Peds 2 Exam 1 (2nd set) Flashcards
1
Q
Describe the three classifications for adaptive equipment, and provide examples of each.
3 A’s
A
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.
2
Q
What are some examples of low-tech, mid-tech, and high-tech adaptive equipment?
A
- 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.
3
Q
Explain the role of adaptive equipment in pediatric physical therapy and its benefits for caregivers.
A
- 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.
4
Q
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A
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5
Q
What is the importance of proper ‘seat dump’ in a wheelchair, and how does it affect hip positioning?
A
‘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.
6
Q
What are the benefits of standing devices for children with mobility limitations?
( increase… enhance… modulate… )
A
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
7
Q
- Compare static and multipositional standers.
- What are their advantages and disadvantages?
A
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.
8
Q
How can adaptive equipment address the influence of retained primitive reflexes like TLR or ATNR?
A
- 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)
9
Q
Discuss funding options for adaptive equipment and the challenges faced by families.
A
- 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.
10
Q
- Why is proper alignment critical in adaptive seating for children?
- What factors should be considered?
A
- 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
11
Q
- Define Spina Bifida
- Differentiate between Spina Bifida Occulta and Spina Bifida Cystica.
A
- 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.
12
Q
What are the primary risk factors associated with Spina Bifida development during pregnancy?
A
Risk factors include…
- low maternal folic acid levels
- genetic predisposition
- maternal hyperthermia
- certain medications (valproic acid & antidepressants)
13
Q
Describe the features of Myelomeningocele and its implications for physical therapy management.
A
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.
14
Q
- What prenatal diagnostic tests can detect Spina Bifida?
- How effective are they?
A
- 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.
15
Q
What is the primary cause of hydrocephalus in children with Spina Bifida, and how is it managed?
A
- 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.
16
Q
Compare Ventriculoatrial (VA) and Ventriculoperitoneal (VP) shunts for managing hydrocephalus.
A
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
17
Q
What are the typical joint contractures observed in neonates with Spina Bifida, and how are they managed?
A
- Common contractures include
- hip flexion/adduction
- knee hyperextension
- ankle dorsiflexion/inversion
- Management includes
- daily ROM exercises
- gentle stretching
- positioning to prevent further deformities
18
Q
Explain the significance of proper positioning and orthoses in children with Spina Bifida.
A
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
19
Q
What are the symptoms of tethered cord syndrome, and why is early detection crucial?
A
- 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.
20
Q
How does Spina Bifida affect skin integrity, and what strategies can be implemented to prevent complications?
A
- 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.
21
Q
- What are the six primary causes of burns in pediatric patients?
- Provide examples for each type.
A
- 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.
22
Q
Describe the classifications of burns based on depth and their associated characteristics.
A
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.
23
Q
What are the goals of physical therapy in managing pediatric burn patients?
A
Goals include
- preventing contractures
- maintaining ROM
- promoting mobility
- managing scars
- ensuring proper positioning for healing
24
Q
What is the importance of splinting in pediatric burn management, and when should splints be used?
A
- 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.
25
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.
26
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.
27
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.
28
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.
29
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).
30
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**.
31
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.
32
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.
33
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.
34
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.
35
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.
36
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.
37
What are the general goals of physical therapy for children with SMA?
Goals include maintaining **joint mobility**, preventing **contractures**, and promoting **function** through stretching, bracing, and alternative exercises like **aquatic therapy** or **vibration training**.
38
What are the common clinical features of Charcot-Marie-Tooth Disease (CMT), and how is it managed?
Features include **foot drop**, **high arches** or **flat feet**, muscle atrophy in legs/arms, and curled toes. Management includes strengthening, orthotics for improved gait, and functional activity training.
39
Why is respiratory function a critical consideration in neuromuscular disorders like SMA and DMD?
Weak respiratory muscles can lead to reduced ventilation, increased risk of infections, and the need for interventions like **assisted coughing**, **positive airway pressure**, or **mechanical ventilation**.
40
What are contraindications for exercise in children with neuromuscular disorders, and why?
Avoid **eccentric exercises**, **high-resistance training**, and prolonged immobilization as they can exacerbate muscle breakdown and lead to faster progression of weakness.
41
What is Respiratory Distress Syndrome (RDS), and what are its key characteristics in neonates?
RDS, also known as hyaline membrane disease, is caused by a **deficient amount of pulmonary surfactant**. Key signs include **airless alveoli**, inelastic lungs, nasal flaring, intercostal retractions, and a respiratory rate >60 bpm.
42
What factors contribute to the development of Bronchopulmonary Dysplasia (BPD) in neonates?
BPD results from prolonged **mechanical ventilation** and oxygen therapy, leading to **lung tissue scarring**, thickened pulmonary arterial walls, and mismatched ventilation/perfusion.
43
Describe the hallmark symptoms of cystic fibrosis (CF) and its impact on the respiratory system.
CF is characterized by **thick, viscous mucus retention**, productive cough, frequent respiratory infections, clubbing of digits, and recurrent pneumonia. It leads to airway obstruction and progressive lung damage.
44
What are the general exercise recommendations for children with cystic fibrosis?
Exercise improves lung function and overall fitness. Activities like **swimming**, **yoga**, and **walking** are encouraged, aiming for at least **30 minutes 2-5 times/week** with monitoring of O2 saturation and respiratory effort.
45
Explain the principles of airway clearance techniques in pediatric patients. Provide examples.
Airway clearance helps mobilize secretions and improve ventilation. Techniques include:
- **Postural drainage**: Uses gravity to drain secretions.
- **Percussion and vibration**: Loosens mucus.
- **Positive expiratory pressure (PEP)** devices.
- **High-frequency chest wall oscillation (HFCWO)** using a vest.
46
What is asthma, and how do symptoms differ between mild and severe cases?
**Mild**: Wheezing, chest tightness, slight shortness of breath.
**Severe**: Dyspnea, nasal flaring, cyanosis, and inability to speak. Severe cases may lead to respiratory failure if untreated.
47
What physical therapy interventions can improve breathing patterns in children with asthma?
Techniques include **rib cage mobility exercises**, **diaphragmatic breathing games**, and **posture training** to reduce accessory muscle activation during quiet breathing.
48
How can early mobility benefit children with pulmonary conditions post-surgery?
Early mobility reduces cardiopulmonary complications by improving **lung ventilation**, promoting **blood circulation**, and preventing complications like **atelectasis** or pneumonia.
49
Describe the contraindications and precautions for high-frequency chest wall oscillation (HFCWO).
**Absolute contraindications**: Unstable head, neck, rib fractures, or active hemorrhage.
**Relative contraindications**: Recent skin grafts, burns, or lung contusion. Always consider patient tolerance and vital stability.
50
What is the role of surfactant in fetal lung development, and what happens in its absence?
Surfactant reduces alveolar surface tension, preventing collapse. In its absence, as in RDS, alveoli remain airless, leading to inelastic lungs and impaired oxygenation.
51
What is the definition of Cerebral Palsy (CP), and how is it classified?
CP is a group of permanent disorders affecting movement and posture due to non-progressive disturbances in the developing fetal or infant brain. It is classified by body parts affected (hemiplegia, diplegia, quadriplegia) and motor types (spastic, dyskinetic, ataxic, hypotonic, mixed).
52
What are the primary risk factors and causes of Cerebral Palsy?
Risk factors include **low birth weight**, **prematurity**, and prenatal events (75% of cases), such as maternal infections. Other causes include perinatal asphyxia, postnatal trauma, or infections like meningitis.
53
Describe the motor classifications of CP based on the type of movement impairment.
**Spastic**: Increased resistance to passive movement, common in 57% of cases.
**Dyskinetic**: Involuntary, uncontrolled movements (e.g., dystonia, choreoathetosis).
**Ataxic**: Poor balance and coordination, with tremors and wide-based gait.
**Hypotonic**: Low muscle tone, often related to chromosomal abnormalities.
**Mixed**: Features of more than one type.
54
What are the hallmark signs and symptoms of Cerebral Palsy in infants and children?
Signs include **abnormal tone**, **persistent primitive reflexes** (e.g., ATNR), **delayed motor skills**, and atypical posture. MRI findings often show brain abnormalities in 70-90% of cases.
55
Explain the Gross Motor Function Classification System (GMFCS) levels for CP.
The GMFCS categorizes functional abilities:
- **Level I**: Walks without limitations.
- **Level II**: Walks with limitations (may need AD).
- **Level III**: Walks with assistive devices; wheelchair for long distances.
- **Level IV**: Limited self-mobility; uses powered mobility or assistance.
- **Level V**: Severe limitations; dependent for mobility.
56
What are the typical postural and gait characteristics in children with spastic hemiplegia, diplegia, and quadriplegia?
- **Hemiplegia**: Asymmetry, toe walking on the affected side, UE retraction, and elbow flexion.
- **Diplegia**: Increased lumbar lordosis, in-toeing, scissoring gait.
- **Quadriplegia**: Limited or absent ambulation; uses gait trainers or wheelchairs.
57
What are common musculoskeletal complications in children with CP, and how are they managed?
Complications include **hip dysplasia**, **spinal deformities**, and **contractures**. Management includes **orthotics**, **surgical interventions**, and **PT interventions** like ROM exercises and positioning devices.
58
Describe the role of spasticity management in CP and the options available.
Management aims to reduce spasticity and improve function:
- **Oral medications**: Baclofen, Diazepam.
- **Neuromuscular blocks**: Botox.
- **Surgical options**: Selective dorsal rhizotomy, intrathecal baclofen pumps.
- **PT**: Stretching, ROM exercises, strengthening.
59
What are the key goals of physical therapy interventions for children with CP?
Goals include improving **strength**, enhancing **ROM**, promoting **functional mobility**, preventing **contractures**, and increasing **participation** through adaptive equipment and task-specific training.
60
How does selective dorsal rhizotomy (SDR) benefit children with CP, and what are its limitations?
SDR reduces spasticity by cutting sensory nerve rootlets while preserving motor function. It is most effective for children with spastic diplegia (GMFCS Levels II-III) but requires intensive postoperative PT for optimal outcomes.
61
Describe the key differences between acyanotic and cyanotic congenital heart defects.
**Acyanotic defects**: Characterized by left-to-right shunting, leading to increased pulmonary blood flow (e.g., VSD, ASD, PDA). Symptoms include rapid breathing and heart failure.
**Cyanotic defects**: Right-to-left shunting, resulting in decreased oxygen saturation and cyanosis (e.g., Tetralogy of Fallot, HLHS). Symptoms include cyanosis, clubbing, and poor weight gain.
62
What is Tetralogy of Fallot, and what are its four defining components?
Tetralogy of Fallot is a cyanotic heart defect with:
- **Large ventricular septal defect (VSD)**
- **Pulmonary stenosis**
- **Overriding aorta**
- **Right ventricular hypertrophy**
63
Explain the stages of surgical repair for hypoplastic left heart syndrome (HLHS).
**Stage 1**: Norwood procedure within the first weeks of life.
**Stage 2**: Glenn procedure at 4-6 months.
**Stage 3**: Fontan procedure at 3-6 years, rerouting venous blood directly to the pulmonary arteries.
64
What is the role of prostaglandin E in managing ductus-dependent congenital heart defects?
Prostaglandin E is used to keep the ductus arteriosus open, ensuring adequate blood flow and oxygenation until surgical repair can be performed.
65
What are the key physical therapy considerations for children with congenital heart defects post-surgery?
Considerations include monitoring vitals, promoting early mobility, managing scar tissue, and adhering to **sternal precautions** (e.g., avoiding underarm lifting). Focus on gradual endurance training and functional mobility.
66
What are the symptoms of congestive heart failure (CHF) in children, and how do they differ for right vs. left heart failure?
**Right HF**: Peripheral edema, hepatomegaly, cyanosis.
**Left HF**: Pulmonary edema, poor perfusion, and difficulty breathing.
67
What is the significance of fetal circulation bypass structures like the ductus arteriosus and foramen ovale?
These structures allow oxygenated blood to bypass the lungs, which are nonfunctional in utero. The **ductus arteriosus** connects the pulmonary artery to the aorta, while the **foramen ovale** allows blood to flow between atria.
68
How does physical therapy help manage developmental delays in children with congenital heart defects?
PT addresses delays by promoting **functional mobility**, enhancing **muscle strength**, improving **endurance**, and incorporating age-appropriate play activities to encourage participation.
69
What are common complications following heart transplant surgery in children, and how are they managed?
Complications include **stroke**, **seizures**, and **graft rejection**. PT focuses on early mobilization, improving endurance, and managing any neurological impairments.
70
What are the sternal precautions for children post-cardiac surgery, and why are they important?
Sternal precautions include avoiding lifting underarms and limiting overhead arm movements for 6 weeks to protect the healing sternum and prevent complications such as dehiscence.
71
What are the common causes of traumatic brain injury (TBI) in pediatric patients by age group?
- **Infants (<1 year)**: Falls and shaken baby syndrome.
- **Toddlers/School-age (1-4 years)**: Falls and motor vehicle accidents (MVAs).
- **Adolescents (5-14 years)**: Sports injuries, MVAs, and recreational accidents.
72
Differentiate between open and closed head injuries and their mechanisms of injury.
- **Open head injury**: Penetrating trauma with skull fracture (e.g., gunshot wounds).
- **Closed head injury**: Blunt trauma from acceleration/deceleration forces (e.g., falls or MVAs).
73
What are the primary and secondary types of brain damage in TBI?
**Primary damage**: Direct result of trauma, including contusions, skull fractures, and diffuse axonal injuries.
**Secondary damage**: Result of subsequent processes like cerebral edema, increased intracranial pressure (ICP), and ischemia.
74
Describe the Rancho Levels of Cognitive Functioning and appropriate PT interventions for low cognitive TBI (Levels I-III).
- **Rancho I-III**: Patients are in a coma or minimally responsive state.
PT interventions include **coma stimulation** using sensory modalities (auditory, visual, tactile), monitoring vital signs, and positioning for contracture prevention.
75
What are the common signs of increased intracranial pressure (ICP) in infants and children?
Signs include **bulging fontanel**, **increased head circumference**, **sunsetting eyes**, irritability, and vomiting. ICP requires immediate intervention to prevent herniation.
76
How is spasticity managed in pediatric TBI, and what are the goals of treatment?
Spasticity management includes **medications** (e.g., Baclofen, Botox), **serial casting**, and **ROM exercises**. The goal is to prevent contractures and improve functional mobility.
77
What are the key PT interventions for mid-cognitive TBI (Rancho IV-V) patients during rehabilitation?
Focus on **structured tasks** to reduce agitation, orientation training, gross motor skill practice, and co-treating with other professionals to address confusion and unpredictable behaviors.
78
Describe heterotopic ossification (HO) in TBI patients and how it impacts rehabilitation.
HO involves abnormal bone growth in soft tissues, causing pain, swelling, and decreased joint ROM. Rehabilitation includes **gentle ROM exercises**, **spasticity management**, and possible surgical intervention.
79
What are appropriate PT goals for high cognitive TBI (Rancho VI-VIII) patients transitioning back to school?
Goals include improving **dynamic balance**, enhancing **gait mechanics**, training on **stair mobility**, and addressing residual motor deficits. Adaptations for school environments may involve mobility aids and adjusted curriculums.
80
What are the differences between decorticate and decerebrate posturing in TBI patients, and what do they indicate?
- **Decorticate posturing**: Flexion of UE and extension of LE, indicating damage above the brainstem.
- **Decerebrate posturing**: Extension of UE and LE, indicating damage to the brainstem. It is associated with a worse prognosis.
81
What are the common causes of spinal cord injuries (SCI) in pediatric patients, and how do they differ by age?
- **Infants and toddlers**: Birth trauma, child abuse, and SCIWORA (Spinal Cord Injury Without Radiographic Abnormality).
- **School-age children**: MVAs, sports injuries, falls.
- **Adolescents**: MVAs, sports, and recreational accidents.
82
What is SCIWORA, and why is it more common in children?
**SCIWORA (Spinal Cord Injury Without Radiographic Abnormality)** occurs due to ligamentous laxity and flexible spines in children. It involves stretching or ischemia of the spinal cord without visible fractures on imaging.
83
Differentiate between complete and incomplete spinal cord injuries using the ASIA scale.
- **Complete SCI (ASIA A)**: No sensory or motor function preserved below the injury level.
- **Incomplete SCI (ASIA B-D)**: Sensory and/or motor function preserved below the injury level, with varying degrees of muscle strength.
84
What are the symptoms of autonomic dysreflexia in SCI patients, and how is it managed?
Symptoms include **elevated blood pressure**, **headache**, **bradycardia**, and sweating. Management involves identifying and removing the noxious stimulus (e.g., bladder distension, tight clothing) and monitoring vitals closely.
85
What are the key physical therapy goals for children with SCI during the acute phase?
Goals include maintaining **ROM** to prevent contractures, addressing **positioning** for skin integrity, initiating **strengthening** exercises as tolerated, and providing **family education** on mobility and transfers.
86
Describe the functional expectations for SCI at the following levels: C5, L2, and S1.
- **C5**: Elbow flexion (biceps); may require power wheelchair with adaptations.
- **L2**: Hip flexion (iliopsoas); potential for walking with bracing and assistive devices.
- **S1**: Ankle plantarflexion (gastrocnemius); independent walking, possibly with minimal bracing.
87
What are the long-term complications associated with pediatric SCI, and how can they be mitigated?
Complications include **scoliosis**, **hip dislocation**, **pressure sores**, and **DVTs**. Mitigation strategies include regular skin checks, orthotic use, and frequent repositioning.
88
What are the clinical features and rehabilitation goals for Brown-Sequard Syndrome?
**Features**: Ipsilateral motor and proprioceptive loss, contralateral pain, and temperature loss.
**Goals**: Focus on strengthening the weaker side, balance training, and compensatory strategies for sensory deficits.
89
How does physical therapy address muscle tone changes (e.g., spasticity or flaccidity) in pediatric SCI patients?
PT involves **stretching** for spasticity, **serial casting**, and neuromuscular electrical stimulation (NMES). For flaccidity, strengthening and play-based activities are used to maintain functional mobility.
90
What are the key differences between anterior cord syndrome and central cord syndrome in SCI patients?
- **Anterior cord syndrome**: Loss of motor function and pain/temperature sensation below the injury, with preserved proprioception.
- **Central cord syndrome**: Greater weakness in the upper extremities than lower extremities, typically from hyperextension injuries.
