Management of Neurologic AND MSK Conditions Flashcards
Cerebral Palsy Classification Systems
GMFCS / FMS - mobility
MACS - UE function
Cerebral Palsy Assessment Tool
GMFM
Manual Ability Classification System (MACS)
Children 4-18 w/ CP
Conducted by asking someone who knows the child / how the child performs
Places child in 1 of 5 categories (1: handling objects easily and successfully to 5: does not handle objects and ability is severely limited)
Functional Mobility Scale (FMS)
Classification System
Describes functional mobility in children with CP aged 4-18
Scores functional mobility over 3 distinct distances (5, 50, 500 meters) to represent mobility in the home / school / wider community
Functional Mobility Scale (FMS) Scoring
1: Uses WC
2: Uses walker / frame
3: Uses crutches
4: Uses sticks (1 or 2)
5: Independent on level surfaces
6: Independent on ALL surfaces
C: Child crawls for mobility at home (5 m)
N: Does not apply (e.g., child doesn’t complete 500 m distance)
GMFM (Gross Motor Function Measure)
Assessment Tool
Criterion-Referenced
Measures changes in gross motor function over time or w/ intervention in children with CP
In addition to CP, the GMFM has also been validated for use with children with ___ ___.
Down Syndrome
(GMFM - 88)
GMFM-88 vs. GMFM-66
88: Original / 5 months - 16 years / raw scores can be calculated / better for very young children, children with complex motor disability, children using ambulatory aids or orthoses / allows testing of one or more specific dimensions
66: Newer, reduced items / 5 years - 16 years / computer program required to calculate scores / based on barefoot testing / less time to administer / more meaningful assessment of change (within and between children)
GMFM (Gross Motor Function Measure) Dimensions and Scoring
Dimensions: Lying and rolling / sitting / crawling and kneeling / standing / walking, running, jumping
Scoring:
0 - does not initiate task
1 - initiates task
2 - partially completes task
3 - completes task
NT - not tested
Higher scores denote better performance
What equipment / space is necessary for the GMFM administration?
Mat / bench / access to stairs (at least 5 steps)
Space for 4.5 m run necessary for running item
Any modification should be as close as possible to recommended equipment and space - document differences
The thermoregulatory system is unreliable in which two age groups?
Older adults
Young children (< 4 y/o)
The risk of hypothermia is ___ in children. Why is this?
higher
They are less efficient in generating heat and lose heat more readily
Developmental Biomechanics
Effects of forces on MSK system during the entire life span
What are the three key tissues in the body directly related to growth?
CT
Bone
Muscle
Dense Ordinary CT (Tendons / Ligaments)
Can heal if torn or surgically cut
Tendon regeneration mediated by fibroblasts in inner tendon sheath or surrounding loose CT - complication can involve development of fibrous adhesions between the tendon and surrounding tissues
Cartilage
Found at the site of articulating joints and provides smooth surface for movement
What three tissues are derived from the Mesoderm Layer of embryonic development?
Bone
Cartilage
Muscle
Epiphyseal Plates
Regions of bone growth
Areas of concern in peds
Various locations along epiphyses of long bones
Epiphyseal Lines
Occur when epiphyseal plates have fused or come together
Growth NOT possible
__ Ultrasound is contraindicated in Growth Plates, while ___ Ultrasound is indicated.
Therapeutic, Diagnostic
Why is Therapeutic Ultrasound contraindicated over Epiphyses of growing bones?
Can produce growth disturbances
Potential to cause early closure
Wolff’s Law
Bones develop in response to mechanical forces placed on them
Hueter-Volkman Principle
Growth plates produce increased growth in response to tension and decreased growth in response to excessive compression
Skeletal Maturity is achieved when ___.
epiphyseal plates close
SMI
Skeletal Maturity Indicators
Bone Age
Helps doctors estimate maturity of a child’s skeletal system
Single X-ray taken of L wrist / hand / fingers
Risser Sign
Percent ossification of Iliac Epiphysis to determine skeletal maturity
Closure of:
Posterior Fontanelle
Anterior Fontanelle
Posterior: 1-2 months
Anterior: 7-18 months
