Neuro and MSK Management Flashcards
what age group is MACS for?
4-18 yo
how is MACS performed?
ask someone who knows the child and how the child typically performs
MACS I
handles objects easily and successfully
MACS II
handles most objects but with somewhat reduced quality and/or speed of achievement
MACS III
handles objects with difficulty
needs help to prepare and/or modify activities
MACS IV
handles a limited selection of easily managed objects in adapted situations
MACS V
does not handle objects and has severely limited ability to perform even simple actions
what is the purpose of the FMS?
describe functional mobility in children 4-18 yo with CP
how is mobility described in the FMS?
over 3 distinct distances: home (5m), school (50m), in wider community (500m)
FMS 6
independent on all surfaces
FMS 5
independent on level surfaces
requires rail for stairs
FMS 4
uses 1 or 2 sticks
FMS 3
uses crutches
FMS 2
uses walker or frame
FMS 1
uses WC
when is a C or N used for FMS?
C - crawling
N - does not apply (can’t complete full distance)
what is the gold standard for classifying CP?
GMFM
what type of assessment is GMFM?
criterion referenced
observational assessment
what diagnoses is GMFM validated for?
CP
down syndrome
GMFM 88 vs 66
88: 5mo - 16 yo
66: 5-16 yo
what 5 dimensions does the GMFM include?
lying and rolling
sitting
crawling and kneeling
standing
walking, running, jumping
GMFM Score:
0
1
2
3
0: does not initiate task
1: initiates task
2: partially completes task
3: completes task
which GMFM should be used for down syndrome?
88
what other diagnoses could GMFM be used for?
TBI
spinal muscular atrophy
osteogenesis imperfecta
hereditary spastic paresis
acute lymphoblastic leukemia
you need at least ___ steps for GMFM
5
you need a space for a ____ meter run for GMFM
4.5 meter
GMFM 88 vs 66
88: more items for level V, eval of ambulatory aids and/or orthoses or shoes of interest
66: barefoot
which GMFM provides a more meaningful assessment of change?
66
precautions for spina bifida
latex allergy
observe and assess hydrocephalus
VP shunt
tethered cord
sudden significant changes in foot posture and/or B&B function
incidence of shunt malfunction
15%
1 year failure rate for VP shunts is ___% for pediatrics and ___ for adult
40-50% peds
29% adult
getting lower tho
tethered cord signs
weakness, numbness in legs
tremors or spasms in leg muscles
changes in foot appearance (higher arches, curled toes)
loss or worsening of B&B function
initial radiographs should be taken between what ages for children with down syndrome?
3-5 years
assessment tools for down syndrome
GMFM
PDMS-2
individuals with disability education improvement act Part B:
age group:
components:
3-21 yo
school aged services
components:
- IEP
- PTE
- NOREP
how often is an IEP developed?
annually
what is a NOREP?
classifies type of classroom and programming
individuals with disability education improvement act Part C:
age group:
components:
birth to 3 yo
early intervention services
IFSP
financial assistance to states for early intervention programs
how often is IFSP reviewed?
at least every 6 mo
purpose of section 504 of rehabilitation act of 1973
discrimination against individuals with disabilities illegal; protects students
Americans with disabilities act of 1990
prohibits discrimination against individuals with disabilities in employment, transportation, public accommodation communities, and government activities
_____ system is unreliable in young children (<4 yo)
thermoregulatory
dense ordinary CT
heals tendons and ligaments
a common complication of tendon regeneration is _____
development of fibrous adhesions b/w tendon and surrounding tissue
what layer of embryonic development is bone, cartilage, and muscle derived from?
mesoderm
Hueter-Volkman Principle
growth plates produce increase growth in response to tension and decreased growth in response to excessive compression
how is bone age usually determined?
X-ray of L wrist, hand, and fingers
what is a Risser sign used to assess?
scoliosis
a ____ Risser sign indicates that a lot of growth is left and scoliosis will get worse
low
when does the anterior fontanelle close?
7-18 months
when does the posterior fontanelle close?
1-2 months
T/F: therapeutic US is NOT safe over growth plates by diagnostic US is
T
what occurs in dominant (classical) OI that leads to brittle bones?
too little or poor quality of type 1 collagen due to genetic mutation of 1 of the type 1 collagen genes
what occurs in recessive OI that leads to brittle bones?
mutation in non-collagen genes
how long does biochemical (collagen) and molecular (DNA) testing take to diagnose OI?
requires several weeks
biochemical (collagen) and molecular (DNA) tests detect almost ___% of type 1 collagen mutations
90%
what meds will someone with OI usually be on?
bisphosphonate
vit D
clinical characteristics of OI
hyperlaxity of ligaments
fragile skin
poor thermoregulation
blue sclerae
dentinogenesis imperfecta (teeth)
how do you educate a parent on infant handling with OI?
- carry w/ widespread hands over head/shoulders and bottom
- diaper changes done by lifting butt not ankles
- do not twist or pull body parts
rules with MMT and OI
may NOT be possible
if tolerate - do a midshaft of bone
what MMT should never be performed for OI pt?
no isolated trunk extension or flexion to assess core strength (d/t spine fx possible)
