Midterm Flashcards
GMFCS has two different descriptor scales for which age groups?
Children b/w their 6th and 12th birthdays
Children b/w their 12th and 18th birthdays
GMFCS Level I (6-12): Children can _ at home, school, outdoors and in the community. They can _ _ without the use of a _. Children perform _ _ _ such as running and jumping, but _, _ and _ are limited.
Children can walk at home, school, etc
They can climb stairs without the use of a railing
Children perform gross motor skills such as running and jumping, but speed, balance, and coordination are limited
GMFCS Level II (6-12): Children _ in most settings and _ _ _ onto a _. They may experience difficulty _ _ _, and _ on _ _, _, in _ areas or _ spaces. Children may walk with _ _, and - _ _ or use _ _ over long distances. Children have _ _ _ to perform gross motor skills like running and jumping.
Children walk in most settings and climb stairs holding onto a railing.
They may experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or in confined spaces.
Children may walk with physical assistance, and hand-held mobility device or use wheeled mobility over long distances
Children have only minimal ability to perform gross motor skills . . .
GMFCS Level III (6-12): Children walk using a - _ _ in most _ _. They may climb stairs holding onto a railing with _ or _. Children use _ _ when _ _ distances and may - for _ distances.
Children walk using a hand-held mobility device is most indoor settings.
They may climb stairs holding onto a railing with supervision or assistance.
Children use wheeled mobility when traveling long distances and may self-propel for shorter distances
GMFCS Level IV (6-12): Children use methods of mobility that require _ or _ _ in most _. They may _ for short distances at home with _ _ or use _ _ or a _ _ _ when positioned. At school, outdoors and in the community children are _ in a _ _ or use _ _.
Children use methods of mobility that require physical assistance or powered mobility in most settings.
They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned.
At school, outdoors, and in the community children are transported in a manual wheelchair or use powered mobility.
GMFCS Level V (6-12): Children are transported in a _ _ in _ settings. Children are limited in their ability to _ _ _ and _ _ and control _ and _ movements.
Children are transported in a manual wheelchair in all settings
Children are limited in their ability to maintain antigravity head and trunk postures and to control leg and arm movements
Which two levels of GMFCS do we see most often in physical therapy?
Levels III and IV
GMFCS I (12-18): youth walk at _, _, _ and in the _. Youth are LE to _ _ and _ without _ _ or a _. They performed gross motor skills such as running and jumping but _, _ and _ are _.
Youth walk at home, school, outdoors and in the community
Youth are able to climb curbs and stairs without physical assistance or a railing
They perform gross motor skills such as running and jumping but speed, balance, and coordination are limited
GMFCS Level II (12-18): youth walk in most _ but _ _ and _ _ influence _ _. At school or work they may require a hand-held mobility device for _ and _ _ holding onto a _. Outdoors and in the community youth may use _ _ when traveling _ distances.
Youth walk in most settings but environmental factors and personal choice influence mobility choices.
At school or work they may require a hand-held mobility device for safety and climb stairs holding onto a railing.
Outdoors and in the community youth may use wheeled mobility when traveling long distances.
GMFCS Level III (6-12): Youth are capable of _ using a - _. Youth may climb stairs holding onto a railing with _ or _. At school they may - a _ _ or use _ _. Outdoors and in the community youth are _ in a _ or use _ _.
Youth are capable of walking using a hand-held mobility device.
Youth may climb stairs holding onto a railing or with supervision or assistance
At school they may use a self-propel a manual wheelchair or use powered mobility
Outdoors and in the community youth are transported in a wheelchair or use powered mobility
GMFCS Level IV (12-18): Youth use _ _ in most settings. _ _ of - _ is required for transfers. Indoors, youth may _ _ distances with _ _, use _ _, or a _ _ _ when positioned. They may operate a _ _, otherwise they are _ in _ _.
Youth use wheeled mobility in most settings
Physical assistance of 1-2 people is required for transfers.
Indoors youth may walk short distances with physical assistance, use wheeled mobility or a body support walker when positioned.
They may operate a powered chair, otherwise they are transported in a manual wheelchair
GMFCS Level V (12-18): Youth are transported in a _ _ in all _. Youth are limited in their ability to maintain _ _ and _ _ and control of _ and _ _. - is severely limited, even with the use of _ _.
Youth are transported in a manual wheelchair in all settings
Youth are limited in their ability to maintain antigravity head and trunk postures and control of leg and arm movements.
Self-mobility is severely limited, even with the use of assistive technology.
_ _ is defined as a permanent but not unchanging neurologically based motor impairment caused by a non-progressive defect or lesion in a single or multiple locations in the immature brain.
Cerebral palsy
2 main ways of acquiring CP and associated definitions. American Academy of CP definition (age range)?
Congenital CP
- damage occurred before at the time of birth
Acquired CP
- damage occurring after birth
American Academy of CP: defines damage as occurring at 5 years old or younger in order to qualify as CP
With acquired CP damage is most commonly caused by _ _, _ and _ _.
Infectious meningitis, trauma, and near drowning
Hemorrhage below the lining of the ventricles, anoxia or hypoxia, and malformations of the CNS are the?
3 main types of neurological lesions seen in CP
In studies looking to relate cerebral lesions to the extent of the disability only the amount of _ _ (not _ _) correlated with severity of disability
Only the amount of white matter, not grey matter correlated with the severity of disability
What are the 6 types of CP?
MS. HARD
Mixed, spastic, hypotonic, ataxic, rigidity, and dystonic
Which type of CP: site of lesion is the motor portion of the cerebral cortex and axons?
Spastic CP
Which type of CP: site of lesion is in the basal ganglia? AKA?
Dystonic, or athetoid
Which type of CP: site of lesion is in the cerebellum
Ataxic
Which type of CP: has no specifically identified site of lesion?
Hypotonic
Which type of CP: is associated with a severe decerebrate lesion?
Rigidity
Which type of cp is described: Signs include severe spasticity in agonist and antagonist muscles. Have little?
Rigidity CP
Have little voluntary movement
Which type of CP is described: Signs include increased muscle tone and DTR’s, clonus and babinski sign. Movement is described as being limited in the -, characterized by _ of muscles, with _, _ movements
Spastic CP
Movement is limited in the mid-range, characterized by coactivation of muscles, with patterned and synergistic movements (all flexion, all extension)
Which type of CP is being described: Signs include fluctuating muscle tone from hyper to hypotonic. Exhibits excessive _ _, without _ _. Movements are _ and _.
Dystonic (athetoid)
Exhibits excessive peripheral movements without central stability
Movements are patterned and synergistic
What type of CP is described: signs include diminished resting muscle tone and hypermobile joints. Movement appears _ “_ _” like, with _ movment.
Hypotonic
Movement appears floppy “rag doll” like, with little movment
What type of CP is described: signs include dysmetria. Characterized by _, _ movements. Is?
Ataxic
Uncoordinated volition all movements
Is Rarer
With mixed CP what two types are involved?
Spastic and dystonic
Problems commonly associated with CP (non-orthopedic): _ disability, _ and _ disorders, _ problems, growth _, and _ problems.
Intellectual disability Seizure and communication disorders Feeding problems Growth retardation Visual problems
What are the 4 categories of intellectual disability?
Min, Mod, Severe, Profound
Strabismus, esotropia more than exotropia, homonymous hemianopsia, nystagmus (ataxic CP) are examples of?
Visual problems associated with CP
Growth retardation seen in CP: Decreased body size can be both _ and -. Severe spasticity/ tone can cause _ _ of muscles. Decreased _ _.
Decreased body size can be both longitudinal and cross-sectional
Severe spasticity/ tone can cause high definition of muscles
Decreased bone density
Commonly seen ROM limitations and Orthopedic concerns: shoulder _ and _ in order to stabilize a _ _. Elbow _ and _. Shortening of the _ _ _.
Shoulder protraction and elevation in order to stabilize a weak head
Elbow pronation and flexion
Shortening of the long finger flexors
Commonly seen impairment of the spine that can develop with CP? What medical treatment may be necessary? Why?
Scoliosis
Spinal fusion may be necessary in order to maintain the ability to sit upright
What are 3 common impairments seen at the hip associated with CP
Dislocated or subluxed hips
Hip flexion contractures
A tight _ can cause an exaggerated _ _ when the CP patient attempts to stand
Tight Iliopsoas can cause exaggerated lumbar lordosis
_ _ in CP patients can cause and increased _ _ range of the hip with a decreased?
Femoral anteversion
- increased internal rotation range at the hip with decreased external rotation
3 common impairment associated with CP that are seen in the knee and ankle. Associated cause?
Knee flexion contracture: tight hamstrings
Knee extension contracture: short quads
Plantar flexion contracture
Sitting with hip extended, flexed knee gait, psuedo-equinus of the ankle and patella Alta are all impairments that can develop from?
Chronically tight hamstrings
Stiff legged gait, inability to flex the knee while the hip is extended, difficulty getting feet under the hips for transfers, and patella alta are all features of?
Shortness in one of the heads of the quads
Plantar flexor contractures can cause a CP patient to walk/ stand _ _ _ _, or cause them to develop _ _ or _ _.
CP patient to walk to stand up on their toes
Cause them to develop genu recurvatum or mid foot collapse
Will my child be able to walk: spastic hemiplegic? Spastic diplegic?
Hemiplegic: usually learn to walk for mobility
Diplegic: ability to walk will vary depending on severity and effort required.
Most spasticity management techniques were developed for?
Spastic diplegic
Will my child be able to walk: quadriplegic with persistent tonic neck reflexes?
Usually do not walk functionally
Will my child be able to walk: if the can sit independently by age _ _, then they usually learn to walk by age _.
If they can sit independently by 24 months, usually learn to walk by age 8
Will my child be able to walk: If they are not walking by _ _, not likely to become a _ ambulators.
Not walking by age 9, not likely to become a functional ambulators
4 “geographical” terms associated with CP?
monoplegia, diplegic, hemiplegia, quadriplegia
Definition of monoplegia? Is?
One extremity involved, Is rare
Definition of hemiplegia? Usually? (2)
On side is involved
Usually:
- spastic
- walk by 2-4 years of age
Definition of diplegic? Always _ type, often seen in _ with an _ event that resulted in _ _. Most therapies are aimed at improving _ in this group, most _ by age _, with diminished ability after _ because?
1st degree involvement is legs and trunk
Always spastic type
Often seen in premise with an anoxic event that resulted in periventricular hemorrhage.
Most therapies are aimed at improving walking in this group, most walk by the age of 7, with diminished ability after puberty because spastic muscle strength cannot keep up with the patients increased length and weight.
Definition of Quadriplegia? Caused by? _ influences give great risk of _.
Whole body is affected with one side having less involvement than the other
Caused by global CNS damage
Asymmetrical influences give a great risk of deformity
What are 3 important issues to assess for when ordering a wheel chair?
- obtaining optimal head and trunk alignment
- repositioning for pressure relief
- home and community access
