Module 2 Flashcards
what is CMT
unilateral shortening of the SCM and fertile rotation away from involved side
what side is CMT named for
shortened side
what nerve is involved with CMT
spinal accessory nerve
insertion and origin of CMT
mastoid process and nuchal line
sternal head and clavicular head
what is CD
distortion of the skull shape
can be pre or post natally
how many infants with CMT have CD
90 percent
what does CD increase risk of
facial, ear, or mandibular asymmetry
what can cause CMT prenatally
ischemic injury or head position
what can cause CMT perinatally
birth trauma from Breech or assisted delivery
what can cause CMT postnatally
hip dysplasia, CD, or positional preferences
what happens with CMT with sternomastoid tumor? what can be present?
excessive fibrosis, hyperplasia, atrophy
nodules may be present
what to do if treating an infant with SCM nodules
refer to surgery
factors that influence CMT prognosis
age of referral, severity of ROM limitations, thickness of nodules, interventions
what can worsen CD postnatally
positioning- supine
CMT
factors associated with CD
male, first born, forceps/vacuum delivery, supine position
bradycephaly CMT
wide medial-lateral
plagiocephaly CMT
long anterior- posterior
grading for CMT
1-8 (higher is worse)
1-3 between 0-6 months
4 and 6 between 7-9 months
5 between 10-12 months
7 between 7-12 months
8 is older than a year
higher stages have more nodules
grading for CD plagiocephaly
1-5
grading for CD brachycephaly
1-3
how can families help with therapy at home for CMT?
put toys on sides that the child is tilted away from
get them to look other direction
facilitate wanted movement
spine involvement with CMT?
changes rotation - curved on opposite side
what is craniosynostosis?
sutures fuse and if they fuse early the skull cannot expand
important to differentiate from CD
who can get acquired CMT?
ocular lesion, benign paroxysmal torticolis, dystonic syndrom, infections, arnold-chiari malformation
what to assess during PT exam for CMT?
cervical PROM and AROM
prone tolerancee
gross motor function
pain
cervical strength
integumentary eval
craniofacial for asymmetries
what to assess during PT exam for CD?
cranial shape
cervical AROM
prognosis for CMT treated at <3 months? 3-6months? 6-18 months?
100%
75%
30%
two factors that help with resolution of CD?
parent education on repositioning
helmet
is CMT causal with scoliosis?
no but it is associated
helmet protocols for CD
start at 4-6 months
wear for 20-23 hours a day for 2-7 months
how does botox help with CMT?
relax SCM by inhibiting EACh release or causing atrophy
discharge criteria for CMT
full PROM of neck, trunk, extremities within 5deg of unaffected side
symmetrical movement
appropriate GM development
no visible head tilt
proper family understanding to maintain gains
highest rates of injury per 1000 hours of game in women
basketball, cross country
highest rate of injury based on athletic exposure
cross country for males, soccer and cross country for females
who has highest rate of injuries
young males as they age
why do males have higher rate of injury
higher body mass can develop greater force
what sport has highest number of catastrophic injuries
football
who has higher risk of ACL injury
girls 2-10x
purpose of PPE for sports participation
determine general health
identify medical contraindications to participation
identify sports that can be safely played
general health screen
fulfill elgal and insurance requirements
evaluate physical maturation
preseason training program should include
identification of strengths and limitations
individualized training
body function assessment
QoL assessment
risk factors for sports injuries
training error, muscle tendon imbalance, anatomical malaligment, improper footwear, surfaces, associated diseases, growth factors
two types of fractures
stress
growth plate
osgood-schlatter
repeat injury at tibial tubercle
most common joint injuries in kids
ligamentous sprains
who should kids see if they have a concussion
vestibular sports med
diagnosis of concussions includes at least one of the following
period of loss of or decreased consciousness
loss of memory
altered mental state
headache, dizziness, nausea, vomiting, sensitivity to light or sound
concussion assessment options
BESS, sensory testing, neck ROM/ strength, posture assessment, ocular testing, cardiovascular testing
how often do cervical injuries happen and what is likelihood of death
1-5% of sports injuries but 50-100% death
ICF framework for kids?
Family
Friends
Fun
Function
Fitness
ITW inclusion critera
kids older than 2 walking on toes at least 25% of time
no known medical cause
typical walking pattern for ITW
forward trunk, flat foot, step by falling
3 phases of stance
1st rocker: PF and heel strike
2nd rocker: forward translation of tibia
3rd rocker: push off
things that can contribute to ITW
genetics
neurological conditions at birth
sensory processing
neuropsychiatric
posture and ITW
will have poor postural stability
can you keep seeing child for ITW if you find yellow or red flag?
yes but refer to neuro or ortho too
toe walking assessment tool is called?
williams
is williams a diagnostic tool
no but it can help you rule out other causes of toe walking
what are some potential MSK problems if ITW is not treated?
ankle injuries and foot pain
decreased gross motor activities
signs to refer kid out with ITW
heel cord tightness
GM delays
pain
impaired QoL
important to remember when treating pediatrics and developing POC
discuss with families! work together
systems review to include in exam for ITW
pain
integumentary
sensory processing
neuro
parent concerns
postural assessment things to look at in NWB for ITW?
leg length
thigh foot angle
hindfoot alignment
what is the gold standard for gait assessment
gait assessment lab
what to use for ankle foot assessment (questionnaire)
Oxford foot and ankle questionnaire
what to include in exam for ITW
body structure/function, activity limitations, and participation restrictions and QOL
common interventions for ITW
PT
orthotic management
serial casting
botox
surgery
PT interventions for ITW
stretching, strengthening, joint mobs, locomotor/treadmill training, Motor control, taping, sensory based, balance, augmented auditory feedback, vibration, visual training, serial casting, orthotics
goals of treatment for ITW
10 deg ankle PROM DF and KE, core and LE strengthening, posture and balance training, locomotor training, orthotic management
how to strengthen for ITW
anterior tibial- heel walk, DF, incline walk
hip and knee extensors, core and pelvic stabilizers
posture control for ITW
weight shifting
goals of PT intervention for ITW
address impairments and max function for pain free participation in home school and community activities
goals of orthotics for ITW
foot and ankle alignment
when to consider orthotics for ITW
toe walking more than 25% of time
orthotics options for ITW
AFOs
SMOs
foot orthoses
carbon foot footplates (CFOs)
what does serial casting help with and what can be used with it
ankle DF range of motion
botox
how long is serial casting for? what do you need to do after
4-6 weeks
rebuild strength after
when is serial casting recommended
less than 0 degrees of ankle DF KE
how does botox work
prevents release of acetylcholine at NMJ which prevents muscle contraction
outcomes of ITW
improve ankle ROM/ DF
improve gait
does botox alone improve ROM or gait
no
what is a second skeletal abnormality of ITW
external tibial torsion
who gets DMD
males- X linked recessive
who gets SMA
males and females- autosomal recessive chromosome 5
what causes DMD
deletion of dystrophin gene
onset of DMD
1-5 yo
what is increased in DMD
creatine kinase
what other organs impacted in DMD
heart brain and smooth muscle
what is seen in a child with DMD
muscle weakness
pseudo hypertrophy
slow 10m WT
what does a 10WT of 12+ seconds indicate in a child with DMD
loss of ambulation within 1 year
ROM findings in child with DMD
tightness of gastroc-soleus complex and TFL first
posture of child with DMD
lordotic posture with scapulae winging and scoliosis
5 stages of DMD
presymptomatic
early ambulatory
late ambulatory
early non ambulatory
late non ambulatory
age and clinical signs of early ambulatory stage of DMD
5 yo
clumsy and falling
proximal LE weakness
calf pseudohypetrophy
Gowers maneuver
clinical signs of late ambulatory stages of DMD
increased LL
+ trendeleberg
stair issues
heel cord, ITB, and hip contractures
age and clinical signs of early non ambulatory phase of DMD
10-12yo
UE geetting weaker
scoliosis risk
pulmonary function decreasing d/t low strength in trunk and diaphragm
clinical signs of late non ambulatory phase of DMD
UE is weaker and posture is bad
UE and LE contractures
cardiac and respiratory failure
why do joint contractures occur in DMD
loss of AROM
sedentary time in flexed posture
muscle imbalance
fibrotic chances
PT treatment for contractures
frequent stretching
orthotics
serial casting
dynamic and solid AFOs
incidence of scoliosis in DMD
63-90%
why is scoliosis bad with DMD
rapidly progressing
decreases VC
loss of functional status
activity outcome measures for DMD
6mwt, timed testing
9 hole peg
how frequent to reassess kids with DMD
4-6 months
motor function scales to use for DMD
NSAA
PUL
goal of PT for early ambulatory phase
keep muscles supple and prevent / minimize tightness
goal of PT for late ambulatory phase of DMD
keep muscles flexible and minimize muscle weakness
goal of PT for early non ambulatory phase of DMD
UE range of motion and flexibility
accommodations and adaptive equipment
goal of PT for late non ambulatory phase
UE flexibility and supportive equipment
general exercise recommendations for DMD
regular submit aerobic exercise
avoid high resistance and eccentric contractions
meds for DMD
corticosteroids to improve strength and function
what is the 2nd most common NMD
SMA
what causes SMA
genetic mutation effecting motor neurons
three types of SMA and severity and life expectancy and prevalence
1: most common and severe, limited life expectancy
2: 2nd most common and severe, short life expectancy
3: least common and severe, normal life expectancy
age of onset for each SMA type
1: 0-4 months
2: 6-12 months
3: 1-10 yrs
activity outcome measures for SMA
6mwt
timed testing
timed towers timed 10m
what to address in non sitters and sitters with SMA
muscle weakness
postural control
contractures
what to address in walkers with SMA
muscle weakness and asymmetries
outcome measure for non sitters SMA
CHOP intend
outcome measure for sitters SMA
upper limb function
hammersmith
outcome measures for walkers SMA
6mwt
precautions for SMA
scoliosis
what is blount’s disease?
tibia vara (proximal tibia)
what is the etiology of blount’s disease?
unknown
may be due to altered endochondral ossification
what happen’s with blount’s disease
decelerated growth at posterior-medial proximal tibial physics and causes various deformity of tibia
what are the 3 clinical classifications of blount’s disease?
infantile: 0-4yo
juvenile: 4-10yo
adolescent: 10+ yo
what to observe with Blount’s disease?
radiographic classification
metaphyseal- diaphysial angle and alignment (uni or bilateral)
activity limitations of blount’s disease
decreased activity, ambulation, and mobility
pain
conservative treatment for blount’s disease
orthotics- young and unilateral involvement
HKAFOs, KAFOs, elastic bracing
surgical treatment for blount’s disease
guided growth
tibial osteotomy
LLD
PT goals of bracing with Blount’s disease
gait re-ed
strengthening and stretching
hip and core strengthening
balance and coordination
weight loss
goals of PT post surgery for Blount’s disease
return to normal activities ASAP and prevent secondary compensatory problems
5 attributes to typical walking
stability in stance
sufficient foot clearance in swing
appropriate positioning for initial contact
adequate step length
energy conservation
neuro pre reqs for gait
CPGs for muscle firing
muscle synergies
coordination
biomechanics pre reqs for gait
ROM strength bone structure and body composition
management of gravity forces
proper muscle and joint kinematics
typical growth
five determinants for mature walking
duration of single limb stance
walking velocity
cadencee
step length
ratio of pelvic span to ankle spread
