Lecture 6 (final): Mamgement Of Neurologic And MSK Conditions Flashcards
T/F: it is typical for a kid to walk with a toe in gait
F , never
What is an important feature of the activity focused model
Integration of impairment focused interventions with functional practice
What are the specific classification systems fro cerebral palsy
▪ GMFCS Level - mobility
▪ FMS - mobility
▪ MACS – upper extremity function
What is a specific assessment tools for cerebral palsy
GMFM
What is the GMFCS level 1 requirement
- Childeren walk at home , school , outside and in the community
- Climb stairs without use of railing
- Perform gross motor skills such as running and jumping , but speed and balance and coordination are limited
Childeren walk at home , school , outside and in the community
Climb stairs without use of railing
Perform gross motor skills such as running and jumping , but speed and balance and coordination are limited
What GMFCS level is this
1
What is the description for GMFCS level 2
- walk in most setting
- climb stairs holding onto railing
- may experiences difficult walking long distances and balancing on uneven surfaces , crowded places
- may walk with AD or us WC over long distance
- only minimal ability to perform gross motor skills such as jumping and running
What is the descriptions for the GMFCS level 3 (walk , stairs, long distances)
- child walks using a hand held device indoor
- may climb stairs holding on railing w supervision or assistance
- child use WC when going long distances and may self propel short distances
What is the descriptions for the GMFCS level 4
- childs methods of mobility that require physical assistance or powered mobility
- may walk for short distances at home w physcial assistance or use of powered mobility or walker
- use WC for school, outside and in community
What is the description of the GMFCS level 5
- child are trasnfported in a manual WC everywhere
- limited in their ability to maintain antigravity head and trunk postures and control legs and arm movements
What is the Manual ability classification system used for (MACS)
The ability of children from 4 – 18 years old with CP to handle
objects in everyday activities can be categorized into 5 levels
MACS level is determined based on what
Knowledge about the child’s actual performance in daily life
How many classifications MACS is there
1-5 (more —> less)
What is the functional mobility scale designed to describe
Functional mobility in children with CP , ages 4-18 years as an aid to communication between surgeons and PT
What is the unique feature of the FMS
Freedom to score functional mobility over 3 distinct distances
What is the functional mobility scale for CP levels 1-3
1: uses a WC
2: used a walker or frame
3: used crutches
What is the functional mobility scale for CP levels 4-6
4: used sticks
5: independent on level surfaces
6: independent on all surfaces
What is the. Assessment tool
designed & evaluated to
measure changes in
gross motor function
over time or with
intervention in children
with cerebral palsy
Gross motor function measure
The newer version of the GMFS 66 age
5 years to 16 years
GMFM-88 is also validated to use with children with what?
Down syndrome
What are the 5 dimensions of the GMFM
- lying and rolling
- sitting
- crawling and kneeling
- standing
- walking; running; jumping
What is the score 0-3 for the GMFM
▪ 0 = does not initiate task
▪ 1 = Initiates task
▪ 2 = Partially completes task
▪ 3 = Completes task
The higher the score .. the ___ the outcome for the GMFM
Better
The validation sample for the original GMFM
included children in what agre
5 months to 16 years
The items of the GMFM are appropriate for those with motor skillls at or below those of a ___ y/o ____ any ____ distability
5
Without
Motor
What is the difference between the GMFM 88 and 66
▪ GMFM-88 original (5 months to 16 years of age)
▪ GMFM-66 – newer version, reduced items (5 yrs to 16 yrs)
T/F: There is some evidence for its use in children with traumatic brain injury, spinal muscular atrophy, osteogenesis imperfecta, hereditary spastic paresis, and acute lymphoblastic leukemia to use the GMFM
T
What equipment and space do u need for the GMFM
Mat , bench , 5 steps
Space for a 4m5 meter run
Should u used the GMFM- 88 or the 66 if the child has more complete motor disability such as those functioning at a GMFCS levle 5 and needs one that describes early motor skills
88
Should u use the GMFM-88 or 66 if u are able to evaluate children using ambulatory aids and/or orthoses or shoes
88 bc scores are based on bare foot
What takes more time to test the GMFM66 or 88
88
66 has less items
When thinking about a kids diagnostic consideration we need to think about what
Their entire life span
For Myelominingocele what is diminished or absent
Trunk to LE strength and sensation
For MYELOMENINGOCELE what do u need to monitor for
Scoliosis
What is the mainstay of treatment for hydrocephalus in both adult and pediatric pt
VP shunt
What are signs of the tethered cord
- weakness , numbness with mm function in the legs
- tremors or spasms in legs mm
- changes in the way the feet look , higher arch’s or curlers toes
- loss or change of bladder or bowel control
Childeren with DS have higher incidence of a number of health issues including what
- cardiac
- hearing
- endocrine
- dental
What are possible defects and instability that a kid with DS may have
Heart defects
Cervical instability
What instability is present in 15% of DS
AA
When should radiographs for DS be taken
Between 3 and 5 years of age
What is the asssesment tool used for DS
GMFM
Another common ones is Peabody
What does part B of the Individuals with Disability Education Improvement Act: state
Federal legislation that establishes school ages services for students (3 to 21 tears) with disabilities
What is the IEP under part B of the Individuals with Disability Education Improvement Act:
Legally binding document developed annually for students
What does PART C of the Individuals with Disability Education Improvement Act: state
Federal legislation that establishes early intervention services for infants and toddlers (Birth to 3 years of age) with disabilities
Who is the Individualized Family Service Plan for under Part C of the Individuals with Disability Education Improvement Act:
For those receiving early intervention , educated at least one per year adn reviewed at least every 6 months
What is the Section 504 of the Rehabilitation Act of 1973:
Federal legislation that makes discrimination against popele with disability illegal
What is teh Federal civil rights legislation that prohibits discrimination against
individuals with disabilities in employment, transpiration, public
accommodations communications, and governmental activities
Americans with Disabilities Act of 1990
Is hypothermia more common in adults or children and why
Children bc they are less efficient in generating heat and lose heat fast
What is the effects of forces on musculoskeletal system during the entire life span
Developmental biomechanics
What are the 3 key tissues of growth
- Connective Tissue
- Bone
- Muscle
What does tissue respond to
- different types of forces
- direction and amount of force
What are the 7 things that influence the body strucuture
- force
- shape
- genetics
- nutrition
- drugs
- hormones
- activities (or lack of)
What are the 2 types of connective tissue
- Dense ordinary CT
- Cartilage
What kind of connective tissue is found a t teh side of articulating joints and provides smooth surface for movement
Cartilage
T/F: Both tendons and ligaments can heal if torn or surgically cut
True
What is tendon regeneration mediated by
fibroblasts in the inner tendon sheath or surrounding loose connective tissue
What is a common complication of tendon regeneration
Development of fibrous adhesions between the tendon and surrounding tissues
Where is the bone , cartilage and mm derived from
Mesoderm layer
What 3 things are derived from
Mesoderm Layer of embryonic
development
- bone
- cartilage
- mm
What are epiphyseal plates
Regions of bone growth
special concern in peds
Is it okay to do ultrasound over epiphyses of growing bones ??
NOOOO , only diagnostic ultrasound
- cant lead to growth problems or early closure
Where is epiphyseal plates located
At epiphyses of long bones
What is it called when epiphyseal plates fused or come together and is growth possible
Epiphyseal lines and no growth is not possible
What is Wolff’s law in terms of principles of growth
Bones develop in response to mechanical forces places on them
What is Hueter-Volkman Principle
growth plates produce increase growth in response to tension and decreased growth in response to excessive compression
When is skeletal maturity achieved
When epiphyseal plates close
How is bone age taken
By a single x ray of the left wrist , hand and fingers
What helps doctors estimate the maturity of a child’s skeletal system
Bone age
What is riser sign
Percent of ossification of iliac epiphysis
1 is bad 5 is fulled fused
When does the posterior fontanelles closed
1- 2 months
When does the anterior fontanelles closed
7-18 months
When does the anterior fontanelles closed
What is the difference between therapeutic vs diagnostic ultrasound
Therapeutic has heat and can not go over growth plates
Diagnostic is okay to do over growth plates that aren’t develop
What is oeestogensis imperfecta
Genetic disorder characterized by bones that break easily, often from little or no apparent cause
What is osteogenesis imperfecta caused by
Genetic defects that affect the body’s ability to make strong bones
In dominant OI a person has to little what
Type 1 collagen or a poor quality of type 1 collagen due to mutation in one of the type 1 collagen genes
What is a major protein of the body’s
connective tissue and the framework that bones are formed around.
Collagen
In recessive OI what interfere with collagen production
Mutations in other genes
What is the result in all classes of OI
Fragile bones that break easily
What test for osteogenesis imperfecta are thought to detect almost 90% of all type 1 collagen mutations
Collagen biopsy test and DNA
What is often known for “osteogenesis imperfecta”
Brittle bone disease
What are clinical characteritsitics for osteogenesis imperfecta
▪ Hyperlaxity of Ligaments
▪ Fragile Skin
▪ Poor Thermoregulation
▪ Blue Sclerae
▪ Dentinogenesis imperfecta – issues
with teeth
How is the characteristic features of OI vary
Greatly from persons to person
What are the OI precautions of infant handling
Carry with widespread hands over head/shoulders and bottome
Diaper changes done by lifting but, not ankles
What are the OI precautions (5)
- infant handling
- do not twist or pull body part
- formal MMT may not be possible (only do if able to tolerate , perform at mid shaft of bone , not at the end)
- no isolated trunk extension/felxion to assess core strength
- extreme caution with managing joint contractures
How many types of OI are there
12
What is the drugs that helps prevents bone loss for OI pateints
Bisphosphonates
What are the PT interventions for SB
- pt and fam education regarding long term implications and the risks for obesity , osteoporosis and UTI
- exercise to maintain ROM and improve strength
- functional mobility training
What are the pre cautions during PT for SB
▪ Decreased cardiorespiratory endurance (higher resting
HR and increased HR during activities)
▪ Increased risk for fracture secondary osteoporosis
▪ Increased risk for hip dislocation
▪ Increased risk for skin breakdown
▪ Latex allergies
▪ Incontinence during exercise
▪ Difficulties with thermoregulation
▪ Increased Risk for Falls
▪ Increased Spasticity during exercise
What are the complications interfering with PT for SB
▪ Illness
▪ Pronounced spasticity
▪ Arnold-Chiari malformation
▪ Fracture
▪ Pressure Sore
▪ Tethered Cord Syndrome
▪ VP shunt failure
▪ Symptomatic hydromyelia
▪ Symptomatic hydrocephalus
What is hydromyelia
Condition where the central canal of the spinal cord becomes abnormally wide , creating a cavity filled with CSF
What can symptomatic hydromyelia cause
Weakness and pain in the arms and legs, headaches and numbness in the neck
What are symptoms of hydroomyelia
• Headaches
• Loss of sensitivity to hot and cold
• Muscle stiffness
• Scoliosis
• Weakness in the arms and legs
• Sensory loss in the neck and arms
• Severe pain in the neck and arms
What are the causes of hydromyelia
Brain related birth defects such as chiari malformation 2 and dandy walker syndrome
What infections can cause hydrocephalus
Meningitis or encephalitis
Tumors growing where can cause hydrocephalus
Near or within the ventricles
An enlarged head; A bulging or tense soft spot on the top of the head; Downward looking eyes; high-pitched cry; problems with
sucking or feeding; recurrent vomiting; seizures;
These are SYMTOMS of hydrocephalus in what population
Infants
An enlarged head; A bulging or tense soft spot on the top of the head; Downward looking eyes; high-pitched cry; problems with
sucking or feeding; recurrent vomiting; seizures;
These are SYMTOMS of hydrocephalus in what population
