Peds 2 Exam 1 (2nd set) Flashcards
Describe the three classifications for adaptive equipment, and provide examples of each.
3 A’s
Assistive technology: Any item, equipment, software program or product system use to increase, improve or maintain function.
- Modified eating utensils, orthotics, or any device that improves or maintains function.
Alternative technology: A substitute toward the same end function.
- A wheelchair for mobility instead of walking.
Augmentative technology: Supplements for an inadequate function but the function remains.
- Speech-generating devices that supplement existing communication functions.
What are some examples of low-tech, mid-tech, and high-tech adaptive equipment?
- Low-tech: Pencil grips, benches for foot support during sitting.
- Mid-tech: Powered toys, recording devices, basic wheelchairs.
- High-tech: Computers with voice recognition, eye gaze systems, powered wheelchairs.
Explain the role of adaptive equipment in pediatric physical therapy and its benefits for caregivers.
- Adaptive equipment serves as an adjunct to direct PT by reinforcing positioning and movements introduced in therapy.
- It reduces caregiver demands and assists with daily management at home by ensuring proper alignment and functionality.
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What is the importance of proper ‘seat dump’ in a wheelchair, and how does it affect hip positioning?
‘Seat dump’ refers to the rear of the seat being lower than the front.
- Increasing hip flexion to reduce extensor posturing and prevent sliding forward.
- This angle, typically 95-110 degrees, promotes stability and comfort.
What are the benefits of standing devices for children with mobility limitations?
( increase… enhance… modulate… )
Standing devices…
- increase LE weight-bearing
- promote bone mineral density
- improve circulation
- enhance GI function
- maintain LE ROM
- modulate spasticity
- encourage social interaction & vertical reach
- Compare static and multipositional standers.
- What are their advantages and disadvantages?
Static standers: Simple setup, small size, fixed position; require dependent lifting.
- Best for stable, single-position support.
Multipositional standers: Offer multiple configurations (e.g., supine, prone, upright); larger and more complex to reconfigure but provide versatile options.
How can adaptive equipment address the influence of retained primitive reflexes like TLR or ATNR?
- Devices can help inhibit or restrict the effects of primitive reflexes by stabilizing posture or limb alignment, allowing for better motor control during activities.
- Use of devices to restrict or inhibit the influence of primitive reflexes is more common (TLR, ATNR)
Discuss funding options for adaptive equipment and the challenges faced by families.
- Funding options include:
- private insurance
- Medicaid
- IDEA (if covered in IEP or IFSP)
- state waivers
- community organizations
- Families often face challenges with high costs, maintenance, and replacement of equipment over time.
- Why is proper alignment critical in adaptive seating for children?
- What factors should be considered?
- Proper alignment ensures functionality and comfort.
- Factors include…
- hip flexion (≥90 degrees)
- seat depth (two-finger space at the popliteal fossa)
- foot support to reduce postural abnormalities like pelvic tilt or kyphosis
- Define Spina Bifida
- Differentiate between Spina Bifida Occulta and Spina Bifida Cystica.
- Spina Bifida Occulta: Non-fusion of the posterior vertebral arch without disturbance of neural tissue.
- It may present with a midline tuft of hair or pigmentation.
- Spina Bifida Cystica: A cyst-like protrusion through the incomplete fusion of the posterior arch, categorized further as…
- Meningocele = Protruding sac containing meninges and cerebrospinal fluid (CSF) / Nerve roots and spinal cord remain intact and in their normal positions / No motor or sensory deficits, associated hydrocephalus, or other central nervous system (CNS) problems.
- Myelomeningocele = Sac containing meninges, CSF and spinal cord protruding through the defect in the vertebrae / Sac covered by transparent membrane OR open with neural tissue exposed / Defect can involve single or multiple vertebral segments.
What are the primary risk factors associated with Spina Bifida development during pregnancy?
Risk factors include…
- low maternal folic acid levels
- genetic predisposition
- maternal hyperthermia
- certain medications (valproic acid & antidepressants)
Describe the features of Myelomeningocele and its implications for physical therapy management.
Myelomeningocele involves a sac containing meninges, CSF, and spinal cord protruding through a vertebral defect.
- PT focuses on managing motor deficits, addressing postural alignment, preventing contractures, and enhancing mobility.
- What prenatal diagnostic tests can detect Spina Bifida?
- How effective are they?
- Alpha-Fetoprotein (AFP): Elevated levels indicate neural tube defects (89% detection rate with maternal blood samples and amniocentesis).
- Ultrasound: Detects abnormalities such as the ‘lemon sign’ (flattened frontal bones) before 24 weeks gestation.
What is the primary cause of hydrocephalus in children with Spina Bifida, and how is it managed?
- Arnold-Chiari II malformation is the primary cause, involving downward herniation of the cerebellum and obstruction of CSF flow.
- Management typically includes placement of a ventriculoperitoneal (VP) shunt to drain excess CSF.
Compare Ventriculoatrial (VA) and Ventriculoperitoneal (VP) shunts for managing hydrocephalus.
Ventriculoatrial (VA) shunt:
- Moves excess CSF from one lateral ventricle to the right atrium of the heart
Ventriculoperitoneal (VP) shunt:
- Preferred treatment for hydrocephalus
- Lateral ventricle, lateral neck, under clavicle and inserts into peritoneum
What are the typical joint contractures observed in neonates with Spina Bifida, and how are they managed?
- Common contractures include
- hip flexion/adduction
- knee hyperextension
- ankle dorsiflexion/inversion
- Management includes
- daily ROM exercises
- gentle stretching
- positioning to prevent further deformities
Explain the significance of proper positioning and orthoses in children with Spina Bifida.
Proper positioning prevents hip dislocations and spinal deformities, while orthoses (e.g., HKAFO, RGO) support mobility and alignment.
Custom orthotics are essential for maintaining functional posture and ambulation.
Low lumbar (L4-L5): strong hip flex/add, min glut med and TFL, strong quads and med hamstrings, RGO, KAFO or AFO
What are the symptoms of tethered cord syndrome, and why is early detection crucial?
- Tethered cord: Occurs when adhesions anchor the spinal cord at the site of the original lesion.
- Symptoms include:
- increased lumbar lordosis
- progressive scoliosis
- spasticity
- changes in gait
- urologic dysfunction
- Early detection prevents neural ischemia and permanent motor impairments through surgical release.
How does Spina Bifida affect skin integrity, and what strategies can be implemented to prevent complications?
- Children with Spina Bifida are prone to pressure ulcers due to impaired sensation.
- Strategies include pressure mapping, regular repositioning, and proper fitting of orthoses and mobility devices.
- What are the six primary causes of burns in pediatric patients?
- Provide examples for each type.
- Thermal: Fires, scalds, or steam exposure.
- Chemical: Contact with acids or alkalis.
- Electrical: Faulty wiring or chewing on cords.
- Mechanical/Friction: Road rash or treadmill injuries.
- Cold: Frostbite.
- Radiation: Sunburns or medical radiation exposure.
Describe the classifications of burns based on depth and their associated characteristics.
Superficial (1st degree): Affects the epidermis; pink/red, no blistering, heals without scarring.
Partial Thickness (2nd degree):
Superficial partial thickness: Epidermis and papillary dermis; red, blistered, painful.
Deep partial thickness: Down to reticular dermis; waxy white, less painful.
Full Thickness (3rd degree): Epidermis, dermis, and subcutaneous tissue; anesthetic to touch, requires grafting.
What are the goals of physical therapy in managing pediatric burn patients?
Goals include
- preventing contractures
- maintaining ROM
- promoting mobility
- managing scars
- ensuring proper positioning for healing
What is the importance of splinting in pediatric burn management, and when should splints be used?
- Splints prevent contractures by holding joints in neutral or end-range positions during healing.
- They are typically worn 24 hours/day, removed only for dressing changes.
How are hypertrophic scars managed in children with burns?
Management includes
- pressure garments
- scar massage
- silicone sheets
- taping
- protecting the area from sun exposure
Surgical options include laser therapy and Z-plasty.
Differentiate between superficial partial-thickness and deep partial-thickness burns in terms of symptoms and outcomes.
Superficial partial-thickness: Red, blistered, painful; sweat and sebaceous glands are spared, heals without significant scarring.
Deep partial-thickness: Waxy, white, reduced sensitivity; damage to sebaceous glands, often requires surgical intervention.
What are the indications for performing an escharotomy, and how does it benefit burn patients?
Escharotomy is indicated for circumferential burns that compromise circulation or respiration. It involves making incisions to relieve pressure and restore blood flow.
What strategies can be used to maintain functional mobility during burn recovery?
Strategies include early mobilization, engaging in age-appropriate exercises, using assistive devices as needed, and incorporating play-based therapy to encourage movement.
How does the location of a burn influence positioning strategies during recovery?
Positioning must prevent contractures specific to the burn site:
- Axilla burns: Abduction and external rotation.
- Elbow burns: Extension and supination.
- Hand burns: Intrinsic-plus position (MCP flexion, IP extension).
Explain the role of airway clearance techniques in pediatric burn patients with respiratory involvement.
Airway clearance helps remove secretions in cases of inhalation injuries. Techniques include postural drainage, percussion, incentive spirometry, and the use of PEP devices.
What is Duchenne Muscular Dystrophy (DMD), and who does it primarily affect?
DMD is the most common neuromuscular disorder of childhood, caused by a mutation in the dystrophin gene. It primarily affects males, with symptoms typically presenting between 2-5 years of age.
What are the hallmark signs of Duchenne Muscular Dystrophy, and how does it progress?
Hallmarks include the Gower sign, pseudohypertrophy of the calf (muscle replaced by fat and fibrosis), and gait abnormalities (toe walking, wide base of support). Progression leads to loss of ambulation by 10-12 years and respiratory/cardiac complications by early adulthood.
Describe the general stages of DMD and key clinical features at each stage.
Presymptomatic: Delayed milestones, clumsiness.
Early ambulatory: Waddling gait, toe walking, Gower sign.
Late ambulatory: Fatigue, difficulty with stairs, loss of independent walking.
Early non-ambulatory: Wheelchair dependence, scoliosis.
Late non-ambulatory: Dependent transfers, severe respiratory and cardiac issues.
What are key physical therapy interventions for DMD, and what should be avoided?
Focus on submaximal effort exercises, contracture management, and mobility aids. Avoid high-resistance and eccentric exercises as they can accelerate muscle damage.
What is Spinal Muscular Atrophy (SMA), and which gene and protein are affected?
SMA is a genetic disorder affecting the SMN1 gene, leading to deficient SMN protein. This results in progressive motor neuron degeneration and muscle atrophy.
How are the types of SMA classified, and what are their general characteristics?
Type 0: Non-viable at birth.
Type 1: Most common, loss of milestones like head control.
Type 2: Affects lower limbs more than upper limbs.
Type 3: Juvenile form, ability to walk independently.
Type 4: Adult onset.
