Peds Cases Test 2 Flashcards
INDIVIDUALS WITH DISABILITIES EDUCATION IMPROVEMENT
ACT (2004), PART C:
Early intervention program for children w/ disabilities
Meds from Downsyndrome case:
RANITIDINE
and
THYROXINE:
Ranitidine- used for acid reflux
Thyroxine- for hypothyroidism
What is a ventricular septal defect (common w/ down syndrome)
Hole in the wall (septum) that
separates the lower chambers of the heart
Precautions for downsyndrome during therapy:
Protect joints from extreme ROM d/t hypotonia and laxity of ligaments
observe for signs of OA instability
Observe for signs of cardiac and thyroid disorders
what complications can happen with down syndrome during therapy
Behavioral challenges d/t young age and mental disability
OA instability
down syndrome affects what chromosome?
T or F: the presence of downsyndrome increases w/ maternal age
chromosome 21 (extra chromosome on this one to make 3/trisomy)
T
How is downsyndrome detected early?
nuchal translucency (using ultrasound to measure the size of
the clear space in the posterior tissues of the neck of the fetus), and maternal blood tests.
what are the common physical characteristics of downsyndrome
small ears,
a wide space between the first and second toes,
small internipple distance
Brushfield’s spots (colored speckles in the iris of the eye),
increased nuchal skinfold thickness.
Other reliable and discriminative signs include hypotonia, a flat
face with upward slant of the eye slit, and brachycephaly
What are the key musculoskeletal problems affecting people with downsyndrome
Ligament laxity
hypotonia
Other problems w/ downsyndrome:
Sleep apnea
Seizures
Leukemia
GI problems
what are neurological impairments associated with downsyndrome?
reduced brain volume
smaller frontal and temporal areas,
smaller cerebellum
smaller hippocampus (critical for long-term memory).
easy fatigability; difficulty walking; abnormal gait or a change in gait; neck pain
or torticollis; limited neck mobility; change in hand function; new onset of
urinary retention or incontinence; increase in incoordination or clumsiness;
sensory impairments; and spasticity, hyperreflexia, or a Babinski’s sign.
Signs of OA instability in downsyndrome
What motor function scale do we want to use for downsyndrome?
Gross Motor Function Measure (GMFM).
best PT interventions for down syndrome?
Care giver education on modifying home environment
Body-weight-support treadmill training for pre-ambulatory pts 8 mins per day 5 days a week
SMO orthosis
Children with Down syndrome show delayed development of postural control that is most affected by:
Smaller than normal cerebellum
What has been shown to help a young child with DS learn to walk independently earlier?
Treadmill training
(from the downsyndrome case) Poor activity tolerance, as evidenced by the child’s refusal to participate in active play for more than a few minutes, could be a symptom of inadequate management of:
Hypothyroidism
Polymicrogyria precautions
Increased tone might require pharmalogical management
Adverse drug reactions can occur (monitor for excess weakness or decreased alertness)
Forcing movements against significantly increased tone can cause structural problems (example: mid foot break)
Polymicrogyria complications interfering with PT
significantly increasing speed/activity can increase tone on hemiparetic side
longterm use of constraint-induced therapy can interfere w/ bilateral limb use
significant tone reduction can negatively affect movement if child is relying on tone for stability
What is Polymicrogyria
Too many small folds (gyri )in the brain
can be unilateral or bilateral
What are the two methods for measuring tone?
Ashworth scale and Tardieu scale
Review
What did research show about the Winter Classification
That children with minimally affected body structures cannot be classified under this system, there need to be a group 0 added to expand the scale
T or F: you want PT to occur after Botulinum toxin injections so that a child can learn new motor plans without spasticity
T
Children with significant impairments are often recommended a ________ AFO
Whereas children with less significant tone show more functional improvements with _____________
Solid ankle AFO
Dynamic AFO
All of the following are true regarding children with hemiplegia, except:
A. They have an asymmetrical gait pattern.
B. They sometimes present with equinus deformity.
C. They always need bracing to normalize gait.
D. They have involvement of the arm and leg on the same side.
C
Children who present with increased tone may benefit from all of the
following, except:
A. Medical management of tone
B. Strengthening programs
C. Bracing during movement
D. Increasing tone for stability
D
What is gowers sign?
When an individual rises from the floor using a 4-point stance and places hands on knees -> hyperextends knees while pushing, compensation for hip weakness
What is hypercapnia
excessive carbon dioxide in the blood, results from lung disease or impaired ventilation
what is pseudo hypertrophy
increase in size of muscle not due to an increase in muscle fibers, instead muscles are replaced by fibrous tissue and fat
sign of DMD
DMD precautions
No resisted or forceful ROM to extremities or trunk d/t high risk of fractures or damage to muscles
assistance required during wb activities to dc fall risk
close monitoring of skin w/ orthosis
for DMD, symptoms typically present at ____ years, the average age of diagnosis is _______
2.5 years
4.9 years
What signs indicate DMD
Gower’s sign
Abnormal muscle function and elevated serum creatine kinase (indicates muscle breakdown) and elevated serum transaminase
What kind of drug is found to sustain neuromuscular function in DMD
Systemic glucocorticoids (corticosteroids)
What physical problems are associated with DMD
Scoliosis
contractures of flexor muscles
fractures
Children with DMD taking corticosteroids will experience what potential side effects
Increased weight
dc height
possibly more fractures
cataracts
Death in persons with DMD usually results from ____
respiratory insufficiency
What is the Egen Klassification Scale (EK scale)
Measures functional ability for non-ambulatory individuals with DMD to preform daily activities
What are the 5 stages of DMD
- Presymptomatic
- early ambulation
- late ambulation
- early non-ambulation
- late non-ambulation
What kind of exercise is supported by research for patients with DMD to delay progressive weakness
assistive bicycle exercise of arms and legs
note: also respiratory exercise / glossopharyngeal breathing
What are biphosphonates (drug you take for osteogenica imperfecta)
prevent loss of bone mass
What is typically used to assess fracture risk and bone health
Bone mineral density (BMD), from a DEXA scan
What are the PT precautions for OI?
No passive twisting, rotating, or forceful ROM d/t high risk of fractures
close guarding during WB activities
Close monitoring of skin w/ AFO
OI is a autosomal dominant mutation effecting _______
type 1 collagen
What is the typical treatment for long bone deformity in OI
Intramedullary rods
what visual analog scale is best to rate a childs pain (in the OI case)
Wong Baker
When working with patients with OI, what kind of exercise do we want to do to initiate weightbearing
in the pool/ aquatic
The most appropriate progression from ambulating with a walker to ambulating without an assistive device for the child with OI would be:
A. Transitioning the child to axillary crutches
B. Having the child practice taking a few steps at a time with light
hand-held assist in a controlled environment
C. Ensuring that the child can first walk community distances with the
walker
D. Check that the child has at least a 4/5 quadriceps strength as tested
with manual muscle test
B
Avoid axillary crutches!
When would it be appropriate to utilize a partial-weightbearing gait therapy device (e.g., LiteGait) as a therapy intervention for a child with OI who has recently begun weightbearing after a rodding surgery?
A. As an alternative to weightbearing in the pool since a partial-
weightbearing gait therapy device can also provide unweighting of the LEs
B. While ambulating on land instead of using a walker
C. A child with OI should never be placed in a partial-weightbearing
gait therapy device.
D. To increase standing tolerance prior to ambulating on land
C
Avoid harness devices, they might cause rib fractures for pt’s with OI
A physical therapist is creating a home exercise program for a child with OI who has just begun weightbearing on land following a rodding revision surgery. Which of the following is not an appropriate exercise
to strengthen the quadriceps for this child?
A. Sit-to-stand transfers from an elevated surface, using a walker for
support
B. Standing quad sets using a walker for support
C. Short arc quads
D. Single leg squats holding a walker for support
D
Section 504 of the Rehab Act of 1973
Ensures access and accommodations for students in public primary and secondary colleges who do not require special education. And for students in college and university, as well as adult employees of the government.
What tool has been found to be reliable to assess adults with CP
Gross Motor Functional Classification System GMFCS
What would be most effective at measuring an adult with CP’s cardiorespiratroy fitness
progressive protocol test with cycle ergometer
Anterior kneepain in adults with spastic diplegic CP is most likely due to
Patella alta (associated w/ crouched gait)
What exercise program would be best for the adult with CP in the case study
progressive resistance exercise and aerobic using a stationary bike or cross trainer.
What are 2 conditions commonly associated with SCI
Autonomic Dysreflexia
Heterotopic ossification
Precautions in PT due to SCI
Monitor for Autonomic dysreflexia
prevent iatrogenic fx when transferring
orthostatic hypotension
What is defined as a pediatric SCI?
SCI in the nerve roots of a person between the ages of newborn and 15 years old
A child’s spine does not mature until..
8-10 years old
What is a SCIWORA
Spinal cord injury without radiographic abnormality
common in children due to the laxity in the vertebrae that may let SCI be injured w/o damage to bones
What does the Ped’s textbook call the ASIA exam that we are learning in neuro?
ISNCSCI developed by ASIA
What outcome measure is reliable and valid to assess functional independence for SCI?
SCIM
What is the recommended standing program to prevent bone loss in SCI?
60 minutes per day 5 days a week
What are 2 types of exercise that the SCI case mentioned?
BW supported treadmill
cycling with LE FES or NMES to increase muscle volume in children with SCI
Which of the following does not contribute to the potential for
SCIWORA?
A. Kyphoscoliosis in young child
B. Disproportionately large head relative to the child’s body
C. Horizontally oriented facet joints in a child
D. Motor vehicle collision
D
Motor vehicle collision will typically be seen on an MRI
Which of the following tests is used to determine the level and severity
of SCI in the pediatric population?
A. WeeFIM
B. Spinal Cord Independence Measure (SCIM)
C. International Standards for Neurological Classification of Spinal
Cord Injury (ISNCSCI)
D. Functional Independence Measure (FIM)
C
Which of the following is a true statement regarding autonomic dysreflexia?
A. It is always characterized by an increase in blood pressure and a
decrease in heart rate.
B. It most commonly affects patients with SCI level at or above T12.
C. Distention of the bowel or bladder is a common cause.
D. Signs and symptoms are more obvious in younger children than in
adolescents and adults.
C
what is chemical meningitis
aseptic meningitis (not due to infection) just due to inflammation
CORTICAL DYSPLASIA:
Congenital malformation of the cortex; a cause of seizures
ventricular catheter vs ventriculoperitoneal shunt
catheter = used during neurosurgery to drain fluid of ventricles from brain
shunt= used to treat hydrocephalus, removes fluid from ventricles to the peritoneal cavity
precautions of hemispherectomy/hydrocephalus?
delayed hydrocephalus can develop at any time post surgery.
signs can include change in school performance. May indicate need for shunt or shunt revision. Or seizures.
Seizures may also indicate need for additional surgery or medication
hemispherectomy has the best outcomes if done before the age of ___
3, this is the critical maturation period where there is the greatest potential to sprout new axons
What 7 things should be noted in the subjective about seizures
- when the seizures began and why
- onset and frequency
- type, dosage, and frequency of AED (anti epileptic drugs)
- PLOF and milestones
- types of surgeries and age of child
- complications
- potential medical treatments
What scale is used as a valid instrument to assess gross motor, fine motor, and cognitive delays in children ages 1 month to 14 months
Bayley scale of infant and toddler development (Bayley-III)
What type of treatment plan improves motor function and increases use of hemiparetic extremity in a child with a cerebral hemispherectomy
CIMT Constraint-induced-movement therapy
The most common indication for a cerebral hemispherectomy is:
A. Cortical tumor
B. Medically intractable seizures
C. Infarcts leading to hemiplegic cerebral palsy
D. Seizures arising from several areas of the brain in both hemispheres
B
Typical clinical presentation of children status/post hemispherectomy
includes:
A. Increased spasticity with more involvement in the involved lower
extremity as compared to the involved upper extremity
B. Visual field cut without sensory deficits in the upper extremity
C. Global delays in all areas with more involvement in the involved
distal upper extremity
D. Increased difficulty in walking recovery for children who walked
previous to surgery
C
Global delays in all areas with more involvement in the involved
distal upper extremity
Physical therapy interventions for children status/post hemispherectomy:
A. should be novel, task-specific, intense, and repetitive.
B. are unlikely to change deficits due to complete disconnection of the
involved cerebral hemisphere.
C. are only necessary in the acute phase of recovery.
D. have been shown to be ineffective when presented in massed
blocked sessions.
A
More marked increase in muscle tone, however affected parts easily moved
Ashworth 2
Considerable increase in muscle tone
passive movement diffcult
Ashworth 3
slight increase in muscle tone followed by minimal resistance at end of ROM
Ashworth 1
note: would be 1+ if there was minimal resistance through less than half of ROM
limb rigid in flexion
Ashworth 4
Child w/ knee hyperext and increasing lumbar lordosis during gait
Winter Gage Hicks group III
Child with foot drop during swing, but adequate dorsiflexion during stance
Winter Gage Hicks Group 1
Child w/ both foot drop during swing and more consistent plantarflexion throughout gait cycle due to severe tone
Group II
Child with limited hip movement and significantly increased lordosis
Winter Gage Hicks group 4
What is a valid tool for assessment of participation and activity in elementary school students
School Function Assessment
__________ is especially important during school years to enable children to interact w/ peer and learn from exploring environment
independent mobility
How much BW supported treadmill training is indicated for infants with DS
8 minutes a day 5 days a week often lets them walk 3 months earlier
