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Peds > Module 2 > Flashcards

Module 2 Flashcards

1
Q

what is CMT

A

unilateral shortening of the SCM and fertile rotation away from involved side

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2
Q

what side is CMT named for

A

shortened side

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3
Q

what nerve is involved with CMT

A

spinal accessory nerve

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4
Q

insertion and origin of CMT

A

mastoid process and nuchal line
sternal head and clavicular head

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5
Q

what is CD

A

distortion of the skull shape
can be pre or post natally

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6
Q

how many infants with CMT have CD

A

90 percent

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7
Q

what does CD increase risk of

A

facial, ear, or mandibular asymmetry

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8
Q

what can cause CMT prenatally

A

ischemic injury or head position

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9
Q

what can cause CMT perinatally

A

birth trauma from Breech or assisted delivery

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10
Q

what can cause CMT postnatally

A

hip dysplasia, CD, or positional preferences

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11
Q

what happens with CMT with sternomastoid tumor? what can be present?

A

excessive fibrosis, hyperplasia, atrophy
nodules may be present

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12
Q

what to do if treating an infant with SCM nodules

A

refer to surgery

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13
Q

factors that influence CMT prognosis

A

age of referral, severity of ROM limitations, thickness of nodules, interventions

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14
Q

what can worsen CD postnatally

A

positioning- supine
CMT

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15
Q

factors associated with CD

A

male, first born, forceps/vacuum delivery, supine position

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16
Q

bradycephaly CMT

A

wide medial-lateral

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17
Q

plagiocephaly CMT

A

long anterior- posterior

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18
Q

grading for CMT

A

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

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19
Q

grading for CD plagiocephaly

A

1-5

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20
Q

grading for CD brachycephaly

A

1-3

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21
Q

how can families help with therapy at home for CMT?

A

put toys on sides that the child is tilted away from
get them to look other direction
facilitate wanted movement

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22
Q

spine involvement with CMT?

A

changes rotation - curved on opposite side

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23
Q

what is craniosynostosis?

A

sutures fuse and if they fuse early the skull cannot expand
important to differentiate from CD

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24
Q

who can get acquired CMT?

A

ocular lesion, benign paroxysmal torticolis, dystonic syndrom, infections, arnold-chiari malformation

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25
Q

what to assess during PT exam for CMT?

A

cervical PROM and AROM
prone tolerancee
gross motor function
pain
cervical strength
integumentary eval
craniofacial for asymmetries

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26
Q

what to assess during PT exam for CD?

A

cranial shape
cervical AROM

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27
Q

prognosis for CMT treated at <3 months? 3-6months? 6-18 months?

A

100%
75%
30%

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28
Q

two factors that help with resolution of CD?

A

parent education on repositioning
helmet

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29
Q

is CMT causal with scoliosis?

A

no but it is associated

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30
Q

helmet protocols for CD

A

start at 4-6 months
wear for 20-23 hours a day for 2-7 months

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31
Q

how does botox help with CMT?

A

relax SCM by inhibiting EACh release or causing atrophy

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32
Q

discharge criteria for CMT

A

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

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33
Q

highest rates of injury per 1000 hours of game in women

A

basketball, cross country

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34
Q

highest rate of injury based on athletic exposure

A

cross country for males, soccer and cross country for females

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35
Q

who has highest rate of injuries

A

young males as they age

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36
Q

why do males have higher rate of injury

A

higher body mass can develop greater force

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37
Q

what sport has highest number of catastrophic injuries

A

football

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38
Q

who has higher risk of ACL injury

A

girls 2-10x

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39
Q

purpose of PPE for sports participation

A

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

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40
Q

preseason training program should include

A

identification of strengths and limitations
individualized training
body function assessment
QoL assessment

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41
Q

risk factors for sports injuries

A

training error, muscle tendon imbalance, anatomical malaligment, improper footwear, surfaces, associated diseases, growth factors

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42
Q

two types of fractures

A

stress
growth plate

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43
Q

osgood-schlatter

A

repeat injury at tibial tubercle

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44
Q

most common joint injuries in kids

A

ligamentous sprains

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45
Q

who should kids see if they have a concussion

A

vestibular sports med

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46
Q

diagnosis of concussions includes at least one of the following

A

period of loss of or decreased consciousness
loss of memory
altered mental state
headache, dizziness, nausea, vomiting, sensitivity to light or sound

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47
Q

concussion assessment options

A

BESS, sensory testing, neck ROM/ strength, posture assessment, ocular testing, cardiovascular testing

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48
Q

how often do cervical injuries happen and what is likelihood of death

A

1-5% of sports injuries but 50-100% death

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49
Q

ICF framework for kids?

A

Family
Friends
Fun
Function
Fitness

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50
Q

ITW inclusion critera

A

kids older than 2 walking on toes at least 25% of time
no known medical cause

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51
Q

typical walking pattern for ITW

A

forward trunk, flat foot, step by falling

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52
Q

3 phases of stance

A

1st rocker: PF and heel strike
2nd rocker: forward translation of tibia
3rd rocker: push off

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53
Q

things that can contribute to ITW

A

genetics
neurological conditions at birth
sensory processing
neuropsychiatric

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54
Q

posture and ITW

A

will have poor postural stability

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55
Q

can you keep seeing child for ITW if you find yellow or red flag?

A

yes but refer to neuro or ortho too

56
Q

toe walking assessment tool is called?

A

williams

57
Q

is williams a diagnostic tool

A

no but it can help you rule out other causes of toe walking

58
Q

what are some potential MSK problems if ITW is not treated?

A

ankle injuries and foot pain
decreased gross motor activities

59
Q

signs to refer kid out with ITW

A

heel cord tightness
GM delays
pain
impaired QoL

60
Q

important to remember when treating pediatrics and developing POC

A

discuss with families! work together

61
Q

systems review to include in exam for ITW

A

pain
integumentary
sensory processing
neuro
parent concerns

62
Q

postural assessment things to look at in NWB for ITW?

A

leg length
thigh foot angle
hindfoot alignment

63
Q

what is the gold standard for gait assessment

A

gait assessment lab

64
Q

what to use for ankle foot assessment (questionnaire)

A

Oxford foot and ankle questionnaire

65
Q

what to include in exam for ITW

A

body structure/function, activity limitations, and participation restrictions and QOL

66
Q

common interventions for ITW

A

PT
orthotic management
serial casting
botox
surgery

67
Q

PT interventions for ITW

A

stretching, strengthening, joint mobs, locomotor/treadmill training, Motor control, taping, sensory based, balance, augmented auditory feedback, vibration, visual training, serial casting, orthotics

68
Q

goals of treatment for ITW

A

10 deg ankle PROM DF and KE, core and LE strengthening, posture and balance training, locomotor training, orthotic management

69
Q

how to strengthen for ITW

A

anterior tibial- heel walk, DF, incline walk
hip and knee extensors, core and pelvic stabilizers

70
Q

posture control for ITW

A

weight shifting

71
Q

goals of PT intervention for ITW

A

address impairments and max function for pain free participation in home school and community activities

72
Q

goals of orthotics for ITW

A

foot and ankle alignment

73
Q

when to consider orthotics for ITW

A

toe walking more than 25% of time

74
Q

orthotics options for ITW

A

AFOs
SMOs
foot orthoses
carbon foot footplates (CFOs)

75
Q

what does serial casting help with and what can be used with it

A

ankle DF range of motion
botox

76
Q

how long is serial casting for? what do you need to do after

A

4-6 weeks
rebuild strength after

77
Q

when is serial casting recommended

A

less than 0 degrees of ankle DF KE

78
Q

how does botox work

A

prevents release of acetylcholine at NMJ which prevents muscle contraction

79
Q

outcomes of ITW

A

improve ankle ROM/ DF
improve gait

80
Q

does botox alone improve ROM or gait

A

no

81
Q

what is a second skeletal abnormality of ITW

A

external tibial torsion

82
Q

who gets DMD

A

males- X linked recessive

83
Q

who gets SMA

A

males and females- autosomal recessive chromosome 5

84
Q

what causes DMD

A

deletion of dystrophin gene

85
Q

onset of DMD

A

1-5 yo

86
Q

what is increased in DMD

A

creatine kinase

87
Q

what other organs impacted in DMD

A

heart brain and smooth muscle

88
Q

what is seen in a child with DMD

A

muscle weakness
pseudo hypertrophy
slow 10m WT

89
Q

what does a 10WT of 12+ seconds indicate in a child with DMD

A

loss of ambulation within 1 year

90
Q

ROM findings in child with DMD

A

tightness of gastroc-soleus complex and TFL first

91
Q

posture of child with DMD

A

lordotic posture with scapulae winging and scoliosis

92
Q

5 stages of DMD

A

presymptomatic
early ambulatory
late ambulatory
early non ambulatory
late non ambulatory

93
Q

age and clinical signs of early ambulatory stage of DMD

A

5 yo
clumsy and falling
proximal LE weakness
calf pseudohypetrophy
Gowers maneuver

94
Q

clinical signs of late ambulatory stages of DMD

A

increased LL
+ trendeleberg
stair issues
heel cord, ITB, and hip contractures

95
Q

age and clinical signs of early non ambulatory phase of DMD

A

10-12yo
UE geetting weaker
scoliosis risk
pulmonary function decreasing d/t low strength in trunk and diaphragm

96
Q

clinical signs of late non ambulatory phase of DMD

A

UE is weaker and posture is bad
UE and LE contractures
cardiac and respiratory failure

97
Q

why do joint contractures occur in DMD

A

loss of AROM
sedentary time in flexed posture
muscle imbalance
fibrotic chances

98
Q

PT treatment for contractures

A

frequent stretching
orthotics
serial casting
dynamic and solid AFOs

99
Q

incidence of scoliosis in DMD

A

63-90%

100
Q

why is scoliosis bad with DMD

A

rapidly progressing
decreases VC
loss of functional status

101
Q

activity outcome measures for DMD

A

6mwt, timed testing
9 hole peg

102
Q

how frequent to reassess kids with DMD

A

4-6 months

103
Q

motor function scales to use for DMD

A

NSAA
PUL

104
Q

goal of PT for early ambulatory phase

A

keep muscles supple and prevent / minimize tightness

105
Q

goal of PT for late ambulatory phase of DMD

A

keep muscles flexible and minimize muscle weakness

106
Q

goal of PT for early non ambulatory phase of DMD

A

UE range of motion and flexibility
accommodations and adaptive equipment

107
Q

goal of PT for late non ambulatory phase

A

UE flexibility and supportive equipment

108
Q

general exercise recommendations for DMD

A

regular submit aerobic exercise
avoid high resistance and eccentric contractions

109
Q

meds for DMD

A

corticosteroids to improve strength and function

110
Q

what is the 2nd most common NMD

A

SMA

111
Q

what causes SMA

A

genetic mutation effecting motor neurons

112
Q

three types of SMA and severity and life expectancy and prevalence

A

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

113
Q

age of onset for each SMA type

A

1: 0-4 months
2: 6-12 months
3: 1-10 yrs

114
Q

activity outcome measures for SMA

A

6mwt
timed testing
timed towers timed 10m

115
Q

what to address in non sitters and sitters with SMA

A

muscle weakness
postural control
contractures

116
Q

what to address in walkers with SMA

A

muscle weakness and asymmetries

117
Q

outcome measure for non sitters SMA

A

CHOP intend

118
Q

outcome measure for sitters SMA

A

upper limb function
hammersmith

119
Q

outcome measures for walkers SMA

A

6mwt

120
Q

precautions for SMA

A

scoliosis

121
Q

what is blount’s disease?

A

tibia vara (proximal tibia)

122
Q

what is the etiology of blount’s disease?

A

unknown
may be due to altered endochondral ossification

123
Q

what happen’s with blount’s disease

A

decelerated growth at posterior-medial proximal tibial physics and causes various deformity of tibia

124
Q

what are the 3 clinical classifications of blount’s disease?

A

infantile: 0-4yo
juvenile: 4-10yo
adolescent: 10+ yo

125
Q

what to observe with Blount’s disease?

A

radiographic classification
metaphyseal- diaphysial angle and alignment (uni or bilateral)

126
Q

activity limitations of blount’s disease

A

decreased activity, ambulation, and mobility
pain

127
Q

conservative treatment for blount’s disease

A

orthotics- young and unilateral involvement
HKAFOs, KAFOs, elastic bracing

128
Q

surgical treatment for blount’s disease

A

guided growth
tibial osteotomy
LLD

129
Q

PT goals of bracing with Blount’s disease

A

gait re-ed
strengthening and stretching
hip and core strengthening
balance and coordination
weight loss

130
Q

goals of PT post surgery for Blount’s disease

A

return to normal activities ASAP and prevent secondary compensatory problems

131
Q

5 attributes to typical walking

A

stability in stance
sufficient foot clearance in swing
appropriate positioning for initial contact
adequate step length
energy conservation

132
Q

neuro pre reqs for gait

A

CPGs for muscle firing
muscle synergies
coordination

133
Q

biomechanics pre reqs for gait

A

ROM strength bone structure and body composition
management of gravity forces
proper muscle and joint kinematics
typical growth

134
Q

five determinants for mature walking

A

duration of single limb stance
walking velocity
cadencee
step length
ratio of pelvic span to ankle spread

135
Q
A

Peds (5 decks)

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