiation of iliac epiphysis left, bad sign if u have scoliosis)
2: 50
3. 75
4: 100
5: fused to ilium
posterior fontanelle closes ___, anterior fontanelle closes _____
posterior: 1-2 mo
anterior: 7-18 mo
fontanelle closure has implications for what child population?
children with plagiocephaly and torticollis!
REFER WAY BEFORE 18 MONTHS
What is the principle where bones develop in response to mechanical forces placed on them?
Wolff’s Law
Difference between epiphyseal plates and lines
plates: occur at various locations at epiphyses of long bones, GROW
lines: plates have fused, growth not possible
What is osteogenesis imperfecta?
genetic disorder where bones break easily
20-50,000 people in USA
dominant/classical OI is a condition where
person lacks TYPE 1 COLLAGEN or has poor quality of type 1 due to mutation in one of those genes
In recessive OI, mutations in -___ interefere with -____
other genes mutation interfere with collagen production
What tests help diagnose OI?
-clinical features
-biochemical biopsy (collagen) test
-molecular (DNA) tests
(tests require several weeks)
*detect almost 90% of all type 1 collagen mutations
What is the medical management of “brittle bone disease” or OI?
▪ Bisphosphonate
▪ Infusions & Vitamin D
clinical characteristics of OI
▪ Hyperlaxity of Ligaments
▪ Fragile Skin
▪ Poor Thermoregulation
▪ Blue Sclerae
▪ Dentinogenesis imperfecta – issues
with teeth
PT precautions with INFANT HANDLING if they have osteogenesis imperfecta
Carry with widespread hands over head/shoulders and
bottom
▪ Diaper changes done by lifting buttocks, not ankles
*open laces/braces WIDE, do not twist, pull on body parts
*MMT ONLY at midshaft of bone, ONLY if osteoporosis is not advanced, prob not tolerated
*no trunk extension/flexion for core strength (spine fx)
*caution with managing joint contractures
