Peds Exam and Eval Flashcards
Family centered care
a philosophy of an individual or institution
Family participation in healthcare - vital role ine
POC
Evaluation
Delivery of care
Family centered care - in PT - vital with a pediatric patient
Caregivers are a necessity
Education - HEP
Equipment needs
Reports childs wants/needs/concerns
Family centered care - principles of family centered care
1 Mutual respect, trust, honesty, open communication
2 Empower the family - they make decisions
3 Serve as teacher, mentor, facilitator, advocate
4 Member of transdisciplinary team
What is the purpose of your exam
1 Diagnostic info - often a team approach to diagnose
2 Screening - are they typical or atypical
3 Problem solving
4 Plan of care
What are the models of care in pediatrics
Direct Integrated Consultative Monitoring Collaborative
What are the models of care in pediatrics - Direct
You provide therapy to an individual
What are the models of care in pediatrics - Integrated
Often in school environment (in their natural environment)
What are the models of care in pediatrics - Consultative
someone is usually having you come in to see them – maybe SLP wanting you to come in to help them with a position of their extremity to use while speaking
What are the models of care in pediatrics - Monitoring
often in school environment but can be outpatient, I am not going to provide therapy to you but I may come in and check on you with a consult to make sure things are continuing along
What are the models of care in pediatrics - Collaborative
as a team you are approaching the patient dysfunctions together, can happen in outpatient and/or in school
Environmental considerations
Natural environment like home, school, day care
Furnishings in environment
Presence of parents
Child clothed
Things to consider
What are the standardized measures for that diagnosis
Diagnosis and understanding of primary and secondary impairments
Normal development - what do you expect for a child at this age
Considerations before the exam begins
Family dynamics
Families understanding of the reason for PT referral
Considerations for the PT - Examination
OBSERVE ENGAGE Establish rapport - start slow Be flexible and spontaneous Use play creatively Be tactful and choose your words carefully
Examination - History
Medical history (delivery, gestational age)
Maternal history or family hx
Growth and development
Current activity level or present function (games they play, nap schedule)
Family, school environments
Patient/Family Goals
Primary concerns
Your expectations vs. family expectations
Childs goals
CP - ANS
Skin temp, color, breathing pattern, nasal flaring, pupils
Tests and Measures - Disposition
Level of alertness
Communication
Tolerance to activity/interactions
Musculoskeletal
Postural alignment
PROM
AROM
Strength - tone? look for synergistic mvmnt patterns vs. isolated control
Musculoskeletal - Alignment
What is childs preferred alignment
Can they actively/passively reach neutral alignment
What is the alignments impact on force production
LOOK AT ALIGNMENT IN ALL POSITIONS!
Musculoskeletal - Head control is dependent on
a good base of support
Need to look at head, shoulder girdle, trunk, and pelvis
Musculoskeletal - Hip
Wt bearing in full stance
If child is non wb - need xray by 2 yr
Dislocation/Sublux
Musculoskeletal - ex of tests
Barlows
Ortolanis
Craigs
Leg length discrepancy
Musculoskeletal - ex of tests - Barlows
Looking for hip dysplasia - abd, ER, and anterior glide to pop back in
Musculoskeletal - ex of tests - Ortolanis
flex hips, add, IR, and do glide to check and see if comes out of acetabulum
Musculoskeletal - ex of tests Craigs
For femoral anteversion and retroversion
Musculoskeletal - ex of tests leg length discrepancy
Medial mall to umbilicus
Medial mall to ASIS
Musculoskeletal - Common Knee measures
Genu Valgum/Varum - Q angle
Tibial torsion
Thigh foot angle
Musculoskeletal Ankle common measures
Talocrural DF/PF
Rearfoot motion (inv/ev)
Forefoot adduction - metatarsus adductus (measuring foot to hindfoot relationship)
Neuromuscular
Reflex integration
Tone/Spasticity
Neuromuscular - functional exam
Supine Prone Sitting Standing (static vs. dynamic) Gait and stairs Transitions
Balance - how does it develop
TEST IN ALL POSITIONS Head righting Equilibrium rxns Protective Tilting rxns
Neuromuscular - what do we look at to assess standing balance
Ankle strategies
Hip strategies
Equilibrium/Trunk rxns
Stepping rxns
Neuro - sensory exam
Vision Hearing Vestibular Reflexes Sensory integration
Motor responses
Balance between agonists/antagonists as age appropriate
Force production - timing, scaling
How do we assess motor responses
Play!
Object manipulation - pick them up, pass them, reach across midline for them, manipulate them, throw them, catch them, bounce them
What else do we assess with motor responses
Isolated movement in extremeties
Isolated movement between extremeties
Dissociation
Functional skills
Feeding/Eating
Dressing/Bathing
Mobility/Transfers
Equipment
Fit and function
Home
School
Transportation
Integumentary - record
Bruises, areas of redness
Diagnosis/Prognosis
Identify impairments, activity limitations, and issues with participation
Consider future needs - wellness across lifespan
Think how it will impact them as they grow and age
Determine optimal outcome
Socioeconomic impact
Plan of Care
Develop STM and LTG based on exam and patient/family goals
Progress will be slow
Goals need to be measurable
