Orthotics & DMD Flashcards
tasks for non-ambulatory AFOs
contracture management
wound healing, protection, prevention
positioning
which type of orthotics use a circumferential force system?
sure step
elastic sleeve for burn pt
sensory dynamic pressure garment
theratogs
2 main ways to improve comfort with an orthotic
- minimize pressure by maximizing the area covered
- provide sufficient leverage through which the longitudinal segments of the orthosis apply force
the common basic pressure system for most orthoses is _____
3-point force system
a parapodium (THKAFO) uses a _____ pressure system
4-point
Winters gait classification group 1
foot drop during swing phase
flat foot or forefoot contact during IC
excessive hip & knee flexion during swing
adequate DF during stance
Winters gait classification group 2
more constant PF throughout gait
Winters gait classification group 3
increased L lordosis
knee hyperextension
Winters gait classification group 4
limited hip movement
significantly increased L lordosis
most severe
common gait compensations for children with hemiplegia
hemi-pelvis retraction
increased push-off on unaffected side
early firing of fib longus
which orthotic is designed for children with down syndrome?
sure step SMO
function of sure step SMO
promote/improve high level activities
correct coronal plane issues at STJ (pronation)
how does a sure step differ from a traditional SMO?
sure step has shorter toe-plate and trimlines
what is down syndrome characterized by?
hypotonia
ligament laxity
flat feet
cognitive limitations
delayed milestones
common comorbidities with down syndrome
AA instability (15%)
cardiac issues
thyroid issues
hip issues (DHD, acetabular dysplasia)
when should a child with down syndrome have initial radiographs taken (for AA instability)?
3-5 yo
purpose of SMO with PLS extension
sagittal plane TCJ issues + coronal STJ issues
what diagnoses would benefit from SMO with PLS extension?
ITW
spastic hemiplegic CP at GMFCS II
what can be added to solid AFO to control hindfoot valgus/varus?
lateral or medial flange
which orthotic was designed for DMD?
GFR AFO
function of GFR AFO
provide extension moment at knee
what is the most common inherited muscular dystrophy and muscle disease of childhood?
DMD
there is an absence of ___ in DMD
dystrophin
gait characteristics of DMD
wide BOS
lumbar lordosis
knee hyperextension
toe walking
what is an important sx to check for if suspect DMD?
Gower’s sign
what can help delay scoliosis in DMD?
prolonged walking and standing
what med helps improve muscle mass, strength, and function in DMD?
corticosteroids
scoliosis affects ___% of non-ambulatory kids with DMD
75-90%
surgery is considered for scoliosis when the curve is _____ degrees, especially if under ___ yo
30 deg
14 yo
primary impairment in DMD
weakness
pattern of weakness in DMD
proximal to distal
(neck flexors and abs 1st)
how to differentiate b/w ITW and DMD?
new onset of toe walking at 5-6 yo with no past hx
characteristics of spinal muscular atrophy
degeneration of ANTERIOR HORN CELLS
muscle atrophy
wide spread muscle weakness
ABSENT DTRs
type 1 spinal muscular atrophy
most severe
50% of cases
manifests before 6 mo
detah by 2 yo
type 2 spinal muscular atrophy
onset 7-18 mo
may live into adulthood with respiratory management
type 3 spinal muscular atrophy
mildest form
onset after 18 mo
may walk I or w/ AD into late adolescents or early adulthood
all 3 types of spinal muscular atrophy are characterized by…
- significant limb & trunk weakness
- more atrophy proximally & in LEs
- hypotonia & areflexia
- progressive MSK issues
a tight gastroc can lead to what deviation?
pronation
what is the gold standard of care for children with CP who are being considered for surgery to improve gait?
motional analysis lab d/t ability to view transverse plane
kinetic vs kinematic
kinetic - force (GFR)
kinematic - ROM
most common gait deviation for hemiplegia
hemi-pelvis retraction
