Pediatrics Flashcards
1
Q
Upper motor neuron bladder
A
Lack of autonomic response for voiding
2
Q
Lower motor neuron bladder
A
Lack of ability to empty bladder
3
Q
Cerebral palsy
A
Umbrella term for neurological brain injury/malformation that occurs before, during or immediately following birth resulting in impaired gross motor, muscle tone, visual impairement, coordination/FMC, balance, posture, reflexes, cognitive processing and oral motor functioning
4
Q
Spastic CP
A
Lesion of motor cortex resulting in spasticity including hypertonia and hyperreflexia
5
Q
Key markers of CP
A
Retention of primitive reflexes
Abnormal muscle tone
Hyper-responsive tendon reflexes
Asymmetrical use of extremities
Clonus
Involuntary movement
Poor feeding and tongue control
6
Q
Dyskinetic CP
A
Lesion of basal ganglia resulting in fluctuations in muscle tone, posturing and involuntary movement including dystonia, athetosis, chorea
7
Q
Dystonia
A
Excessive repetitive movement and abnormal postures that increase with intention
8
Q
Athetosis
A
Writhing involuntary movements that are more distal than proximal
9
Q
Chorea
A
Involuntary movements that are more proximal than distal
10
Q
Ataxic CP
A
Lesion in cerebellum that results in hypotonia, ataxia movement and lack of stability
11
Q
Monopleegia
A
One extremity
12
Q
Hemiplegia
A
UE and LE on same side
13
Q
Paraplegia
A
LE
14
Q
Quadriplegia
A
All extremities
15
Q
Diplegia
A
UE involvement < LE involvement
16
Q
Common complications with CP
A
Seizures, cognitive deficits, visual impairment, dysphagia
17
Q
GMFCS Level 1
A
Walks without restrictions, limitations in advanced gross motor skills
18
Q
GMFCS Level 2
A
Walks without AE, limitations walking outdoors and in community
19
Q
GMFCS Level 3
A
Walks with AE, limitations walking outdoors and in community
20
Q
GMFCS Level 4
A
Self-mobility with limitations, transported in w/c or use of power mobility outdoors and in community
21
Q
GMFCS Level 5
A
Self-mobility severely limited even with AT use
22
Q
MACS Level 1
A
Handles objects easily and successfully
23
Q
MACS Level 2
A
Handles most objects with some reduced quality and speed
24
Q
MACS Level 3
A
Handles objects with difficulty and needs help to modify or prepare activities
25
MACS Level 4
Handles limited section of easily managed objects
26
MACS Level 5
Does not handle objects and has severely limited ability to perform simple actions
27
CP tx
- Motor planning, control, coordination practice
- AROM/PROM with stretching, exercise, orthotic
- AE for participation
- Seating and positioning education
- CIMT
28
Spinal bifida occulta
Bony malformation with seperation of vertebral arches with no external malformation, may not be discovered until late childhood
29
Spina bifida cystica
Exposed pouch composed of CSF, meninges and/or spinal cord
1. Meningocele
2. Myelomeningocele
30
Meningocele
Contains CSF and meninges but not spinal cord - usually does not present symptoms impacting function if spinal chord is not entrapped, symptoms may include occasionally instability, gait disturbances and bowel/bladder impairment
31
Myelomeningocele
Contains CSF, meninges and spinal cord/nerve roots, most commonly in lumbar region, sensory/motor impairment below the level of the injury, incontinence, ulcers, DVT
32
Common complications of myelomeningocele
Hydrocephalus
Arnold-chiari
Tethered cord
33
Tonic-clonic seizures
Tonic phase: loss of consciousness, stiffening of body, heavy/irregular breathing, drooling, pale skin
Clonic phase: alternating rigidity and rhythmic and relaxation of muscles
Postictal state: period of drowsiness, disorientation or fatigue
34
Absence seizure
Brief lapse or loss of awareness with absence of motor activity that lasts 15 seconds and mimics daydreaming
35
Status epilepticus
Extended seizure
36
Akinetic seizure
Loss of muscle tone for 30 seconds
37
Myoclonic seizure
Contractions of single muscles or muscle groups
38
Public health model of service delivery levels
1. Universal (whole population design)
2. Targeted (selective services)
3. Intensive
39
RTI approach to school-based practice
Tier 1: school-wide efforts for all children
Tier 2: developing and running programs for at-risk student and consulting with teachers to modify learning demands
Tier 3: individual or group interventions for students
40
CBT strategies
1. Psychoeducation
2. Affective education
3. Cognitive restructuring
4. Relaxation training
5. Exposure of fears and contingency mgmt
41
Affective education
Teaching skills to identify and recognize emotions and what impacts emotions
42
Cognitive restructuring
Teaching stills to recognize maladaptive thoughts
43
Positive behavioral intervention and supports (PBIS) Model
Consistent application of procedures for correcting misbehaviors at school
Rules with instructions for behaviors with consistent expectations
Focus is on positive reinforcement and talking through the negative behaviors with the child to teach
Within the 3 tier system
44
Shifting FM skill
Ability to move objects between fingers
- Trying to separate two pieces of paper that are stuck together
- Move fingers closer to the end of your pencil to begin writing
45
Examples of fingers-to-palm translation skill
Grabbing coins out of purse
Crumbling papper
46
Example of palm-to-fingers translation skill
Placing game pieces on a board
47
Shaping technique for learning
Successively approximating or learning intermediate behaviors that are prerequisite of the final behavior with reinforcers applied in small steps
48
What dx commonly co-occurs with ODD
Attention deficit hyperactivity disorder (ADHD)
49
When does transition planning typically start
Age 14 to 16
50
Social–Cognitive Intervention Model
Facilitate learning of behaviors by observing the behavior of others
51
Ideational praxis
Conceptualize, plan, and execute a complex, sequence of motor actions to interact with objects such as toys or climbing equipment
52
Adaptation
Responding to environment challenges as they occur
53
Mental schemas
Organizing experiences into concepts
54
Operations
Cognitive methods used by child to organize schemes and experiences to direct future action
55
Equilibrium
Balance between what child knows and can do vs what environment provides
56
Assimilation
Ability to take new situation and change it to match existing scheme (generalization)
57
Accomodation
Development of new scheme in response to new situation (discrimination)
58
Bayley Scales of Infant Development
What: assess multiple areas of development for baseline including cognitive, language, motor, adaptive behavior and social-emotional behavior (standardized)
Method: age appropriate performaced-based items and parent questionnaire
Population: 1 to 3.5
59
Hawaii Early Learning Profile
What: assess 6 areas of function including cognitive, language, GM, FM, social emotional and self-help (criterion-based)
Method: age appropriate performance-based items administered
Population: birth to 3 with development delay or at risk for development delay
60
Miller assessment for pre-schoolrs
What: assess sensory, motor and cognitive abilities (standardized)
Method: age appropriate performance-based items administered
Population: 2 years 9 months to 5 years 8 months
61
Pediatric evaluation of disability inventory
What: assess capabilities and detects function deficits to determine developmental level across self-care, mobility and social skills (standardized)
Method: observation and interview
Population: 6 months to 7.5 years
62
Developmental Assessments
Bayley Scales of Infant Development
Hawaii Early Learning Profile
Miller assessment for pre-schoolrs
63
BOT-2
What: assess FM and GM (standardized)
Method: long and short form with eight subtests (fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running and ability, upper limb coordination, strength)
Population: 4-21
64
Peabody developmental motor scales
What: assess GM and FM (standardized)
Method: test items to address reflexes, sustained control locomotion, object manipulation, grasping ,visual motor integration
Population: birth to 6 with motor, speech, hearing disorders
65
Motor assessments
BOT-2
Peabody
66
Berry-VMI
What: assesses visual motor integration
Methods: copy 24 geometric shapes (standardized)
Population: 2-100
67
DTVP-2
What: assess visual perceptual skills and visual motor integration
Methods: eight subtests (eye-hand coordination, copying, spatial relations, visual-motor speed, position in space, figure ground, visual closure, form consistency)
Age: 4-10
68
MVPT-4
What: assess visual motor without motor components
Method: 5 subtests (spatial relations, visual discrimination, figure ground, visual closure, visual memory
Population: 4 - 95
69
MFVPT-vertical
What: assess individuals with spatial deficits due to hemispatial neglect or abnormal visual saccades
Method: 36 items placed vertically are used to assess spatial relationship, visual discrimination, figure ground, visual closure and visual memory without motor components
Population: 4 - 95
70
Visual perception assessments
MFVPT
Berry-VMI
DVTP
MVPT
71
Childhood Autism Rating Scale
What: determine severity of ASD as mild, moderate, severe and distinguished children with ASD from children with development delays
Method: observational tool to rate behaviors
Population: children 2+ with ASD
72
Copying inventory and early copying inventory
What: assess coping habits, skills and behaviors including effectiveness, style, strengths and vulnerability to develop intervention for coping skills
Method: questionnaire or caregiver questionnaire
Early: 4 - 36 months
Coping: 15 years +
73
Revises Knox Preschool Play Scale
What: observations of play skills to differentiate developmental play abilities, strengths, weakness, interests
Method: two 30 min observations completed in natural indoor and outdoor environment with peers and observations are organized according to 6 month intervals up to age 3 across four dimensions (space mgmt, material mgmt, symbolic and participation)
Population: 0 - 6
*useful when standardized assessment might not be possible
74
Test of playfulness
What: assess child's playfulness
Method: observation of four aspects of play including intrinsic motivation, internal control, suspension from reality and framing. The extent, intensity and skillfulness of play are rated (more of each = more play)
Population: 15 months to 10 years
75
Transdisiplinary play-based assessment
What: assesses child development, learning style, interaction patterns and behaviors to determine need for services
Method: non-standardized play assessment using observation across 6 stages
Population: 0 - 6
76
School function assessment
What: assess functional performance to promote participation in school environment (does not measure academic performance)
Method: criterion-referenced questionnaire that addresses level of participation, type of support required and performance on school-related tasks
Population: K - 6th grade (5 - 12)
77
Bradydysrhythmia
Abnormally slow HR (<60 bpm)
Atrioventricular block most common
May require pacemaker
78
Tachydysrhythmia
Abnormally fast HR (>200-300)
Can lead to CHF
May result in irritability, poor eating habits, pallor skin
79
Respiratory distress syndrome
Deficiency of surfactant (supports breathing upon birth), can result in chronic lung conditions due to compromised O2 absorption
80
Bronchopulmonary dysplasia
Due to prolong use of mechanical ventilation to treat acute respiratory problems leading to thickening of airway and greater risk for future infection/problems
81
Asthma
Airway constriction in lower respiratory tract, difficulty breathing, wheezing
82
Asthma intervention
Reduction to irritant education
Pacing
Stress mgmt
Structured peer-groups
Breathing exercises
83
Cystic fibrosis
Degenerative condition resulting in malfunctioning mucus-producing glands that block small intestine and pancreas
Can result in chronic pulmonary disease that causes chronic cough, wheezing and lower respiratory tract infection
84
Intervention for CF
Education on progression
Energy conservation
Strategies for efficient breathing
85
Signs of hemophilia
Excessive bleeding
Excessive bruising
Spontaneous bleeding
Nosebleeds
86
Osteogenesis imperfecta
Brittle bones disease, minor trauma results in fractures, frequnetly develop progressive deformities
87
What strategies are important for osteogenesis imperfecta
Caregiver ed on handling and positioning
Include activity with weight bearing
88
Marfan syndrome
Excessive growth at the epiphyseal plates resulting in lax and hypermobile joints and abnormal connective tissue which provides support for the body and organs
89
Arthrogryposis multiplex congenita
Incomplete contracture of joints at birth associated with reduction of anterior horn cells, patients present with increased stiffness and incomplete fibrous ankylosis
90
Focus of intervention with Arthrogryposis multiplex congenita
Increase and maintain ROM
Stretching/strengthening program
Use of adaptive equipment for ADL/IADL
91
Congenital clubfoot
Forefoot adduction and supination, heel varus, equinus of the ankle, and medial deviation of the foot.
92
Congenital club hand
Partial/full loss of radius and bowing of the ulnar shaft, underdevelopment of the upper extremity nerves and musculature
93
Dysplasia of the hip
Dislocation of head of femur from acetabulum resulting in hip laxity that can lead to long term disability if not diagnosed early but with splinting/casting there are good outcomes
94
Barlow test
Used to assess dysplasia of hip - determines if head of femur is dislocated from acetabulum when in adduction with posterior force
95
Without tx for dysplasia of hip what will result
Trendelenburg's sign - hip drops to the opposite side of dislocation and trunk shifts toward dislocated when the child stands on one foot
96
Polydactyly
Additional fingers or toes
97
Syndactyly
Webbing occurs beween fingers and toes
98
Megadactyly
Overly large digits - difficulty with FMC
99
Microdactyly
Overly small digits
100
Amelia
Absence of limb or segment of limb
101
General presentation of JRA
Joint inflammation
Joint stiffness
Joint contracture
Change in growth patterns
102
Three types of JRA
1. Pauciarticular: four or fewer joints
2. Polyarticular: five or more joints
3. System "stills disease: polyarticular with organ involvement (fever, rash, anorexia, elevated WBC, spleen/liver enlargement)
103
Intervention for JRA
Splinting as needed
AROM/PROM
Monitor joint functionality
Monitor joit defority
Energy conservation
Adaptive equipment
104
Types of fractures
Complete
Comminuted
Compound
Epiphyseal
Greenstick
Intrauterine
105
Lordosis
Anteroposterior curvature in lumbar region
Hollow back
Anterior pelvic tilt
106
Lordosis tx
Stretching hip flexors
Strengthening abdominals
Postural training
Back brace
107
Kyphosis
Posterior convexity
Round back in thoracic region
Posterior pelvic tilt
Lateral flexion
108
Kyphosis tx
Postural training
Strengthening
Milwaukee brace
Anterior spinal release
109
Scoliosis
Lateral curvature of the spine
110
Types of scoliosis
1. functional: due to bad posture, contracure. leg discrepancy or pain, spine is still flexible
2. Congenital: structure due to abnormal spinal structure
111
Severity of scoliosis based on degrees
Cure 20 degrees or less: mild
Curve more than 40 degrees: permanent deformity
Curve 65-80 degrees: reduced cardiopulmonary fx
112
Scoliosis tx
Boston brace
Thoracolumbosacral orthotic
Abdominal muscle strengthening
ADP adaptations
113
Muscular dystrophy category classified by
Progressive degeneration and weakness of muscle groups that can lead to death
114
Limb girdle muscular dystrophy
Affects proximal muscles of pelvis and shoulder girdle with slow progression
115
Facioscapulohumeral muscular dystrophy
Affects face, upper arms, scapular region with limited ability to raise arms and decrease mobility in facial muscles
116
Duchenne's muscular dystrophy (DMD)
Most common form of muscular dystrophy with symptoms developing between ages 2-6 and fast progression of muscle weakness
117
How is DMD diagnosed
Gower's sign - when asked to get up from sitting on floor child moves hands on legs and crawls up to thighs to assume standing
118
Prognosis of DMD
Age expectancy in 20s due to respiratory/cardiovascular complications
Wheelchair by age 9
119
Congenital muscular dystrophy
Onset in utero with brain involvement impacting neuro-muscular functioning with symptoms including hypotonia, generalized muscle weakness and contractures
120
Categories of congenital muscular dystrophy
CMD I: no sever intellectual impairment
CMD II: muscle and brain abnormalities
CMD II and IV: muscle brain and eye abnormalities
121
Condition mgmt. spina bifida 5-6 years old
Begin pressure checks
Communicate with caregivers about body changes
Keep track of AD
Self-catheterization at school
Carry doctor contact info in case of emergency
122
Condition mgmt. spina bifida 10-14 years old
Recognize when feeling bas is due to condition
Name docs
Know medications
Direct others how to help with AD
Self-catheterization in community
Takes responsibility for health
123
Condition mgmt. spina bifida 15-18 years old
Take meds independently
Know how to contact docs and therapists
perform regular skin checks
Maintain equipment
Manage weight
124
Erb-Duchenne palsy
Injury to brachial plexus (C5 and C6) due to extreme shoulder flexion which is common with breech deliveries resulting in unilateral weakness and wasting of small muscles of hands and shoulder and difficulties with sensory discrimination of UE
125
Characteristic posture of Erb-Duchenne
Waiter's tip position - shoulder adduction and internal rotation, elbow extension, forearm pronation and wrist flexion
126
Klumpke's palsy
Compression to brachial plexus (C8 and T1) resulting in paralysis of hand and wrist muscles and claw deformity
127
OT intervention with brachial plexus injury
Observation of ADL
Fabrication of sling that fits proximally around humerus to ensure alignment of shoulder joint
PROM/AROM
Resistive and WB exercises
Tactile stimulation using texture, vibration, massage
Bilateral based activities
Edema mgmt
128
Is mental imagery a CBT approach
Yes
129
Zones of regulation
Curriculum to teach children about regulating emotions and sensory needs and using strategies reach optimal regulation across four zones
130
Four zones of regulation
Red: high arousal, intense emotions, anger
Yellow: less arousal but still more heightened state, stress, anxious, nervous
Green: optimal state, ready to work, calm, focused and attentive
Blue: sadness illness, boredom, fatigue
131
3 types of learning disabilities
Dyslexia
Dysgraphia
Dyscalculia
132
Atlantoaxial instability
Common complication with down syndrome of excessive movement at the junction between the atlas (C1) and axis (C2) a which can lead to dislocation of atlantoaxial joint and permanent spinal cords damage, children should not hyper-flex neck or perform front rolls
133
Prader willi syndrome
Moderate intellectual disability, food seeking behaviors, hypotonia, poor thermal regulation, underdeveloped sex organs, long faces with slanted eyes
134
Williams syndrome
Intellectual disabilities, cerebral and cardiovascular abnormalities, interest in muscle, social interaction and writing, difficulties with visual, spatial and motor skills
135
Fragile-X syndrome
Intellectual disability, cranial-facial deformities, prominent jaw/forehead, flat feet, hypermobile joints
136
PKU
Inborn error in processing amino acids resulting in severe intellectual and behavioral difficulties if specific diet of limited protein is not followed (can resolve around age 10 if followed correctly)
137
Galactosemia
Inborn error due to inability to convert milk sugar to glucose which can result in spleen and liver dysfunction with symptoms of jaundice, vomiting, lethargy, cataracts, tremors, choreoathetosis, ataxia and infection and if left untreated death. Treatment involves no milk diet.
138
Lesch-Nyhan syndrome
Inborn error due to inability to metabolize purines, infant often appear normal for firs year and then regress and present with intellectual disability , neuro-motor degeneration, spastic, nail-biting and face-rubbing compulsions, treatment involved self-injurious behavior
139
Developmental coordination disorder
Condition of motor incoordination, symptoms first present as delayed achievement of motor millstones and self-care skills and progress to difficulty with FM/GM skills as well as social skills and academics due to underlying motor coordination impairment
140
Implications for OT with developmental coordination disorder
Focus on performance across contexts
Use modification/accommodations for written language including keyboarding
Provide support in PE
Practice safe motor skills
Develop self concept and self esteem
141
Common approach for developmental coordination disorder
CO-OP (cognitive orientation to daily occupational performance
142
CO-OP
Client-centered and cooperative problem-solving approach used to coach child through self-discovery to determine solutions for problems that involve motor performance, child helps to formulate and select goals and work on way to generalize across contexts
143
Anticipated outcomes of CO-OP
Acquisition, generalization and transfer of skill
Improved self-efficacy and independent strategy development
144
Typical grasp progression
Primitive - transitional - mature
145
Primitive grip
Whole hand with pronated forearm used to hold pencil with writing movement coming from shoulder
146
Transitional grip
Flexed fingers with radial side down and pronated forearm that transitions to supinated forearm position
147
Mature grip
Pencil stabilized by distal phalanges of thumb, middle, index with writs slightly extended and forearm supinated resting on table
148
Functional grips for handwriting
Dynamic tripod
Lateral tripod
Dynamic quadrupod
Lateral quadrupod
149
Word legibility formula
Total # legible words / total number of words written
150
Neurodevelopmental approach to HW
For children who have poor postural control, abnormal tone and poor proximal stability focuses on completed preparation activities for posture/stability and UE function
151
Acquisitional approach to HW
HW should be taught directly through brief daily lessons and individualized to the child
152
Three phases of HW using acquisitional approach
1. Cognitive phase: child understands demand of HW and develops cog strategies for required motor output
2. Associate phase: child practices and starts to self-monitor, use of proprioceptive feedback and visual cues
3. Autonomic phase : child performs HW with minimal conscious effort
153
Sensorimotor approach to HW
Multi-sensory input provided to enhance snsory system for HW including use of alternative media experiences and multiple writing tools, surfaces and positioning
154
Biomechanical approach to HW
Focused on ergonomic factors that impact production of writing including sitting posture, paper position, pencil grasp and paper modifications
155
Psychosocial approach to HW
Focused on improving self-control, copying skills and social behaviors
156
Miller Function and participation scales age group
2 years 6 months to 7 years 11 months
157
BOT-2 age group
4-21 years
158
SFA age group
K - 6th grade (5 - 12)
159
Sensory integration and praxis test age group
4 years through 8 years, 11 months
160
Standardized tests for sensory integration assessment
BOT
SFA
MFUN
SPIT
161
Caregiver questionnaires for sensory integration assessment
SP
SPM
Touch inventory for elementary-school-aged children
162
Common assessments for students with behavioral disorders
SFA
Social skills rating system
163
Intervention strategies for studnets with behavioral disorders
- Take place in context
- Goal-directive
- Motivational and meaningful
- Enjoyable
- Just right challenge
- Rational intervetnion
164
What is rational intervention
Therapists uses least amount of control necessary to support child based decisions with understanding that safety and respect are priorities and that each interaction is an opportunity for learning
165
Color zones used in rational intervention to classify behavior and determine whether intervention is needed
Green: behaviors appropriate and acceptable
Yellow: behaviors are slightly problematic and require additional observation, child may benefit from enviro adjustments, cues or facilitation
Red: behaviors require immediate intervention because child or others are being put at risk by negative behavior (verbal or physical)
166
RI response options
Matching
Facilitation
Monitoring
Gentle correction
Moderate correction
Strong correction
167
Matching
OT match response to child behavior
168
Facilitation
Observe child and improve environmental supports
169
Monitoring
Observe child and let child know OT is present to encourage and prompt with guiding questions to help child problem solve
170
Gentle correction
Altering environment, reminding child of expectations, modeling appropriate behavior, redirecting to different location/activity
171
Moderate correction
Giving child a break by redircting
