Module 1 Flashcards
Birth Trauma
Pressure forces and anatomical design
Pressure forces:
-Cspine has horizontal facets better adaptation to bending forces
Adapted to withstand compressive forces
Traction and rotation forces:
-wea Cspine ligaments provide poor protection for spinal cord + nerve traction or rotation forces
-Greater tendancy for subluxation
-Spinal cors structures + meninges 8 x vulnerable as postural connective tissues- has lack of elasticity during traction.
What percentage of newborn suffer some degree of neuromusckuloskeletal issue?
70%
What is the min and max peak forces for vacuum extraction
min 176N
max 241 N
In 34% >216N was used
The measured forces was 4 x higher than estimated force used.
Name some of the injuries that occur in the head, neck, arm, leg during birth trauma
Head
Cephalohaematoma
Caput succedaneum
Cranial bone fracture
Facial nerve injury
Intracranial
haemorrhage
Leptomeningeal cysts
Retinal
haemorrhages
•
Neck
-SCM injury
-Other neck muscles
e.g.scalenes
-Joint injury
–subluxation and dislocation
-Spinal fracture
-Clavicle fracture
-Brachial plexus nerve injury
-Phrenic nerve injury
-Spinal cord injury
Arm
-Shoulder and other upper extremity joint injury
-Humerus
fracture
Leg
-Femur fracture
Labour is defined as?
Established contractions of 10 mins or less
What are the ris factors for spinal column and spinal cord injuries occuring at or around time of birth
10.
.
Intrauterine position
eg
breech, OP
2.
Precipitate delivery > 6 hour labour*
3.
Prolonged delivery > 12 hour labour*
4.
Multiple foetuses
5.
Limb prolapse
6.
Shoulder dystocia
7.
Hypoxia
8.
Birth weight above 3500gms
–
average weight
3.3 to 3.4 kg
9.
Postmaturity
10.
Caesarean
Age Definitions
Neonate
Infant
Toddler
Preschooler
School aged
Adolescent
Child
Neonate: 0-8 weeks
Infant: 0-1 year
Toddler 1-2 yrs
Preschooler: 2-5 years
School aged 5-15 years
Adolescent: 13-19 years
Child: 1- 15 years
Too much stress during pregnancy may result in?
- Preterm birth
- Developmental delays
- Behaviour abnormalities in the children
- Increased risk of infections and illnesses.
Maternal perinatal depression and anxiety were associated with?
- Poor emotional development
-cognitive development
-language development
-motor development
-adaptive behaviour development
What are the risks of taking Paracetamol during pregnancy
Dont do it- increases risk of ADHD, Autism, and lower IQ
High levels of fluoride exposure in pregnancy was linked too
Lower IQ squares
Response to Dressing
nappy Change
bath
Dressing- dislike- shoulder, neck, elbow or wrist subluxation
Nappy change- sacral or neck subluxation (AS)
Bath (neck or shoulder girdle subluxation (rare)
Kids who have prolonged crying beyond 3 months age
lead to increased risk of
Cognitive problems
Lower IQ scores
poorer fine motor abilities
hyperactivity
discipline problems
How do you measure the Anterior and posterior fontanelle size?
At what ages do they close?
What is a bulging fontanelle a signs of?
Risk evaluation for premature closure of anterior fontanelle?
a + b / 2 (length and width)
Anterior - closes 7 months to 19 months (90%)
Posterior (closes by 2 months)
Buldging fontanelle - bacterial meningitis - maybe also more benign causes
Risk evaluation for premature closure of anterior fontanelle?
Gross motor development of children with premature closure of AF was significantly underdeveloped compared with the control group.
What is the Woodside Chart designed to assess?
How do you use it?
- Social
- Hearing and language
- Gross Motor
- Fine Motor
Suitable 0-4 years
Using Woodside charts
if can do both tests place “x” on top line of step
if can do 1 test place “x” on bottom line of step
if can not do expected tests for age move down y-axis to level of next step (but on same x-axis age) and record results at this level
make sure you can Chart
Woodside
WHO ARTHRO
practice it
List the essential milestones for each of these developmental ages
Birth:
4-6 weeks:
6 weeks:
12-16 weeks:
12-20 weeks:
20 weeks:
26 weeks:
9-10 months
13 months
Birth:
Prone- pelvis high, knees flexed under abdomen
ventral suspension- elbows flexed, hips partly extended
4-6 weeks:
Smiles at mother, vocalised 1-2 weeks later
6 weeks:
Pelvis flat when prone
12-16 weeks:
turns head to sound
holds object placed in hand
12-20 weeks:
20 weeks:
goes for objects and gets them without being placed in hand
26 weeks:
Transfers object, one hand to another
chews and feeds self with biscuit
sits with hand forward for support
9-10 months
bye bye, helps dress , index finger approach finger thumb opposition
13 months:
Walks with no help
bla bla
Plagiocephaly
What are the 2 types
- Synostotic Plagiocephaly (which include unilateral coronal or lamdoidal synostosis
- deformational Plagiocephaly
Which is otherwise known as occipital, posterior or non synostotic plagio.
What is the Distinctive features of unilambdoidal synostosis versus deformational occipital plagiocephaly
- Contralateral posterior bossing occurring in the parietal region in patients with unilambdoidal synostosis versus occipital bossing in patients with deformational occipital plagiocephaly.
- Ipsilateral occipitomastoid bossing in patients with unilambdoidal synostosis versus no bossing in patients with deformational occipital plagiocephaly.
- Ipsilateral inferior tilt of the posterior skull base in patients with unilambdoidal synostosis versus a horizontal skull base in patients with deformational occipital plagiocephaly.
- A trapezoid head shape as viewed from the vertex in patients with unilambdoidal synostosis versus a parallelogram head shape in patients with deformational occipital plagiocephaly.
In addition with unilambdoidal synostosis a prominent ridge is palpated in the area of the mastoid bone or is observed on CT scanning. (2)
What should the examiner note for deformational plagiocephaly?
• The examiner should note
- the side of occipital flattening,
- presence and side of frontal bossing,
- presence and side of anterior ear displacement,
- sutural patency assessment,
- anterior fontanelle state and size measurement.
• Regular head circumference measuring with plotting on appropriate charts such as WHO Anthro should be performed.
• The gold standard for determining severity of deformational plagiocephaly is the transdiagonal difference (Glasgow, Siddiqi, Hoff, & Young , 2007).
This measurement is the difference noted when measuring between two diagonals of the skull illustrated in Diagram 1. A head band is typically used to facilitate accurate reproducible placement of the calliper.
What scale do you use for Deformational Plagio?
See the ARGENTA SCALE
List some differential diagnosis to Torticollis
-Cervical spine joint dysfunction (subluxation)
-Infection (grisels syndrome, retropharyngeal or parapharyngeal abscess, discitis)
Congenital conditions: ie congenital vertebral abnormality,
congenital shortened SCM, scoliosis
Neuromuscular conditions: -meh
Trauma- clavicle fracture, asymmetric brain injury, Atlanta-axial subluxation eh Down syndrome, JIA, skeletal dysplasia
What are some red flags with Torticollis
What are specific examinations we should check?
Severe pain - fractures, osteomyelitis, retro pharyngeal abscess
Vomiting/ drowsiness - increased ICP
Trauma- intracranial injury
Seizures- epilepsy or ICP
Acute onset- infection, abscess, Grisels syndrome
Reflux - Sandifer Syndrome, pathological GORD
Fever- infection/ abscess
Specific examination:
Sunset phenomenon - increased ICP
Buldging fontanelle- increased ICP
Lymphadenopathy- infection, pre-symptomatic Juvenile IA
What is the Management of Deformational Plagiocephaly?
Chiropractic management of deformational plagiocephaly includes but is not limited to
- Correction of cervical spine dysfunction
- Positional management
- Cervical spinal muscle stretching
- Physical growth monitoring (head circumference, weight and length)
- Head asymmetry monitoring
- Neurodevelopment monitoring
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