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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
when should we look at developmental vs functional skills
may be at same developmental level forever, so not a good measure for goals - good for qualifying services functional better for goal setting
26
what are 3 clinical ways of assessing functional skills
transfers - bed, floor, wc amb - bracing (w or w/o AD) wheeled mobility
27
what is an objective test for assessing functional skills
PEDI/PEDI-CAT
28
what are 6 parameters of activity and mobility
endurance efficiency effectiveness safety level of independence accessibility
29
endurance vs efficiency vs effectiveness w activity/mobility
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
what is motor level
lowest intact functional neuromuscular segment (ie lowest level/myotome that has gravity resisted movement)
31
what is included or determines the PT dx
are they performing function based on level of innervation - ortho involvement/complications
32
what is PT prognosis
changes in function
33
why is PT prognosis so important
social and community requirements
34
at what motor lesion levels are consistent community ambulators
L5 and down
35
at what motor lesion level are orthoses no longer needed for amb
S1
36
what does 0-3/5 on an iliopsoas MMT indicate as an ambulation predictor
partial or complete w/c use
37
what does 4-5/5 on iliopsoas and quad MMT indicate as ambulation predictors
community amb w AD, bracing
38
what does 4-5/5 on gluteal and ant tib MMT indicate as ambulation predicotrs
community amb w no AD or orthosis
39
what are 8 factors that impact PT prognosis
motor level age cognition body proportions sensation ortho complications spasticity UE function
40
what are 4 major goals of a PT intervention
1. minimize impact & development of impairments 2. optimize development 3. optimize functional mobility 4. ongoing surveillance
41
what impairments does PT aim to minimize the impact and development of (5)
joint deformities postural changes decubiti weakness cardiovascular endurance
42
what development is PT aiming to optimize (4)
motor cognitive ADL social-emotional
43
how does PT help to optimize functional mobility (2)
energy consumption accessibility
44
what does PT provide ongoing surveillance of
signs of CNS complications
45
what are 5 areas of PT interventions
strengthening functional balance transfers/transitional movements amb/wheeled mobility self management
46
what strengthening is important and how do the PT intervention strategies change w age
esp UE & residual LE infants - supine kicking toddlers - functional school age/older - progressive resistive exercise (PRE) - functional estim (FES)
47
what is an example of a transitional movement for young infants/children
prone <-> sitting
48
what is the key to ambulation as an intervention
early and as long as reasonable
49
what are the benefits of ambulation as an intervention
dec fx and skin breakdown
50
what are 6 components of an intervention of safety & self-care management
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
what are 5 indications for an impairment based intervention
1. interferes w function 2. impairments will progress & then interfere 3. emphasis on strength, endurance 4. protect WB joints 5. skin management (insensate)
52
what are 3 indications for interventions on activity limitations or participation restrictions
to improve: - efficiency - effectiveness - safety
53
what are 4 reasons for bracing
joint alignment WB mobility amb
54
what is the best way to assess bracing needs
3D gait analysis + MMT
55
when is it best to start bracing and what are 3 indications
early - alignment - WB - developmentally appropriate
56
what is a parapodium/swivel walker? what are the pros and cons?
upright frame - benefits of WB and UE tasks - "exercise" walking con - limited distance mobility
57
what motor lesion levels are RGOs and HKAFOs indicated for and why
L1-3 motor levels - need some hip flex to use cables in RGO effectively
58
how does an RGO work
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
what motor lesion level are KAFOs used in
L3-4
60
what are 3 indications for KAFOs
weak at knee (4- or less) absent ankle ms unstable knee
61
what motor lesion level are AFOs used in
L4-S1
62
what are 4 indications for AFOs
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
what motor lesion level are SMOs used in
S1-3
64
what is the purpose of a SMO
supramalleolar orthotics shoe insert w support at ankle - helps w MSK alignment in individuals who prob won't need bracing for amb
65
what are 3 indications for SMOs
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
what is a lifespan approach to interventions in infancy
family education & direct intervention - positioning/handling for ROM, bony alignment, postural control, mobility, insensate limbs
67
what are 5 components of a lifespan approach to interventions in childhood
mobility transfers amb fitness safety
68
what are 4 components of a lifespan approach to interventions in adolescence
functional changes equipment for mobility self-management fitness
69
what is the most common cause of morbidity in young adults
urinary tract issues
70
what are 5 common complaints in young adults that PT can help w
obesity chronic decubiti joint pain HTN depression
71
what are 4 components of education
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
what are 6 other components of the patient's care that PT needs to coordinate with
orthopedic management DME SLP OT social worker spina bifida clinic associated with

Neuro Rehab 1 (27 decks)

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