PT Exam in Child with TBI

Question 1

ROM

Answer 1

Limited ROM may be result of multiple factors:
prolonged bed rest, immobilization, pain , peripheral nerve injury, side effects of medical treatment, skeletal injury due heterotrophic ossification (HO)

HO- localized and progressive formation of pathologic bone that develops in soft tissue adjacent to large joints, 20% chance of development in children with TBI, risk increased with increased severity of injury

Spasticity- use modified ashworth scale

Ataxia- oscillations during movement

• sensory ataxia worsens when child’s eyes are closed
• increased oscillations as difficulty of task increases
• injuries to cerebellum or sensory structures

Child may not understand ROM assessment, may need to get info through observation

Question 2

Strength

Answer 2

Atrophy and weakness occur d/t prolonged bed rest

MMT may be difficult, may need to get info through observation

Sensory testing- due to cognitive deficits may not be able to accurately respond to sensory input
- note responses as localized or generalized

Question 3

Motor Performance

Answer 3

Use of standardized assessments- want to determine developmental level
AIMS, GMFM, Bayley, PDMS 2, BOT

Question 4

Postural Control and Balance

Answer 4

Postural orientation problems may result from sensory impairment like hemianopsia, impaired proprioception, impaired tactile sensation, impaired righting reactions

Younger children have greater reliance on vision for sensory input

Use of TUG, BERG, functional reach, BOT

Pediatric Clinical test of Sensory interaction for balance (4-9 y/o), clinical test of sensory interaction for balance (8 years and older)–> both look at standing balance under various sensory conditions

Question 5

Gait

Answer 5

Assessment of gait parameters

Timed walking tests and shuttle walk-run tests are reliable

Question 6

Cardiorespiratory Status and Fitness

Answer 6

Autonomic Instability is common- presents with s/s of hyperstimulation of SNS, prevalence of symptoms decreased with recovery

Respiratory issues are often directly related to trauma
- may also see pneumonia, neurogenic pulmonary edema, respiratory failure, and tracheal airway complications

Examine HR, RR, BP, and O2 sats

Question 7

Functional Assessment

Answer 7

PEDI- 6 mo-7 years, measures child’s ability to perform self care, mobility, and social function. Additionally rates caregiver assistance and modification

WeeFIM- 18 items related to independence in daily functions

• self care, sphincter control, mobility, locomotion, communication, and social cognition
• each item is scored based on amount of assist required to complete task
• 6 mo- 7 yrs, > 7 yrs can use adult FIM Scores