Pediatrics

Question 1

APGAR meaning and scoring

Answer 1

Activity (muscle tone (0-2)
Pulse (heart rate 0-2)
Grimace (reflex irratibility 0-2)
Appearence ( Skin colour 0-2)
Respiration (breathing rate and effort 0-2)

Score given at 1 and 5 minutes post birth
Score 0-10
Severely depressed 0-3
Moderately depressed 4-6
Excellent condition 7-10

APGAR score that remains low 10 minutes after birth are at a risk of neurological complications

Question 2

Preterm birth and gestational ages

Answer 2

Preterm is birth of viable infant before 37 weeks of gestation
-Preterm birth and low borth weigbht combined increases the risk for neurological complications

Gestational age:
Extremely preterm: <28 weeks
Very preterm: 28-32 weeks
Moderate to late pretem 32-37 weeks
Term birth : 37 weeks (typically 38 to 41 weeks

Preterm babies adjusted age is based on 40 weeks gestation timelinbe

• subtract chikds chronological age from number of weeks they are bon prematureelly (subtracted from 40)
  e. g chronolical age=20, weeks born premature=6 weeks, adjusted age=14 weeks

Question 3

Assymetrical tonic neck reflex ATNR

Answer 3

Integration: 5 mnonths
Stimulus:turning head
response: Extenseion of UE and LE on the side the face is turned to

Question 4

Rooting reflex

Answer 4

Integration: 3 months
Stimulus: Lightly stroking the perioratal area
response: Movement of head and lips towards the stimulus

Question 5

Suck-swallow reflex

Answer 5

Integration: 5 months
Stimulus: touch to the inside of the mouth
response: rhythmic sucking and swallowing

Question 6

palmar grasp

Answer 6

Integration: 7 months
Stimulus: pressure against the palm of the hand
response: Flexion of the fingers

Question 7

Flexor withdraawal

Answer 7

Integration: 2 months
Stimulus: noxious stimulus to the bottom of the foot
response: Extension of the toes, ankle DF, knee and hip flex on stimulus side

Question 8

Crossed extension

Answer 8

Integration: 2 months (inconsistent)
Stimulus: noxious stimulus to the bottom of the foot
response: flexion of LE on stimulated side and ext and adduction on the LE of contralateral side

Question 9

Moro reflex

Answer 9

Integration: 5 months
Stimulus: Sudden head drop backwards
response: Extension and abduction of the UE with opening of the hands and crying, may be followed by flexion and adduction of UE

Question 10

Positive support

Answer 10

Integration: 2 months (incomnsistent)
Stimulus: feet in contact with the floor
response: bilateral leg extension with bilateral support

Question 11

Stepping refleex

Answer 11

Integration: 4 moths
Stimulus: supported upright vertical with fet in contact with flat surface
response: rhythmic high stepping movement

Question 12

Landau

Answer 12

Integration: 24 months (2 years)
Stimulus: supported in prone with hands under thorax
response: head, neck, back, and LE exteension

Question 13

Symmeetrical tonic neck reflex(STNR)

Answer 13

Integration: 12 months
Stimulus: flexion or extension of cervical spin
response: Cervical spinee flexion causes UE flexion & LE extension, C spine extension causes UE extension and LEE flexion

Question 14

Milestones (Roll, sit, crawl, cruising, standing, walking, stair climbing (step to pattern), Running, kicking a ball, skipping

Answer 14

Roll (1st roll from prone to supine (3-6 months)
sit: 6 months 
crawl: 8-9 months 
cruising: 9 months
standing: 9 months 
walking: 10-15 months,
 stair climbing (step to pattern): 18-20 months
Running: 2 years 
kicking a ball: 3 years 
skipping: 5 years

Question 15

Alberta infant motor scale (AIMS)

Answer 15

0-18 months

-motor skills

Question 16

Bayley scasle of infant motor development (BSID)

Answer 16

• 1-42 months

- mental, motor, and behavior scales

Question 17

Peabody development motor scales (PDMS-2

Answer 17

• 0-60 months

- Fine and gross motor skills

Question 18

Bruininks oseretsky tests for motor performance (BOT-2)

Answer 18

• 4 - 21 years
• fine and gross motor skills
• Can test and document longitudinal impact of condition on motor function

Question 19

Down syndrome (Trisomy 21)

Answer 19

-Genetic diisorder caused by faulty cell division resulting in an extra 21st chromosome
-mild developmental delay, follows normal developmental curve but is just slightlydelayed
-Mild to moderate intellectual delay
Distinct facial features:
1)Flattened nose
2) Small mouth and jaw
3) Narrow eyes
4) Protruding tongue

Will have increased ligament laxciity and hypotonia, need to bee aware for mobilizations bc atlantoaxcial joint could lead to a high level SCI

Question 20

Cerebral palsy

Answer 20

-Describes a group of permanent disorders of the development of movement and posture, that lead to non-progressive disturbances that occurred in the developing fetal or infant brain.

Risk factors:

• Prematurity (linked to periventricular leukomalasia)
• Atypical intrauterine growth
• infection (in utero & post-natal)
• Infarction of the mother
• developmental defect
• Multiple gestations
• placental pathology
• trauma (prenatal, perinatal, early postnatal)

-Spastic type CP is the most common

Type of impairment

Spastic

• velocity-dependent resistance to movement
• Damage to the cortex or white matter to and from the sensorimotor cortex
• Most common type of CP
• Positive UMN syndrome
• Diplegia is the most common type of spastic CP (scissoring gait, and toe walking)

Dyskinetic
Ataxia:
-Movement disorder characterized by intention tremor, lack of muscle control,, and poor coordination of voluntary movements
-Most children with ataxic CP can walk without a gait aid but may have difficulty with balance

Athetosis:

• Movement disorder characterized by slow, continuous, involuntary writhing movements
• Commonly affects the distal extremities and the mouth
• Difficulty maintaining a stable posture
• significant limitation in gross motor function

Dystonic

• Movement disorder characterized by involuntary sustained or intermittent muscle contractions leading to repetitive movements, abnormal fixed postures, and disordered tone
• May include twisting or tremulous movements
• dystonic posture: co-contraction of muscles making a sustained abnormal posture
• often triggered by voluntary movement
• significant limitations in gross motor function and fatigue due to high metabolic demand

Mixed:

• Combination of dyskinetic and spastic CP
• Diffuse injury to the motor cortex and basal ganglia

Question 21

GMFCS for CP

Answer 21

scale is considered stable after 2 years old

Level 1: Walks without restrictions, limitations in more advanced gross motor skills

Level 2: Walks without devices, limitations in walking outdoors and in the community

Level 3: Walks with mobility devices, limitations in walking outdoors and in the community

Level 4: Self mobility with limitations, children are transported or use a power mobility outdoors and in the community

Level 5: Self mobility is severely limited, even with the use of supporting technology

Question 22

AFOs for CP

Answer 22

Solid AFO: Blocks ankle movement at talocrural and subtalar joints

• often used with rocker bottom shoe
• limits knee hyperextension
• Indicated for correctable equinus, and excessive DF

Hinged (srticulated) AFO

• Allows controlled DF while still limiting PF
• Limits movement at subtalar joint
• Limits knee hyperextension
• Indicated for true equinus that isn’t fixed, drop for, medial lateral instability

Geound reaction force AFO

• Blocks movement at the talocrural joint and limits subtalar movement
• Increases knee extension
• Good for crouch gait, with weak quads, and overlengthened calf muscles

Question 23

Duchene muscular dystrophy (DMD)

Answer 23

Genetic disorder characterized by progressive weakening and degeneration of muscle leading to activity limitations and participation restriction

• Mutation of the dystrophin gene
• Life expectancy is 20-30 years

Typical presentation:

• Clinical signs become apparent at 2-5 years old
• early motor milestones are achieved at expected ages (Difficulty with walking at 6-8 y.o)
• Impairments become more apparent with higher level gross motor activities (difficulty with run ning at 2-6 y.o)
• 8-12 y.o wheelchair dependent
• 12 y.o completely dependent

Progressive muscle weakness and wasting

• Lower limbs>upper limbs
• proximal>distal
• muscles of face, eyes, speech and swallowing and sphincter typically not involved

S & S:

• Waddling gait
• Psudohypertrophy of calves
• Gowers sign
• Toe walking
• Lumbar Hyperlordosis
• Wide stance with ER of LE

PT management

• Avoid aggressive strengthening (esp eccentric contraction)
• Strengtheing and ROM
• Gait training (try to prolong ambulation not fix it)
• Education on overexertion and energy conservation
• Respiratory exercise (breath stacking, assistive cough, and incentive spirometer)
• Transfer training
• Equipment selection (wheelchair, transfer lifts, power mobility)

Question 24

Duchene muscular dystrophy (DMD)

Answer 24

Genetic disorder characterized by progressive weakening and degeneration of muscle leading to activity limitations and participation restriction

• Mutation of the dystrophin gene
• Life expectancy is 20-30 years

Typical presentation:

• Clinical signs become apparent at 2-5 years old
• early motor milestones are achieved at expected ages (Difficulty with walking at 6-8 y.o)
• Impairments become more apparent with higher level gross motor activities (difficulty with run ning at 2-6 y.o)
• 8-12 y.o wheelchair dependent
• 12 y.o completely dependent

Progressive muscle weakness and wasting

• Lower limbs>upper limbs
• proximal>distal
• muscles of face, eyes, speech and swallowing and sphincter typically not involved

S & S:

• Waddling gait
• Psudohypertrophy of calves
• Gowers sign
• Toe walking
• Lumbar Hyperlordosis
• Wide stance with ER of LE

PT management

• Avoid aggressive strengthening (esp eccentric contraction)
• Strengtheing and ROM
• Gait training (try to prolong ambulation not fix it)
• Education on overexertion and energy conservation
• Respiratory exercise (breath stacking, assistive cough, and incentive spirometer)
• Transfer training
• Equipment selection (wheelchair, transfer lifts, power mobility)