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Physio > Paediatrics > Flashcards

Paediatrics Flashcards

Kiddos

1
Q

Cerebral Palsy: Pathophysiology

A

Non progressive lesion of the brain the occurs before the age of two
Cause: any prenatal, perinatal or postnatal condition that results in anoxia, hemorrhage or brain damage
Periventricular leukomalacia: most common ischemic brain injury in premature babies –> form of brain injury, damage to white mater near ventricles, most commonly due to hypoxia and effects premature babies

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2
Q

Cerebral Palsy: Risk Factors

A
  • Older mom
  • Low birth weight/small for gestational age
  • Invitro fertiziation (IVF)
  • Abnormal placenta attachment
  • Blood type incompatibility
  • Prematurity
  • Low APGAR score
  • Anoxia
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3
Q

Cerebral Palsy: Potential Presentation

A

Varies between different serverity (1 least severe - 5 most severe)
- Movement disorders
- Decreased functional independence
- Hearing and speech problems
- Hydrocephalus
- Microcephaly
- Hip dislocation
- Cognitive impairments

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4
Q

Cerebral Palsy: Types of CP - Spastic

A

Spasticity present - velocity dependent resistance to muscle stretch
Muscle stiffness
Decreased ROM
Movement often limited to synergies (primitive movement patterns)
Trouble with starting/stopping movements
May walk with scissor gait pattern due to high tone adductors

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5
Q

Cerebral Palsy: Types of CP - Ataxia

A

Caused by cerebellar damage
Coordination problems
Abnormal rate, range, force, duration of movement
Difficulty with rapid movement, gait, fine motor, balance

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6
Q

Cerebral Palsy: Types of CP - Athetoid

A

Caused by damage to basal ganglia
Uncontrolled writhing movements of extremities and peri-oral muscles
Slow, twisting, wide amplitude movements
Changing of mouth positions
Lack of co-contraction of muscles leads to postural instability

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7
Q

Cerebral Palsy: Types of CP - Dystonic

A

Caused by damage to basal ganglia
Long sustained involuntary movements and postures (whole body movements)
Tend to lock joints in end range
Middle range control is difficult
Full ROM normally present

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8
Q

Cerebral Palsy: Types of CP - Hypotonic

A

Lack of tone, weakness

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9
Q

Cerebral Palsy: PT Treatment

A
  • Manage atypical muscle
  • Strengthen lone tone muscles (usually core)
  • Stretching program (maintain ROM)
  • Positioning
  • Orthotics
  • Gait re-training with/without gait aid
  • Hip health - prevent/manage hip subluxations
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10
Q

Cerebral Palsy: Hip Subluxations

A
  • Spasticity of adductor longus and iliopsoas can cause hip dislocation
  • Non-ambulatory child at most risk
  • First indication is unable to abduct 45 degrees
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11
Q

Cerebral Palsy: Hip Subluxation Treatment

A
  • Seating (pummel between legs)
  • Botox to adductors with stretching/positioning
  • Surgery (tendon release)
  • Baclofen pump
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12
Q

Cerebral Palsy: Outcome Measures

A
  • Gross Motor Function Measure
  • Gross Motor Function Classification System
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13
Q

Spina Bifida: Risks

A
  • Neural tube defect resulting in vertebral and/or spinal cord malformation
  • Link between decreased material folic acid, infection, exposure to teratogens (alcohol)
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14
Q

Spina Bifida: Possible Presentation

A
  • Flaccid paralysis
  • Muscle wasting
  • Muscle weakness
  • Decreased/absent reflexes
  • Bowel and bladder incontonence
  • Hydrocephalus
  • Meningitis
  • Foot deformities (club foot - especially with L4-L5
  • Decrease/absent sensation
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15
Q

Spina Bifida: Secondary Features

A
  • Skin breakdown due to ulcers due to lack of sensation
  • Osteoporosis
  • Delayed development is unable to explore the environment
  • Soft tissue contractures
  • Higher risk of latex allergy
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16
Q

Spina Bifida: Spina Bifida Occulta

A
  • No spinal cord involvement, may be indicated by hair tuft
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17
Q

Spina Bifida: Spina Bifida Cystica

A
  • Meningocele: includes cerebrospinal fluid: cord intact
  • Myelomeningocele: cyst includes cerebrospinal fluid, herniated cord tissue, cord damage
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18
Q

Spina Bifida: Hydrocephalus

A
  • Condition with abnormal accumulation of CSF within the brain
  • 60% of myelomeningocele develop hydrocephalus after surgical closure of their lesion
  • Early warning signs: irritability, changes in sleep patterns, changes in appetite and weight
  • 80-90% will require a shunt
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19
Q

Spina Bifida: Stunt Blockage Signs

A

Vomiting, fever, irritability, headache, head enlargement, bulging eyes

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20
Q

Spina Bifida: Functional Outcomes

A

T12: wheel chair
L1: household ambulation with gait orthotic and elbow crutches
L2/L3: KAFO with crutches, wheel chair for distance
L4: AFO with crutches or cane for balance, may need wheelchair in adulthood
L5/S1: AFOs, may need crutches/cane
S2/3/4: ambulation without gait aid

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21
Q

Spina Bifida: PT Treatment

A
  • Strengthen weak muscles
  • Teach transfers
  • Equipment needs
  • Standing and ambulation
  • Education about sensory issues and skin health
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22
Q

Muscular Dystrophy: Overview

A

Group of inherited diseases that are characterized by weakness and wasting away of muscle tissue
There are subtypes of DMD

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23
Q

DMD: Duchenne MD
Overview

A
  • Mutation of single X chromosome - fail to produce dystrophin protein
  • Diagnosed by 5, death by ~20
  • Key signs: Gower’s sign and calf pseudohypertrophy
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24
Q

DMD: Dystrophin

A
  • Necessary for muscles to function properly
  • Provides integrity to muscles by linking sarcolemma to actin
  • Disruption leads to muscle weakness
  • Muscle is replaced with fat and connective tissue
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25
Q

DMD: Presentation

A
  • Proximal muscle weakness (pelvic girdle, shoulder girdle) and progresses to distal muscles
  • Symmetrical muscle wasting
  • Waddling gait
  • Toe walking
  • Lordosis (anterior pelvic tilt)
  • Frequent falls
  • Difficulty with stairs
  • Scoliosis
  • Lower IQ
  • Reduced function residual capacity should be normal
  • Total lung capacity, FEV1 will be decreased
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26
Q

DMD: PT Treatment

A
  • Slow development pf contractures and muscle weakness
  • Functional strength training for independence
  • Stretching programs and bracing for ROM, standing frames
  • Gait aids to help maintain mobility: walkers, orthoses and wheel chairs
  • Aerobic exercise: low impact - i.e: swimming
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27
Q

Motor Development: How Movement is Acquired

A
  • Environment
  • Maturation
  • Individual growth characteristics
  • Tempo of Growth
  • Genetics
  • Effects of Prior Motor Experiences
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28
Q

Peds: Growth Curves

A
  • 0 - fives years old: large amount of brain development
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29
Q

Peds: Motor Patterns

A

Basic movemebt of movements involved in the performance of a task

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30
Q

Peds: Motor Skill

A

Emphasizes the accuracy, precision and economy of performance

31
Q

Peds: Subjective Assessment

A
  • Strengths, concerns, goals
  • Pregnancy complications
  • Birth
  • PMHx
  • Background: day care/school, siblings
  • Previous milestones
32
Q

Peds: Objective Assessment

A
  • Getting babies into positions, AIMS
  • Children: higher-level skills, Ages and Stages, BOT2, Peabody)
33
Q

Red Flags

A
  • Regression of skills
  • Restricted/asymmeterical ROM
  • Absent primitive reflexes
  • Abnormal reflexes
  • Hypotonia/hypertonia
  • Extremely irritable or fatigued
  • Signs of pain or limping
34
Q

Torticollis

A

Tightening of the SCM which causes ipsilateral side bend and contralateral rotation

35
Q

Torticollis Causes

A
  • Idiopathic
  • High birth weight
  • Breech position
  • Low head control
  • Visual/vestibular differences
  • Plagiocephaly
36
Q

Plagiocephaly

A

Flattening of the head on one side when the baby’s skull is still soft and not fused

37
Q

Torticollis and Plagiocephaly Treatment

A
  • Tummy time to increase head and neck control
  • Positioning
  • Strengthening opposite side
  • Stretching involved side
  • Helmet
38
Q

Grasp Reflex: palmer and planter

A
  • Placing finger or stroking infant’s palm
    ○ + if they grasp
    ○ Disappears around 4m-6m
  • Placing finger underneath the toes
    ○ + if they grasp
    ○ Disappears around 9m - 1y
39
Q

Moro Reflex (startle)

A
  • When infant hear a sudden loud noise or experiences unexpected movement
    ○ + extend the arms with the palms facing up
    ○ Disappears around 6m
40
Q

Rooting Reflex

A
  • Stroking the infants cheek or side of mouth
    ○ + head will turn towards side that is stroked and possibly open mouth
    ○ Disappears around 4m
41
Q

Sucking Reflex

A
  • When something touches the top of the infants mouth
    ○ + start sucking
    ○ Disappears around 4m
42
Q

Babinski Reflex

A
  • Bottom of the foot is stroked from the heel upward along the outward part of the foot
    ○ + if big toe bends back and other toes fan out
    ○ Disappears around 1y
43
Q

Crawling Reflex

A
  • Place them on stomach and apply pressure with hand on the sole of the foot
    ○ + if the infant pushes against hand and moves arms and legs in a crawling motion
    ○ Disappears at about 1m
44
Q

Step Reflex

A
  • Hold infant upright and legs and feet are touching a surface
    ○ + if they move legs like taking steps or walking
    ○ Disappears at 3-4m
45
Q

Tonic Neck Reflex

A
  • Infants head is turned to a particular side
    ○ + if the leg and arm on the turned side with extend and the leg and arm on the opposite side will flex
    ○ Disappears around 4-6m
46
Q

Developmental Reflexes

A
  • Originates in the CNS in response to stimuli
  • Not present in neurologically intact adults
  • Gradually inhibited
47
Q

Postural Reactions: Righting reactions

A
  • Goal: create efficient alignment of body parts
  • Hold baby diagonal and the will right their head vertically
48
Q

Postural Reactions: Equilibrium reactions

A
  • Goal: Fine postural changes to maintain alignment - hip, knee and ankle strategies
  • Initiate ankle strategies for small perturbations
49
Q

Postural Reactions: Protective reactions

A
  • Goal: automatic response to protect with arm when falling - forward down, sideways, backwards
  • If you push, arms will come out to protect
50
Q

Hypotonia

A
  • See in kids with delayed motor development, Down syndrome, CP
  • Decreased joint stability, difficulty grading movements, decreased proximal stability results in decreased distal stability, difficult initiating movement
  • Wide BOS, lock joints, lean for support, poor sitting posture
51
Q

Hypertonia

A
  • Caused by spasticity, rigidity, dystonia or a combonation
  • Excessive co-contraction, difficulty controlling movement, general muscle and joint stiffness, disuse atrophy
52
Q

Motor Milestones: 0-3m

A
  • Control head
  • Random kicking in supine
  • Head right and reflex stepping
  • Requires full support in sitting
53
Q

Motor Milestones: 4-5m

A
  • Legs and pelvis stabilize in prone
  • Feet and hands to mouth in supine
  • Supported sitting
  • Follow objects
54
Q

Motor Milestones: 5m

A
  • Roll prone to supine
  • Head control in supporte sitting
55
Q

Motor Milestone: 6-7m

A
  • Control of arms and upper trunk
  • Reach with one hand
  • Roll supine to prone
  • Sit unsupported
  • Stand with support
  • Belly crawling
56
Q

Motor Milestone: 8-9m

A

Ease of movement stage
- 4 point from prone
- Pivot in sitting
- rocking on all fours
- Can develop ability to crawl forward
- Pull to stand on furniture
- Lower into sitting

57
Q

Motor Milestones: At 9m

A
  • Control over lower trunk and pelvis
  • Transfer objects from one hand to another
58
Q

Motor Milestones: 10-11

A
  • Stand hands free for a few seconds
  • Crawl upstairs
59
Q

Motor Milestones: 9-11

A
  • Bear walks
  • Walk with hands held
  • Pincer grip
60
Q

Motor Milestones: 12-15m

A
  • Independent standing
  • Walk independently
  • Throw call
  • Walks a few steps backwards
61
Q

Motor Milestones: 16-24m

A
  • Squat and transition up to stand in mid floor
  • Walks up and down stairs with hand held
  • Initiates kicking a ball
62
Q

Motor Milestones: 2-2.5 years

A
  • Walks on tippy toes
  • Jumps with two feet
  • Stands on one foot
  • Controlled kick of ball
  • Running
  • Stairs slowly
63
Q

Motor Milestone: 3-5 years

A
  • Becoming functionally independent
64
Q

APGAR Assessment

A
  • System for evaluation of infants physical condition
  • Score < 4 is resp distress
  • Typical score 7-10
  • Activity, pulse, grimace, appearance and respiration
65
Q

Pediatric Cardiorespiratory

A
  • Increased compliance of chest wall
  • Normal shape at 10 years
  • Narrow airways
  • RR 66

3-6m: RR 30-60

6-12m: RR 24-30, airway size increases

In children, normal SBP 85, DBP 60

66
Q

Bronchiolitis

A
  • Lower respiratory tract infection
  • Usually caused by RSV
  • V/Q mismatch causes hypoxia (decreased O2) and hypercapnia (increased CO2)
67
Q

Bronchopulmonary Dysplasia

A
  • Chronic lung disease in newborns, can be mild, moderate or severe
  • More common in babies with low birth weight
  • Cyanosis, hypoxemia, hypercapnia, delayed growth and development
  • Frequent lower respiratory infections
  • Crackles, wheezing and decreased breath sounds
  • Hyperinflation, low diaphragm and atelectasis
68
Q

Hirschsprung’s Disease

A
  • Constipation in an infant caused ab absent ganglion cells inlarge intenstine, fail to pass first stoo
  • Will have abdominal distention
  • Need surgery
69
Q
A
70
Q

Osteochondritis Dessecans

A
  • 10-20 years old who are highly active
  • Distrubtion of blood supply causing subchondral necrosis of bone
  • Unknown cause - could be trauma/abnormal bone stress
  • Painful, swollen joint with increases with activity, sesnsation of giving way, decreased joint ROM
  • Treatment: May need surgery to remove fragments, bracing, strengthening and stretching
71
Q

Legg- Calve-Perthes

A
  • Common in children 4-8 years old but can occur between 2-15
  • Avascular necorosis of femoral head due to inadequate blood supply to the head and neck of the femur - leads to abnormal shape of the femoral head and acetabulum
  • Increased risk of knee OA
  • Mild hip, knee or groin pain
  • Increase pain with running, walking and jumping, less ROM in IR and abduction, limp usually unilateral
  • Treatment: decrease pain, maintain ROM, positioing, stretching, limit mechanical stress, minimize femora; head deformity
72
Q

Slipped Capital Femoral Epiphysis

A
  • Most common child hip condition
  • 10-16 years old
  • Slippage of the epiphysis (growth plate) of the femur, hip joint heals abnormally
  • Can lead to severe knee OA
  • Hip, groin, medial thigh and/or knee pain, pain increases with activity, acute or insidious onset of the limp, decreased hip ROM
  • Treatment: surgery
73
Q

Developmental Dysplasia of the Hip

A
  • Present at birth or later if walking is delayed
  • Abnormal growth of the hips, shallow acetabulum
  • Asymmetry of the gluteal thigh or labral skin folds, decreased abduction on the affected side, standing or walking with external rotation, leg length discrepancy
  • Tests to sublux hip (Barlows) and reduce (ortolani)
  • Treatment: good prognosis, surgery or harness
74
Q

Salter Harris Fracture

A
  • Involves growth plate of a bone
  • 9 types, 5 common
  • Slip, above, lower, through everything, rammed
  • PT Treatment: restore ROM, 85% heal with no deficits, most common complication is a leg length

Physio (11 decks)

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