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Lifespan > Pediatrics Test 1: Lecture 2 > Flashcards

Pediatrics Test 1: Lecture 2 Flashcards

1
Q

things to keep in mind when performing a neuromuscular peds exam

A

be diligent with following new tests/measures

need a detailed knowledge of typical motor development

exam/interventions should be based on developmental model

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2
Q

things to keep in mind when considering a peds neuromuscular intervention

A

intervention should focus on age appropriate functional motor behaviors; don’t necessarily have to stick to strict developmental sequence (i.e. don’t have to crawl before they walk)

assess impairments in body structure to determine reasons for activity restrictions

major intervention goal = improve motor ability and participation in home, school, and community

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3
Q

when testing a kid’s motor behaviors when they have a neuromuscular condition they can be variable. This can be attributed to what factors

A

fluctuating/abnormal mm tone

poor motor coordination

medications

factors related to fatigue, age, behavior, pain, attention, etc

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4
Q

testing considerations with neuromuscular exam in kids

A

test items may need to be repeated in a single session and again in later sessions to determine the most common behavior

kid may have concomitant deficits and/or emotion/behavior problems - may be hard to determine if these things are also affecting motor behavior

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5
Q

kids with neuromuscular disabilities are organized by testing categories; these include what

A

age range for tests and recommended use based on 3 major testing purposes (discriminative, predictive, and evaluative)

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6
Q

impairement of body structures and functions within diagnoses varies greatly and depends on

A

location
severity
age at time of injury
motor behaviors kid learns to use
practice
available support

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7
Q

what is mm tone and how does it relate to kids with NM disabilities

A

active mm contraction

readiness to move

kids with NM disabilities can be hyper or hypo

can fluctuate resulting in involuntary movements like athetosis and ataxia

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8
Q

what intrinsic changes are related to hypertonia

A

contracture of collagen tissues

decrease in viscoelastic properties of mm tissue

collagen accumulation in mm

changes in mm fibers (atrophy; especially of type II)

decreased force production in mm cells

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9
Q

what happens when there is a decreased facilitation of polysynaptic reflexes and what might a kid do to compensate

A

may result in weakness and pareis during movement in individuals with hypertonia

kid may compensate by using co-contraction to create sufficient tension for postural control and movement

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10
Q

sx/drug interventions to help with hypertonia

A

goal = lower excitation in motor neuron pools

selective dorsal rhizotomy

intracathecal or oral baclofen

botox

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11
Q

what happens once spasticity is reduced via sx or meds

A

normal movement does NOT automatically emerge

underlying secondary MSK changes ,weakness, and contractures can still impede movement in addition to learned motor patterns

learned motor patterns also do not disappear once the spasticity is removed; it’s important to understand under what conditions sx/meds are best and will be most effective

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12
Q

examples of standardized assessments in infants

A

Harris Infant Neuomotor Test (HINT)

Test of Infant Motor Performance (TIMP)

Alberta Infant Motor Scale (AIMS)

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13
Q

infant standardized tests that help predict the likelihood of CP

A

TIMP

General Movement Assessment (GMA)

Hammersmith Infant Neurological Examination (HINE)

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14
Q

developmental tests for older children typically look at what types of factors

A

complex balacnce/coordination

SLS

hopping

gallop

jump patterns

skipping

fine and gross motor

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15
Q

examples of assessment for young kids

A

Bayley Scales of Infant Development

Gross Motor Function Measure

Peabody Developmental Motor Scales, 2nd edition

moderate to good reliability - might be used for discriminative, evaluative, and predictive purposes

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16
Q

what is one of the few tests of motor performance that is for older kids ages 4-21

A

Bruininks-Oseretsky Test of Motor Proficiency

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17
Q

functional tests that examine child’s activity and participation levels

A

pediatric evaluation of disability inventory (PEDI)

PEDI computer adaptive test (PEDI-CAT)

childhood health assessment questionnaire (CHAQ)

clinical observation of motor and postural skills (COMPS)

goal attainment scaling (GAS)

school function assessment (SFA)

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18
Q

what is the timed obstacle ambulation test

A

TOAT

obstacle course tha requires the child to move across different floor surfaces; step up, down, over; duck under obstacles; negotiate through turns and narrow path

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19
Q

testing conditions for the pediatric clinical test of sensory interaction on balance (P-CTSIB)

A
  1. eyes open normal surface - vision, vestibular, somatosensory available
  2. eyes closed normal surface - no vision
  3. dome normal surface - compromised vision
  4. eyes open foam surface - somatosensory compromised
  5. eyes closed on foam - no vision; compromised somatosensory
  6. dome, foam surface - vision and somatosensory compromised
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20
Q

youngest survivable gestational age

A

22-25 weeks

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21
Q

when in gestation are major brain structures present

A

24 weeks

lack of O2 to brain can result from minor stress to infants system

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22
Q

hypoxemia

A

decrease in amount of oxygen in blood

often occurs with ischemia

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23
Q

ischemia

A

decreased vascular perfusion to a tissue bed such as the brain

often occurs simultaneously with hypoxemia

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24
Q

asphyxia

A

most severe lack of O2

“without pulse”

prolonged = results in hypotension and ischemia causing cellular death - usually leads to permanent disability

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25
Q

major brain areas involved in movement generation and control

A

subcortical nuclei

cerebellum

cortex

basal ganglia

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26
Q

things that can cause CP

A

unknown genetic alterations causing neurological malformations

lack of O2 at or around birth or during early development

insults/trauma to head

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27
Q

what is selective neuronal necrosis

A

in full term infant = neuronal injury with characteristic pattern in CNS

early neuronal changes occur within 24-36 hours of injury

signs of cell necrosis within several days

over next several weeks - macrophages will consume necrotic cells

with severe lesions, a cavity may form in cerebral cortex that becomes a fluid filled cyst

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28
Q

what is CP

A

most common peds disability

general term for CNS insult

gross motor classification system (5 levels)

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29
Q

characteristics of CP

A

primary CNS disorder; motor disabilities due to early damage of brain in areas controlling motor behaviors

characteristic ortho impairments associated with a GMFCS level such as scoliosis or hip dysplasia

kids with CP often have more variability in the size of mm fibers, type of mm fibers/composition, atrophy, decreased vascularization, increased extracellular space, and increase in fatty and connective tissue deposit in mm

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30
Q

do CP lesions progress

A

no

sequelaw may vary as child ages as a result of the development of atypical motor habits used by the child to compensate for poor motor/posture control and motor learning deficits

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31
Q

how are kids with CP classified

A
  1. distribution of motor disability
    -quadraplegia = all limbs involved
    -hemi = one side
    -diplegia = primarily LEs
  2. type of mm tone or motor control disorder
    - spastic = exaggerated reflexes with abnormal patterns posture/mvmt
    - dyskinetic = atypical patterns of posture and involuntary uncontrolled reoccuring stereotyped mvmt
    -dystonic = involuntary, sustained, intermittent mm contraction with repetitive mvmt and abnormal posture
    - athetosis = slow continuous writhing movements
    - ataxic = inability to generate normal or expected voluntary mvmt trajectories not due to weakness or involuntary mm activity
    - mixed = spasticity and dyskinesia
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32
Q

secondary to the brain insult, what other S&S are typical with CP kids

A

hearing impairments
sensory impairments
seizures

functionally = problems with sustaining postural control in prone, sitting, and standing; trouble with complex movements

wide range of limits/restrictions

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33
Q

what are hyperkinetic movements

A

unwanted excess movements

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34
Q

dystonia

A

in reference to hypertonia… increased tone not always present in dystonia

movement disorder in which involuntary sustained or intermittent mm contractions cause a twisting and repetitive movements and/or abnormal postures

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35
Q

chorea

A

on going random appearing sequence of one or more discrete movements or movement fragments

vary in timing, duration, direction, and body location

distinguish from dystonia by unpredictable and continuous nature of movement

distinguish from atheosis by presence of discrete movements within the continuing sequence of movement

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36
Q

tremor definition

A

rhythmic back and forth or oscillating involuntary movement about joint axis

relative symmetry in speed

can be resting, postural, or action tremor

intention tremor = cerebellar dysfunction; worsening when reach target; can resemble dysmetria

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37
Q

dysmetria

A

inaccurate movements leading to repeated over corrective attempts

38
Q

ataxia

A

gross lack of coordinated movements that generally originates from damage to cerebellum

child with ataxia generally has normal strength and no hypertonia, but movements are jerky and inaccurate

can be limb, trunk, or gait ataxia depending on where the cerebellar lesion is

39
Q

how to look at coordination of voluntary movements in kids

A

often difficult; requires complex computer equipment (measures kinematics, kinetics, and EMG during movements like gait and reach)

video based tech can measure duration, accceleration, and types of leg movement in infants; can see subtle differences in movement in kids to determine if movements are typical or atypical

40
Q

clinical testing of the neuromuscular system to look at coordination of voluntary movements in kids with CP usually involves what

A

methods of observational analysis of motor coordination during balancing

i.e. therapist can place child on a movable surface, move the surface under the child, and subjectively grade the motor response caused by the perturbation

tests like this are informative but reliability is questionable

41
Q

spine related problems in kids with CP

A

15% incidence of scoliosis

lack of stability and decreased amount of movement places child’s spine in atypical postures for prolonged periods resulting in flexible or fixed deformities

42
Q

pelvis/hip related problems in kids with CP

A

result from bony abnormalities, alignment, and shape and mm abnormalities

hypertonicity around hip (common with spastic CP) of hip flexion, adduction, IR can lead to atypical posture, bony alignment, ROM limits, and hip dislocations

PPT often occurs with tight HS and results in trunk flexion

43
Q

foot/ankle problems common with kids with CP

A

reduced DF = most common impairment (bc shortened gastroc)

inability to generate sufficient stability at ankle

child assumes PF position

44
Q

interventions for kids with CP

A

provide WBing opportunities - promotes bone modeling and increased ROM

deficits in ROM change normal skeletal alignment and decrease fluidity and efficiency of movement (want to help ROM as best you can)

decisions to use AFO should be carefully considered and individualized to each child

tendon lengthening or transfers if ROM and splinting are unsuccessful

strength training; positive benefits in gait characteristics, endurance, and functional activities

45
Q

describe the neurodevelopmental treatment

A

1940s; Karl and Berta Bobath

focus shift from ortho to neuro

sensory and motor impairments like abnormal tone interpreted as release phenomena controlled by lower centers of the hierarchical nervous system

skilled handling to reduce tone and facilitate normal movement

integrate current motor learning principles and emphasizes the goal of gradual reducing the reliance on passive handling techniques

little formal evidence on effectiveness

46
Q

describe the sensory integration theory

A

Jean Ayres in 1960s

addresses the sensory processing and motor/perceptual deficits of kids with learning disabilities

states that motor learning is dependent on the ability to take in sensory info derived from the environment and from movement of the body, process and integrate these inputs in the CNS, and use this info to plan and produce organized behavior

47
Q

describe the cognitive education theory

A

not considered a PT intervention but peds therapists may be involved

Andras Peto (Hungarian neurologist) developed in 1940s

holistic approach to development and edu of children with neuro dysfunction

not a therapy system but a system of edu that aims to teach kids to be active and self reliant participants in the world

48
Q

evidence based treatment for CP kids

A

bimanual training
constraint induced movement therapy
context focused therapy
fittness training
strength training
goal directed training
home exercise programs

improve motor activity performance and cardiovascular endurance

kids with CP often use assistive devices

49
Q

what is autism spectrum disorder

A

complex developmental condition

limits in social interaction, communication, and restricted or repetitive behaviors that interfere with a child’s ability to function

50
Q

describe sensory abnormalities with ASD

A

between 40-90% of kids with ASD have them

95% have processing impairments

may be over-responsive to typical sensory input (hypersensitivity) or under responsive (hypo)

some kids have hypo and hyper at the same time

responses may fluctuate so interventions can be complicated

51
Q

describe the rate of fine/gross motor defiicts in kids with ASD and how PT can help

A

63% of kids had decreased fine and gross motor skills (measured by peabody)

this qualifies kids for early intervention

PTs should be involved with screening kids in schools; often PT is underutilized

52
Q

other S&S of ASD in kids aside from social skills

A

hypotonia
gait dysfunction
toe walking
decreased posture control
dyspraxia

53
Q

what does evidence suggest could be an early predictor of ASD before specific dx signs occur

A

early motor delay

54
Q

ways to help increase participation in kids with ASD

A

sensory integration
sensory based interventions
relationship based interventions

55
Q

what is developmental coordination disorder

A

overall deficit in motor control and motor learning

specifically, lack of predicted control of movements described as internal modeling deficits

56
Q

interventions for developmental coordination disorder

A

task specific interventions based on motor learning principles

neuromuscular task training which accentuate the use of augmented feedback for learning, memory cues, and practice in varied environments

fitness activities and karate have good research

57
Q

what is cognitive orientation to daily performance and what is this intervention often used for

A

often used to improve motor performance in kids with DCD

focuses on increasing performance of child using a problem solving approach with task specific strategies

58
Q

explain what factors are important when collaborating with the child, family, and other team members of kids who have a DCD dx

A
  1. explain the nature of the disorder
  2. provide strategies for controlling sensory input to make learning more successful
  3. devise appropriate consistent behavioral consequences to support the child in trying activities
59
Q

what do longitudinal studies on kids with DCD suggest

A

some problems may decrease with age but they usually do not disappear

60
Q

describe the pathophysiology of down syndrome

A

most common chromosomal abnormality in kids; 90% have extra chromosome on chromosome pair 21

neuropathological differences:
- small/smooth brain (76% of normal) especially in frontal lobe
- small cerebellum and brainstem (66% of normal)

intellectual deficits can affect motor abilities

visual/vestibular deficits can affect postural control

61
Q

common comorbidities with down syndrome

A

respiratory issues
GI issues
cardiovascular issues
endocrine issues
immune health problems
MSK issues
neurological issues
hearing loss
visual deficits
ortho limits
GU issues
sensory limits

62
Q

describe the physiological structure difference of neurons in those with down syndrome

A

structural difference in spines of pyramidal neurons

lack of myelination of neurons in cortex and cerebellum

decrease neurons in hippocampus

increase in alzheimer’s neurofibrillary tangles with age

63
Q

what are common reasons you may see a down syndrome pt in PT

A

short stature
pes planus
hip dysplasia
ligamentous laxity
patellar dislocation
low mm tone (hypotonus)
alantoaxial instability
ligamentous laxity

64
Q

common problems that develop with adults with down syndrome (usually due to excessive wear and tear on joints)

A

patellofemoral instability

genu valgus

pes planus

hip instability

65
Q

hypoextensibility of connective tissues in those with down syndrome results in what

A

decreased rebound of tissue

66
Q

low mm tone in those with down syndrome usually has what affect

A

decreased effectiveness of stretch reflex because the proprioceptors are not at a hight state of readiness to respond

67
Q

examples or recommended interventions for down syndrome pts may include

A

strengthening using resistive training

balance training

treadmill gait training

orthotic management

associated BMI issues = ongoing aerobic conditioning and promotion of wellness

68
Q

orthotics that may be used with down syndrome

A

supramalleolar orthotics

used to improve postural stability and lower extremity alignment

prevent secondary deformities that can result from malalignment and overuse

** do not want to give orthotics before they are able to ambulate independently; may negatively impact child’s motor skill development

69
Q

rates of TBI in kids

A

kids 0-4 have highest risk (due to fall)

children under 17 were among those most likely to sustain a TBI due to blunt force trauma by an object

70
Q

what is a closed head TBI and what are the implications of this

A

occurs focally at point of impact and diffusely

reverberations occur to the brain within the cranium or shearing forces cause by initial blow

ischemic damage can occur after initial trauma if child stops breathing

71
Q

what is cerebral edema (associated with TBI) and what are ways to manage it

A

occurs due to bilogical products leaking from dead cells

immune system products sent by body to combat damage and can destroy the remaining unharmed brain tissue if left uncontrolled

shunting and medication to releave ICP can improve outcomes

72
Q

S&S associated with kids with TBI

A

show some cognitive, emotional, behavioral control problems

attributed to frontal and temporal lobes to shearing force damage

can include hyperactivity, distractibility, involving poor ability to filter out unimportant sensory stimuli in the environment

difficulty with visual perception

73
Q

factors that glascow coma scale measures

A

eye opening
verbal response
motor response

74
Q

interventions for kids as they are coming out of a coma following TBI

A

want active movement in response to passive ROM and sensory stimuli

sensory stimulation - cutaneous (brushing/tapping), auditory (talking/music), visual (use of lights and bright colored objects), gustatory (tastes), and olfactory (diff odors)

all of the above may trigger child to come out of coma

75
Q

common impairments seen with kids post TBI

A

decreased balance and gait speed

increased step length variety

76
Q

what is spina bifida

A

split spine

indicates that bony structures of the spinal vertebrae fail to close over the posterior aspect of the spinal cord at some level or levels during neurulation (around week 3-4 of gestation)

77
Q

what is myelodysplasia

A

displacement of some tissue in a sac that protrudes through this posterior opening of the spinal vertebra

degree to which neural elements are involved in this protrusion and the level of the spinal cord affected define the severity of the loss of motor and sensory function around and below that level

78
Q

what is spina bifida occulta (closed)

A

malformation of one or more vertebrae is malformed

most cases, this one does not cause impairments

79
Q

what is a meningocele

A

a sac protrudes at spinal opening containing spinal fluid and meninges but no neural tissue

LMN damage is likely

80
Q

what is a myelomeningocele

A

protruding sac contains spinal fluid, meninges, and neural tissue

81
Q

treatment of a myelomeningocele and the pros/cons

A

in utero or post birth, protruding tissue is excised and spinal opening is surgically closed

at 26 weeks in utero:

pros = decreases need for postnatal ventriculoperitoneal shunting, hindbrain herniation, and improved motor function

cons = risk of ruptured membrane during pregnancy, preterm delivery, and unknown urologic function

82
Q

etiology of myelomeningocele

A

unknown

thought to be a combo of genetics and environment

relationship between inadequate vitamins and folic acid intake in neural tube defects

83
Q

how can open lesions of MM be detected

A

before birth

mother’s erum alpha fetoprotein levels

ultrasound

amniocentesis (more invasive)

84
Q

S&S of spina bifida kids

A

mix of LMN and brain dysfunction

affects motor control learning and functional motor ability

51-65% of kids with myelodysplasia develop hydrocephalus

bowel/bladder problems common

visual deficits (especially if kid has hydrocephalus)

85
Q

what is arnold chiari or chiari II malformation

A

brainstem is displaced inferiorly beyond foramen magnum

partial blockage of passage of CSF from brain to SC

86
Q

likelihood of walking in kids with spina bifida based on location of lesion

A

thoracic and high lumbar lesions - kids may start walking; less than 20% still walking by 9 years

midlumbar level lesions = more likely to walk; 40-70% still walking by 9

sacral lesions = reach and maintain functional ambulaiton with ADs and/or orthotics

87
Q

overall goals for intervention with kids with spina bifida

A
  1. strengthen innervated mm and teach compensatory movement patterns and posture control necessary for kid to achieve functional movement
  2. prevention of further MSK problems, LE contractures, OA, scoliosis, or pain
  3. prevent skin breakdown due to loss of sensation
88
Q

interventions for spina bifida that do not have adverse effects

A

E-stim, exercise training, and motor skill training lead to improvements in strength with no adverse effects

89
Q

how to determine the type of mobility that should be encouraged with kids with spina bifida

A

must be individualized to pt according to
- child/family desires
- social issues
- energy consumption for different types of mobility
-cognitive development

encourage assistance with early mobility; mobility development linked to some cognitive abilities (depth perception, cause and effect links, and object permanence)

90
Q

describe brachial plexus injuries in kids and the general outcomes expected

A

at birth or in older kids after trauma

2 most common types: Erb’s palsy (C5 and C6) and Klumpke Palsy (C8 and T1)

good prognosis with early therapy for Erb

most kids recover triceps, biceps, deltoid, and wrist ext function by 6 moths

long term difficulty is likely if there is not significant recovery by 6 months

91
Q
A

Lifespan (6 decks)

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