Pediatric Chiro Eval Flashcards
What is a reverse fencer?
Invert infant - relax tension on one leg and watch child’s head turn to that side
What is a positive fencer?
Infant considered restricted or twitches turning to one side compared to other
Suggests subluxation between atlas-axis or atlas-occ on that side
If an infant arches backwards during a fencer what may this be a sign of?
Meningeal tension
What MUST you check before performing the fencer on an infant?
Hip stability (orthani’s)
True or false; if the landau’s response is present in an infant reverse fencer is no longer a viable test
true (landau is when infant is suspended prone when head looks up so do the feet - if the head looks down the feet go down)
What is the acetabular pump part of the reverse fencer? How do you interpret findings?
Infant supine - apply pressure along shaft of femur - the “spongy” side consider side of atlas laterality (if they’re even consider occ)
True or false; infants have a normal flexed tone and legs are commonly in “frog leg” position
true
What is KISS? What are the 2 types?
KISS = Kinematic imbalances due to suboccipital stress
KISS 1: Fixed lateroflexion
KISS 2: Fixed retroversion (hyperextension during sleep)
Signs & symptoms of KISS
Torticollis, scoliosis, plagiocephaly (flat spot on baby’s head)
Frequent vomitting, dysphagia, colic with excessive crying
What is KISS induced Dyspraxia and Dysgnosia (KIDD)?
Syndrome related to KISS that has been associated with:
Slow development of fine and gross motor skills
Poor posture and equilibrium
Delayed language development
Restless ADHD
Essentially neurological complications related to KISS
What is the normal “evolution” from bowlegs to knock-knees to normal valgus knees
2 years = bowleg
3 years = Knock knees (extreme valgus)
5 years = normal valgus
True or false; typical causes of Toe-out during a prone leg check would include: EX ilium, tibial torsion, femoral anteversion, weak psoas or glute max, cerebral palsy
false; all of those would cause Toe-IN
Common causes of toe-out during prone leg check
IN ilium
Hypertonicity of psoas or glut. max
True or false; placing patient prone during instrumentation can be helpful with infants and children
true
How many degrees F does it take for an atlas reading to be considered significant clinically
> 0.5 asymmetrically
True or false; during lateral bend at C1-Occ area small children differ from adults or older children in that their atlas moves up toward your finger - contrast adults or older children atlas moves under occiput during lateral flexion
true
What motion should be assessed first from C2-L5 on infants
P-A motion (segments not always rotated)
True or false; when infants lay prone and turn head ipsilateral SI motion may appear restricted
true
When would you use a reverse fencer?
Infants under 6 months
Restricted occ. glide bilaterally; both condyles are restricted in flexion are motion findings with what listing?
AS occ
Restricted occ glide, and lateral flexion with pain over ipsilateral nuchal line, “High ear” are findings with what listing?
Occ PS-RS
True or false; you should palpate atlas laterality in a seated or upright position
true
Where do infants tend to hold their head relative to atlas subluxation
Opposite (example: ASR would hold head to left)
Note: Breastfed infants may be irritable/feed poorly on breast that requires them to lie with subluxated side down
What response can be triggered by a C1 adjustment
Moro (commonly causes infant to cry)
True or false; extension will be restricted at C2 on P, PLS/PRS, or ESL/ESR listings
true all have restricted extension (note ESL/ESR not toggle listing - with no uncinates yet they segment can move that way relative to C3)
True or false; during a PLS/PRS listing at C2 pain will be felt on ipsilateral articular pillar
False; pain will be felt both at lateral inferior tip of spinous and OPPOSITE articular pillar (side of body rotation)
Pain will be felt at the lateral/inferior tip of spinous on ESL/ESR listings at C2. Where else would infant feel pain?
Ipsilateral articular pillar (contrast opposite articular pillar in PLS/PRS)
In a P listing at C2 where would pain be felt in an infant
over spinous and both lamina
When do unicnates typically begin to develop?
6-9 years
For C2-C7 what should your contact be? How much rotation? Should you limit it?
Tip of index
25-30 degrees; yes you should - no uncinates so need to be cautious with rotation component
True or false; anterior adjusting is recommended on infants
false; not recommended under 3 years
What is the preferred technique for thoracic adjusting in infants
DTH (either side of spinous)
What is the preferred technique for infants when adjusting L1-L3
DTH (contact mammillary processes)
Explain infant adjusting technique for L4-L5
Contact spinous on side of spinous laterality with thumb (#9) contact
Apply light pressure over contralateral mammillary process for stabilization
Explain gluteal cleft deviation in infants?
Pinch gluteal cheeks; cleft should be midline
IF deviates may indicate side of PI ilium OR side of AI sacrum
True or false; some recommend that side posture be reserved for patients >1 year
true
What technique do most use on infants for SI misalignment
Prone
How long do infants typically have horizontal facets?
~ age 10
What is Swischuk’s line? What is it checking for?
Line connecting anterior cortices of spinous’ C1-C3
Line should intersect or lie within 1 mm anterior to anterior cortex of SP of C2
IF C2 is >2mm off line = true injury
True or false; pseudosubluxation is a normal variant occuring MC at C2/C3
True
Detected by Swischuk’s line
DDx pseudosubluxatoin v. Hangman’s fx
Pseudo = C2 may appear anterior relative to C3 by as much as 5mm
Hangman’s = Fx of arch C2 - Vertebral body moves anterior while arch and spinous move posterior
True or false; if you see lateral masses hanging over C2 in infant automatic diagnoses of burst fx
false; normal variant up to 6mm common
