lecutre 3: examination &evaluation of atypical development Flashcards
describe the cervical posture or malalignment of a 4 month old infant presents with severe left torticollis
L sb with R rotation
what mm are shortened with torticollis
SCM
traps
scalenes
what mm is the main contributor to torticollis
SCM
can atypical development start out just as typical development does
yes but then many typical components are missing and then babies learn to compensate
what is very important to obtain to know if atypical development is occurring
the babies developmental history
what may provide an indicator of the chronic neurological condition of the fetus
the quality of fetal movement in the womb
what is apart of the examination
hx
systems review
tests and measures
what is the essential elements of history
general demongraphics
social history and living environment
employment
growth and development
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
in a systems review what 5 things are u looking for
◦Communication skills
◦Affect
◦Cognition
◦Language abilities
◦Learning style
what does a skeletal exam include (4)
Anthropometric Characteristics
Joint Integrity/Mobility
Posture
Range of Motion
what does a mm function test include
Muscle Performance (Strength, Power,
Endurance
what does movement test include
Gait, Locomotion, Balance
Motor Function (Motor Control/Learning
what does a gross motor/fine motor functional skills test include
Motor Function
Neuro-motor Development
Self-Care/ADL’s
Work (Job/School/Play
Aerobic Capacity/Endurance
Arousal/Attention/Cognition
Circulation
Environmental Barriers
Ventilation/Respiration
these are included in what type of exam
general observations
what kinds of methods of examination are important (3)
- interview
- observation
- direct handling
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
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
when is eye dominance established
6 years
when is a hand dominance usually established
4 to 6
when is leg dominance typically established
6 years
*Though eye dominance and handedness (being right-handed or left-handed) are not directly related, these traits are ____ associated.
significantly
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
▪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
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
- Neck PROM.
- Neck and trunk AROM.
- Development of symmetrical movement.
- Environnemental adaptations.
- 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
20
in kids with DDH Approx. 10% ____ _____ or ____
metatarsus adductus or calcaneovalgus
what are the 5 types of DDH
- Typical & Stable
- Subluxable
- Dislocatable
- Dislocated & Reducible
- 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
6
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
