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Pediatrics Flashcards

1
Q

According to the principles of motor development, motor development occurs in a ______ to _____ direction.

A

proximal to distal direction

cephalocaudal

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2
Q

What is the normal gestational period?

A

38-42 weeks

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3
Q

At what gestational period is an infant considered as premature?

A

Born earlier than 37 weeks

40 weeks is typically used when determining corrected age

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4
Q

When during the gestational period does the muscle start to differentiate and the tissue becomes specialized?

A

first trimester

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5
Q

When during the gestational period do motor endplates form?

A

second trimester

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6
Q

When during the gestational period does a clonus response emerge to stretching?

A

second trimester

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7
Q

When during the gestational period does the first sensory system develops?

A

first trimester

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8
Q

When during the gestational period does a reponse to tactile stimuli emerge?

A

first trimester

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9
Q

When during the gestational period do the touch and tactile system receptors start to differentiate?

A

second trimester

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10
Q

When during the gestational period does functional touch and temperature discrimination occur?

A

third trimester

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11
Q

(true/false) The vestibular system does not start functioning until the second trimester

A

False - starts to function at the end of the first trimester

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12
Q

When during the gestational period does the startle reflex emerge?

A

second trimester

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13
Q

When during the gestational period does visual processing emerge?

A

second trimester

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14
Q

When during the gestational period does visual fixation occur?

A

third trimester

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15
Q

When during the gestational period is there response/turning to auditory stimuli?

A

second trimester

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16
Q

When during the gestational period is there debris in the middle ear leading to decreased hearing?

A

third trimester

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17
Q

What is the most mature sensory system at birth?

A

touch and tactile system

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18
Q

When during the gestational period when do nasal plugs disappear and olfactory perception emerges?

A

third trimester

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19
Q

When during the gestational period do the taste buds develop?

A

first trimester

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20
Q

When during the gestational period does the infant respond to different tastes?

A

third trimester

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21
Q

When during the gestational period does sucking occur?

A

first trimester

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22
Q

When during the gestational period does hiccupping occur?

A

first trimester

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23
Q

When during the gestational period does fetal breathing start?

A

first trimester

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24
Q

When during the gestational period does quick, generalized limb movement start to occur?

A

first trimester

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25
Q

When during the gestational period do positional changes start to occur?

A

first trimester

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26
Q

When during the gestational period does the fetus start to bend their neck and trunk?

A

week 7.5

first trimester

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27
Q

When during the gestational period do sleep states start to emerge?

A

second trimester

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28
Q

When during the gestational period does the grasp reflex emerge?

A

second trimester

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29
Q

When during the gestational period do reciprocal and symmetrical limb movements start to emerge?

A

second trimester

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30
Q

What is the Test of infant motor performance (TIMP) used for?

A

Evaluation of spontaneous and elicited movements to postural alignment and selective control for functional movements

32 weeks after conception to 3.5 months after birth

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31
Q

What is the APGAR screening test used for?

A

Evaluation of the following at 1 minute, 5 minutes, and 10 minutes after birth:
- Appearance (color)
- Pulse
- Grimace (reflex irritability)
- Activity
- Respiration

Keeps being administered every 5 minutes if infant is having difficulties after the 10 minute test

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32
Q

What bone may fracture during birth?

A

clavicle

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33
Q

(true/false) An infant’s hip can dislocate during birth

A

true

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34
Q

(true/false) It is normal for kyphosis to be present at birth

A

true

Abnormal findings: scolisos, spina bifida (tuft of hair and/or dimple), visible pigmentation

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35
Q

What is the Pediatric Evaluation of Disability Inventory (PEDI) used for?

A

Functional assessment for ADLS

self-care, mobility, social functioning

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36
Q

(true/false) The PEDI can be modified by the caregiver

A

true

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37
Q

What does the WeeFim assess?

A

Functioning in:
- self-care
- mobility
- locomotion
- communication
- social cognition

Functional Independence Measure for Children (WeeFim)

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38
Q

When during an infant’s life is an Early intervention program implemented?

A

0-3 y/o

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39
Q

What kind of treatment utilizes therapeutic handling as the primary intervention strategy?

A

Neurodevelopmental Treatment (NDT)

Also focuses on important components of motor learning and sensory input

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40
Q

How are preterm infants categorized other than by gestation period at birth?

A

birth weight

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41
Q

(true/false) A preterm infant can develop the physiological FLX of a full-term newborn.

A

False

Postural and movement profile:
- hyperEXT of neck and trunk
- shoulder Elevation, ABD, and extension
- scapular RET
- Hip ABD and EXT
- anterior pelvic tilt (lumbar lordosis)
- decreased midline UE movement
- WB on toes when in supported standing

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42
Q

What causes Meconium Aspiration Syndrome?

A

Bowel movements in utero that mixes with amniotic fluid - the infant inhales the substance

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43
Q

What can meconium aspiration syndrome develop?

A

Respiratory distress

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44
Q

What treatment plan should be kept in mind with infants who have meconium aspiration syndrome?

A

Treat in a silent environment due to hypersensitivity to environmental stimuli

20% of cases present with developmental delays that can last up to 3 y/o

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45
Q

diagnosis

Symptoms include rapid, shallow breathing and a sharp pulling in of the chest below and between the ribs with each breath

A

respiratory distress syndrome (RDS)

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46
Q

What causes respiratory distress syndrome?

A

Development of atelectasis caused by surfactant not developing in the lungs at 24 weeks

–> lungs are not ready for air until 26 weeks of gestation

Can lead to acute respiratory failure and death

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47
Q

What can chronic RDS lead to?

A

bronchopulmonary dysplasia

When the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the alveoli

  • predisposes the infant to respiratory infections and developmental disability
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48
Q

What are the treatments for RDS?

A
  • oxygen supplementation
  • assisted ventilation
  • surfactant administration
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49
Q

What are the causes of bronchopulmonary dysplasia?

A
  • mechanical ventilation
  • oxygen administration
  • chronic RDS
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50
Q

What are the treatments for bronchopulmonary dysplasia?

A
  • respiratory support
  • infection control
  • bronchodilators
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51
Q

What is periventricular leukomalacia (PVL)? What is the cause?

A

necrosis of white matter adjacent to the ventricles of the brain

causes:
- systemic hypotension
- ischemia

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52
Q

What can periventricular leukomalacia (PVL) result in?

A

Cerebral palsy

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53
Q

diagnosis

Bleeding into the immature vascular matrix

A

periventricular-intraventricular hemorrhage

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54
Q

What grades of periventricular-intraventricular hemorrhage can result in cerebral palsy?

A

Grades II-IV

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55
Q

What causes retinopathy of prematurity (ROP)?

A

combination of low birth weight and high O2 levels

abnormal vascularization of the retina that causes visual deficits

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56
Q

What is done in the NICU to infants who develop retinopathy of prematurity (ROP)?

A

Infant eyes are covered to prevent exposure to bright light

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57
Q

What is necrotizing enterocolitis?

A

ischemia resulting in inflammatory, bowel infection

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58
Q

What is patent ductus arteriorsus (PDA)?

A

An opening between two blood vessels (pulmonary artery and aorta) leading from the heart resulting in non-oxygenated blood being circulated

The ductus arteriosus (temporary vessel between the pulmonary artery and aorta) should close soon after birth

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59
Q

Premature infants lack adipose tissue and the CNS is unable to control the body temperature prior to ___ weeks of gestation

A

32 wks

  • keep infant warm to decrease energy expenditure and increase the energy needed for other body functions
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60
Q

If an infant was premature, what should activities and positioning focus on?

A
  1. Facilitating shoulder PROT and ADD while doing visual and auditory tracking and reaching
    - ex: supported side-lying
  2. Supervised side-lying and prone positioning to promote FLX
  3. sleeping in supine
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61
Q

What activities should you avoid when an infant is premature?

A

Those that can increase extensor tone

ex: jumpers and walkers

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62
Q

When can CP manifest?

A

Until 2 y/o

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63
Q

What can cause non-progressive encephalopathy?

A
  1. hemorrhage below ventricle lining
  2. hypoxic encephalopathy
  3. malformation
  4. trauma of CNS
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64
Q

What is the most common impairment of CP?

A

movement disorders:
- spastic
- athetosis
- ataxia
- dystonia
- hypotonia
- mixed movement disorders

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65
Q

definition

fluctuating muscle tone, involuntary slow writhing movements

A

athetosis

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66
Q

Where is a lesion present when athetosis is present?

A

basal ganglia

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67
Q

Where is a lesion present when spasticity is present?

A

motor cortex

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68
Q

definition

instability of movements

A

ataxia

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69
Q

Where is a lesion located when ataxia is present?

A

cerebellum

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70
Q

definition

involuntary movements with sustained contractions

A

dystonia

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71
Q

What is level 1 of gross motor coordination for cerebral palsy?

A
  • walking without restrictions
  • limitation in more advanced gross motor skills
72
Q

What is level II of gross motor classification for CP?

A
  • walking without AD
  • limitation with community ambulation and outdoors
73
Q

How many levels of gross motor classifications for CP are there?

74
Q

What is level III of gross motor classification for CP?

A
  • walking with AD
  • limitation while ambulating outdoors and in the community
75
Q

What is level IV of gross motor classification for CP?

A
  • self mobility with limitations
  • children are transported or using power mobility device when outdoors or in the community
76
Q

What is level V of gross motor classification for CP?

A
  • self mobility is severely limited with use of assistive technology
77
Q

What is hemiplegia?

A

one side of body affected

78
Q

What is diplegia?

A

both LEs are affected

79
Q

With what type of CP is there presentation of crouching gait?

A

spastic CP

80
Q

Describe crouching gait.

A

walking with hip FLX, ADD, IR and knee FLX

81
Q

Type of CP

  • abnormal posture and movement with patterns of FLX/EXT
  • imbalance of tone across joints (can cause contractures)
  • visual, auditory, cognitive, and oral motor deficits
  • decreased ability to learn unique movements
  • insufficient force generation
A

spastic CP

82
Q

Type of CP

  • generalized decreased muscle tone (floppy baby syndrome)
  • poor functional stability (especially proximal joints)
  • ataxia and incoordination when in upright position with a decreased BOS and muscle tone fluctuations
  • poor visual tracking, speech delay, and oral motor problems
  • decreased ability to learn unique movements
  • insufficient force generation
A

athetoid CP

83
Q

Type of CP

  • low postural tone with poor balance
  • wide BOS
  • intention tremor of hands
  • uncoordinated movements
  • poor visual tracking and nystagmus
  • speech articulation problems
  • hypotonia –> ataxia
84
Q

Initial hypotonia can be followed by _____ when CP is present

85
Q

Ambulation with athetosis, diplegia, and mild quadriplegia can be attained with the use of what assistive devices?

A

Rollator and/or crutches

86
Q

What orthotics are commonly used with CP?

A
  • AFO
  • submalleolar orthosis
87
Q

How should a person with CP be positioned when seated in a WC?

A
  • Trunk upright
  • hips, knees, and ankles at 90 degrees
  • posterior tilt
  • hip ABD if spatic ADD is present
88
Q

Why should posterior tilt be used in those with CP?

A

Decreases extenor tone and maintains hip FLX

89
Q

What is the recommended amount of time for a person with CP to WB through their LEs to improve bone mineralization?

A

> 5 hrs/wk

90
Q

What reflexes may be persistent and block functional postures and movements in those with CP?

A

Tonic reflexes

  • ATNR
  • tonic labyrinthine (TLR)
  • STNR
91
Q

-

What position will help decrease the effect of tonic labyrinthine reflex?

A

side-lying

92
Q

What type of rollator helps maintain an upright position and decrease extensor tone within the UEs?

A

posterior rollator

93
Q

(true/false) all children with CP will not be able to ambulate.

A

False

Those with spastic hemiplegia, moderate spastic CP, and mild ataxia will be able to ambulate.

94
Q

A good prognosis for ambulating with CP is when what happens?

A

the child can sit independently 2 y/o

95
Q

What does intrathecal baclofen (ITB) do?

A

Delivered to a specific segment of the spine and controls spasticity below that segment

–> catheter in the subarachnoid space of the spinal cord

holds 1-4 month supply (refill every 3 months)

96
Q

What does Diazapam (Valium) act on and what does it do? What is a con of the medication?

A
  • Acts on the CNS to Improve motor control
  • Con: difficult to maintain steady state
97
Q

What does baclofen (lisoresal) act on and what does it do? What is a con of the medication?

A
  • Acts on the CNS to decrease muscle spasticity
  • cons: decreased stength leading to postural control
98
Q

What does anasthetic/diastnostic nerve blocks do? What is a con of the medication class?

procaine and lidocaine

A
  • decreases local spasticity, contractures, and dystonia
  • improves motor control

Con: not permanent

99
Q

What does neurolytic nerve blocks do? What is a con of the medication class?

ethanol and phenol

A
  • decreases spasticity contractures, and dystonia
  • improves motor control

Con: not permanent

Ethanol and phenol requires experience for injection and increases the risk of parasthesia

100
Q

How long can botulism toxin last after injected?

A

4-6 months

101
Q

What are possible side effects of baclofen?

A
  • drowsiness
  • dizziness
  • fatigue
  • weakness
  • ataxia
  • confusion
102
Q

Procedure:

dorsal sensory nerve rootlets are stimulated and those responding abnormally are severed

  • decreases spasticity, improves motor control, and not reversible
  • Cons: irreversible, sensory loss, not effective for dystonia
A

selective dorsal rhizotomy (SDR)

103
Q

How long do peripheral nerve blocks commonly last?

A

3-6 months

104
Q

What are the common tendons that are lengthened with lengthening procedures?

A
  • achilles
  • hamstrings
  • iliopsoas
  • hip ADD
105
Q

(true/false) muscle lengthening procedures increase contractility of muscles.

A

false

decreases contractility

106
Q

procedure

Cutting, removing, or repositioning of bone to facilitate normal alignment and prevent subluxation/dislocation

A

osteotomies

107
Q

diagnosis

neural tube defect resulting in vertebral and/or spinal cord malformation

A

spina bifida/myelodysplasia

108
Q

What form of spina bifida is characterized by a tuft of hair, dimples, or sinus?

A

spina bifida occulta

109
Q

What form of spina bifida does not have spinal cord involvement?

A

spina bifida occulta

110
Q

What form of spina bifida has visible or open lesions?

A

spina bifida aperta/cystica

111
Q

What are the types of spina bifida aperta?

A
  1. myelomeningocele
  2. meningocele
112
Q

What is a meningocele?

A

Cyst that contains cerebral spinal fluid

113
Q

(true/false) Myelomeningocele has no spinal cord involvement

A

False: meningocele has an intact spinal cord whereas myelomeningocele has herniated spinal cord tissue

114
Q

What are neural tube defects linked to?

A
  • decreased maternal folic acid
  • infection
  • hot tub soaking
  • exposure to teratogens (alcohol and valproic acid)
115
Q

(true/false) hydrocephalus is significantly related to closure of a neural tube defect.

A

True

shunting relieves pressure

116
Q

What is arnold chiari malformation?

A

cerebellum and brain stem are pushed through the foramen magnum

117
Q

What can occur if a neural tube defect is not corrected shortly after birth?

A

meningitis

118
Q

What makes ambulation possible if the hip flexors are weak or paralyzed?

A

Reciprocating gait orthoses (RGO)

119
Q

When does spina bifida aperta have to be closed?

A

In utero OR 24-48 hours postnatally

120
Q

What tests should be used for evaluation of functional abilities in those with spina bifida?

A

PEDI or WeeFIM

121
Q

What are the signs of possible shunt malfunction?

A
  • irritability
  • decreased muscle tone
  • Sz
  • vomiting
  • bulging fontanels
  • HA
  • redness along the shunt tract
122
Q

When do brachial plexus injuries commonly occur?

A
  • During birth
  • Cervical rib abnormality
123
Q

What is klumpke’s paralysis?

A

Brachial plexus injury with C8-T1 involvement

Involvement of intrinsic muscles of the hand, finger flexors, and finger extensors
–> also weakness of FCU

124
Q

What nerve roots are affected with erb-klumpke palsy?

125
Q

What impairments are present with Erb’s paralysis?

A
  • sensory deficits
  • decreased shoulder girdle function (1:1 humeroscapular movement)

Functioning of hand is spared

126
Q

What impairments are present with klumpke’s paralysis?

A
  • decreased wrist and hand function
  • sensory deficits
127
Q

What is the characteristic positioning of Erb’s paralysis?

A

Shoulder: ADD and IR
Elbow: EXT and PRON
Wrist: FLX
Fingers: waiter’s tip deformity

128
Q

When is surgical nerve repair warranted for avulsion injuries of the brachial plexus?

A

If not resolved after 3 months

129
Q

What reflex tests should be tests on infants for brachial plexus injury?

A
  • Moro
  • biceps
  • radial reflexes
  • grasp

Moro, biceps, and radial reflexes are not present; grasp is intact

130
Q

What needs to occur immediately after brachial plexus injury to prevent further injury?

A

Partial immobilization across the upper abdomen for 1-2 weeks

–> initiate gentle ROM after period of immobilization

131
Q

diagnosis

Chromosomal abnormality caused by breakage and translocation of a piece of chromosome onto a normal chromosome

A

down syndrome

trisomy 21

132
Q

What are the 3 types of down syndrome?

A
  1. standard (95%)
  2. translocation
  3. mosaic (rare)
133
Q

Those with down syndrome have (decreased/increased) brain, brain stem, and cerebellum weight

134
Q

What are other impairments of down syndrome?

A
  • hypotonia and decreased force generation
  • visual and hearing loss
  • congenital heart defects (primarily septal defects)
  • AA subluxation/dislocation (due to laxity of transverse dens ligament)
  • gross motor developmental delay
  • eating and speech development deficits
  • cognitive and perceptual deficits
135
Q

What are s/s of transverse odontoid laxity (AA subluxation/dislocation)?

A
  • decreased strength and ROM
  • decreased DTRs
  • decreased sensation
  • head tilt
  • increased muscle tone
136
Q

What movements should be avoided if AA ligament laxity is suspected?

A

Forceful neck FLX and ROT

137
Q

What must you do for muscle testing on a child < 3 y/o?

A

Observe developmental postures and movements

138
Q

What should you do to promote oral motor function?

A
  • facilitate lip closure and tongue retrusion
  • short, frequent feeding sessions
139
Q

What joint movements must you avoid in a patient with down syndrome during activity?

A

hyperextension of knees and elbows

Avoid all traction on extremities and spine

140
Q

When should radiographs be taken in a person with down syndrome?

A

Every year starting at the age of 3

XR unable to image AA subluxation before 3 y/o - treat patient as though they have AA instability until XR can be taken

141
Q

(true/false) plagiocephaly is associated with gross motor delays

142
Q

How long are helmets supposed to be worn when correcting plagiocephaly?

A

20-23 hours/day for 2-7 months

143
Q

The best outcomes of cranial remolding is when the helmet is started by what age?

A

4-6 months

144
Q

Once the child is ___ months old, the cranial sutures fuse and cranial helmets are no longer useful

145
Q

What behavioral scales should be used to assess a child’s orientation to the time, place, and ability to respond to various stimuli after they experience a TBI?

A
  • rancho los amigos coma scale
  • GCS
146
Q

What coma/TBI scale should be used to assess a child’s orientation to time, place, and ability to response to various stimuli if they are nonverbal?

A

infant coma scale

147
Q

What medications can be used for control of intracranial pressure?

A
  • barbiturates
  • diuretics
  • sedatives
  • paralytics
148
Q

Is duchenne’s X or Y linked? Is the father or mother the carrier?

A

X-linked carried by the recessive gene of the mother

149
Q

When is the diagnosis of duchenne’s normally determined?

A

between 3-6 y/o

150
Q

What are the early signs of duchenne’s?

A
  • progressive weakness
  • delay with ambulation
  • diffuculty rising from supine and sitting positions
  • proximal shoulder weakness and/or pelvic weakness occurs before distal weakness
151
Q

What is the Gower’s sign?

A

“walking up the legs” when transitioning to a standing position

Commonly observed with duchenne’s

152
Q

What are the functional limitations of duchenne’s?

A
  • delayed developmental milestones
  • decreased ambulation ability
  • progressive cardiopulmonary limitations
  • contractures/deformity
  • weakness
153
Q

what medication has been shown to increase life expectancy of a child with duchenne’s?

A

Steroids (prednisone)

decreases pulmonary dysfunction (treats pulmonary infection)

154
Q

Autism spectrum disorder (ASD) develops within the first ______ years of life and affects the brain’s normal development of social and communication skills

A

develops within the first 3 years of life

Linked to abnormal biology and chemistry in the brain

155
Q

What is the cause of ASD?

A

unknown

Genetic link is suspected

156
Q

What impairments are seen in those with ASD?

A
  • difficulty with verbal and nonverbal communication, social interaction, and atypical play skills
  • sensory integration issues
  • decreased coordination
  • decreased balance
  • decreased strength and ROM
  • delayed gross motor skills
157
Q

Are boys or girls commonly seen with ASD?

158
Q

How early can some cases of ASD be diagnosed?

A

6 months old

159
Q

_____% of children with ASD have above average intelligence

160
Q

What adaptive equipment is used to decreased scissoring extension pattern? (hip EXT, ADD; knee EXT; PF)

A

abductor pad

161
Q

What degree should an AFO be set in to decrease genu recurvatum?

A

5-10 degrees DF

162
Q

What kind of AFO should be used for reciprocal or swing-through gait?

A

KAFO

used by children with spina bifida or spinal cord injury

163
Q

What type of AFO is used for swing-thorugh gait?

A

HKAFO

used by children with spina bifida or spinal cord injury

164
Q

What is a reciprocating gait orthosis (RGO)?

A

HKAFO with a molded body jacket that uses a cable system allowing a FWD step with lateral weight shifting

165
Q

What AFO is commonly used by children with thoracic level spinal bifida or SCI?

A

Reciprocating gait orthosis (RGO)

166
Q

What is the reason for a pavlik harness to be used?

A

For infants with congenital hip dysplasia

Holds the hips in FLX and ABD to keep femoral head in the acetabulum

167
Q

How early can a power WC be used by a child?

A

As early as 18 months

168
Q

What mobility aid provides maximum support to the upper extremities and the trunk?

A

gait trainer

169
Q

What AD encourages shoulder depression, elbow extension, neutral wrist, and may decrease scissoring?

A

posterior walker

170
Q

What is the single most important constant and environmental factor when treating a pediatric patient?

171
Q

(true/false) EIP programs are not mandated by public law

A

false

they are mandated (IDEA/Individuals with disabilities act)

172
Q

What age population can can IEP (individual action plan) be used for?

Free and appropriate public education for all children with disabilities

173
Q

(true/false) The family is a member of the EIP team

A

true

Individual family service plan (IFSP) was developed

174
Q

What intervention program is used for infants and children from birth to 3 years?

175
Q

What is the least restrictive form of early intervention and eduation setting?

A

individual education plan via school system

NPTE (22 decks)

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