Pediatrics Flashcards
Development at 1 month
lifts head follows a moving object exhibits reflex stepping in supported stand decreased flexion hands fisted with indwelling thumb reciprocal & symmetrical kicking neonatal reaching
Development at 2 months
head lifts 45 deg in prone
prone on elbows with elbows behind shoulders
head bobs in supported sitting
head lags in pull to sitting (traction reflex)
can’t accept weight on LEs
Development at 3 months
can prop self into prone on elbows with weight on forearms
coos, chuckles
takes weight with toes curled in supported standing
head elevation to 90 deg, elbow in line with shoulders
head in midline in supine, hands on chest
Development at 4 months
rolls to side
sits with support
no head lag in pull to sit
bilateral reaching with forearm pronated when trunk supported
ulnar-palmer grasp
laughs out loud
Development at 5 months
roll prone to supine
head control in supported sitting
weight shift from 1 forearm to other in prone
Development at 6 months
prone on hands with elbows extended, weight shifting hand to hand
roles supine to prone
independent sitting
pulls to stand with hands held, bounces
Development at 7 months
maintains quadruped
pivots on belly
prone extension position
assumes sitting from quadruped
trunk rotation in sitting
recognizes tone of voice
may show fear of strangers
Development at 8-9 months
belly crawls
quadruped creeping
sit sitting
pulls to stand through kneeling
cruises sideways
can stand alone
pincer grasp with thumb and forefinger
can transfer objects form 1 hand to the other
moves quadruped to sitting
Development at 10-15 months
stands and begins to walk unassisted
begins self-feeding
searches for hidden toys
plays patty cake and peek a boo
imitates
reaches with supination
neat pincher grasp and release
build a tower of 2 blocks
Development at 18-20 months
can walk up and down stairs with assistance
ascends stairs with step to pattern
sits on a small chair
begins to run more coordinated
jumps off bottom step
plays make believe
throws ball overhead
Development at 2 years
runs well
can go up stairs reciprocally
active, restless
tantrums
jumps with 2 feet
catches large ball
Development at 3 years
goes down stairs reciprocally
rides tricycle
begins to catch a ball
jumps with 2 feet
understands sharing
stands on one foot briefly
climbs
3.5 y/o: hops on 1 foot, kicks ball
Development at 4 years
hops on 1 foot several times
climbs
throws ball overhand
stands on tiptoes
relates to friends
Development at 5 years:
skips
kicks ball well
dresses and undresses self
swings self on playground
Development of gait
birth-9months:
- antigravity strength obtained
- hip flexor strength by kicking
- hip extensor strength by crawling on hands and knees, kneeling
- hip ABD strength by cruising
- extremities and trunk lengthen
- myelination of nerves completed
9-15 months:
- fat decreases
- initial gait consists of: flexion, ABD and ER of hips, genu varum, calcaneal eversion, absent longitudinal arches, femoral anteversion, internal tibial torsion
18-24 months:
-gait characterized by: decreased BOS, heel remains everted, less co-contraction of muscles, genu vacuum resolved and knee in neutral
3-3.5 years:
-more mature gait: genu valgum, heel eversion decreasing, consistent heel strike, femoral anteversion decreasing, arm swing noted
6-7 years:
-fully mature gait: knees and heels in neutral, femoral ante version almost resolved
gestational vs. conceptional age vs. corrected age
Gestational: from 1st day of mother’s last normal menstrual period
- normal= 38-42 weeks
- premature=
Apgar screening test
administered to newborn at 1, 5, 10 minutes after birth; continues every 5 minutes if infant is having difficulties
5 items:
- HR
- RR
- reflex irritability
- muscle tone
- color
Scoring: 0-2
- total score >7 is normal
- total score 5-6 requires some care (ventilation, stimulation or resuscitation)
- total score 4 or less requires immediate care
exam:
Apgar screening
neurological exam of newborn:
- assign state of consciousness
- tests newborn reflexes
skeletal system exam:
- fractured clavicle
- dislocated hip: asymmetrical gluteal folds, hip click
- spine: curved, inflexible, kyphosis, scoliosis; spina bifida (dimple, patch of hair, pigmentation visible and x ray verification)
- talipes equinovarus (clubfoot): PF, forefoot ADD and supination
ROM:
-newborn has decreased ROM into extension d/t physiological flexion, but increased DF of ankles and flexion at wrists
posture
- physiological flexion of all 4 limbs d/t to position in utero
- head to one side
movements:
- spontaneous and reflexive
- occasional tremulousness normal
neonatal reflexes
- primary motor patterns and infant reflexes and reactions
- present at birth and become “integrated” or inhibited, or not evident later in development
- in CNS lesions, may persist and interfere with motor milestone attainment or cause deformities
screening tests
standardized motor tests
sensory integration and praxis test
- sensorimotor assessment for children between 4-9 y/o with mild-mod learning impairment
- includes tests of balance, proprioceptive and tactile sensation and control of specific movements
comprehensive developmental assessments
pediatric functional assessments
neonatal reflexes
- primary motor patterns and infant reflexes and reactions
- present at birth and become “integrated” or inhibited, or not evident later in development
- in CNS lesions, may persist and interfere with motor milestone attainment or cause deformities
Babinski flexor withdrawal crossed extension galant or trunk incurvation reaction moro reflex primary standing reaction primary walking neonatal neck righting rooting sucking startle tonic labyrinthine reflex asymmetrical tonic neck reflex palmar grasp plantar grasp placing reactions traction or pull to sit optical and labyrinthine righting protective extension body righting reaction acting on the head/body symmetrical tonic neck reflex landau's reaction tilting reactions
Babinski reflex
stroke lateral aspect of the plantar surface of foot, get extension and fanning of toes
0-12 months
Flexor withdrawal and crossed extension reflexes
sharp quick pressure stimulus to solve of foot or causes withdrawal of stimulated extremity and extension of opposite leg
0-2 months?
galant or trunk incurvation reaction
sharp stroke along paravertebral line from scapula to top of iliac crest results in lateral trunk flexion toward stimulated side
0-2 months
moro reflex
sudden extension of neck results in flexion, abduction of shoulders, extension of elbows
-followed by shoulder adduction and elbow flexion
also results in crying - test last
0-4 months
primary standing reaction
infant held in supported standing position supports some weight and extends LE
if this reflex persists, will interfere with walking by causing extension of all joints of the LE and preventing disassociation of flexion and extension
neonatal neck righting
neck righting on body (NOB)
turn head with infant in supine; body log rolls towards same side
0-6 mo
rooting reflex
stroking of perioral region results in head turning to that side with mouth opening
0-3 months
important feeding reflex
sucking reflex
touch to lips, tongue, palate results in automatic sucking
0-6 mo
important feeding reflex
startle reflex
loud noise, sudden light or cold stimulus causes a sudden jerking of whole body or extension and abduction of UE followed by adduction of shoulders
0-6 months
tonic labyrinthe reflex (classic)
prone position results in max flexor tone
supine position results in extensor tone
if reflex persists and is strong, may block rolling from supine position, due to increased extensor tone
0-6 months
asymmetrical tonic neck reflex
rotation of head results in: “fencing position”
- extension of face side extremities
- flexion of skull side extremities
stronger in LEs
0-5 months
if reflex persists, may result in scoliosis or hip dislocation and interfere with grasping and hand mouth activities
palmar grasp
pressure stimulus against pam results in grasping of object with slow release
0-4 months
plantar grasp
pressure stimulus to sole or lowering of feet to floor results in curling of toes
must be integrated before walking occurs
0-9 months
placing reactions
drag dorm of foot or back of hand against edge of table–> get placing of foot or hand onto table top
0-6 months
traction or pull to sit reaction
pull infant to sitting from supine
-UEs will flex and head will lag until 4-5 months
optical and labyrinthine righting reflex
head orients to a vertical position when body is tilted
*test labyrinthine with eyes blindfolded
1month- throughout life
protective extension reflex
quick displacement of trunk in downward direction while held or while sitting in forward, sideward or backward direction results in extension of extremities to catch weight
Begins:
- downward begins at 4 months
- sideward sitting at 6 months
- forward siting at 7 months
- backward sitting at 9 months
persists t/o life
symmetrical tonic neck reflex
neck extension produces extension of UEs and flexion of LEs
neck flexion produces flexion of UEs and extension of LEs
6-8 months
can strongly influence ability to assume a quadruped position as well as ability to crawl
Landau’s reaction
infant held in ventral suspension will extend neck, trunk and hips
4-18 months
tilting/equilibrium reactions
displace COG by tilting or moving the support surface
results in curvature of the trunk toward the upward side along with extension and abduction of the extremities on that side
-protective extension on opposite side
onset: 6 months
persists t/o life
standardized motor tests
Movement assessment of infants
Peabody developmental motor scales
Gross motor function measure
Bruininks-oseretsky test of motor proficiency
Movement assessment of infants
identifies motor dysfunction and changes in the status of motor dysfunction and establishes an intervention program for infants-1y/o
exam of muscle tone, reflexes, automatic reactions and volitional movements
Peabody developmental motor scales
assesses gross and fine motor development from birth-42 months
includes spontaneous, elicited reflexes and automatic reactions
Gross motor function measure (GMFM-88)
developed to measure change in gross motor function over time in children with CP and DS
all items could be accomplished by a 5 y/o with typical motor development
focuses on voluntary movement in 5 developmental dimensions: prone/supine, sitting, crawling/kneeling, standing, walking/jumping
Bruininks-oseretsky test of motor proficiency
developed to measure gross and fine motor ability in children 4.5-21 y/o
norm referred on typical children
Pediatric functional assessments
PEDI: pediatric eval of disability inventory
-interview or questionnaire scale of ADL, with or without modification by caregiver
FIM for children (WeeFIM)
-assess function in self-care, mobility, locomotion and communication/social cognition
School functional assessment (SFA)
measures participation, task supports, activity performance, physical tasks and cognitive/behavioral tasks within school setting
-children 5-12 y/o (K-6th)
pediatric therapies
developmental activities to facilitate development of functional motor skills
-postures and movements from developmental sequence to increase strength, ROM, coordination
neurodevelopmental treatment (NDT)
motor control/motor learning approaches
sensory integration
neurodevelopmental treatment (NDT)
sets anticipated outcomes and impairment goals in partnership with the family, client and interdisciplinary team
encourages active, goal directed functional movements appropriate for the developmental level of the child
utilizes therapeutic handling as the primary intervention strategy
provides specific sensory input using careful grading of the intensity, rhythm and duration of somatosensory inputs
focuses on important components of motor learning
- practice of task components as well as practice of the whole task
- repetition
- structuring an environment conducive to client participation and support
prematurity PT practice
birth of infant
prematurity medical complications
*depend on severity of prematurity and birth weight
1- meconium aspiration syndrome
2- respiratory distress syndrome (RDS) or hyaline membrane disease
3- bronchopulmonary dysplasia
4-periventricular leukomalacia (PVL)
5- periventricular-intraventricular hemorrhage
6- retinopathy of prematurity
7- necrotizing enterocolitis
8- patent ductus arteriosus (PDA)
9- failure to thrive
10- increased fragility of skin
11- thermoregulation problems
12- feeding problems
13- interaction/attachment problems with caregiver
meconium aspiration syndrome
due to bowel movement in utero (meconium) that mixes with amniotic fluid
near term or term infant inhales substance and can develop respiratory distress
infants are hypersensitive to environmental stimuli- treat in quiet environment
20% present with developmental delays, some up to 3 y/o
Respiratory distress syndrome (RDS)
“hyaline membrane disease”
respiratory distress due to atelectasis caused by insufficient surfactant in premature lungs
may lead to acute respiratory failure and death
treatment: oxygen, assisted ventilation, and surfactant administration
chronic RDS may lead to bronchopulmonary dysplasia
Bronchopulmonary dysplasia
chronic lung disease as a result of damage to lungs from mechanical ventilation, oxygen administration and chronic RDS
predisposes child to frequent respiratory infections and developmental disability
treatment: respiratory support, infection control and bronchodilator administration
periventricular leukomalacia (PVL)
necrosis of white matter adjacent to ventricles of brain due to systemic hypotension or ischemia
may result in CP
periventricular-intraventricular hemorrhage
bleeding into immature vascular matrix
bleeds graded I-IV
II-IV may result in CP
retinopathy of prematurity (ROP)
due to combo of low birth weight and high oxygen levels
sequelae may range from nonsignificant to detachment of retinas and blindness
necrotizing enterocolitis
ischemia results in inflammatory, infected bowel
Patent ductus arteriosis (PDA)
ductus arteriosus (temporary vessel between aorta and the pulmonary artery) should close soon after birth
non oxygenated blood is circulated
PT should monitor O2 saturation, signs of cyanosis, SOB and RR
failure to thrive
infant lacks adequate nutritional intake
infant can present with developmental delays
PT for prematurity
interventions/activities to teach parents:
play activities and positioning to facilitate shoulder protraction and adduction such as supported SL while doing visual (block, white, and red objects 9in away) and auditory tracking and reaching
midline positioning of head
encourage reaching for toys, parent’s face if infant is over 32 weeks conceptional age
supervised SL and prone positioning for periods during the day
-sleep in supine to decrease possibility of SIBS
avoid activities that may increase extensor tone, such as use of infant jumpers and walkers
Cerebral palsy (CP)
a group of non progressive disorders resulting from gestational, perinatal, or postnatal CNS damage
major causes include:
- hemorrhage below lining of ventricles
- hypoxic encephalopathy
- malformations
- trauma of CNS
spastic paraplegia is especially common after premature birth
CP classifications
1- by area of body showing impairment
monoplegia, diplegia, hemiplegia, quadriplegia
2- by movement disorders (most obvious impairments) -spastic* -athetosis* -ataxia * -dystonia: involuntary mvmts w/ sustained contracures -hypotonia -mixed * (most likely spastic and athetosis) *4 main syndromes
3- gross motor function classification
levels I-V
spastic CP
- most common syndrome
affects the UMN with spasticity
affected limbs have increased DTRs, increased muscle tone, abnormal postures and movements with mass patterns of flexion or extension, weakness and a tendency to contractures (especially of hip flexors, adductors, IR and knee flexors, PF in LE; scap retractors, GH extensors and adductors, elbow flexors, forearm pronators)
scissoring gait and toe walking are characteristic
“crouched gait”: hip flexion, hip IR and knee flexion
visual, auditory, cognitive and oral-motor deficits may be present
Athetoid CP
athetosis: fluctuating muscle tone, involuntary slow writhing movements, lesion of BG
generalized decreased muscle tone, floppy baby syndrome
poor functional stability especially in proximally joints
ataxia and incoordination when child assumes upright position with decreased BOS and muscle tone fluctuations
poor visual tracking, speech delay and oral motor problems
tonic reflexes: ATNR, STNR and TLR may be persistent, blocking functional postures and movement
Ataxic CP
uncommon
results from cerebellar involvement
weakness, poor coordination and intention tremor produce unsteadiness, wide based gait and difficulty with rapid or fine movement
gross motor classification for CP
Level I:
- walk without restrictions
- limitations in more advanced gross motor skills
Level II:
- walk without AD
- limitations walking outdoors and in the community
Level III:
- walk with AD
- limitations walking outdoors and in the community
Level IV:
- self-mobility with limitations
- children are transported or use power mobility outdoors and in the community
Level V:
-self mobility is severely limited even with the use of assertive technology
impairments for all classifications of CP
insufficient force generation
tone abnormality
poor selective control of muscle activity
poor regulation of muscle activity in anticipation of postural changes
decreased ability to learn unique movements
abnormal patterns of movement in total flexion and extension
persistence of primitive reflexes
- interfere with normal posture and movement
- may cause contractures and deformities
functional limitations:
- depend on classification of CP
- spasticity may lead to decreased ROM, limited mobility (special attention to ROM needed during growth spurts)
- ambulation
interventions and goals in CP
focus on prevention of disability by minimizing effects of impairment, preventing or limiting secondary impairment (contractures, scoliosis)
maximize gross motor functional level
- utilize principles of motor learning and motor control (facilitate functional motor skills (voluntary movement, anticipatory and reactive postural adjustments) - use toys etc to facilitate postural control and developmental activities
- use WB and postural challenge to increase muscle tone and strength
- incorporate orthoses as necessary
utilize adaptive equipment as necessary
- standers used to promote WB and encourage bone mineralization (5hrs/wk), GI function, tone, strengthening of LE, and social interaction
- SL will help reduce effect of TLR
Prognosis:
- most children with spastic hemiplegia, mild-mod spastic CP and mild ataxia will be able to ambulate
- good prognosis for ambulation if child can sit independently by 2 y/o
- if child is going to walk, most will walk by 8 y/o
medical management of CP
1- oral meds: presynaptic inhibition of acetylcholine release
2- intrathecal baclofen (ITB) pump:
3- neurosurgery
- neuroectomy
- anterior rhizotomy
- selective dorsal rhizotomy:
- corectomy
- thalmotomy
- deep brain stimulation
*intensive strengthening program after surgery when ambulation is goal
4- peripheral nerve block
5- botox injections (paralyzing muscle 4-6 months)
ITB pump
Intrathecal baclofen (ITB) pump
GABA b-agonist: inhibitory CNS neurotransmitter
- intrathecal (subarachnoid) space delivery
- produces muscle relaxation
- delivered to specific segment to control spasticity below segment
OD S&S:
- drowsy
- dizzy
- respiratory depression
- seizures
- hypotonia
- loss of consciousness–>coma
Withdrawal S&S:
- increased spasticity
- itching without rash
- tingling
- headaches
- hyperthermia
- hypotension
- seizures
- hallucinations
- altered mental state
- autonomic dysreflexia
selective dorsal rhizotomy
common procedure: dorsal sensory nerve rootless are stimulated, those responding abnormally are severed
-usually done between 4-10 y/o
pros: decrease spasticity, improved motor control, not reversible
cons: possible sensory loss, not reversible, not effective for dystonia, anesthesia risks
orthopedic surgery of CP
lengthening procedures
- to correct deformity or weak muscle - prevents hip subluxation/dislocation
- muscles most often lengthened: achilles tendon, hamstrings, iliopsoas, hip adductors
muscle transfers:
- muscle attachments moved to change direction of force in order to increase functional and decrease spasticity
- most often done with hip adductors transferred to hip abductor
osteotomies
- cutting. removing or repositioning bone to facilitate normal alignment, prevent subluxation/dislocation
- most often performed in LEs- femoral, tibial or pelvic osteotomy
Spina Bifida
“myelodysplasia”
“myelomeningocele”
neural tube defect resulting in vertebral and/or SC malformation
-a defect in the vertebrae resulting in protrusion of the SC and meninges
detected by: sonogram and/or elevated serum or amniotic alpha-fetoprotein, amniotic acetylcholinesterase in prenatal period
neural tube defects linked to maternal decreased folic acid, infection, hot tub soaks and exposure to teratogens (alcohol and valproic acid)
after surgical closure, hydrocephalus may become a problem and require shunting of the CSF to decrease intracranial pressure
- may develop arnold chair malformation type II: cerebellum and BS are pushed through the foramen magnum
- meningitis common if defect not closed soon after birth (24-48 hours)
spina bifida occulta
no SC involvement, may be indicated by a tuft of hair, dimple or sinus
spina bifida cystica
visibile or open lesion
meningocele: cyst includes CSF, cord intact
myelomeningocele: cyst includes CSF and herniated cord tissue
impairments of spina bifida
- functional problems will vary depending upon level of SC defect
foot deformities -talipes equniovarus is common, especially with L4-5 level
tethered cord may lead to increased severity of problems as child grows
latex sensitivity/allergy
strength deficits
hip flexor and adductor tightness
-weakness or paralysis- makes ambulation possible only with reciprocating gait orthosis
bowel and bladder problems (L4-5)
sensory loss
low tone with poor head control
-poor strength and/or spasticity in UEs
developmental delays
cognitive impairments including mental retardation, learning and perceptual disabilities, language disorders
Treatment for spina bifida
proper positioning
orthotic devices
standing frames
parapodium for early standing
swivel and rollator walkers for lower thoracic lesion
reciprocating gait walkers/orthoses for upper lumbar lesions
adapted w/c for upper thoracic lesions
facilitate functional motor development, including appropriate developmental activities, primary or voluntary movements as well as reactive and anticipatory postural adjustments
education on shunt malfunction; S&S:
- increased irritability
- decreased muscle tone
- seizures
- vomiting
- bulging fontanels
- headache
- redness along shunt tract
spina bifida orthotics and functional prognosis
thoracic-L2
- orthosis: THKAFO, parapodium
- w/c for all functional mobility, standing and walking for physiological benefits
L1-L3
- orthosis: RGO, HKAFO
- w/c for most functional mobility, short household ambulation is possible; standing and walking for physiological benefits
L3-L4
- orthosis: KAFO
- w/c for community mobility, household ambulation is possible
L4-S1
- orthosis: AFO, ground reaction AFO
- household or community ambulation, although may be limited
S1
- orthosis: foot orthosis, supramalleolar orthosis
- community ambulation
Brachial plexus injury
traction or compression injury to unilateral brachial plexus during birth process or due to cervical rib abnormality
Erb’s paralysis: C5-6
Klumpke’s paralysis: C8-T1
Total or whole arm paralysis (Erk-Klumpke) C5-T1
nerve sheath is torn and nerve fibers compressed by hemorrhage and edema, although total avulsion of nerve is possible
traction injuries resolve spontaneously
avulsion injuries may require surgical nerve repair if not resolved w/in 3 months
shoulder subluxation and contractures of muscles may develop
PT:
- partial immobilization 1-2 weeks to avoid further injury
- gentle ROM after initial immobilization to avoid contractures
- elicit muscle activity with age appropriate functional movements of UE
- may use gentle constraint of unaffected arm to facilitate use of affected UE through positioning
Erb’s palsy
upper brachial plexus injury
C5-C6 nerve roots are stretched during birth
patient has weakness in GH abduction and ER, elbow flexion and supination
classically the shoulder is adducted and IR and presents with the “waiter’s tip” deformity
neutral positioning of the arm with gentle ROM exercises may be done early
functionally, in severe cases (nerve root avulsion) the child will not be able to use the involved side to hug a doll, drink from a cup, zip a coat
decreased shoulder girdle function with 1:1 humeroscapular movement
Klumpke’s palsy
lower brachial plexus injury
C8-T1 nerve roots are stretched
result is weakness of the hand and wrist flexors
“claw hand” appearance
down syndrome
impairments and functional mobility
a congenital chromosomal abnormality, resulting in an extra chromosome 21
Impairments:
- hypotonia
- decreased force generation of muscles
- visual and hearing losses
- congenital heart defects
- cognitive deficit
- AA subluxation/dislocation could be due to laxity of transverse odontoid ligament (S&S: decreased strength, decreased ROM, hyporeflexic DTRs, decreased sensation in extremities, persistent head tilt and increase in muscle tone)
Functional limitations:
- gross motor developmental delay
- difficulties in eating and speech development d/t low tone
- cognitive and perceptual deficits may result in delay of fine motor and psychosocial development
PT for down syndrome
*forceful neck flexion and rotation activities should be limited, due to AA ligament laxity
Minimize gross motor delay
- facilitate gross and fine motor development through appropriate positioning, posture and movement activities
- increase strength and stability by manipulating gravity and resistance in a graded manner
Encourage oral motor function
avoid hyperextension of elbow and knees during WB activities
avoid all traction on extremities or spine d/t ligamentous laxity and low muscle tone
prognosis may be correlated with tone: lower tone=more significant motor delay
-most children will walk by age 2 and all will walk by age 5
consider energy conservation strategies if congenital heart defects are present
TBI
primary: due to mechanical forces of initial impact
- acceleration–dependent - coup-contrecoup
- nonacceleration-dependent- skull depression into brain tissue and vibration
Secondary: due to processes initiated as a result of initial trauma
- cerebral edema increases intracranial pressure leading to herniation, cerebral infarctions, brainstem injury and coma
- epidural hematoma due to bleeds
- subdural hematoma
Impairments;
- depend on severity and location
- level of consciousness and cognitive level impaired
- spasticity, loss of functional ROM, contractures, deformities
- weakness, balance and coordination problems
- heterotopic ossification- pathological bone formation around joint due to increased tone around joint, immobility, and coma
Duchenne’s muscular dystrophy
X linked recessive, inherited by boys, carried by recessive gene of mother
dx: EMG, muscle biopsy, DNA and blood enzyme levels
dystrophin gene missing results in increased permeability of sarcolemma and destruction of muscle cells
collagen, adipose laid down in muscle leading to pseudohypertrophic calf muscles
Becker’s muscular dystrophy
- slower variant of DMD
- late childhood or adolescence
- cease walking around 27
- death around 42
Impairments of Duchenne’s muscular dystrophy
progressive weakness from proximal to distal beginning at 3 y/o to death in late adolescence or early adulthood
+ Gower’s sign d/t weak quads and gluteal muscles
-child must use UEs to “walk up legs” and rise from prone to standing
waddling gait pattern, toe walking, lordosis, frequent falls, difficulty standing, problems climbing stairs
contractures and deformities develop d/t muscle imbalances especially in heel cords and TFL
cardiac tissue involved
lumbar lordosis and kyphoscoliosis
TX for DMD:
maintain mobility as long as possible by encouraging functional activities to maintain strength and cardiopulmonary function
maintain joint ROM, positionally devises
- Gastroc and TFL shorten first
- night splints may be used
e-stim for younger children may increase contractile ability
don’t exercise at max level- may injure muscle tissue
steroids: increase life expectancy by decreasing pulmonary dysfunction
- antibiotics for pulmonary infections
autism spectrum disorder
Pathology:
- developmental disorder that appears in first 3 years and affects brain’s normal development of social and communication skills
- linked to abnormal biology and chemistry in the brain
- seems to be a genetic link
- 40% have above average intelligence
- seen more in boys
Impairments of autism
difficulties with verbal and nonverbal communication, social interaction and atypical play skills
sensory integration issues:
- hyposensitive (sensory seekers)
- hypersensitive (sensory avoiders)
decreased coordination
high level balance impairments
occasional strength and ROM deficits
delayed gross motor skills
TX for autism
gross motor skill training to promote age appropriate abilities
strengthening
coordination training
balance training
sensory integration
many are independent ambulators but have delay in high level skills: coordinated running, skipping, riding a bike, standing on one leg
-some will demo toe walking
tend to have a problem with new people and situations
-prefer a consistent routine and schedule
agressive or passive behaviors
speech and OT
meds for attention deficits and anxiety
charcot-marie-toot disease
“peroneal muscular atrophy”
a hereditary disorder of the peroneal and distal leg muscles
patient problems include foot drop and “stork leg deformity”
orthotic devices that correct for the equinovarus deformity can be helpful during tx
legg-calve-perthes disease
idiopathic aseptice necrosis of the femoral capital epiphysis
usually unilateral
affects mostly boys 5-10 y/o
TX:
- prolonged bed rest
- mobile traction and sling
- casting
- special hip ABD orthosis
positioning equipment
used to maintain skeletal alignment, prevent/reduce contractures, facilitate functional abilities
Standers:
- WB experience
- hips, knees, ankles and trunk in optimal position
- facilitates formation of acetabulum
- aids bowel/bladder function
- reduce influence of primitive reflexes
Side-Lyres:
- decrease effects of TLR
- puts hands in visual field
Adaptive seating; tilt in spac
abductor pad
-decrease adduction spasticity
equipment for therapeutic exercise
balls:
- promote strengthening, balance, coordination, and motor learning fun
wedges: facilitate or increase muscle contraction
bolsters: combine characteristics of ball and wedge
swings: sensory integration
scooter boards: prone stability/mobility work
LE orthotics
AFO: provides support to foot, ankle, knee, BOS, reduce effects of spasticity and hypo extensibility of muscles
- ankle set at 5-10 DF to decrease genu recurvatum
- articulating ankle AFO controls amount of DF/PF
- tone reducing AFO
KAFO
- standing or ambulation
- reciprocal or swing through gait
- used for children with spina bifida or DMD
HKAFO
- swing through gait
- children with spina bifida or SCI
Reciprocating gait orthosis (RGO)
- HKAFO with molded body jacket
- cable system allows forward step with lateral weight shift
- used by children with thoracic level spina bifida or SCI
Pavlik harness
- infants with congenital hip dysplasia
- hips held in flexion and ABD to maintain femoral head in acetabulum
