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Neuro Rehab 1 > Neural Tube Defects: PT Management > Flashcards

Neural Tube Defects: PT Management Flashcards

1
Q

what are 3 purposes of a PT exam of neural tube defects

A
  1. understand current status
  2. identify potential for secondary complications
  3. monitor for progressive neurologic dysfunction
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2
Q

what secondary complications are pts w NTDs at risk for (2)

A

ms length restrictions
ortho concerns

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3
Q

for optimal treatment, what providers should pts be connected to

A

connected to major health center for management of spina bifida
- local treatment related to PCP

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4
Q

what are intervals when pts w NTDs should have regular exams

A

newborn pre-op, post-op q 6mo until 24mo
- annually from age 2 on

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5
Q

other than regular exams, what are intervals that require interventions to manage NTDs

A

w body proportion changes
- be proactive w shunt placement

proportion changes can cause progressive neurologic dysfunction, worried ab tethered cord

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6
Q

what is the difference b/w intra-uterine and post-natal closure

A

intra-uterine reduces complications (ie hydrocephalus)
- but no functional outcome differences

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7
Q

what patients is a birth history important in

A

toddlers and younger

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8
Q

what are components of history in the PT exam (5)

A
  1. birth hx
  2. CNS complications
  3. other system complications & medical intervention
  4. surgical hx
  5. latex allergy
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9
Q

what are components/questions in taking a birth history (3)

A

in-utero or post-natal closure
length of gestation
birth wt/length

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10
Q

what are CNS complications to ask ab when taking a hx in a PT exam

A

shunt? how many revisions?
sx tethered cord?
sx ACMII?

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11
Q

what are 4 things used in clinical and objective testing

A

observation
individual/parent observations
overal functional/developmental abilities
equipment

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12
Q

what is a critical component of clinical and objective testing

A

individual/parent/caregiver observations

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13
Q

what functional/developmental abilities are assessed in clinical/objective testing (5)

A

communication
behavior
eating and drinking
motor - gross/fine
ADLs (IADLs as applicable)

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14
Q

at a BSF level, what are 6 impairments to clinically and objectively test and how

A
  1. PROM - goni
  2. sensation
  3. strength
  4. spinal alignment / pelvic alignment / posture
  5. club feet / tibial rotation / hip subluxation or dislocation
  6. integ
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15
Q

what is a consideration when testing these pt’s PROM

A

careful w handling, shorter lever arms and don’t force end range
- at risk for fx, dec bone mineral density -> high risk even without trauma
- esp in non-amb pts

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16
Q

how can impaired sensation present in pts w NTD

A

impairments in all areas of sensation
- may be symmetrical, asymmetrical
- may skip dermatomes, right/left differences

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17
Q

what are strategies to test sensation in young children

A

look for response w tickle, sharp (paper clip)
- might get flexor withdrawal

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18
Q

what are 5 key points of strength testing

A
  1. palpation for ms activation very important
  2. MMT - adequate but problematic
  3. dynamometer
  4. specific testing of LE ms is critical
  5. take care w reflexive vs voluntary motion
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19
Q

what are considerations when using MMT for testing strength

A

okay for initial eval
monitoring better w HHD
consider age

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20
Q

what is an age consideration w strength testing

A

from newborn to 5yo
- describe gravity resisted, spontaneous motion / AROM (along w palpation)
- describing functional motions

can’t follow directions to MMT

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21
Q

what has dynamometry been shown to be sensitive to

A

grip strength decline shown to be sensitive to progressive neuro dysfunction

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22
Q

why is specific testing of LE ms strength so critical (3)

A

functional prognosis
indication for orthoses/equip
dec over time? -> progressive neuro dysfunction

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23
Q

what are clinical tests of developmental skills (6)

A

prone
supine
sitting
transitions
standing
amb

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24
Q

what are objective tests of developmental skills

A

various test lol
- some w +/- validity

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25
Q

when should we look at developmental vs functional skills

A

may be at same developmental level forever, so not a good measure for goals
- good for qualifying services

functional better for goal setting

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26
Q

what are 3 clinical ways of assessing functional skills

A

transfers - bed, floor, wc
amb - bracing (w or w/o AD)
wheeled mobility

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27
Q

what is an objective test for assessing functional skills

A

PEDI/PEDI-CAT

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28
Q

what are 6 parameters of activity and mobility

A

endurance
efficiency
effectiveness
safety
level of independence
accessibility

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29
Q

endurance vs efficiency vs effectiveness w activity/mobility

A

endurance
- can go between rooms of house
- from house to car

efficiency
- HR
- walking speeds (practical for every day activities?)

effectiveness
- level of assistance needed for transfers, ADLs, amb

30
Q

what is motor level

A

lowest intact functional neuromuscular segment (ie lowest level/myotome that has gravity resisted movement)

31
Q

what is included or determines the PT dx

A

are they performing function based on level of innervation
- ortho involvement/complications

32
Q

what is PT prognosis

A

changes in function

33
Q

why is PT prognosis so important

A

social and community requirements

34
Q

at what motor lesion levels are consistent community ambulators

A

L5 and down

35
Q

at what motor lesion level are orthoses no longer needed for amb

A

S1

36
Q

what does 0-3/5 on an iliopsoas MMT indicate as an ambulation predictor

A

partial or complete w/c use

37
Q

what does 4-5/5 on iliopsoas and quad MMT indicate as ambulation predictors

A

community amb w AD, bracing

38
Q

what does 4-5/5 on gluteal and ant tib MMT indicate as ambulation predicotrs

A

community amb w no AD or orthosis

39
Q

what are 8 factors that impact PT prognosis

A

motor level
age
cognition
body proportions
sensation
ortho complications
spasticity
UE function

40
Q

what are 4 major goals of a PT intervention

A
  1. minimize impact & development of impairments
  2. optimize development
  3. optimize functional mobility
  4. ongoing surveillance
41
Q

what impairments does PT aim to minimize the impact and development of (5)

A

joint deformities
postural changes
decubiti
weakness
cardiovascular endurance

42
Q

what development is PT aiming to optimize (4)

A

motor
cognitive
ADL
social-emotional

43
Q

how does PT help to optimize functional mobility (2)

A

energy consumption
accessibility

44
Q

what does PT provide ongoing surveillance of

A

signs of CNS complications

45
Q

what are 5 areas of PT interventions

A

strengthening
functional balance
transfers/transitional movements
amb/wheeled mobility
self management

46
Q

what strengthening is important and how do the PT intervention strategies change w age

A

esp UE & residual LE

infants - supine kicking
toddlers - functional

school age/older
- progressive resistive exercise (PRE)
- functional estim (FES)

47
Q

what is an example of a transitional movement for young infants/children

A

prone <-> sitting

48
Q

what is the key to ambulation as an intervention

A

early and as long as reasonable

49
Q

what are the benefits of ambulation as an intervention

A

dec fx and skin breakdown

50
Q

what are 6 components of an intervention of safety & self-care management

A
  1. skin protection, pressure relief
  2. joint alignment
  3. donning/doffing orthotics
  4. health literacy ab condition
  5. equipment use, management
  6. self advocacy
51
Q

what are 5 indications for an impairment based intervention

A
  1. interferes w function
  2. impairments will progress & then interfere
  3. emphasis on strength, endurance
  4. protect WB joints
  5. skin management (insensate)
52
Q

what are 3 indications for interventions on activity limitations or participation restrictions

A

to improve:
- efficiency
- effectiveness
- safety

53
Q

what are 4 reasons for bracing

A

joint alignment
WB
mobility
amb

54
Q

what is the best way to assess bracing needs

A

3D gait analysis + MMT

55
Q

when is it best to start bracing and what are 3 indications

A

early
- alignment
- WB
- developmentally appropriate

56
Q

what is a parapodium/swivel walker? what are the pros and cons?

A

upright frame
- benefits of WB and UE tasks
- “exercise” walking

con - limited distance mobility

57
Q

what motor lesion levels are RGOs and HKAFOs indicated for and why

A

L1-3 motor levels
- need some hip flex to use cables in RGO effectively

58
Q

how does an RGO work

A

cables enable independent movement of one LE from other

facilitates hip flex as person shifts wt using UE on walker
- (A) hip ext & swing phase

59
Q

what motor lesion level are KAFOs used in

A

L3-4

60
Q

what are 3 indications for KAFOs

A

weak at knee (4- or less)
absent ankle ms
unstable knee

61
Q

what motor lesion level are AFOs used in

A

L4-S1

62
Q

what are 4 indications for AFOs

A
  1. weak or absent ankle ms but knee ext at least 4/5 MMT
  2. ineffective/absent push-off
  3. ineffective/absent toe clearance
  4. crouched gait
63
Q

what motor lesion level are SMOs used in

A

S1-3

64
Q

what is the purpose of a SMO

A

supramalleolar orthotics

shoe insert w support at ankle
- helps w MSK alignment in individuals who prob won’t need bracing for amb

65
Q

what are 3 indications for SMOs

A
  1. unequal wt distribution -> skin breakdown, foot deformities, uneven shoe wear
  2. medial/lateral ankle instability affecting balance esp on uneven terrain
  3. poor alignment of foot/ankle
66
Q

what is a lifespan approach to interventions in infancy

A

family education & direct intervention
- positioning/handling for ROM, bony alignment, postural control, mobility, insensate limbs

67
Q

what are 5 components of a lifespan approach to interventions in childhood

A

mobility
transfers
amb
fitness
safety

68
Q

what are 4 components of a lifespan approach to interventions in adolescence

A

functional changes
equipment for mobility
self-management
fitness

69
Q

what is the most common cause of morbidity in young adults

A

urinary tract issues

70
Q

what are 5 common complaints in young adults that PT can help w

A

obesity
chronic decubiti
joint pain
HTN
depression

71
Q

what are 4 components of education

A
  1. caregiver/parent management of health condition, impairments, prevention
  2. self management of health condition
  3. full participation (thrive vs survive)
  4. independent living
72
Q

what are 6 other components of the patient’s care that PT needs to coordinate with

A

orthopedic management
DME
SLP
OT
social worker
spina bifida clinic associated with

Neuro Rehab 1 (27 decks)

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