Mod 6: Peds/Pregnancy Flashcards
ideal position for exercise after 1st trimester
L sidelying
preg: mobilize (2)
general strength?
mobilize rib cage & thoracic spine
core & lumbar strength for stability & posture, Kegels, TAs
this mm spasm/shorten d/t postural changes & hip ER in preg
piriformis
techniques for standing posture in preg
weight on heels to center shifted COM
relax glutes
scap retraction to lift ribs
chin tuck
knees slightly bent (not locked)
diastasis recti diagnosis
hooklying- rectus abs crunch w/ 2 finger width or greate
aerobic ex FITT in preg
50-60% MHR, 30 min
absolute contraindications for aerobic ex
heart disease
RLD
PTL risks
persistent bleeding
active labor
preeclampsia
placenta previa
relative contraindications for aerobic ex
severe anemia
cardiac arrhythmia
chronic bronchitis
poor controlled DM 1, seizures, hyperthyroidism
extreme over/underweight
Contraindicated modalities in preg
electrotherapy or US on trunk
hydrotherapy (inc. core body >100.8F)
diathermy
mech. traction
prolonged positioning- supine, prone, R sidelying
Avoid these exercises on preg Bedrest
abdominal exercise (TA set, rectus abs)
no Valsalva
APGAR categories
-when calculated
-passing score is ___
appearance, pulse rate, grimace, activity, respiration
check at 1 min & 5 min after birth
7-10 score
Steps in Motor Planning (7)
attend to instructions/listen
recall them in correct sequence
carry out task
adapt motor behavior to complete task
recognize success/failure
interpret problems leading to failure
re-adjust/modify
receipt & propulsion requires judging ____ (3)
speed, direction, distance
when might primitive reflexes reemerge?
when stressed or injured
if UMN lesion
Name 2 transitional reflexes, not present at birth
STNR
Landau
-stroke sole of foot in upward direction & toes fan out
from birth - 12/24 mo
Babinski reflex
touch on cheek causes head to turn with mouth open
28 wks gestation to 3 mo
rooting reflex
rooting reflex integration for:
head control development, optical righting
when head drops into extension, arms abduct/ fingers open and then cross into adduction with crying
28 wks gestation to 5 mo
moro reflex
moro reflex integrates for:
sitting progression; balance reactions, protective response, hand-eye coordination
pressure applied to extended LE and the opposite LE flexes
birth to 6 wks
crossed extension reflex
pressure on palm of hand cause baby to grip
birth to 4 mo
palmar grasp
palmar grasp integrates for:
WB on hands, voluntary grasp/release, pushing prone to supine
pressure to base of toes causes toe flexion
28 wks to 9 mo
plantar grasp
plantar grasp integrated for:
LE WB with flat feet, balance reactions, weight shifts in standing
touch skin along spine from shoulder to hip causes lateral flexion to same side of stimulus
30 wks gestation to 2 mo
Galant’s Response
Galant’s response integrates for:
sitting balance
head turns side & arm/ leg on face side extend, arm/leg on scalp side flex
birth to 6 mo
asymmetrical tonic neck reflex
ATNR integrates for:
rolling, crawling, feeding, visual tracking, midline use of hands
head position into flexion causes arm flexion/ leg extension
head position into extension causes arm extension/leg flexion
6-8. mo
symmetrical tonic neck reflex (STNR)
STNR integrates for:
POE, quadruped, crawling reciprocally, sitting balance
position of head causes body/extremities held in extension in supine
-body/extremities held in flexion in prone
birth to 6 mo
Tonic Labyrinthine Reflex
TLR
TLR reflex integrates for:
initiating rolling, POE, supine to sit transitions, sitting balance
loud sudden noise causes arms to abduct w/ elbows flexed & hands closed
28 wks gestation to 5 mo
startle reflex
startle reflex integrates for:
sitting balance, protective response in sitting, hand-eye coordination, attention
weight placed on balls of feet when upright causes trunk/LE to extend
35 wks gestation to 5 mo
positive support
positive support reflex integrates for:
standing/walking, balance reactions, possible contractures
supported upright w/ feet on solid surface cause reciprocal flex/ext of legs
38 wks gestation to 2 mo
walking/stepping reflex
walk/step reflex integrate for:
standing/walking, balance reactions, weight shifting
child held suspended in prone causes extension of head, trunk & LEs
3mo to 12/24 mo
Landau reflex
Landau reflex absence may indicate:
hypertonia or hypotonia
3 righting reactions that orient head to vision, vestibular input & w/ tactile cues/proprioception
1- Optical righting reaction
2- labyrinthine righting reaction
3- body on head reaction
2 righting reactions to orient body to head & surface:
neck on body (for segmental rolling)
body on body (head & trunk follow leg/pelvis rotation)
order(positions) that balance/tilting reactions develop
prone to supine to siting to quadruped to standing
body stabilizes in response to destabilizing forces applied anywhere to body (except supporting surface)
Postural fixation reactions
reaction that protects body from injury from a fall
-extremities will break fall F/B/side
Protective Reactions
Peds Dx: shortening of STM mm d/t cramped position in utero, forceps/vacuum delivery, etc
-mm tissue becomes fibrotic
Torticollis
Peds Dx: hip instability d/t cramped position in utero, birth hormones, tight swaddling
-clunk, asymm. leg length
developmental dysplasia of the hip
prematurity may cause these pathologies:
respiratory distress syndrome > bronchopulm. dysplasia
seizures
aspiration
intraventricular hemorrhage
dev. delays
asphyxia
encephalopathy
cerebral palsy
interventions for prematurity: positioning?
promote flexion
avoid supine
-develop midline orientation
Peds Dx: movement disorders d/t brain damage acquired in utero, during birth, or infancy before age 2
s/s: variable, abnormal mm tone, impaired movement modulation, abnormal reflexes, impaired mobility
Cerebral Palsy
2 primary motor patterns w/ CP
4 types of distribution to extremities
spastic (motor cortex, UMN) or athetoid (basal ganglia)
monoplegia, diplegia, hemiplegia, quadriplegia
various forms of myelodysplasia (neural tube deficit)
-in thoracic, lumbar or sacral regions
-lack of folic acid causes failure of neural tube to close
spina bifida
-non fusion of spinous process of vertebrae though meninges intact
-herniation of meninges, CSF & spinal cord w/ defect extending through vertebrae
-cyst-like protrusion through non fused vertebrae
-herniation of meninges & CSF into sac that protrudes through vertebral defect
spina bifida occulta
myelomeningocele
spina bifida cystica
meningocele
cerebellum protrudes into cervical spine through magnum foramen d/t hydrocephalus
Arnold chiari malformation
what is used in spina bifida to prevent hydrocephalus?
where does it drain?
ventricular shunt
catheter drains CSF into peritoneal cavity
non-progressive NM disorder from 1st trimester
s/s: cylinder like extremities, contractures, joint dislocation, mm atrophy
arthrogryposis multiplex congenita (AMC)
group of disorders characterized by difficult social interaction, communication, repetitive behaviors
autism spectrum disorder
progressive disorder caused by absence of gene required to produce dystrophin & nebulin
-fat & fibrotic tissue replace mm
s/s: proximal to distl weakness; no core stability
Duchenne’s muscular dystrophy
precautions w/ Down Syndrome
hyperflexibility/hypermobile jts so don’t overstretch
congenital heart disease: know cardiac status
AA jt unstable & alar ligament laxity: no tumbling/gymnastics
hypotonic mm: don’t overdo exercise
genetic condition diagnosed by physical attributes & behavior patterns (chrom 5 deleted)
s/s: small hands/feet, hypotonia, obese, coordination & intellectual disability, constantly hungry
Prader-Willi Syndrome
progressive degeneration of anterior horn cells (LMN); autosomal recessive
-progressive mm weakness/atropohy, dec DTRs, normal sensation & intelligence
spinal muscular atrophy (SMA)
who pays for medical based ped therapy?
private insurance, Medicaid, out of pocket
-in private clinics, hospitals, home based
IFSP?
therapy goals are related to what?
for ages: ___
individualized family service plan
education related goals but home based
birth to 3 years
IEP?
for ages: ____
individualized education plan
ages 3+ to age 21
when?
lifts chin in prone
roll partly to side
track object to midline
newborn to 1 month
when?
kicks legs reciprocally
roll prone to supine
lift head in prone
2-3 months
when?
POE
roll supine to side
sit alone briefly
4-5 months
when?
roll supine to prone
1 arm reach
sit independently
radial palmar grasp
6-7 months
when?
quadruped
pulls to stand
8-9 months
when?
crawling
stands briefly without support
10-11 months
when?
walks independently
crawls up stairs
12-15 months
when?
squats in play
walk backward
stairs w/ help
kick/throw ball
16-24 months
when?
tricycle
SL hops
scissors w/ help
walk downstairs alt. feet
2 yrs
