Pediatrics

Question 1

crossed extension reflex

Answer 1

one hip placed in flex, pop hip moves into ext. early propulsion. 0-2 mo.

Question 2

flexor withdrawal

Answer 2

touch, stroke, tickle sole foot and infant flex hip, knee, ankle. protective mechanism. 0-2 mo.

Question 3

plantar grasp

Answer 3

pressure to plantar surface foot at base toes, toes curl down and over. fades with exposure to surfaces and WB. 0 to 4-9 mo.)

Question 4

spontaneous stepping

Answer 4

child held upright and slight amount weight on feet, stepping motions, automatic walking. 0-2 mo.

Question 5

placing

Answer 5

dorsum of hand or foot stimulated, child lift to clear foot/hand and place it out on surface. allows child begin to reach and make palmar contact. 0-2 mo.

Question 6

galant

Answer 6

light touch or stroke to one side trunk, infant laterally flex toward that side. 0- 2mo.

Question 7

tonic labyrinthine

Answer 7

placd in prone, automatically increase flexor tone and flex extremities. supine increase extensor ton eor extension extremities. 0-6mo.

Question 8

moro/startle

Answer 8

quickly tipped back or startled, first abduct and extend then adduct and flex as if to grab support. 0-6mo.

Question 9

instinctive grasp

Answer 9

light touch either border hand causes hand to orient with palm towards object or surface to make contact (4-11 mo.)

Question 10

asymmetrical tonic neck reflex

Answer 10

ATNR: head turned to one side arm on same side abduct and extend at elbow, opp. arm abduct and flex at elbow 0-4mo.

Question 11

symmetrical tonic neck reflex

Answer 11

neck flexed, UE flex and LE ext. neck ext UE ext, LE flex. 0-6mo.

Question 12

rooting

Answer 12

supine, lightly touch child on one side check respond by opening mouth and turning head toward stimulus. 0-3 mo.

Question 13

suck-swallow

Answer 13

supine. apply light touch to oral cavity, infant begin sucking pattern. 0-5mo.

Question 14

labyrinthine righting

Answer 14

head realigns to vertical when body tilted in spaced. onset 4-6 mo.

Question 15

Landau:

Answer 15

baby prone airplane position. head ext, hip/shoulder ext. head flex, hip/shoulder flex. 0-6mo.

Question 16

Parachute response

Answer 16

tilt toward floor, reach for floor as if to brace. onset 8-10 mo.

Question 17

trunk righting

Answer 17

sitting push to side, resist and use pop. hand to brace. onset 4-6 mo.

Question 18

4 types cerebral palsy and part brain involved

Answer 18

spastic - motor cortex or white matter projections
dyskinesia or athetosis - basal ganglia
ataxia - cerebellum
Mixed - spastic and dyskinesia

Question 19

Impairments in CP

Answer 19

weakness, spasticity, hyperreflexia, hypoextensibility/ contracture, poor motor control (synergies), persistent primitive reflexes, poor postural reactions

Question 20

changes in CP muscle

Answer 20

becomes stiff. fewer, longer sarcomeres in series. not just spasticity.

Question 21

prognostic indicators for walking

Answer 21

sit Indep by 24 months will walk. nearly all who walk do so by 8 years.

Question 22

diagnosis of CP

Answer 22

TIMP sensitive at 1 week. most diagnosed by 6 months with standardized measures.

Question 23

evidence based interventions for CP

Answer 23

serial casting, botox, BWSTT, estim, strenthening program.

Question 24

Developmental Coordination Disorder (DCD)

Answer 24

impaired motor coordination. frequently low tone leading to lordotic posture and hyperextension knees. diminished endurance. may have delayed milestones for walking, running, jumping, kicking ball, handwriting, dressing fine motor. hypermobile joint common. require extra attention for task, may lose focus.

Question 25

treatment DCD

Answer 25

ritalin for attention. practice motor skill - task specific training. cognitive approach break down task and talk through strategy. teach specific skill/ practice. must have motivation and attention to task.

Question 26

Major impairments DMD

Answer 26

weakness due to loss of myofibrils, contracture, scoliosis 90%, respiratory compromise, cardiac complications, gower's maneuver

Question 27

Age diagnosis, loss walking, death in MD

Answer 27

DMD: onset 1-4 years, diagnosed by 5. loss walking 9-10 years. death late teens/20s. BMD: onset 5-10 years. loss walking >16 years, death 40s

Question 28

pseudohypertrophy. what is it? who has it?

Answer 28

fatty tissue in muscle, loss of muscle fibers. usually plantar flexors. muscular dystrophy.

Question 29

characteristics gait in DMD

Answer 29

toe walking, waddling, lumbar lordosis, lateral trunk sway, wide BOS, retraction shoulders with lack arm swing. usually don't have UE strength for AD. AFOs block compensation and make walking harder. KAFOs may prolong walking, usually need surgery prior,

Question 30

evidence based interventions for MD

Answer 30

submaximal exercise, aquatics, avoid eccentric and high intensity, contracture management - night splints and ROM most effective, can increase respiratory endurance with training, estim may be beneficial,

Question 31

cranial nerve involvement in DMD

Answer 31

no

Question 32

pattern weakness in DMD

Answer 32

symmetrical. proximal to distal

Question 33

what is myotonia? seen in what disease?

Answer 33

delay is muscle relaxation after contraction. seen in myotonic MD.

Question 34

pathophysiology of spinal muscular atrophy

Answer 34

survival motor neuron produces protein of same name (SMN). this maintains anterior horn cells. Without this protein apoptosis of anterior horn cells. progressive, 4 types with varying speeds of progression. type i infants die early. type 4 adult onset almost normal lifespan.

Question 35

impairments spinal muscular atrophy

Answer 35

weakness, areflexia, hypotonia, fatigue, may have orthopedic/ respiratory complications.

Question 36

Brooks scale UE 1-6 for MD

Answer 36

1. arms over head, 3. glass to mouth 6. no use hands

Question 37

Vignos scale 1-10 MD

Answer 37

1. walks and climbs stairs. 4. walks, no stairs. 7. WC and bed mob I. 10. in bed needs assist

Question 38

Egen Klassifikation (EK) scale MD

Answer 38

10 questions 0-3. 0=independent, 30=max assist. looks at trunk, UE, WC mobility, standing, respiratory

Question 39

Motor Function Measure (MFM) for MD

Answer 39

for nonamb over 6 years. 32 items. D1: standing/posture/transfers 40% predictive of loss ambulation in 12 months

Question 40

myelomeningocele

Answer 40

open spinal cord defect that usually protrudes dorsally, not skin covered, usually associated with spinal nerve paralysis

Question 41

meningoceles

Answer 41

skin covered, initially associated with no paralysis

Question 42

signs and symptoms of shunt dysfunction

Answer 42

changes in speech, fever, headache, decreased activity level, crossed eyes, changes appetite/weight, incontinence, worse spasticity, worse scoliosis, irritability, decrease strength, lethargy, decreased coordination, seizures

Question 43

3 year old

Answer 43

Alternate feet up stairs Ride trike Momentary single hopping on preferred foot Step backward

Question 44

12-18 mo

Answer 44

``` Roll supine to prone Walking indep. Sitting indep Pull to stand Creeping hand and knees Sitting to quadruped Sitting to prone Quadruped ```

Question 45

2-2.5 years

Answer 45

``` Walking well, steps short Running Climbing stairs indep. Jump off bottom step Kick ball Steer push toy Walk on tip toe Jump both feet Stand one foot Throw catch ball with arms and body together Dress indep eat with spoon ```

Question 46

4 years

Answer 46

``` Walk down step to Catch with hands only Roller skates or small bike Run, jump, climb Feed indep. ```

Question 47

5 years

Answer 47

``` Skip Long jump two feet Climb with sureness Jump rope Acrobatic tricks Overhand throw Play with blocks Indep eat and use knife ```

Question 48

6years

Answer 48

Tug, lug, dig, dance, climb, push, pull, body balance in climbing. Crawl over, under Swing too high Build too tall