Pediatric Rehabilitation Flashcards
What is the most common upper limb deficiency in the pediatric population?
Left terminal transradial deficiency
When is the fetus most susceptible to a congenital abnormality?
3-8 weeks
mesodermal formation of limb by interacting with the ectoderm
What is the limb deficiency called with a flipper-like appendage attached to trunk?
Phocomelia
Absence of proximal segment
Others:
Amelia - absence of limb
Hemimelia - partial/missing
When is the best time to fit a pediatric patient with a prosthesis?
6 months: achieved sitting balance which enables midline activities
What is the most common congenital lower limb deficiency?
Fibular longitudinal deficiency (fibula hemimelia)
When is a lower limb-deficient child fit with a prosthetic?
8-10 months: when pulls to stand
True or false: Congenital-limb deficient children do not develop phantom sensation or pain even after conversion to surgical amputee of the limb
True
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?
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)
3 mo with decreased RUE movement, -movement at birth or now. Where is the injury?
Global = flail arm
+/- Horner’s due to affect on superior cervical sympathetic ganglion at T1
6 mo with decreased LUE movement. Right handed with decreased grasp and reach. Where is the injury?
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
Describe the following type of nerve injury:
Neuropraxia
Nerve stretched (recovery usually by 2-3 mo)
Describe the following type of nerve injury:
Avulsion
Nerve root avulsed from cord
Describe the following type of nerve injury:
Rupture
Nerve ruptured distal from cord
Describe the following type of nerve injury:
Neuroma
Prior stretched or ruptured nerve that heals into scar. May impair signaling.
Asymmetric moro reflex would hint what type of injury?
Brachial plexus
What is the threshold to send a child to surgery for brachial plexus injury?
- Elbow flexion / shoulder abduction/flexion less than 50%
- If global injury = surgery <3mo
- If upper/limited elbow flex or shoulder abduction 3-9 mo
With brachial plexus injury in child, what type of shoulder dislocation may you see as a complicated of GH dysplasia?
Posterior dislocation
Caucasian Female b/t 1-3 yo
ANA positive –> incr change of Uveitis
1 active joint
Dx?
Oligoarticular Juvenile Idiopathic Arthritis or JRA
Female in adolescence 5 or more joints RF+ ANA + HLA-DR4
Dx?
Polyarticular JRA / JIA
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?
Systemic JRA / JIA
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?
Psoriatic arthritis
How much folate is recommended to take with a FH of spina bifida?
4mg folate
Neck flexor weakness not achieved by 3 mo…which dystrophic myopathy is this associated with?
Duchenne’s
What is the difference between Duchenne’s and Beckers
Duchenne’s: Absent or decreased dystrophin
Becker: Truncated or shortened protein with Becker
