Quiz 1 (Ped Chiropractic Eval) Flashcards
What are the 3 landmarks for an Infant Postural Evaluation?
- -Glabella
- -Sternum
- -Symphisis
What is an infants normal posture?
Flexed tone (frog leg posture)
What is the ideal position for a baby in utero?
Left Occiput Lateral (LOL)
What is the KISS grade for a Fixed lateroflexion infant posture?
KISS 1
What is the KISS grade for a Fixed retroversion infant posture?
KISS 2
What are 4 key visual characteristics of KISS 1?
- -Torticollis
- -Asymmetry of the skull
- -C-scoliosis of neck and trunk
- -Asymmetry of motion of the limbs
What are 4 key visual characteristics of KISS 2?
- -Hyperextension
- -(Asymmetrical) Occipital flattening
- -Shoulders pulled up
- -Breastfeeding difficult on 1 side
Which grade of KISS can lead to the following symptoms?
–Retardation of motor development on 1 side
KISS 1
Which grade of KISS can lead to the following symptoms?
- -Cannot lift trunk from ventral position
- -Orofacial muscular hypotonia
KISS 2
What are 3 characteristic symptoms of KISS syndrome?
- -Frequent vomiting,
- -Problems swallowing
- -Colic w/ excessive crying
What are 4 sings/symptoms associated w/ KISS-induced Dyspraxia adn Dysgnosia (KIDD)?
- -Slow development of fine and gross motor skills
- -Poor posture and equilibrium
- -Delayed language development
- -Restlessness, ADHD
Infant supine, turn head to one side
–Observe ipsilateral extension and contralateral flexion of the arms and legs
Asymmetric Tonic Neck (Fencer’s Reflex)
When does Fencer’s Reflex peak?
~2-3 months
When should Fencer’s Reflex disappear?
~6 months
When is Fencer’s Reflex, prior to 6 months age, considered a concern?
If infant never exhibits or seems locked in the posture
When is it appropriate, development-wise, to perform a pediatric posture analysis?
Once they’re standing
What are the 7 subjects for a pediatric posture analysis?
- -Head tilt
- -Head rotation
- -High shoulder
- -Scoliosis
- -High Ilium
- -Gene Varus and Valgus
- -Foot rotation
Clinical interpretation of findings must be based on what 2 factors?
Childs age and development
What ilium position is potential cause for Toe-In?
EX ilium
What ilium position is potential cause for Toe-Out?
IN ilium
Weak psoas or gluteus Maximus is associated w/ what foot rotation vs hypertonicity?
–Weak psoas or glut. Max = Toe-In
–Hypertonicity = Toe-out
What are the 3 procedures for an infant supine leg check?
- -Gently straighten the legs
- -Keep head in neutral position
- -Compare medial malleoli
What are 3 potential challenges when using instrumentation on infants/pediatrics?
- -Width of probes
- -Skin elasticity and folds
- -Patient cooperation
What is helpful when performing instrumentation on infants/peds?
Placing the patient prone
Describe the McMullen Reverse Fencer newborn assessment?
2 part protocol:
- -Heel swing
- -Acetabular pump
McMullen Reverse Fencer should be used only w/ infants up to what age?
<6 months
What is Landau’s response?
Ability to raise head and see horizon
What are 3 risks when considering developmental hip dysplasia?
- -Breech birth
- -Family Hx
- -Girls > boys
What are 3 signs when considering developmental hip dysplasia?
- -Asymmetric thigh/buttock skin folds or creases
- -Decreased hip abduction
- -Notable difference in leg length
Infant inverted, relax the tension on one leg and watch the child’s head turn to that side.
Heel swing
Heel swing
–If the infant is “restricted” or “twitches” turning to one side compared to the other, this indicates a subluxation complex b/w 1 of what 2 structures?
- -Atlas-axis
- -Atlas-Occ
Heel swing
–If the infant arches backwards, this may be a sign of…
Meningeal tension
What is the procedure for an Acetabular pump?
Apply pressure along the shaft of the femur into the Acetabular fossa
–compare resistance on each side
Acetabular pump
–The “spongy” side is said to be the side of..
Atlas laterality
Acetabular pump
–If they’re even, consider what structure…
Occiput
What are the 6 parts of static palpation?
- -Sudoriferous changes
- -Turgidity changes
- -Surfacce toxicity
- -Tissue prominence
- -Palpatory tenderness
- -Deep tonicity
What direction does the Atlas move under Occiput during Lateroflexion for adults?
Toward the concave side of the head
What direction does the Atlas move under Occiput during Lateroflexion for small children (before verticalization)?
Moves to convex side
C1 laterality should be palpated w/ the patient in what position?
Upright or seated
What plane of motion should be palpated first when assessing C2-L5?
P-A
During motion palpation, what position should the hips and knees be in?
Hips and knees flexed
When infants lay prone w/ the head turned, what SI motion may appear to be restricted?
Ipsilateral SI
What are 5 normal pediatric variants for pediatric adjusting?
- -Underdeveloped cervical lordosis
- -Low vertebral height
- -Horizontal facets
- -Underdeveloped uncinates
- -Spine is flexible
Pseudosubluxations occur most commonly at what location?
C2/C3
–(sometimes at C3/C4)
Pseudosubluxations are a normal variant for children up to what age?
<7
What roentgenometric distinguishes pseudosubluxations from pathological subluxations?
Swischuk’s line
Swischuk’s line should connects what anatomical structures
Anterior vortices of the spinous processes of C1 and C3
The anterior cortex of the spinous process of C2 should intersect or lie w/in how many mm’s of Swischuk’s line?
1 mm
If C2 is > 2mm off Swischuk’s line, what does it indicate?
True injury
C2 may appear to anterior relative to C3 by as much as 5 mm.
–Pseudosubluxation or Hangman’s fracture
Pseudosubluxation
Fracture of the arch of C2
Hangman’s fracture
Vertebral body moves anteriorly while the arch and spinous process move posteriorly
–Pseudosubluxation or Hangman’s fracture
Hangman’s fracture
The atlas lateral mass can over overhang C2 by how many mm and still be a normal variant?
6 mm
Pseudospread (aka Overhang) of C1 on C2 can be seen up to what age?
< 7
