Neural Tube Defects: PT Management Flashcards
what are 3 purposes of a PT exam of neural tube defects
- understand current status
- identify potential for secondary complications
- monitor for progressive neurologic dysfunction
what secondary complications are pts w NTDs at risk for (2)
ms length restrictions
ortho concerns
for optimal treatment, what providers should pts be connected to
connected to major health center for management of spina bifida
- local treatment related to PCP
what are intervals when pts w NTDs should have regular exams
newborn pre-op, post-op q 6mo until 24mo
- annually from age 2 on
other than regular exams, what are intervals that require interventions to manage NTDs
w body proportion changes
- be proactive w shunt placement
proportion changes can cause progressive neurologic dysfunction, worried ab tethered cord
what is the difference b/w intra-uterine and post-natal closure
intra-uterine reduces complications (ie hydrocephalus)
- but no functional outcome differences
what patients is a birth history important in
toddlers and younger
what are components of history in the PT exam (5)
- birth hx
- CNS complications
- other system complications & medical intervention
- surgical hx
- latex allergy
what are components/questions in taking a birth history (3)
in-utero or post-natal closure
length of gestation
birth wt/length
what are CNS complications to ask ab when taking a hx in a PT exam
shunt? how many revisions?
sx tethered cord?
sx ACMII?
what are 4 things used in clinical and objective testing
observation
individual/parent observations
overal functional/developmental abilities
equipment
what is a critical component of clinical and objective testing
individual/parent/caregiver observations
what functional/developmental abilities are assessed in clinical/objective testing (5)
communication
behavior
eating and drinking
motor - gross/fine
ADLs (IADLs as applicable)
at a BSF level, what are 6 impairments to clinically and objectively test and how
- PROM - goni
- sensation
- strength
- spinal alignment / pelvic alignment / posture
- club feet / tibial rotation / hip subluxation or dislocation
- integ
what is a consideration when testing these pt’s PROM
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
how can impaired sensation present in pts w NTD
impairments in all areas of sensation
- may be symmetrical, asymmetrical
- may skip dermatomes, right/left differences
what are strategies to test sensation in young children
look for response w tickle, sharp (paper clip)
- might get flexor withdrawal
what are 5 key points of strength testing
- palpation for ms activation very important
- MMT - adequate but problematic
- dynamometer
- specific testing of LE ms is critical
- take care w reflexive vs voluntary motion
what are considerations when using MMT for testing strength
okay for initial eval
monitoring better w HHD
consider age
what is an age consideration w strength testing
from newborn to 5yo
- describe gravity resisted, spontaneous motion / AROM (along w palpation)
- describing functional motions
can’t follow directions to MMT
what has dynamometry been shown to be sensitive to
grip strength decline shown to be sensitive to progressive neuro dysfunction
why is specific testing of LE ms strength so critical (3)
functional prognosis
indication for orthoses/equip
dec over time? -> progressive neuro dysfunction
what are clinical tests of developmental skills (6)
prone
supine
sitting
transitions
standing
amb
what are objective tests of developmental skills
various test lol
- some w +/- validity
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
what are 3 clinical ways of assessing functional skills
transfers - bed, floor, wc
amb - bracing (w or w/o AD)
wheeled mobility
what is an objective test for assessing functional skills
PEDI/PEDI-CAT
what are 6 parameters of activity and mobility
endurance
efficiency
effectiveness
safety
level of independence
accessibility
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
what is motor level
lowest intact functional neuromuscular segment (ie lowest level/myotome that has gravity resisted movement)
what is included or determines the PT dx
are they performing function based on level of innervation
- ortho involvement/complications
what is PT prognosis
changes in function
why is PT prognosis so important
social and community requirements
at what motor lesion levels are consistent community ambulators
L5 and down
at what motor lesion level are orthoses no longer needed for amb
S1
what does 0-3/5 on an iliopsoas MMT indicate as an ambulation predictor
partial or complete w/c use
what does 4-5/5 on iliopsoas and quad MMT indicate as ambulation predictors
community amb w AD, bracing
what does 4-5/5 on gluteal and ant tib MMT indicate as ambulation predicotrs
community amb w no AD or orthosis
what are 8 factors that impact PT prognosis
motor level
age
cognition
body proportions
sensation
ortho complications
spasticity
UE function
what are 4 major goals of a PT intervention
- minimize impact & development of impairments
- optimize development
- optimize functional mobility
- ongoing surveillance
what impairments does PT aim to minimize the impact and development of (5)
joint deformities
postural changes
decubiti
weakness
cardiovascular endurance
what development is PT aiming to optimize (4)
motor
cognitive
ADL
social-emotional
how does PT help to optimize functional mobility (2)
energy consumption
accessibility
what does PT provide ongoing surveillance of
signs of CNS complications
what are 5 areas of PT interventions
strengthening
functional balance
transfers/transitional movements
amb/wheeled mobility
self management
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)
what is an example of a transitional movement for young infants/children
prone <-> sitting
what is the key to ambulation as an intervention
early and as long as reasonable
what are the benefits of ambulation as an intervention
dec fx and skin breakdown
what are 6 components of an intervention of safety & self-care management
- skin protection, pressure relief
- joint alignment
- donning/doffing orthotics
- health literacy ab condition
- equipment use, management
- self advocacy
what are 5 indications for an impairment based intervention
- interferes w function
- impairments will progress & then interfere
- emphasis on strength, endurance
- protect WB joints
- skin management (insensate)
what are 3 indications for interventions on activity limitations or participation restrictions
to improve:
- efficiency
- effectiveness
- safety
what are 4 reasons for bracing
joint alignment
WB
mobility
amb
what is the best way to assess bracing needs
3D gait analysis + MMT
when is it best to start bracing and what are 3 indications
early
- alignment
- WB
- developmentally appropriate
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
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
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
what motor lesion level are KAFOs used in
L3-4
what are 3 indications for KAFOs
weak at knee (4- or less)
absent ankle ms
unstable knee
what motor lesion level are AFOs used in
L4-S1
what are 4 indications for AFOs
- weak or absent ankle ms but knee ext at least 4/5 MMT
- ineffective/absent push-off
- ineffective/absent toe clearance
- crouched gait
what motor lesion level are SMOs used in
S1-3
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
what are 3 indications for SMOs
- unequal wt distribution -> skin breakdown, foot deformities, uneven shoe wear
- medial/lateral ankle instability affecting balance esp on uneven terrain
- poor alignment of foot/ankle
what is a lifespan approach to interventions in infancy
family education & direct intervention
- positioning/handling for ROM, bony alignment, postural control, mobility, insensate limbs
what are 5 components of a lifespan approach to interventions in childhood
mobility
transfers
amb
fitness
safety
what are 4 components of a lifespan approach to interventions in adolescence
functional changes
equipment for mobility
self-management
fitness
what is the most common cause of morbidity in young adults
urinary tract issues
what are 5 common complaints in young adults that PT can help w
obesity
chronic decubiti
joint pain
HTN
depression
what are 4 components of education
- caregiver/parent management of health condition, impairments, prevention
- self management of health condition
- full participation (thrive vs survive)
- independent living
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
