Pediatric Cardiopulmonary Rehab Management

Question 1

in general, infants & children have different normal vital signs than adults. Do infants & children have higher or lower ____ than adults?
– HR
– RR
– BP

Answer 1

– higher
– higher
– lower

Question 2

is the following situation considered normal or abnormal?
Baby often cries when hungry or tired, shows visable response to parents, and moves extremities well

Answer 2

normal

Question 3

is the following situation considered normal or abnormal?
Baby flares nostrils when breathing, is audiably loud when breathing, and has absent respiratory effort

Answer 3

abnormal

Question 4

is the following situation considered normal or abnormal?
Baby’s skin appears a more blue/yellow appearance, has weak pulses, bleeding, and capillary refill > 2 seconds

Answer 4

abnormal

Question 5

what resting position is an infant in when hospitalized?
- hips:
- knees:
- ankles:
- shoulders:

Answer 5

gravity-dependent positions
- hip flexion, abduction, ER
- knee flexion
- ankle PF
- shoulder abduction, ER, scapular retraction

Question 6

if a baby is in a prolonged gravity dependent position, this can lead to:

Answer 6

decreased extensibility and ROM –> may slow developmental progression

Question 7

due to the resting position of an infant in the hospital, premature infants have ___(less/more)___ physiological flexion

Answer 7

less

Question 8

what is a developmental concern in infants we should be conscious of if they spend prolonged periods in the hospital/this resting position?

Answer 8

delayed ability to get to midline

Question 9

what are some reasons that the thoracic cavity of children with cardiopulm conditions lose mobility?

Answer 9

prolonged immobilization
guarding of postural muscles
overuse of accessory muscles
scar tissue
shallow breathing
surgical scars (due to surgical precautions)

Question 10

how do you measure thoracic expansion in a pediatric patient?

Answer 10

at the bottom of the rib cage by tape measure with inhalation

Question 11

what shape/position is the thorax and ribs in a:
– 0-3 month old baby
– 6-12 month old baby

Answer 11

– triangular thorax with horizontal ribs
– rectangular thorax with down-angled ribs

Question 12

what are treatments focused on for pediatric CVP patients?

Answer 12

impairments that arise from developmental abnormalities, prematurity, immunologic deficiencies, and trauma

Question 13

true or false. infants/children require less monitoring because they exhibit less changes and distress

Answer 13

false - they need closer monitoring because of decreased tolerance for hemodynamic changes and limitations in communicating distress

Question 14

what are three techniques that can be used to improve rib cage mobility?

Answer 14

gentle thoracic cage mobilizations
manual release techniques
scar tissue massage

Question 15

gentle thoracic cage mobilizations can be performed in _____ positions, with _______ caution in children with osteopenia or other structural impairments

Answer 15

all ; increased

Question 16

where do you perform manual release techniques in children?

Answer 16

over intercostals to gain extensibility

Question 17

in order to prevent abnormal skin adherence and scar tissue build up, where would you perform scar tissue massage?

Answer 17

over sternotomy, thoracotomy, or invasive line sites

Question 18

what’s the purpose of interventions focused on flexibility in children?

Answer 18

elongate all muscles with decreased extensibility

Question 19

what muscles are elongated in sidelying trunk rotation?

Answer 19

intercostals

Question 20

what are you accomplishing by putting a child in supine on a ball?

Answer 20

elongated rib cage muscles
thoracic extension
shoulder retraction

Question 21

what muscles do you especially want to stretch in pediatric patients?

Answer 21

pec major
quadratus lumborum
lats
rectus abdominus
hamstrings

Question 22

what’s the best way to perform strength exercises in children?

Answer 22

utilize the child’s own body weight and gravity for resistance

Question 23

wheelbarrow walking or crab walking are examples of what kind of intervention?

Answer 23

upper extremity weight bearing

Question 24

squat to stand to retrieve toys, hopping, and jumping are all examples of what kind of intervention?

Answer 24

lower extremity weight bearing

Question 25

reaching for toys while seated on therapy ball, prone on therapy ball, and walking hands out until only feet are on the ball are examples of what kind of intervention?

Answer 25

dynamic trunk stabilization

Question 26

what three things affects a child’s posture?

Answer 26

flexibility
strength
thoracic mobility

Question 27

you want to assess and address a child’s posture in ______, _____, and _____ to ensure proper alignment to prevent scoliosis and thoracic deformity

Answer 27

stroller, car seat, or wheelchair

Question 28

by what age should children not use accessory muscles during quiet breathing?

Answer 28

2

Question 29

what do you want to train in children who overuse accessory muscles for breathing?

Answer 29

the diaphragm and intercostals to be the prime muscles for inspiration

Question 30

what’s an example of an intervention that can be performed in a child who overuses accessory muscles for breathing?

Answer 30

diaphragmatic breathing by using a toy on their stomach for visual cue

Question 31

inhalation is paired with _______
exhalation is paired with _______

Answer 31

extension
flexion

Question 32

what are some airway clearance techniques that can be used on children?

Answer 32

postural drainage
percussion
vibration

Question 33

can you use trendelenburg position on children?

Answer 33

not under the age of 2 due to lower esophageal sphincter not strong enough yet to prevent reflux

Question 34

what children commonly use a high frequency chest wall oscillation vest?

Answer 34

CF or children with low tone who can’t effectively mobilize secretions

Question 35

positive expiratory pressure (PEP) devices provide:

Answer 35

resistance to exhalation and breaks up thick secretions

Question 36

what can be provided during exhalation to splint open airways and facilitate mobility of secretions?

Answer 36

pressure/vibration to the chest walls

Question 37

what are child specific interventions that help encourage deep breathing?

Answer 37

blowing bubbles through a straw into water
kazoo
pinwheel
incentive spirometer (pediatric versions can be made into a game)

Question 38

what is the benefit of swadldling a baby with their hands near their face?

Answer 38

assists in bringing extremities to midline for self calming and motor milestone development

Question 39

what are bolsters or “nesters” good for?

Answer 39

positioning to facilitate shoulder protraction, hands to midline, hip flexion, etc.