lecutre 3: examination &evaluation of atypical development Flashcards by sophia carrasco

describe the cervical posture or malalignment of a 4 month old infant presents with severe left torticollis

L sb with R rotation

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what mm are shortened with torticollis

SCM
traps
scalenes

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what mm is the main contributor to torticollis

SCM

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can atypical development start out just as typical development does

yes but then many typical components are missing and then babies learn to compensate

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what is very important to obtain to know if atypical development is occurring

the babies developmental history

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what may provide an indicator of the chronic neurological condition of the fetus

the quality of fetal movement in the womb

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what is apart of the examination

hx
systems review
tests and measures

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what is the essential elements of history

general demongraphics
social history and living environment
employment
growth and development

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a systems review finding may do what 3 things

◦May affect patient management process
◦May narrow the focus of of Tests & Measures
◦May identify need to refer patient to other
providers

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in a systems review what 5 things are u looking for

◦Communication skills
◦Affect
◦Cognition
◦Language abilities
◦Learning style

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what does a skeletal exam include (4)

Anthropometric Characteristics
Joint Integrity/Mobility
Posture
Range of Motion

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what does a mm function test include

Muscle Performance (Strength, Power,
Endurance

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what does movement test include

Gait, Locomotion, Balance
Motor Function (Motor Control/Learning

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what does a gross motor/fine motor functional skills test include

Motor Function
Neuro-motor Development
Self-Care/ADL’s
Work (Job/School/Play

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Aerobic Capacity/Endurance
Arousal/Attention/Cognition
Circulation
Environmental Barriers
Ventilation/Respiration

these are included in what type of exam

general observations

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what kinds of methods of examination are important (3)

interview
observation
direct handling

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what are the essential components in the examinations ( 9)

◦Functional Skills
◦PROM/AROM
◦Muscle Tone
◦Skeletal Alignment (Posture)
◦Balance/Postural Control
◦Muscle Strength
◦Quality of Movement
◦Primitive Reflexes
◦Pain

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what are patterns of immature movements

▪______ of performance
▪_____ Plans of Motion
▪_____: the inability to stop activity when
appropriate
▪____ Movements
▪____ and _____ in bilateral coordination

▪Inconsistency of performance
▪Limited Plans of Motion
▪Perseveration: the inability to stop activity when
appropriate
▪Extraneous Movements
▪Asymmetry and difficulty in bilateral coordination

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when is eye dominance established

6 years

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when is a hand dominance usually established

4 to 6

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when is leg dominance typically established

6 years

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*Though eye dominance and handedness (being right-handed or left-handed) are not directly related, these traits are ____ associated.

significantly

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how can u test a child’s eye dominance

by asking them to look thru a kaleidoscope, camera window, or even a toilet paper tube

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▪Loss of Dynamic balance
▪Falling after finishing a motor task
▪Inability to control force: unable to generate enough
force or uses too much force
▪Inability to maintain rhythm or movement patterns
▪Inappropriate motor planning
▪Lack of or decreased transverse plane mvt

these are all patterns of an immature ___ system

motor

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how is PROM easiest tested in

supine

what are 3 **tone** assessment scales that u could use

◦Modified Ashworth Scale (MAS) ◦Tardieu Scale ◦R1 vs. R2

what does the modified ashworth scale tell us (0, 1 , 1+, 2 ,3, 4)

0: in increased in mm tone , normla 1: slight increase in tone MANIFESTED BY A CATCH AND RELEASE or by a minimal resistance at the end range of motion 1+: slight increased in mm tone , manifested by a. catch , followed by minimal resistance throughout the remainder of the ROM (3rd quarter) 2: more marked increas in mm tone thru out most of he ROM , but affected parts are easily moved 3: considerable increase in mm tone , passive movements difficult 4: affected part rigid in flexion or extension

what are the grades from clonus (0,1,2,3,)

◦0: Absent ◦1: Un-sustained (a few beats at a time) ◦2: Sustained (continuous beating) ◦3: Spontaneous/light touch provoked and sustained

what is the grading for a deep tendon reflex 0 1 2 3 4

Grading: ◦0: No reflex jerk ◦1: Lower than normal reflex ◦2: Normal reflex ◦3: Higher than normal reflex ◦4: Exaggerated reflex along with clonus

at what age can u start MMT

not attempted before the age of 5 a typical 8 y/o should be able to follow basic MMT direction

what is the FLACC observation scale

for use w/ infants , preschoolers and non verbal children have 5 categories ; (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Ability to console is scored from 0-2, which results in a total score between zero and ten.

what age is **The Wong-Baker Faces Pain Rating Scale**

agree 3 and older

what age is the **The Verbal Analog Scale** used for

ages 10+

is the Inability to laterally flex in prone and side-lying typical or atypical

atypical

what are the 2 general types of diagnosis in kiddos

MSK and neuromuscular

what is congenital muscular torticollis

a non progressive unilateral contracture of the SCM

what do u need to do prior to initiating PT for CMT

need to rule out non muscular torticollis

▪Cervical Skeletal Malformation, cervical rib ▪Posterior fossa tumor ▪Sandifer’s syndrome (gastroesophageal reflux), ▪Subluxation of cervical vertebrae ▪Extraocular muscle paresis ▪Ocular strabismus or nystagmus, cataract, ▪Klippel-Feil syndrome, or Sprengel’s deformity ▪Brachial Plexus Injury or clavicular injury during a forceful birth these are all casues of what

non muscular torticollis

what is Atypical posture of head and neck due to SCM shortening

congenital muscular torticollis

what is the baby posture if they have congenital muscular torticollis EX: right torticollis

▪Lateral flexion TOWARDS affected SCM and rotation AWAY ex: right scm is tight …. right lateral flexion with L rotation

comprehensive treatment of CMT includes a screening for what

hip instability

CMT is associated with what 10-20%

DDH

Asymmetries of even ___ to ___ degrees in hip _ may indicate **hip dysplasia**

5 to 10 abduction

what are things u need to assess with CMT

decreased AROM and PROM of c spine gross motor skills

what are things u should **screen** for with **CMT**

▪ screen for other contractures and for DDH ▪ screen for Plagiocephaly and asymmetry of ears & eyes ▪ screen for issues with: feeding, vision, hearing 58

what are the goals for treatment for CMT

•No residual head tilt •Full active and passive cervical range of motion in all directions •Typical Cervical Strength in all directions •No palpable tumor – tumors should resolve by 12 months of age •Prognosis is considered to be better if conservative treatment if begun before 1 yr. of age

what should a home program from CMT consist of

active and passive ROM and positioning to increased range and strength q

a comprehensive home program from CMT. is ___

key

to increased lateral neck flexion in kids with CMT what is used

lateral or optical righting

what is effective for kids who have CMT and are 3-4 months old

weight shifting activities on a ball or lap

what is the difference between plagiocephaly and brachycephaly and scaphocephaly

plag: mis formed head on one side brach: flat head scaph: both sides of head squished in

when does the **posterior fontanelle** usually close

1-2 months

when does the **anterior** **fontanelle** usually close

7-18 months

what is the **torticollis CPG** include ? (8 specific health history factors) should be done ___ to initial screening

▪age at initial visit, ▪age of symptom onset, ▪pregnancy history, ▪delivery history including birth presentation and use of assistance, ▪head posture/preference, ▪family history of CMT, ▪other known or suspected medical conditions, and ▪developmental milestones prior

the **torticollis CPG action 7** states that there should be an inclusive of screening for what

possible hip dysplasia or spine asymmetry

a kid with CMT can have what kind of skin folds

asymmetrical

what are the 5 things that **torticollis intervention CPG action statement 12** include

1. Neck PROM. 2. Neck and trunk AROM. 3. Development of symmetrical movement. 4. Environnemental adaptations. 5. Parent/caregiver education

Torticollis- Early Intervention is Key 1. ____ PROGRAM with parent education 2. PROM for ____ and ____ 3. ____ supine, prone, and sidelying 4. Massage and myofascial release to SCM 5. Positioning 6. Facilitation of typical developmental sequence 7. ____ as needed 8. Cranial orthosis as needed

home SB and rotation AROM kinesiotaping

how should u feed a baby with torticollis

with head in midline

how should a baby sit with torticollis at home

side prop sitting and sidelying when playing

what is dysplasia of the hip

atypical development of the hip

▪DDH etiology is thought to be ____

multifactorial

what are the mechanical factors that are believed to predispose an infant to DDH

small intrauterine space, breech position, fetal hip against mother’s sacrum

what are the **Physiologic** **factors** that are believed to predispose an infant to DDH

maternal hormonal influence of estrogen and relaxin (6:1 female to male incidence, more common in females)

what are the **environmental** **factors** that are believed to predispose an infant to DDH

strapping of children’s lower extremities in extension, such as on a cradle board, noted in Eskimo and some other Native American cultures

is the right or left hip more commonly t dislocated

left

what is the **gold standard** for confirming hip dislocation

ultrasound

what is the most consistent clinical sign of **hip dysplasia** in **neonates**

hip abduction limitation or asymmetry

how much diffence in ROM of hip ABDUCTION is a single for DDH

5 to 10°

in kids with DDH Approx. ___% incidence of CMT

in kids with DDH Approx. 10% ____ _____ or ____

metatarsus adductus or calcaneovalgus

what are the 5 types of DDH

1. Typical & Stable 2. Subluxable 3. Dislocatable 4. Dislocated & Reducible 5. Dislocated & not Reducible

what is. a(+) **galeazzi sign**

uneven knee heights in hook lying (+) for DDH

what is a (+) **barlow**

first flex and abduct the hip then adduct with posterior pressure and u feel dislocation

what is a (+) **ortolani test** for DDH

start in flexion and adduction and gently move hip into abduction with flexion and slight traction to reduce hip

▪Barlow and Ortolani are typically done until about __months of age

most infants have how many ° of **abduction**

75 to 90

what does asymmetric thigh folds indicate

DDH

what is the pavlik harness used for in DDH interventions (infants)

puts hip into a position of flexion and abduction

what does the pavlik harness restrict

hip extension and adduction and therefore attempting to keep hip joint in proper alignment

what intervention is used for DDH if a brief trial ( 3 weeks) of pavlik harness is not successful in reducing a dislocated hip

a closed reduction and spica cast (3-6 months of age)

what complications could come with using the pavlik harness for DDH

a vascular necrosis femoral nerve palsy inferior dislocation

if DDH is not detected in the **neonatal** or **infancy** period then what happens to the prognosis

less favorable

•For dislocated hips dx’d bet. __ to __ months of age, surgical tx. Is usually require

6 to 18

•Dx of hip dislocation in the child age ___ or ___ is generally considered to mandate open reduction.

2 or older

•Older children with continuing acetabular dysplasia may benefit from a ___ ___, as the remodeling potential of the acetabulum decreases with age

pelvic osteotomy

what are the 3 medical intervention post ambulation

• Femoral Osteotomy • Femoral Shortening • Periacetabular Osteotomy

what are the 3 types of pelvic osteotomies

pemberton salter steele

t/f: •A number of children with acetabular dysplasia are never diagnosed as infants or toddlers

true