Module 3 Flashcards
These are the learning objectives
- Develop an understanding of the unique characteristics of the paediatric spine
- Be able to confidently communicate the specifics of the listing systems
- Begin to practice various motion palpation techniques on infants and older children
- To be aware of the principles of safe and effective adjusting methods for infants and children
At birth the spinal column Is ____% of total body height?
By the end of the adolescent period this pine will have grown by 70cm!
40%
With one congenital defect, there is a higher risk of others
- Limb deforimities
- Renal
- Genitourinary
- Gastrointestinal
- Cardiovascular
Cervical curve development
Cervical lordosis becomes more distinct around age
The cervical lordosis angle (C3-C7) decreases with age in both sexes until
The cervical curve is ACCENTUATED AND DEVELOPS after birth (with extension against gravity), but is APPARENT in utero
Cervical lordosis becomes more distinct around age 3-4 months as infant begins to raise their head
• Cervical lordosis increases around 9 months of age as the infant sits
• The cervical lordosis angle (C3-C7) decreases with age in both sexes until 9 years of age and then increases through to skeletal maturity
Disc development
The annulus:
– develops from
The Nucleus pulposus:
- develops from
At birth the ratio of the height of vertebra to height of disc is
By maturity this reaches
The annulus:
– develops from sclerotomal cells
- the segmental sclerotomes spit and recombine
- This leaves rudiments that lies intersegmentally.
The Nucleus pulposus:
- develops from notochord remnants
- In parallel with chondrification, the notochord enlarges between the vertebral bodies to form the nucleus pulposus of the future intervertebral discs and disappears in the areas where vertebrae are developing
At birth the ratio of the height of vertebra to height of disc is 1:1 By maturity this reaches 3:1 to 5:1
Some factors in lateral curve development and posture ie what things can influence how the shape of the spine develops.
• Subluxation:
1. neurological effects
2. mechanical effects
• Inuteropositioning
• Prone(tummy)time
• Muscletone
• Crawlingandwalkingdevelopment • Trauma(e.g.vertebralfracture)
• Developmentconditions(e.g.Scheuermann’sdisease) • Coremusclecontrol
• Emotion
Physiological Hypermobility- what are things that contribute to hyper mobility?
The fulcrum of movement in the paediatric spine is at
Compared to in the adult spine
- Ligamentous laxity
- Shallow and horizontal facet joints
- Underdeveloped S.P.’s,
- Physiologic anterior wedging of the vertebral bodies
- Immature disc-annulus complex
- Greater elasticity of the joint capsules and ligaments.
- Incomplete ossification of the odontoid process
- Relatively large head
- Immature NMS system
= Predisposes to risk for subluxation and spinal injury
The fulcrum of movement in the paediatric spine is at C2/3
Compared to C5/6 in the adult spine
AS Condyle: Common effects
- Breastfeeding difficulty:
-difficult attachment
-arching fussiness - Head preference/Plagiocephaly (head preference to other side)
- Increased vomiting
- Poor swallow, increased gagging
- Unsettled behaviour (tendency to arch)
- Reflux (GER) and regurgitation
- Poor head control (pull to sit)
- Hates nappy changes
- Head tilt towards side of AS
- Increased or persistent Moro reflex 11. Increased head extension when prone
PS Condyle: Common effects
- Increased tendency towards head held in flexion
- Increased (usually very pronounced) dribbling
- Head tilt away from side of PS
- Difficult to clean or dry under chin
Understanding compensation
1. hyper-mobility
2. muscle hypertonicity
3. hypo-mobility
Methods to detect compensation clinically
1. Static (x-ray)
2. Static (postural)
3. Dynamic (motion palpation)
- hyper-mobility - hypo-mobility
- Why does a compensation occur?
- Do we need to treat a compensation?
- What may happen as a result of treating a compensation?
Gonstead listings:
Some basic rules:
Some rules/conventions:
1. list the superior segment
Exception: lumbo sacral joint and the sacral segments and coccygeal segments as well as coccyx (e.g.BP
sacrum)
2. list the direction of normal movement
Whats the listing?
This is designated the listing AS
What is the listing?
This is designated the listing PS
Occipital-atlantal Positional dyskinesia: C0 RS/LS
Reference is condyle on affected side
The condyle on the affected side always moves superiorly due to it’s convex shape This is rotation around the z-axis
This is designated the listing RS or LS depending on side affected
Occipital-atlantal Positional dyskinesia: C0 LP/LA
Reference is condyle on affected side
- The condyle on the affected side MAY then also rotate anterior or posterior.
- This is rotation around the z-axis
Note: this is determined on xray analysis by the compensatory rotation of the atlas
i.e left condyle is narrow thus atlas has compensated by rotating posteriorward, thus left condyle is anterior. Full listing is AS-LS-LA
Give a summary of the Atlanto- occipital listings?
You will need to review the book for the rest of the listings. this is too time consuming.
