Ped Cases (credit to Kaylee Tang and Becky Master of Making Deckys) Flashcards
What is the gestational age + chronological age called?
post- conceptual age
A baby is born at 28 weeks, 1 month ago. How old is the babies chronological age?
1 month
A baby is born at 30 weeks and since then 4 months have passed, what is the babies adjusted age?
4 months - 10 weeks.
Between 1 and 2 months old
Purpose of a posterior-wheeled walker?
promotes upright posture
decreases forward lean
promotes EXTENSION
Medical management of extremely premature and very low weight infants (under 1500g) includes what 4 things
surfactant administration
respiratory support
parental and enteral nutrition
early caffeine initiation
What level evidence does kinesiotaping and using a TOT collar for torticollis have?
C
What is neuropraxia
temporary nerve conduction block d/t stretching of nerves
T or F: Premature birth alone predisposes infant to neurodevelopmental delays
T
they can have whitematter abnormalities that persist into school age
What are the 2 major factors that impact survival/health status of extremely premature infants?
- Gestational age (most important)
- Birth weight
others: male sex, multiple births, lack of antenatal steroids
What should the first intervention be for infants with torticollis
PROM
What are the 5 sections of the apgar test
what is considered a normal score?
What is low?
- respiratory effort
- heart rate
- mm tone
- reflexes
- skin color (all scored 0-2)
7-10 is good
under 6 is considered low
What is patent ductus arteriosus (PDA)
failure of ductus arteriosus to close, causing heart failure, redistribution of systemic blood flow, reduced renal and cerebral flow
Breathing disorder in newborns caused by immature lungs w/ insufficient surfactant
rapid, shallow breathing and sharp pulling in of chest between each breath
Neonatal respiratory distress syndrome
need mechanical ventilation and surfactant
Common pregnancy complication that places mother at risk of mortality and risk of brain injury, clotting issues, and organ problems.
Marked by hypertension and protein in urine
preeclampsia
What is bronchopulmonary dysplasia
large alveoli and abnormal pulmonary vasculature, infant will require supplemental O2 for atleast 28 days
most common cause of chronic lung disease in infants
Erbs palsy causes what position of the arm
Waiters tip
shoulder ADD+IR
elbow Ext, forearm pronation
wrist and finger flexion
What is apnea of prematurity (AOP)
Absence of respiration for more than 20 seconds
usually accompanied by bradycardia and/or oxygen saturation
What are the 3 subgroups of brachial plexus injury, which is most common?
Upper = Erb’s palsy C5-C6 maybe C7 (MOST COMMON)
Lower = Klumpke Palsy - C7-T1 (LEAST COMMON)
Total = erb-klumpke palsy - c5-t1
What is the neonatal unit that provides the highest level of comprehensive care for critically ill infants
Level 4 neonatal intensive care
in the NICU case, it is stated that Tummy time should be _____ per day
30 minutes
Resolution of CMT is achieved when an infant has _________ (Discharge!)
Full PROM within 5 degrees of other side
midline head/trunk
symmetric AROM
Achieved age appropriate motor skills
parents have good understanding of what to monitor
Infant is below 10th percentile for it’s gestational age
Intrauterine growth restriction
Can be symmetric or head-sparing
A 5 month old has a 25 degree PROM restriction of L rotation with an SCM mass, what is the grade
Early grade 3 severe
early because 6 months
grade 3 severe because SCM mass present
Risk factors for CMT
Large baby
Breech Birth
Decreased intrauterine space
primiparity
male
foreceps/vacuum delivery
What is Cranial Vault Asymmetry?
Measurment of cranial asymmetry by obtaining the shortest and longest diagnol from the forehead to posterior skull
(Longest-shortest)/Longest gives you the fraction of asymmetry
What kind of brace is used to treat equino varus/clubfoot
Foot adduction brace. Straightlaced shoes or boots connected w/ attachment bar allowing LE to be held in 70 degrees hip ER and 10 degrees of ankle DF
what is craniosynostosis
premature closure of cranial suture
requires referal to neuro surgeon
What is the muscle function scale
6 point scale used to measure lateral cervical flexion strength in infants older than 2 months
When an infant with CMT should be referred to a specialist:
When condition is the same after ______ of treatment
__________ months of treatment with only moderate results
infant older than _________
infant has __________ restriction of ROM
Infant is ____________ or older with a SCM mass
4-6 weeks
6 months
older than 1 year
10-15 degrees
7 months
Ponseti method for correcting club foot
Serial casting technique to realign talus in TC joint
Several above knee casts -> percutanous achilles lenghtening -> joint is casted for 3 weeks -> child wears foot adduction brace for 23 hours a day for 3 months
they will wear this brace up to 5 years old for atleast 10-12 hours a day
What are the indicators that an infant needs surgery for OBP injury
Lack of bicep function
lack of shoulder ER and forearm supinators
Precaution for kids with club foot in PT
Stress fractures after serial casting
avoid high impact activities (running, jumping, hopping)
identify and prevent compensatory strategies during high level WB activities
What is the arm position and what muscles arent working in a child with Klumpke palsy (lower OBPP)
Intact shoulder and elbow
Paralysis of wrist flexors, extensors, and hand muscles
involved arm is held in supination with a poor grasp
What bacterial infection present in a woman can be passed to infant during delivery
if infant is infected they are at risk for pneumonia, sepsis, and meningitis
Group B streptococcal infection
What is a TOT collar?
tubular orthosis for torticollis
provides noxious stimulus to lateral aspect of skull to promote midline head position
What are the 2 biggest predictors of outcome in a premature population?
- (most important) Gestational age
- birth weight
Infants receiving treatment for CMT prior to age of ______ have excellent outcome
3 months
contraindications and precautions for treating children with OBPP
Any movement or PT assessment of UE during rest period (7-10 days after birth)
Aggressive movements that overstretch UE
Treatment and HEP: precaution related to joint dislocation/sublux
precautions related to premature infants
- monitor vitals and behavioral cues
- monitor medical lines and tubes
- determine whether physiologic cost of exam outweights benefits
Will a child with clubfoot be able to squat well?
No they will have secondary complications due to hip and knee weakness even later on
precautions for CMT
passive stretching of cervical structures may be contraindicated if other conditions present
passive stretching can cause snapping of SCM in 8% of infants
common gait pattern that indicates relapsing clubfoot
early heel rise after inital contact with intoeing during stance phase
anatomical position of club foot that is not completely corrected
Retracted PF first ray, forefoot adduction that does not correct past neutral
prominent base of the fifth met on palpation
Appropriate HEP to give a child with clubfoot
balance on one foot
club foot position
Talus rotated medially on calcaneus
short medial longitudinal arch
long lateral column of the foot
AIMS is for children of what age
0-18 months
signs and symptoms of clubfoot
difficulty to squat
early heel rise, weight shift onto uninvolved side
intoeing during stance phase (IR Is never normal in the gait pattern)
What is a breech birth
baby comes out feet or bottom first
What is oligohydramnios
decreased amount of amniotic fluid during pregnancy
next step for ITW if conservative treatment doesn’t work
serial casting
four criteria to have a formal diagnosis of DCD
below age average performance in daily activity requiring motor coordination
motoric disturbances interfere with academic performance or ADLs
all other conditions causing coordination problems ruled out
coordination difficulties are significantly more than developmental cognitive level
precautions for treating ITW
pain or spasms related to overstretching plantarflexors (especially in serial casting)
What is dyspraxia
impaired ability to perform coordinated movement
What 2 neuro behavioral disorders occur with DCD
ADHD and ADD
How long should a child wear a foot adduction brace after corrected through ponseti method
up to 5 years
noncompliance can cause reoccurrence of clubfoot
What muscles are short and what muscles are long in clubfoot?
Long: fibularis muscles
Short: medial muscles
What is the first indication of clubfoot relapse
intoeing during gait
precautions for PT for kids with DCD
close positioning of PT to child during training of gross motor skills
safety during all movements due to potential impulsivity
Involuntary movements that occur when a person is engaged in difficult movement
typically observed in children up to 8. After this time, these movements indicate CNS damage
associated reactions
What is the CO-OP program
designed to remediate motoric skills in children with developmental coordination disorder by using motor learning and dynamic systems framework
approach designed to address posture and movement disorders
encourages inhibition of atypical or abnormal movement patterns and facilitation of typical patterns to promote skill development
NDT
neuro developmental treatment
What apgar scores are associated with CP
Scores of 6 and below taken at 1 and 5 minutes after birth
3 clusters of DCD
Ideomotor dyspraxia with movement deficits, problems with imitation, dynamic balance, and handwriting
visual spatial and visual construction dyspraxia, deficits in both visual motor skills and handwriting
mixed dyspraxia
classification system for self initiated mobility for kids with CP
Gross motor functional classification system
includes sitting, walking, and wheeled mobility
What is the federal legislation that establishes school based services for students 3-21 years with disabilities
Individuals with disabilities education improvement act PART B
(IDEA)
for infants/toddlers with IDEA PART C services, what is the multidisciplinary assessment of family resources, priorities, and needs of child and individual service plan to meet these needs
individualized family service plan IFSP
Reviewed every 6 months, evaluated once a year
Best therapy approach for kids with DCD
task-oriented
the prevalence of CP is higher in babies born before ________ gestation
28 weeks
What is the federal service that established early intervention for services for toddlers and infants w/ disabilities 0-3 and their families
IDEA part C
PT precautions for kids with CP
monitor skin integrity closely
be close to child during gait/transfers
safeguard due to potential impulsivity
Though CP is not a progressive disorder, what secondary complications can progress overtime
Contractures
skeletal deformities
decreased strength
limited endurance
osteopenia/porosis
for children who are non-ambulatory, _________ reduces spasticity, improves bone density, hip stability, social interaction, and alertness (Grade B evidence)
supported standing programs
Valid tool to assess participation for young kids with CP
valid tool for assessing difficulty of caregiving for kids with CP
Child engagement in daily life CEDL
Ease of caregiving for children measure
4 diagnoses to rule out for ITW?
CP
Duechennes muscular dystrophy
Autism
Sensory Processing disorder
_______ supplementation has significantly reduced the incidence of spina bifida, and lack of said nutrient is a risk factor for spina bifida
Folic acid
mild asymptomatic form of spina bifida
spina bifida occulta (no herniation of meninges)
what is the most severe form of spina bifida
spina bifida myelomeningocele (part of the spinal cord has herniated out)
What is the most common sign of VP shunt failure
headache
Complications due to ________ are the leading cause of death in people with spina bifida
arnold chiari malformation
note: second most common cause of decline (not death) in children is tethered cord syndrome
The most common orthopedic problems associated with spina bifida are…
Foot deformities
Scoliosis
T or F: Children with spina bifida causing hydrocephalus have lower IQ and impairments in social language and peer interactions
T
What kind of PT treatment is best for children with spina bifida who struggle with wheelchair mobility
strengthening of UE
The _______ is a reliable and valid assessment tool that can measure
change in function over time in the functional ability of children with
spina bifida.
WeeFIM
Which of the following is true about ambulation in children with spina
bifida?
A. They are never able to ambulate and rely on wheeled mobility to access the community.
B. They can ambulate independently with an assistive device.
C. Their ability to ambulate is dependent on the level of the spinal cord lesion.
D. Their ability to ambulate is related to the presence of hydrocephalus.
C, their ability to ambulate is dependent on the level of spinal cord lesion
What is Pervasive Developmental Disorder Not otherwise specified
PDD-NOS
Classification for children with atypical autism not otherwise specified
What is stereotypy
Ritualistic movement pattern seen in children with ASD
Secondary to ASD diagnosis
Precautions for ASD in PT,
Cues and warnings may be needed for transitioning between activities to avoid overstimulating child
Children with ASD have been noted to have difficulty with what motor movement
Head lag in infancy
Motor coordination deficits
Low muscle tone
Difficulty with symmetrical movements
Apraxia
What outcome measure is used for children with autism
Movement assessment battery for children - good for balance
BOT 2- good for biannual coordination
What are two methods of therapy that have gained popularity with treating ASD
Aquatic therapy
Riding therapy
Also: repetitive play activities
Which outcome measure is reliable for evaluating bilateral coordination in children with ASD
BOT-2
