Pediatric Rehab Flashcards
normal growth and developmental milestones - 6 months
manipulate objects and transfer across midline at 6 months
also generally suppression of reflexes at 6 months; broad generalization
using upper limb in more complex ways → this is when an upper extremity prosthesis might be first prescribed
left terminal radial limb deficiency (most common)
normal growth and developmental milestones - 1 year
walk at one
also age of rapprochment → child exploring close by then runs back to mother
“walk/wondering and one”
this is when a lower extremity prosthesis might be prescribed
primitive reflexes
typically (generalization) disappear by 6-8 months
moro: sudden startle when loss so support → infant outstretches arms
fencer: turning head → extension of limbs ipsilaterally, flexion contralaterally
palmar grasp: digits flex w stroking palm
babinski: toes up
normal growth and developmental milestones - 2 years
“two things”
2-word sentences
200 words
2/4 words are intelligible (50%)
starts to run (using two legs)
walks up stairs one foot at a time
normal growth and developmental milestones - 3 years
3-word sentences
¾ words intelligble (75%)
3 wheel bike
walks up stairs alternating feet
normal growth and developmental milestones - 4 years
more complex sentences and word choice
4/4 words intelligible
Malformations and TORCHS infections
variety of fetal malformations
toxoplasmosis
other (viruses)
rubella
CMV
herpes
syphilis
rubeolla not implicated in congenital malformations
genetic disorders
Down syndrome (trisomy 21): upward slanting eyes, simian crease, cardiac dz (endocardial cushion defects)
Turner syndrome (XO): webbed neck, shield chest, coarctation of aorta
Klinefelter syndrome (XXY): tall stature, gynecomastia, small testicles
all of these carry some degree of intellectual disability
congenital limb deficiencies - most common
left terminal radial deficiency
historically related to thalidomide exposure or maternal diabetes
prosthesis should enhance and not limit function (i.e., child never had a limb and prosthesis should not interfere with compensation/function)
Krukenberg procedure → separates radius/ulna → pincer grasp objects → sensation intact (unlike prostheses)
congenital limb deficiencies - most common LE
fibular hemimelia → leg length discrepancy → syme amputation
fibular is entirely absent (longitudinal deficiency)
congenital limb deficiency - partial proximal femoral focal deficiency (PFFD)
femur is short, patients also typically have a fibula deficiency
sometimes Van Ness Rotation → rotates short limb 180 degrees → intact foot can plantar/dorsi flex acting like the knee and can control new prosethesis
pediatric osseous defects - club foot
excessive severe equinovarus of foot, idiopathic →
plantar flexion, inversion, subtalar adduction → constantly rolling ankle w walking
Tx: PT, serial bracing (correct over time), surgery
pediatric osseous defects - tibia vara
abnormal varus bowing of proximal tibia d/t abnormal medial tibial growth plate
Tx: osteotomy of tibia
pediatric osseous defects - developmental hip dysplasia; Dx/PE, Tx
AKA congenital hip dislocation (bc easily dislocates)
malformation hip joint (femoroacetabular joint) → congenital dislocation of hip
Galleazzi: flex both knees with baby on back → knee is lower on dislocated hip side
Barlow: knees in flexion/adduction → posterior directed force dislocates hip
Ortolani: relocate hip and notice “clunk of relocation” by abducting thighs and applying anterior/medially directed force
US useful for Dx
Tx: Pavlik harness keeps femoral head in acetabulum for few months to prevent AVN
torticollis - pathophysiology, Px
intrauterine malpositioning → SCM scarring and excessive contraction → postural abnormality w head tilting towards affected SCM and chin turning away from affected SCM
Tx: PT, ROM of neck and SCM, surgery
grading of SCFE
head of femur slipping and sliding off femoral growth plate
Hx: obese adolescent male
PE: leg in external rotation
1: 0-33% sliding
2: 34-50% sliding
3: >50% sliding
Tx: always needs surgical pinning or else AVN
Cobb angle for scoliosis
< 20 deg - observe
20-40 deg - Milwakee Brace 24 hours/day, very restrictive
> 40 deg - surgery
Scheurmann dz
idiopathic juvenile kyphosis → restrictive lung pattern
XR: anterior kyphotic deformity, VB wedging, Schmorl nodes (nucleus pulposus leaks into adjacent vertebral body)
Tx: PT, TLSO brace, surgery
Jones criteria, particularly migratory polyarthritis, and elevated CRP/ESR → Dx?
Hx Strep pyogenes (GAS) infection → systemic inflammatory reaction
Tx: PT, NSAIDs, steroids → reduce inflammation and maintain fucntion
DMD - etiology, EDX
X linked recessive, Xp21 mutation → no dystrophin being produced → progressive myopathy w muscle tissue replaced by fibrosis starting w neck flexors
labs: elevated CK, muscle Bx shows fiber degeneration
NCS: normal SNAPs, CMAP amplitude low
EMG: myopathic motor units (SDSA, early recruitment, decreased insertional activity)
myotonia congenita
genetic disorder → myotonia, spasms, muscle hypertrophy; worsed by cold weather → unable to smoothly grasp and release
NCS: normal
EMG: myotonic discharged (divebomber sound), otherwise normal
juvenile rheumatoid arthritis - subtypes
polyarticular: many joints; worse prognosis if RF+ (majority RF-)
pauciarticular: <5 joints, but severe; usually ankles/knees; HLA B27+ and ANA+
* *ophthalmology referral** → mandatory bc risk of uveitis/iridocyclitis and needs regular slit lamps evals
systemic: multiorgan involvement + joints; fever/rash/hepatosplenomegaly
CP subtypes and clinical presentation
spastic diplegia (paraplegia) most common spasticity, scissoring, toe walking, crouch gait
dyskinetic - movement disorders
choreoathetosis, ataxia, dystonia
sitting up by age 2 = better prognosis for ambulating
