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BOARDS > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Development at 1 month

A 
lifts head
follows a moving object
exhibits reflex stepping in supported stand
decreased flexion
hands fisted with indwelling thumb
reciprocal & symmetrical kicking
neonatal reaching
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2
Q

Development at 2 months

A

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

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3
Q

Development at 3 months

A

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

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4
Q

Development at 4 months

A

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

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5
Q

Development at 5 months

A

roll prone to supine

head control in supported sitting

weight shift from 1 forearm to other in prone

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6
Q

Development at 6 months

A

prone on hands with elbows extended, weight shifting hand to hand

roles supine to prone

independent sitting

pulls to stand with hands held, bounces

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7
Q

Development at 7 months

A

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

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8
Q

Development at 8-9 months

A

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

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9
Q

Development at 10-15 months

A

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

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10
Q

Development at 18-20 months

A

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

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11
Q

Development at 2 years

A

runs well

can go up stairs reciprocally

active, restless

tantrums

jumps with 2 feet

catches large ball

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12
Q

Development at 3 years

A

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

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13
Q

Development at 4 years

A

hops on 1 foot several times

climbs

throws ball overhand

stands on tiptoes

relates to friends

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14
Q

Development at 5 years:

A

skips

kicks ball well

dresses and undresses self

swings self on playground

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15
Q

Development of gait

A

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

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16
Q

gestational vs. conceptional age vs. corrected age

A

Gestational: from 1st day of mother’s last normal menstrual period

  • normal= 38-42 weeks
  • premature=
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17
Q

Apgar screening test

A

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
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18
Q

exam:

A

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

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19
Q

neonatal reflexes

A
  • 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
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20
Q

Babinski reflex

A

stroke lateral aspect of the plantar surface of foot, get extension and fanning of toes

0-12 months

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21
Q

Flexor withdrawal and crossed extension reflexes

A

sharp quick pressure stimulus to solve of foot or causes withdrawal of stimulated extremity and extension of opposite leg

0-2 months?

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22
Q

galant or trunk incurvation reaction

A

sharp stroke along paravertebral line from scapula to top of iliac crest results in lateral trunk flexion toward stimulated side

0-2 months

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23
Q

moro reflex

A

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

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24
Q

primary standing reaction

A

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

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25
Q

neonatal neck righting

A

neck righting on body (NOB)

turn head with infant in supine; body log rolls towards same side

0-6 mo

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26
Q

rooting reflex

A

stroking of perioral region results in head turning to that side with mouth opening

0-3 months

important feeding reflex

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27
Q

sucking reflex

A

touch to lips, tongue, palate results in automatic sucking

0-6 mo

important feeding reflex

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28
Q

startle reflex

A

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

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29
Q

tonic labyrinthe reflex (classic)

A

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

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30
Q

asymmetrical tonic neck reflex

A

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

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31
Q

palmar grasp

A

pressure stimulus against pam results in grasping of object with slow release

0-4 months

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32
Q

plantar grasp

A

pressure stimulus to sole or lowering of feet to floor results in curling of toes

must be integrated before walking occurs

0-9 months

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33
Q

placing reactions

A

drag dorm of foot or back of hand against edge of table–> get placing of foot or hand onto table top

0-6 months

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34
Q

traction or pull to sit reaction

A

pull infant to sitting from supine

-UEs will flex and head will lag until 4-5 months

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35
Q

optical and labyrinthine righting reflex

A

head orients to a vertical position when body is tilted

*test labyrinthine with eyes blindfolded

1month- throughout life

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36
Q

protective extension reflex

A

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

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37
Q

symmetrical tonic neck reflex

A

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

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38
Q

Landau’s reaction

A

infant held in ventral suspension will extend neck, trunk and hips
4-18 months

39
Q

tilting/equilibrium reactions

A

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

40
Q

standardized motor tests

A

Movement assessment of infants

Peabody developmental motor scales

Gross motor function measure

Bruininks-oseretsky test of motor proficiency

41
Q

Movement assessment of infants

A

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

42
Q

Peabody developmental motor scales

A

assesses gross and fine motor development from birth-42 months

includes spontaneous, elicited reflexes and automatic reactions

43
Q

Gross motor function measure (GMFM-88)

A

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

44
Q

Bruininks-oseretsky test of motor proficiency

A

developed to measure gross and fine motor ability in children 4.5-21 y/o

norm referred on typical children

45
Q

Pediatric functional assessments

A

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)

46
Q

pediatric therapies

A

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

47
Q

neurodevelopmental treatment (NDT)

A

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
48
Q

prematurity PT practice

A

birth of infant

49
Q

prematurity medical complications

A

*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

50
Q

meconium aspiration syndrome

A

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

51
Q

Respiratory distress syndrome (RDS)

A

“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

52
Q

Bronchopulmonary dysplasia

A

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

53
Q

periventricular leukomalacia (PVL)

A

necrosis of white matter adjacent to ventricles of brain due to systemic hypotension or ischemia

may result in CP

54
Q

periventricular-intraventricular hemorrhage

A

bleeding into immature vascular matrix

bleeds graded I-IV
II-IV may result in CP

55
Q

retinopathy of prematurity (ROP)

A

due to combo of low birth weight and high oxygen levels

sequelae may range from nonsignificant to detachment of retinas and blindness

56
Q

necrotizing enterocolitis

A

ischemia results in inflammatory, infected bowel

57
Q

Patent ductus arteriosis (PDA)

A

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

58
Q

failure to thrive

A

infant lacks adequate nutritional intake

infant can present with developmental delays

59
Q

PT for prematurity

A

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

60
Q

Cerebral palsy (CP)

A

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

61
Q

CP classifications

A

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

62
Q

spastic CP

A
  • 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

63
Q

Athetoid CP

A

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

64
Q

Ataxic CP

A

uncommon

results from cerebellar involvement

weakness, poor coordination and intention tremor produce unsteadiness, wide based gait and difficulty with rapid or fine movement

65
Q

gross motor classification for CP

A

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

66
Q

impairments for all classifications of CP

A

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
67
Q

interventions and goals in CP

A

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
68
Q

medical management of CP

A

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)

69
Q

ITB pump

A

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
70
Q

selective dorsal rhizotomy

A

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

71
Q

orthopedic surgery of CP

A

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
72
Q

Spina Bifida

A

“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)
73
Q

spina bifida occulta

A

no SC involvement, may be indicated by a tuft of hair, dimple or sinus

74
Q

spina bifida cystica

A

visibile or open lesion

meningocele: cyst includes CSF, cord intact
myelomeningocele: cyst includes CSF and herniated cord tissue

75
Q

impairments of spina bifida

A
  • 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

76
Q

Treatment for spina bifida

A

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
77
Q

spina bifida orthotics and functional prognosis

A

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
78
Q

Brachial plexus injury

A

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
79
Q

Erb’s palsy

A

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

80
Q

Klumpke’s palsy

A

lower brachial plexus injury
C8-T1 nerve roots are stretched

result is weakness of the hand and wrist flexors

“claw hand” appearance

81
Q

down syndrome

impairments and functional mobility

A

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
82
Q

PT for down syndrome

A

*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

83
Q

TBI

A

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
84
Q

Duchenne’s muscular dystrophy

A

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
85
Q

Impairments of Duchenne’s muscular dystrophy

A

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

86
Q

TX for DMD:

A

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

87
Q

autism spectrum disorder

A

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
88
Q

Impairments of autism

A

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

89
Q

TX for autism

A

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

90
Q

charcot-marie-toot disease

A

“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

91
Q

legg-calve-perthes disease

A

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
92
Q

positioning equipment

A

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

93
Q

equipment for therapeutic exercise

A

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

94
Q

LE orthotics

A

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

BOARDS (26 decks)

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