Module 3 Flashcards
Primary CP s/s
neurological insult
Secondary CP s/s
abnormal growth and development of MSK
tertiary CP s/s
movement compensations for NM and MSK systems in order to achieve function
overarching concepts of PA and kids with CP
limited access to resources in community for recreation
barriers to PA and fitness
more sedentary than typical youth
more deconditioned than typical youth
three components of PT examination for kids with CP
history
systems review
examination
fitness components
strength, ROM, aerobic capacity, balance, endurance, power
activity measurements for kids with CP
PEDI
gait speed
gross motor performance (GMFM 66)
motor planning and performance
participation measures for CP
COPM
GAS
PEM-CY
SFA
CAPE
CP measurement for goal attainment
GAS
participation in environment measure for CP
PEM-CY
school measure of participation for CP
SFA
how to measure submit aerobic capacity for CP
10 meter walk test
1, 3, 6MWT
how to measure functional mobility for CP
modified TUG
how to measure max aerobic capacity for CP
shuttle run test
how to measure anaerobic power for CP
muscle power sprinter test
how to measure muscular endurance for CP
30sec RM lateral step ups or sit to stands
how to measure PA for CP
pedometers
precautions for kids with CP
check vitals
obesity
covid
how to measure pain in kids with CP
FACES scale
or behavioral cues
how to measure spasticity in kids with CP
modified tardieu scale
modified ashworth scale
what is SCALE
selective control assessment of lower extremity
shows ability to move one joint of LE selectively without involving others
balance measures for CP
SATCO
pediatric reach test
pediatric balancee scale
righting reactions
MSK considerations for CP
scoliosis
ROM of hip ankle and knee
alignment of femoral head
symmetry of leg length
why is hip surveillance important for kids with CP
hip dysplasia happens frequency and want to avoid surgery
components of hip surveillance with kids with CP
questions on pain and stiffness
x-rays
Tardieu, Thomas, and galeazzi tests
when to refer during hip surveillance
migration greater than 30%
hip ABD end range in <30 deg
asymmetry of hip abd test
how to measure muscle strength CP
MMT
handheld dynamometry
isotonic strength
functional strength
isokinetic
is break or make test better for CP
make test
test for aerobic capacity CP
SRT 1-3
test for muscular endurance for CP
sit to stand
lateral step ups
1/2 kneel to stand
gold standard for activity and participation measure for CP
gross motor function measure (GMFM)
ages for GMFM for CP
5mo to 16yo
what does GMFM measure
gross motor capacity
5 dimensions of GMFM
lying and rolling
sitting
crawling and kneeling
standing
walking, running, jumping
ages for PEDI
6mo-7.5yo
3 domains of pedi
self care, mobility, social function
PEDI CAT ages
birth- 21 yo
equinus gait
hip and knee extended
knee recurvatum
heels off ground
jump gait
APT and lumbar lordosis
hip and knee flexed
heels off ground
apparent equinus gait
hip and knees flexed
decreased equinus but heels off ground
crouch gait
excessive hip and knee flexion
scissoring
excessive DF
ages for SFA
K- 6th grade
ages for CAPE
6-21yo
ages for PEM-CY
5-17yo
components of functional training for kids with CP
strength mobility and endurance
medication options for CP
baclofen or botox for spasticity
seizure meds
orthopedic surgeries that are common with CP
single event multi level surgery
soft tissue or osteotomies
neurological surgeries common with CP
selective dorsal rhizotomy to relieve negative symptoms of spasticity
Strength interventions for CP
formal strengthening program
functional strengthening
considerations for strength training for CP
progression
sequencing
program variation
outcomes for power training and CP
promote well being
maintain BMD
improve pain
improve energy levels
improve bowel and bladder control
muscle strength and walking capacity improved
options for land based aerobic exercise for CP
sports drills
relay activities
obstacle courses
things to consider when choosing aerobic activity equipment with CP
functional abilities/goals
alignment
amount of impact
size of equipment
UE vs LE involvement
Childs’ wants
what is DCD?
children with significant motor incoordination
what does DCD affect
impairs gross motor, postural, and motor performance and ADLs
who has DCD
5-6% of kids, boys 2x more than girls
cause of DCD
no known cause
pathologies of DCD
lack of automatization of motor actions- cerebellum
motor imagery deficits- impaired feed forward
lack of internal models
long term prognosis for DCD
persists into adulthood
at risk for physical, emotional, behavioral and mental health consequences
DCD activity limitations
motor coordination and planning are lacking
difficulty with stairs, in/out car, complex movements
DCD participation restrictions
difficulty with sports and play
hard time with sports teams and interactions
DCD diagnosis
diagnosis by exclusion with specific motor signs
DCD differential diagnosis
rule out neuro trauma, euro and medical conditions, , and CSN issues
activity examples that are difficult for kids with DCD
run, skip, hop, jumping jacks, use scissors, throwing/catching a ball, multi step movements, proprioception
PT initial eval for DCD
medical history, general health of child, observation of movement patterns
assessment of strength, ROM, and balance
assessment of movement skills
screening for visiual, language or intellect deficits
refer as needed
outcome measures for DCD
BOT-2
MABC-2
DCD-Q
GAS
COPM
PT intervention framework for DCD
work on Coordination, communication, consultation
PA at school and home
lifelong management
PT intervention goals for DCD
improve strength
improve balance
improve body awareness
improve skills with task-oriented and specific learning
what to avoid making worst with DCD
poor posture
walking with feet turned in/out
delayed learning
low self esteem
obesity or heart disease
how is Down syndrome caused
genetic condition with trisomy 21 (one extra chromosome)
three types of down syndrome
trisomy 21 (most common)
translocation
mosaicisim
common characteristics of down syndrome
presentation differs by type and severity by involves multiple systems with medical impairments
common physical signs of down syndrome
flat back of head
broad flat face
slanting eyes
short nose
congenital heart disease
abnormal pelvis
low tone
short hands
common co-morbidities with down syndrome
hearing loss
otitis media
eye disease
obstructive sleep apnea
congenital heart disease
seizures
leukemia Alzheimer’s
primary impairment of down syndrome
intellectual disability
criteria of intellectual disability for down syndrome
IQ greater than 2 SD below mean
challenges with reasoning, judgment, problem solving
deficits in personal independence and social responsibility
BS/BF impairments with Down syndrome
joint hyper-flexibility
low tone
short limbs
foot deformity
SCFE LCP
biggest MSK precautions for down syndrome
Atlanto-axial instability
what is atlanto-axial instability
excessive movement of C2 or C1 that can lead to SCI and death
cardiopulmonary precautions for down syndrome
septal defects
ASD
tetralogy of fallot
PDA
neuromuscular characteristics of down syndrome
low tone
impaired postural control
gross motor function timelines for kids with down syndrome
slower motor milestones and then maxes out at 85%
outcome measure for gross motor in down syndrome
gross motor function measure (GMFM-88)
dimensions of GMFM
lying and rolling
sitting
crawling and kneeling
standing
walking, running, jumping
participation outcome measures for down syndrome
CAPE
PEDI
SFA
activity outcome measures for Down syndrome
TUDS
TUG
TFTS
FSST
BS/BF outcome measures for down syndrome
health status
auscultation
BMI
pediatric functional reach
PBS
Beighton scale
joint rom
postural alignment
strength
6MWT
shuttle run
PT exam for down syndrome
parent interview
observations of skills and cognitive level
screening (tests/measures)
considerations for developing POC for down syndrome
fun
no complex movements
easy instructions
demonstrate
repeat
patience
precautions for PT down syndrome
AA clearance
joint integrity
make sure good MSK alignment
maintain postural stability
avoid contact sports
dosage with max HR of 17-180
check for hypothyroidism
PT intervention strategy tips for Down syndrome
decreased ability to generalize
give info in small pieces
set up is important
follow kids lead
see how kid reacts with learning new gross motor skills
know when to stop
be strategic with planning and giving support
takes a while for skills to be refined
do not change an established skills
learn best through gradual process
what age do kids with downsyndrome work on sitting and crawling
0-18 months
what Agees for kids with down syndrome work on standing alone and walking
18-36 months
what to work on at 18-36 months with down syndrome
positioning and handling for weight bearining
integrate axial and extremity strengthening
what age do kids with Down syndrome learn to run, walk up/down stairs, and jump
3-6 yo
PT interventions 3-6 yo kids with down syndrome
collaborate for active lifestyle and participation
work of unctinoal skills, postural control, balance, increase PA
what to work on in PT with adults with down syndrome
maintain strength, balance, and aerobics, and PA
consider weight, bone health, and discuss community resources
types of interventions for PT with down syndrome
strength
posture control
aeorbics
weight bearing exercise
communicate with team and family
consider orthoses, theratogs, taping
