Pediatric Rehabilitation

Question 1

What is the most common upper limb deficiency in the pediatric population?

Answer 1

Left terminal transradial deficiency

Question 2

When is the fetus most susceptible to a congenital abnormality?

Answer 2

3-8 weeks

mesodermal formation of limb by interacting with the ectoderm

Question 3

What is the limb deficiency called with a flipper-like appendage attached to trunk?

Answer 3

Phocomelia
Absence of proximal segment

Others:
Amelia - absence of limb
Hemimelia - partial/missing

Question 4

When is the best time to fit a pediatric patient with a prosthesis?

Answer 4

6 months: achieved sitting balance which enables midline activities

Question 5

What is the most common congenital lower limb deficiency?

Answer 5

Fibular longitudinal deficiency (fibula hemimelia)

Question 6

When is a lower limb-deficient child fit with a prosthetic?

Answer 6

8-10 months: when pulls to stand

Question 7

True or false: Congenital-limb deficient children do not develop phantom sensation or pain even after conversion to surgical amputee of the limb

Answer 7

True

Question 8

3 mo with decreased RUE movement, +hand movement at birth, with new elbow flexion. Shoulder dystocia during labor with 1st time Mom. Where is the injury?

Answer 8

Upper trunk C5-C6 +/- C7 = Erb’s

• Cannot flex, abduct, or externally rotate
• Waiter’s tip (arm is adducted, internally rotated, extended, pronated, and wrist flexed)
• Most common
• Likely neuropraxia (stretch)

Question 9

3 mo with decreased RUE movement, -movement at birth or now. Where is the injury?

Answer 9

Global = flail arm

+/- Horner’s due to affect on superior cervical sympathetic ganglion at T1

Question 10

6 mo with decreased LUE movement. Right handed with decreased grasp and reach. Where is the injury?

Answer 10

Lower trunk C8-T1 = Kulmpke’s

• Decreased hand function “ claw hand “
• Concern at 6 months for other injury such as stroke, brain injury etc–> get MRI of brain

Question 11

Describe the following type of nerve injury:

Neuropraxia

Answer 11

Nerve stretched (recovery usually by 2-3 mo)

Question 12

Describe the following type of nerve injury:

Avulsion

Answer 12

Nerve root avulsed from cord

Question 13

Describe the following type of nerve injury:

Rupture

Answer 13

Nerve ruptured distal from cord

Question 14

Describe the following type of nerve injury:

Neuroma

Answer 14

Prior stretched or ruptured nerve that heals into scar. May impair signaling.

Question 15

Asymmetric moro reflex would hint what type of injury?

Answer 15

Brachial plexus

Question 16

What is the threshold to send a child to surgery for brachial plexus injury?

Answer 16

• Elbow flexion / shoulder abduction/flexion less than 50%
• If global injury = surgery <3mo
• If upper/limited elbow flex or shoulder abduction 3-9 mo

Question 17

With brachial plexus injury in child, what type of shoulder dislocation may you see as a complicated of GH dysplasia?

Answer 17

Posterior dislocation

Question 18

Caucasian Female b/t 1-3 yo
ANA positive –> incr change of Uveitis
1 active joint

Dx?

Answer 18

Oligoarticular Juvenile Idiopathic Arthritis or JRA

Question 19

Female in adolescence
5 or more joints
RF+ 
ANA +
HLA-DR4

Dx?

Answer 19

Polyarticular JRA / JIA

Question 20

Poly or oligoarthritis
1-6 yo child
Persistent intermittent fever daily, spikes daily or twice daily
Rash-transient, nonpruritic, with fever
Hepatosplenomegaly, lympahdenopathy
Serositis of heart or lungs

Dx?

Answer 20

Systemic JRA / JIA

Question 21

White male
Dactylitis
Nail changes (pitting)
Skin changes: Auspitz’s sign, silvery scales on extensor surfaces
HLA-B27 +
Asymmetric monoarticular or oligoarticular involvement (Large joints –> knee)
DIP involvement
Enthesitis : inflammation of insertion of ligament, tendon, joint, etc)

Dx?

Answer 21

Psoriatic arthritis

Question 22

How much folate is recommended to take with a FH of spina bifida?

Answer 22

4mg folate

Question 23

Neck flexor weakness not achieved by 3 mo…which dystrophic myopathy is this associated with?

Answer 23

Duchenne’s

Question 24

What is the difference between Duchenne’s and Beckers

Answer 24

Duchenne’s: Absent or decreased dystrophin

Becker: Truncated or shortened protein with Becker

Question 25

Anterior horn cells affected
Progressive, proximal>distal, LE>UE
Floppy baby, tongue fasciculations, +/- reflexes
Bulbar Palsy
Respiratory findings - “Bell shaped” chest
Sensation intact

Answer 25

Spinal Muscle Atrophy

SMN gene on 5q

Question 26

What is cerebral palsy?

Answer 26

Non-progressive anomaly in or around the time of birth that affects movement

(The most common motor disability of children)

Question 27

MC finding on MRI for CP?

Answer 27

PVL (Periventricular leukomalacia)

Question 28

What is dystonia?

Answer 28

Slow rhythmic movement with tone changes generally found in the drunk and extremities, associated with abnormal posturing

Question 29

What is the threshold for migration percentage of acetabulum in CP for orthopedic surgery?

Answer 29

30%