Midterm Flashcards
Transactional Model of Development
reciprocal relationship between the child and the caregiving environment
proximal vs distal environment
distal - curbs, wheelchair ramps, playgrounds, etc
proximal - within the home
What is the ACE study?
looks at effect of childhood trauma on health
Barnard-Four features of successful parent-child interactions
- Sufficient repertoire of behaviors, such as body movements and facial expressions
- Contingent responses
- Rich interactive content in terms of play materials, positive affect, and verbal stimulation
- Adaptive response patterns that accommodate the child’s emerging developmental skills
Multidisciplinary service
Professionals work independently but recognize and value the contributions of other professions
Interdisciplinary service
Individuals from different disciplines work together cooperatively to evaluate and develop programs.
Emphasis is on teamwork. Role definitions are relaxed.
Transdisciplinary service
There is teaching and ongoing work among professionals across traditional disciplinary boundaries. Role release occurs when a team member assumes the responsibilities of other disciplines for service delivery
what are positive signs? examples?
- behaviors that are present and not expected in the typical population
- lead to increased frequency or magnitude of muscle activity, movement, or movement patterns
- hypertonia, chorea, tics, tremor
What are negative signs? examples?
- behaviors that are absent because of the pathophysiology
- insufficient muscle activity or insufficient control of muscle activity
- weakness, impaired selective motor control, apraxia, ataxia
T/F: Negative signs are easier to detect in the clinic
false - positive signs are easier to detect
______ motor signs may be even more significant contributors to disability that _______ signs
Negative, positive
Reduced Selective Motor Control
impaired ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement
- muscles are able to generate full force in other contexts, just not voluntary
ex: activation of knee and hip flexors during DF
ataxia
inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints
- can lead to decreased accuracy
Dysmetria
inaccurate motion to a target
Dyssnergia
decomposition of multijoint movements
Dysdiadochokinesia
lack of rhythmicity
Apraxia
impaired ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity
Developmental dyspraxia
failure to have ever acquired the ability to perform age-appropriate complex motor actions
ex: monkey bars, jump 3 times, tying shoes
head/neck extension response
facilitates extension and inhibits flexion
head/neck flexion response
facilitates flexion and inhibits extension
head/neck lateral flexion response
facilitates hip abduction
arms ER, supination, extended elbows response
facilitates trunk extension and inhibits trunk flexion
arms IR response
facilitates trunk flexion and inhibits trunk extension
Arms horizontal abduction w/ ER response
facilitates ER of hips and inhibits spasticity of pecs
Arms elevated overhead w/ ER response
very facilitatory to extension may
- may be too much
arms diagonally backward w/ ER response
facilitates trunk extension and hand opening
- may use w/ ambulatory child to build extensor tone
Abduction thumbs response
facilitates finger opening
legs and pelvis flexion of hips and knees response
favors abduction and ER of hips, ankle DF
legs and pelvis ER of lower extremities in standing response
facilitates hip abduction and ankle DF
DF of toes 2-5 response
inhibits LE spasticity and facilitates DF
anterior pelvic tilt response
promotes extension
posterior pelvic tilt response
promotes flexion
What is the GMFCS?
gross motor functional classification system
T/F: GMFCS is an outcome measure
false - it is a classification system
T/F: In CP, stiffness is usually greater distally than proximally.
true
athetosis
slow, involuntary, and writhing movements of the limbs, face, neck, tongue, and other muscle groups
GMFCS Level V – 90% of motor potential reached by age ___
3
GMFCS Level I- 90% of motor potential reached by age ___
5
What are poor prognosis for ambulation?
- rigidity
- persistent tonic neck reflexes
What are predictors of ambulation potential?
- hemiplegic
- sit by 24 months
Nearly all who eventually walk do so by age ___ – only exception are kids w/ pure athetosis
8
Indications needed for posterior spinal fusion
curve approaching 90 degrees when the child is sitting w/ difficulty side bending back towards the middle
benefits of standers
- standing w/ abducted hip to promote compression of hip
- weight bearing helps acetabulum form, blood flow, bone density, improved digestion, breathing, alertness
What type of deformity is more common at the foot and ankle in hemiplegia? What muscles are weak?
varus deformity
- weak fibularis/peroneals, spastic anterior and posterior tibialis
Kids start to realize their differences around age __
6
How to test for femoral antetorsion?
lay kid on stomach and IR and ER LE
uncompensated femoral antetorsion gait
pigeon toe
compensated femoral antetorsion gait
gait w/ external tibial torsion
How to assess for tibial torsion? What is more common?
lay kid in prone and look down calcaneus and look at angle to the thigh
external is more common than internal
What muscle is weak w/ foot flat?
tib posterior
What muscle is weak w/ flat foot step?
poor DF
What muscle is weak w/ toe walking?
PF contracture
CP knee flexion gait cause
hip or knee contracture
CP lacking hip extension gait can lead to what?
can lead to crouched gait and/or shorter stride length
______ pulls tibia backwards to help extend the knee in midstance
Soleus
Why is there limited swing phase knee motion in CP?
hip flexors supply momentum and rectus gets recruited and ends up also extending knee
- 2 joint muscles are a problem in CP
crouched gait requirements. What does it require?
knee flexion > 20 during initial contact or stance phase
- requires more quad strength, chronic stress to knee, and often results in patella alta
The crouched position itself reduces ________ control. What muscle becomes a knee flexor that is not usually a knee flexor?
extensor
- rectus femoris
Kids exposed early on to alcohol have different ________ as that is developed early
facial features
Kids exposed later in term to alcohol have _________
behavioral issues
What are the causes of crouched gait? (6)
- lower limb extensor weakness
- loss of PF/knee extension couple
- weakness of soleus
- lever arm dysfunction due to femoral and tibial torsion
- popliteal angle/spastic hamstrings
- tight hip flexors
