Peds Final Practical Flashcards
What do thoracic level spina bifida patients present with?
“frog leg deformity”- legs abducted, ER, and flexed w/ feet in plantarflexion
What do high lumbar level spina bifida patients present with?
some active hip flexion and adduction, but no other strong movements
What do low lumbar level spina bifida patients present with?
strong hip flexors and adductors (no hip ext)
strong dorsiflexors (no plantarflexion)
In-toeing
Ambulatory with use of orthotics and glut med lurch/lumbar lordosis
What do sacral level spina bifida patients present with?
strong knee flexors and hip abduction
weak plantarflexors
mostly independent with gait
What would you include in the examination of a patient with spina bifida?
History (development, surgical, etc.)
MMT, ROM, sensory assessment, gait
Functional status
What interventions would you provide to a patient with spina bifida?
Encourage upright positioning to integrate equilibrium and righting reactions and to active abdominals
ROM and stretching to prevent contracture
Balance activities
Strengthen hip flexors to counteract weak PFs (active facilitated, resisted step ups, etc.)
Pressure relief
What are some special considerations for spina bifida?
Latex allergies
Skin breakdown
Hydromyelia (hypertonus, weakness in UEs, scoliosis)
Tethered cord (hypertonus, weakness, gait, etc.)
What would you include in the examination of a patient with TBI?
History: onset and MOI, medical precautions, vital signs, Cogntition Sensory exam (skin integrity) Functional mobility ROM (check for heterotopic ossification)
What is the Pediatric Rancho Scale?
I- oriented to self and surroundings II- responsive to environment III- localized response IV- generalized response V- no response
What is the modified ashworth scale?
0: no increase in tone
1: slight increase in tone
1+: slight increase through less than half of ROM
2: marked increase, full ROM available
3: considerable increase, PROM difficult
4: affected part is rigid
What is low cognitive level TBI and what interventions would you do?
Pediatric V-III –> Stimulation
Prevent complications from immobilization (Skin breakdown, contracture development, respiratory issues)
Vestibular, Visual, Olfactory, Tactile, Auditory
What is mid cognitive level TBI and what interventions would you do?
Pediatric II –> Structure
Agitation: work in a dimly lit room with no distractions. perform simple activities that are familiar to the child (ROM, sitting, standing, walking)
Confusion: simplify environment or instructions, promote functional tasks, constantly orient the child to surroundings, don’t rely on memory
What is higher cognitive level TBI and what interventions would you do?
Pediatric I –> School/community reintigration
Evaluate for orthotics, AD, recommendations for environmental home or school modifications
Wean child from structure and cueing
Focus on treating residual motor deficits
What are some special considerations for patients with TBI?
autonomic dysreflexia, heterotopic ossification
What is the ASIA impairment scale?
A: complete
B: incomplete
C: incomplete, muscle grade 3 below level
D: incomplete, muscle grade 3 and above below level
What would you include in the examination of a patient with SCI?
MOI, loss of consciousness?, treatment received, developmental history, medications
Vital signs (risk for orthostatic hypotension)
Integumentary screen
ROM, strength, tone
Funcional measure (QIF, SCIM)
What are the muscles added for the spinal cord levels?
C5: addition of biceps
C6: addition of pectorals
C7: addition of triceps
T4-T6: upper abdominals
T9-T12: lower abdominals
L2-L4: gracilis, iliopsoas, and quadratus lumborum
L4-L5: hamstrings, quadriceps, anterior tibialis
What interventions would you provide to patient with a spinal cord injury
Skin health (positioning and pressure relief Contracture prevention (ROM, stretching) ADL and ambulation training depending on level
What are some special considerations for a patient with SCI?
autonomic dysreflexia
hip subluxation
scoliosis
bone density
What are some signs and symptoms of Duchenne muscular dystrophy?
Between ages 2-5 Pseudohypertrophy of calves Wide base of support during gait Lumbar lordosis Gower's sign Reluctance to or incoordination with gait
What should you include in the examination of a patient with DMD?
Developmental history, child and parental concerns
Pulmonary history
Functional abilities (time testing important)
MMT, ROM
What interventions would you provide to a patient with DMD?
Goal = prolong ambulation and independence, improve pulmonary function
Stretching, strengthening
Diaphragmatic and breathing exercises
W/C safety: pressure relief, etc.
What are the 3 main phases of DMD?
Early/ambulatory stage
Transitional stage
Later/wheelchair stage
What are the symptoms of Type I (Werdnig-Hoffman) SMA?
Present in the first 3 months of life
Floppy baby with head lag
Never learn to sit
What are the symptoms of Type II SMA?
Present around 1 year Weakness and wasting of extremities and trunk Fasciculations with tone Fine tremor when using UE Never learn to walk without an AD
What are the symptoms of Type III (Kugelberg-Welander) and IV SMA?
Diagnosed later in life
DTRs decreased
Progressive spinal deformities and contractures uncommon
Typically walk independently
What would you include in the examination of a patient with SMA?
History: medical, developmental, medications, etc.
ROM, MMTs
Functional testing to track progression
Respiratory abilities
What interventions would you provide to a patient with SMA?
Goal=maintenance of function and flexibility
Type I: percussion and postural drainage, switch toys, quality of life
Type II: prone and quadruped skills, distmal muscle strengthening, ROM and stretching to prevent contractures
Type III: maintain function and flexibility, WB activities
What are the main musculoskeletal concerns in patients with Downs Syndrome?
Hypotonia, slow reaction time, joint hyperflexibility, ligamentous laxity, foot deformities, scoliosis, atlanto-axial instability, congenital heart defects
What would you include in the examination of a patient with Downs Syndrome
Functional abilities
Cognition
Posture
MMT, ROM, hip instability?
What interventions would you provide to a patient with Downs Syndrome?
REPETITION AND CONSISTENCY
depends on functional deficits…
improve postural mechanics
strengthen weak muscles (ankles and hips)
tactile awareness: heavy touch, weight bearing, joint approximation
What are some special considerations in patients with Down Syndrome?
Atlantoaxial instability!
Hyperlaxity
Repetition is key
What is important to include in the examination of a patient with cardiac problems?
Medical and surgical history, developmental history,
MEDICATIONS! (blood thinners?)
Lab values (CBC, INR)
Vital signs at rest and during activity
Pain, integumentary screen, thoracic deformities or excursion, functional mobility (transfers)
Aerboic capacity- 6 min walk test (use Borg RPE)
What interventions would you provide to a patient with cardiac problems?
Positioning: promote varied positions to promote oxygenation (prone and sidelying)
Posutral control
Consider sternal precautions for 6 wks!!
Breathing games: blowing bubbles, pinwheel, etc.
Aerobic endurance training
Sternal precautions (no lifting greater than 10 lbs for 6-8 wks)
What are the typical parameters for aerobic/endurance training in pediatric cardiac patients?
mode: bicycle, treadmill, ellipitical, UBE, walking
frequency: min 3 days/wk up to 7
duration: start with 3-5 min and work up to 30-45 min
intensity: begin at 11-15 on Borg RPE or 50% max HR
Measure vital signs throughout
Warm up and cool down are important
What information is important to know when examining a patient with pulmonary disorder?
Medical chart (clinical course of illness, previous treatment, developmental history, etc.) Medical/surgical history Vital signs Skin integrity Lab values Auscultation and cough Posture/mobility Aerobic capacity- 6 min walk test
What interventions would you provide a patient with a pulmonary disorder?
Posture, strengthening
Diaphragmatic breathing
Pt education- optimal time to use inhaler= 30 min before ex
Airway clearance procedures (percussion, postural drainage, vibration, etc.)
Ensure than environment is dust free
What are some differential diagnoses for anterior shoulder pain?
Little league shoulder GIRD SLAP lesion Multidirectional Instability AC joint pain Clavicle fracture Biceps tendinopathy
What are some differential diagnoses for medial elbow pain?
Little league elbow Medial epicondyle apophysitis Avulsion fracture UCL Panner's Disease Supracondylar elbow fracture Monteggia fracture
What are some differential diagnoses for lateral elbow pain?
Panner's disease Osteochondritis Dissecans (OCD) Supracondylar fracture Lateral condyle fracture Monteggia fracture
What are some differential diagnoses for the hand and wrist?
Gymnast wrist Scaphoid fracture Fracture of hook of hamate Boxers fracture Finger fracture
What are some differential diagnoses for hip pain?
Pelvic apophysitis Avulsion fracture Snapping hip syndrome Labral tear Muscle strain Slipped capital femoral epiphysis Legg-calve-perthes Spondylolisthesis Ewing sarcoma
What are some differential diagnoses for thigh pain?
Fracture
muscle strain
Osteosarcoma
Heterotopic ossificans
What are some differential diagnoses for knee pain?
ACL, LCL, PCL, MCL Meniscus tear OCD lesion Patellar dislocations PFPS Osgood Schlatter and Sindig-Larsen-Johansson Jumper's Knee PLica syndrome
What are some differential diagnoses for medial lower leg pain?
Medial tibial stress syndrome
Tibial stress fracture
Compartment syndrome
Osteosarcoma
What are some differential diagnoses for lateral lower leg pain?
Shin splints
Stress fracture
Anterior compartment syndrome
What are some differential diagnoses for ankle pain?
Ankle sprains Ankle fractures Triplane and Tillaux Fractures OCD lesion of talar dome Ankle impingment
What are some differential diagnoses for foot pain?
Achilles tendonitis Sever's disease Iselin's Disease Lisfranc injury Tarsal Coalition Turf toe
How is ligamentous laxity inspected?
Beighton-Horan ligament laxity scale
0/9 normal…9/9 highly lax
What things would you include in the examination of a patient with JIA?
Medical history
Functional abilitys and age-appropriate activities
ROM, muscle strenth, aerobic endurance
Joint examination: swelling, tenderness, pain, ROM
Postural and gait assessment
What are the goals of intervention in patients with JIA?
preserve joint mobility and integrity/function
promote independence
preserve energy with mobility and improve function
What types of ROM/Flexibility would you provide to a patient in the acute stages of JIA?
Daily AROM or AAROM of all active and adjacent joints
1-2 reps, 1-2 x /day
What types of ROM/Flexibility would you provide to a patient in the subacute and chronic stages of JIA?
Daily AROM of all active and adjacent joints
1-2 reps 1x / day
Active flexibility exercises and modified yoga poses
What types of ROM/Flexibility would you provide to a patient in the inactive form of JIA (clinical remission)?
Daily AROM of all active joints and adjacent joints
What types of aerobic activity would you provide to a patient in the acute stages of JIA?
Balance rest for active joints w/ low-intensity, low-impact PA to maintain physical stamina, reduce load on inflamed joints
● Exercise in warm pool
● Tricycle or bicycle
What types of aerobic activity would you provide to a patient in the subacute and chronic stages of JIA?
Increase weight bearing PA to promote bone health and lower limb muscle strength
● Walking, low-impact dance
● Use joint supports,, splints, orthoses as recommended
What types of aerobic activity would you provide to a patient in the inactive stages of JIA (clinical remission)?
Accumulate 60 min/day of moderate-vigorous PA
● Aerobic dance, step aerobics, Tai Chi, biking, swimming, jumping rope
What types of neuromuscular training would you provide to a patient in the acute stages of JIA?
One set of 1-6 repetitions of submaximal isometric muscle contractions performed at multiple points within the available pain-free ROM (performed several x/day)
● One rep includes “ramp up” contraction for 2 sec, hold for 6 sec, “ramp down” for 2 sec
● 20 sec rest b/w reps
What types of neuromuscular training would you provide to a patient in the subacute and chronic stages of JIA?
Dynamic exercises
● Must be able to perform 8-10 reps against gravity w/ good form and w/o pain before adding resistance
● Use functional movement
● To increase muscle endurance, perform 15-20 reps w/ no added resistance
● Use light weights, 0.5-2.5 kg (bottles filled with water or sand, handheld cuff weights, elastic bands)
What types of neuromuscular training would you provide to a patient in the inactive disease stages of JIA (clinical remission)?
Resistance Training
● Determine starting weight based on a 6-10 RM or targeted number of reps
● Include closed chain activities to promote bone health and improve proprioception
Include coordination, speed, and agility drills to promote motor skills for safe age-appropriate physical play and sports
What types of things would you include in an examination of a pediatric oncology patient?
Blood count Vital signs Pain MMT, ROM History of disease and developmental history Look for foot drop
What types of things would you include in intervention of a pediatric oncology patient?
modalities for pain Positioniong Strengthening (therex stair climbing squats) Stretching: CPM machine aerobic: bike, treadmiss, swimming
What are exercise guidelines for RBC count?
See hemoglobin
What are exercise guidelines for platelet count?
No exercise: 50,000
What are exercise guidelines for hemoglobin?
No exercise: 10
What are some exercise guidelines for WBCs?
No exercise: 5000
Resistive exercise: >5000
What are some symptoms of low RBC (anemia)?
pallor and fatigue
What are some symptoms of low platelet count (thrombocytopenia)?
bruising and petechiae
What are some symptoms of low hemoglobin (anemia)?
pallor and fatigue
What are some symptoms of low WBCs?
infection
What are normal RBC values?
Men: 4.7-5.5 x 106 / uL
Women: 4.1-4.9
What are normal Platelet values?
150,000-350,000
What are normal hemoglobin values?
10-13
What are normal WBC values?
4500-11,000
