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OT 533 Pediatrics > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

3 Major Criteria for Intellectual Disability

A
  1. Manifest before 18 years old
  2. IQ score falls 2 SD below mean < 65-75
  3. Adaptive behavior skills deficit in : communication, self-care, social skills, home living, self direction, leisure, work, health & safety, academics
    Difficulties with reasoning, problem solving, planning, abstract thinking, judgment, learning from instruction and experience
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2
Q

Intellectual Disability IQ Score

A

100 Normal or average IQ
Blew 70-75 = DSM V classification for ID
70-79: Borderline
55-69: Mild (most common)
40-54: Moderate
25-39: Severe
Below 25: Profound

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3
Q

Intellectual Disability Incidence

A

Males more than females; 1-3% of population
6 out of 1,000 with severe disability
Down Syndrome most prevalent form
1 in 800-1,000 live births
Causes: infections, chromosomal abnormalities, environmental causes, no specific etiology

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4
Q

Motor Impairments with ID

A

Hypotonia, motor control, postural control, balance, force production, flexibility

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5
Q

Assessment & Intervention

A

Identify the smallest of the child’s abilities
Focus intervention to maximize those abilities
Must inform parents/team of positive abilities
Determine basic responsiveness
Visual stimulation and vestibular input activities to practice tracking and focusing
Heavy touch and pressure or weight bearing
Choose activities that stimulate antigravity extensor (swings, barrels, scooter boards)

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6
Q

Treatment Principles for Children with ID

A

Use all areas for potential learning (motor, cognitive, affective)
Choose activities that accommodate the “mental” age of the child
Activities should be meaningful and functional
Use repetition and consistency
Establish appropriate goals

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7
Q

Down Syndrome

A

Chromosomal disorder that results in 47 chromosomes instead of 46
Affects the 21st pair of chromosomes (Trisomy 21)
Most common cause of Intellectual Disability

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8
Q

Types of Down Syndrome

A
  1. Trisomy 21 (no disjunction) caused by a faulty cell division that results in having 3 #21 chromosomes
    Most common (90-95% have this type)
  2. Translocation (3-4% of all cases) #21 breaks of during cell division and attaches to another chromosome
    Genetic predisposition, parent may be carrier
  3. Mosaicism: occurs when some cells receive an extra copy of chromosome 21, Others do not after fertilization
    Least common type
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9
Q

Diagnosis of Down Syndrome

A

Usually identified at birth or shortly after
Based on physical characteristics: low muscle tone, single palm crease, flattened facial profile, upward slant in eyes
Amniocentesis performed 12-20 weeks gestation
Chronic Villus Sampling between 8-12 weeks
Percutaneous Umbilical Blood Sampling performed after 20 weeks

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10
Q

Down Syndrome Health Issues

A

Brain weight - 76% of normal (microbrachycephaly, decreased # of secondary sulci, decreased # of neurons & synapses, delayed or lack of myelination, seizure disorder, increase in Alzheimer tangles)
Congenital heart defects (VSD)
Visual/Hearing: adult onset cataracts, strabismus, nystagmus, otitis media, hearing loss
Higher incidence of infection, respiratory, vision, hearing problems
Life expectancy 55 years, may be older
Decreased stature, leg length, finger length, hypotonia, ligamentous laxity, decreased strength, Pes Plannus, Patellar Instability, Atlanta-axial instability, Scoliosis, Hip dysplasia
Premature aging seen
Wide space between 1st and 2nd toe, small nose, narrow palate, small mouth, delayed formation of teeth, protruding abdomen

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11
Q

Assessment of Hypotonia

A

Morgan-Paleg Hypotonia Scale
Score 1-3 (1=normal, 2=mod, 3=severe)
1. Head control
2. Vertical suspension
3. Sitting
4. Hip abduction
5. Ankle dorsiflexion
6. Standing

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12
Q

Assessment of Ligamentous Laxity

A

Score of > or = 4/9 considered indicative of generalized hypermobility
Apposition of thumb to forearm
Extension of pinky to 90 degrees
Extension of elbow beyond 90 degrees
Extension of knee beyond 10 degrees
Forward flexion of trunk, legs straight, palms touching floor

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13
Q

Orthotics

A

Have child fitted for orthotics when they begin to pull to stand and cruise
Wear 50% of the time
During therapy use orthotics with postural work or play
SMO

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14
Q

Hip helper shorts

A

Minimize external rotation and excessive abduction in babies and toddlers with low muscle tone
Improves rotational movement and limits W sitting
Designed for babies 6 months to 3 yrs old

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15
Q

Standers

A

Start at 9 months if child is not sitting independently for play
Start at 12-15 months if child is not yet pulling to stand or cruising
Position in hip abduction

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16
Q

Treadmills

A

Recommend 8 min 5x a week for pre-walkers
Or 20min 5x a week for older children

Gait Trainers
If no treadmill, start at 9-12 months

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17
Q

Aging with Down Syndrome

A

Hypothyroidism: low energy, weight gain, bradycardia, constipation, dry skin
Cardiovascular: mitral valve prolapse
Obesity: 79% male, 69% female
Arthritis, hip dysplasia, osteoporosis
Alzheimer’s Disease
Depression

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18
Q

ADHD criteria

A

symptoms present for 6 months that is maladaptive and inconsistent with development level of the child
clinically significant impairment present in 2 or more settings
onset of impairment must be before age 7, even if diagnosed later
boys>girls
most common type is combined inattentive and hyperactive-impulsive
when girls diagnosed, most often it is inattentive type

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19
Q

Inattention symptoms

A
  1. careless mistakes
  2. Attention difficulty
  3. Listening problem
  4. Loses things
  5. Fails to finish things
  6. Organizational skills lacking
  7. Reluctance in tasks requiring sustained mental effort
  8. Forgetful in Routine activities
  9. Easily Distracted
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20
Q

Hyperactive Impulsive Symptoms

A
  1. Runs about or is restless
  2. Unable to wait his/her turn
  3. Not able to play quietly
  4. On the go
  5. Fidgets with hands or feet
  6. Blurts out answers
  7. Staying seated is difficult
  8. Talks excessively
  9. Tends to interrupt
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21
Q

ADHD exclusion criteria

A

ADHD is not diagnosed if the symptoms occur in the course of a pervasive developmental disorder, psychotic disorder OR
if the symptoms are likely due to another psychiatric disorder

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22
Q

ADHD Co-Morbid Conditions

A

Oppositional Defiant Disorder: pervasive pattern of negativistic, defiant, disobedient, and
hostile behaviors toward authority figures
Conduct Disorder: Repetitive pattern of violating the basic rights of others and/or societal laws
Mood Disorders: depression, bipolar
Anxiety
Learning Disorders
**Child with ADHD + Conduct Disorder more likely to develop antisocial behavior

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23
Q

Medications and Side Effects for ADHD

A

Methylphenidates & Amphetamines (appetite loss, sleep distrubance, changes in blood pressure/pulse, dysphoria, irritability, exacerbation of tics)
Strattera (nausea, headache, anorexia, insomnia)
Wellbutrin (weight change, dry mouth, headache, GI effects, insomnia, contraindicated in seizure disorders, eating disorders)
Clonidine (dry mouth, dizziness, drowsiness, fatigue, constipation, arrythmias)

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24
Q

Conduct Disorder: Childhood Onset

A
  • Oppositional Defiant Disorder in preschool
    years developing into a serious conduct
    disorder by adolescence
  • This group has a 2-3 fold likelihood of becoming juvenile offenders
  • Prior to age 10
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24
Q

Conduct Disorder

A

Repetitive behaviors that violate the rights of others
and/or societal laws, with 3 or more of the following in
past 12 months, with one in last 6 months:
– Aggression or cruelty to people or animals
– Destruction of property
– Theft
– Truancy
– Running away
Boys>girls
most frequent reason for psychiatric hospital admissions for children and adolescents
childhood and adulthood onset

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25
Q

Conduct Disorder: Adolescent Onset

A
  • Behaviorally normal until middle school, when symptoms of Conduct Disorder become prevalent
  • This group has a more favorable prognosis; more likely to respond to
    treatment
  • Following age 10
25
Q

Conduct Disorder Pyschosocial Correlates & Risk Factors

A

harsh punishment, institutional living, inconsistent parenting figures, poor parental monitoring in early childhood, parental conflict, maternal depression, paternal alcoholism
Risk Factors: fetal alcohol syndrome, prenatal drug exposure, ADHD

26
Q

Transient Tic Disorder

A
  • Single or multiple motor and/or vocal tics, occurring many times a day, nearly
    every day, for at least 4 weeks, but no longer than 12 months
    don’t usually cause distress
27
Q

Tourette’s Disorder

A
  • Multiple motor and one or more vocal tics lasting at least 1 year, many times a day
  • nearly every day without a tic-free period of more than three consecutive months
    *onset before 18, peak onset at 5 to 8, severity peaks at 8-11 with improvement during puberty
    boys>girls
    comorbidity: OCD, depression, anxiety, ADHD
28
Q

PANDAS

A

Pediatric Autoimmune Neuropsychiatric Disorders Associated with group A Streptococcus
infection may cause tics, compulsions, emotional lability, episodic or recurrent

29
Q

Anxiety

A

etiology: genetic, environmental, temperament
Symptoms: headache, stomachache, pain, difficulty falling asleep, overeating when mild, under-eating when severe, avoiding outside activities or social gatherings, poor school performance, inattention, distraction, excessive need for reassurance

30
Q

Generalized Anxiety Disorder

A

Excessive anxiety or worry that is difficult to control, lasts at least 6 months and creates impairment in functioning
Accompanied by at least one of the following:
* Restlessness
* Fatigue
* difficulty concentrating
* Irritability
* muscle tension
* sleep disturbance
Mean age of onset: 10-13

31
Q

Social Anxiety Disorder

A

Intense fear of acting in a way or showing anxiety symptoms that will be negatively evaluated
* Fear out of proportion to actual danger of situation
* Avoidance of school
* Selective mutism

32
Q

Seperation Anxiety Disorder

A

most common childhood anxiety
most commonly occurs at age 7 or 8, onset before 18
duration of disturbance at least 4 weeks
Psychosocial theory is that angry feelings toward
parents are displaced, so the environment is
perceived as threatening

33
Q

Seperation Anxiety Criteria

A

Developmentally inappropriate, excessive worry concerning separation from those to whom the young child is attached, evidenced by at least three of the following :
-Recurrent and excessive distress when separation from home or major
attachment figures occurs or is anticipated
-Persistent, excessive worry about losing, or possible harm, major attachment figures
-Persistent, excessive worry that an event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
-Persistent reluctance or refusal to go to school or elsewhere because of fear of separation
-Persistently, excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
-Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
-Repeated nightmares involving the theme of separation
-Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

34
Q

Obsessive Compulsive Disorder

A
  • Recurrent, time-consuming obsessions or compulsions that cause distress
    and/or impairment
  • The compulsive behaviors are often an attempt to reduce the obsessive
    thoughts
    high genetic etiology
    10% precipitated by PANDA
    CBT first treatment
    Setraline meds for 6+
    Fluvoxamine for 8+
35
Q

Social Phobia

A
  • Social phobia involves fear of embarrassment in social
    situations, during a performance, speaking in front of a group, starting a conversation, or eating in public
  • Social phobia is more common in adults, but can occur in children or adolescents and may interfere with
    school functioning
    Could also be a mood disorder
36
Q

Major Depression Diagnostic Criteria

A
  • At least 5 of 9 symptoms for a 2-week period,
    representing a change in previous functioning
  • At least one of the symptoms must be
    depressed mood (irritable in children) or loss of interest or pleasure in usual activities
  • Feelings of worthlessness or guilt (which may be delusional)
  • Inability to concentrate; indecisiveness
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide
    attempt or a specific plan
    1. Depressed mood (feels sad or empty) by self-
    report or observation
    2. Diminished interest or pleasure in most
    activities
    3. Weight gain or weight loss; in children, failure
    to make expected weight gain
    4. Insomnia or hyper-somnia nearly every day
    5. Psychomotor agitation or retardation nearly every day, observable by others
    6. Fatigue or loss of energy
37
Q

Major Depression Symptoms

A

Symptoms that increase with age:
* Sleep/Appetite Changes
* Fatigue
* Anhedonia (“I’m bored”)
* Psychomotor retardation
* Hopelessness
* Delusions
Symptoms that decrease with age, but may
be seen in children:
* Somatic complaints (head, stomach, muscle aches)
* Behavioral problems
* Guilt, irritability
* Hallucinations
Symptoms that are consistent across age
groups:
* Depressed mood
* Impaired concentration
* Suicidal ideation

38
Q

Suicide

A

4th leading cause of death in children aged 10-15, 3rd leading cause for 15-25
attempts 3x higher in females, completed 5x higher in males

39
Q

Cerebral Palsy

A

non-progressive disorder of movement and posture due to a defect or lesion of the immature brain.
can occur in utero, during or after birth
hypoxia very common injury
Spastic (most common), Dyskinetic/Athetoid, Ataxic, Hypotonic, Mixed
Diplegia, Quadriplegia, Hemiplegia (more freq on right), double hemiplegia, monoplegia

40
Q

Periventricular Leukomalacia

A

white matter necrosis
5% of all hospital births, 35% of low birth weight newborns
late 3rd trimester hypoxic/ischemic damage
most infants develop CP
common locations: anterior frontal horns, angles of lateral ventricles, lateral trigone

41
Q

neonatal hemorrhages

A
  1. Subdural hemorrhage
  2. Subarachnoid hemorrhage
  3. Subpial hemorrhage
  4. Intracerebral hemorrhage of Hemorrhagic Infarction
  5. White matter hemorrhage or hemorrhagic infarction
  6. Germinal matrix hemorrhage (IVH): primarily occurs in low birth weight, premature babies under 34 weeks of age, occurs before 48hrs postpartum
  7. Choroid plexus hemorrhage
42
Q

Kernicterus

A

Jaundiced Nuclei
yellow staining of the deep gray matter and brainstem due to unconjugated bilirubin
deposition of bilirubin leads to necrosis of neurons in selected regions of the CNS
poor prognosis, rare condition

43
Q

The Gross Motor Function Classification System

A

Level 1: children highest functioning, walks without restrictions, limitations in balance, coordination
Level 2: walks without assistive devicees, limitations in walking outdoors in the community
Level 3: walks with an assistive mobility device, limitations in walking outdoors in the community
Level 4: self-mobility limitations, walk short distances, transported using power mobility outdoor
Level 5: lowest functioning, self mobility is severely limited even with use of assistive technology

44
Q

Associated Disorders with CP

A

Intellectual Disability
Communication Disorders related to oral motor function, central language dysfunction, hearing, and cognitive deficits
Seizure disorders
Eye disorders
Auditory impairments
Impairments include: contractures, hip subluxation, torsional deformities, scoliosis, back pain, patello-femoral dysfunction

45
Q

Neuro Developmental Treatment NDT

A

rehabilitation of individuals with neurological pathophysiology.
consists of a dynamic reciprocal interaction between the client and therapist for activation of optimal sensorimotor processing, task performance, and skill acquisition.
Treatment involves active participation of the individual with direct handling to optimize function with gradual withdrawal of direct input from the therapist.

46
Q

Handling

A

Treatment with hands on the client that provides proprioceptive, tactile, kinesthetic and vestibular input. Includes use of key points of control for guidance of movement: trunk, shoulders, pelvis, arms, legs, feet, hands
more proximal more control

47
Q

Facilitation

A

Sensorimotor input that creates the possibility
of new movements. Assists in the activation of muscles or muscle groups to perform
Tapping, sweep tapping, intermittent tapping, compression, place & hold

48
Q

Inhibition

A

Sensorimotor input that reduces the possibility of movement. The act of
inhibiting abnormal reflex activity or movement patterns via handling and
positioning
Vibration, maintained pressure, traction, rhythmic rotation, relaxation techniques

49
Q

Strengthening

A

More effective with children with better isolated movement or selective voluntary control, suggest use of 60% of 1 rep max

50
Q

Kinesiotaping

A

can be used to facilitate movement patterns and muscle use, increase stability, and improve alignment and function
always use test patch 4 days prior to taping
trunk is more sensitive to tape

51
Q

Body weight support therapy

A

BWSTT allows repetition and intensity of training in the task-specific practice of
walking.
2-5 days a week
5-30min per session
treadmill speed 0.05-3mph

52
Q

Constraint Induced therapy

A

Stronger arm is
restrained for (6 hours a
day for 21 days)
Weaker arm is then
facilitated and trained in
specific age appropriate
tasks

53
Q

HABIT: Hand Arm Bimanual Training

A

in children with hemiplegia
aims to improve the use and coordination of both arms in daily function, involves 90 hours of intensive bimanual training in group settings

54
Q

Orthotics examples

A

AFO ankle foot orthotic
HAFO hinged afo
DAFO dynamic afo
KAFO knee ankle foot
HKAFO hip knee ankle foot
Scoliosis bracing
Night splints
Hand splints
Neoprene garments

55
Q

Infancy (concerns, assessment, treatment)

A

Concerns: disrupted nurturing, dealing with diagnosis, apprehension, positioning & care, facilitating movement
Assessment: AIMS, BINS, TIMP, GMFM, HELP
Treatment: handling & positioning, NDT, family education, facilitating optimal sensorimotor development

56
Q

Preschool Years (concerns, assessment, treatment)

A

Concerns: beginning interaction with community, prediction of achievable skill levels, development of mobility, gross motor play, self-care, language, cognition
Assessment: ROM, strength, gait, GMFM, Peabody, PEDI, WeeFIM, COPM, Goal attainment scale
Treatment: prevention of contractures, increasing force generation, developing mobility, development of play skills, ADL’s, social skills, NDT, strengthening, mobility training, play based intervention, spasticity management, orthopedic management, ADL

57
Q

School Age (concerns, assessment, treatment)

A

Concerns: participation in educational environment, peer acceptance, child’s awareness of disability, limitations in mobility & self-care, secondary impairments, societal barriers, privacy
Assessments: GMFM, GMPM, gait analysis, PEDI, COPM, handwriting, school functional assessment, Bruininsky-Oseretsky
Treatment: move toward self-management of exercise, weight management, stretching, contracture management, strengthening, endurance, sports, technology

58
Q

Adolescence (concerns, assessment, treatment)

A

Concerns: independence, social acceptance, ownership of health responsibilities, acceptance of plateau, weight control, planning for transition
Assessment: gait analysis, PEDI, COPM, Bruininsky-Oseretsky, Berg balance test, GAS, school function
Treatment: involved in treatment decisions, age appropriate activities, involve peers/siblings, promote fitness/wellness, stretching/strengthening, independence with home program, sports

59
Q

Adulthood (concerns, assessment, treatment)

A

Concerns: Independence, Employment,Transportationsocial Isolation, Loss of Function, Intimacy, Pain, Overuse syndromes, Degenerative Joint Disease/osteoporosis, Fitness/Wellness
Assessment: VAS for pain, SF-36, FIM, Berg Balance, COPM, OASIS for ADLs/IADL
Treatment: maintenance of mobility and function, pain management, breath volume, fitness/wellness, ROM/strengthening, endurance, pain management, problem solving environmental adaptations

60
Q

Aging with CP

A

increased UTI’s
swallowing difficulties
lack of dental care
osteoporosis
pain in hip, knee, ankle, lumbar, and cervical spine
contractures
scoliosis
degenerative arthritis
spondylotic myelopathy

61
Q

current view of orthopedic surgery

A

-The surgical procedure chosen must be appropriate and have a reasonable chance of improving
function…….
-Post-operative care must be well chosen, thorough and long……
-The family and the patient must be prepared to give full cooperation in the post-operative period…..

62
Q

Botulinum Toxin

A

injected into the muscle
Interferes with release of acetylcholine at the neuromuscular junction
No systemic effect
May be administered without anesthesia
EMG guidance for small muscles
Results typically last 3-6 months

OT 533 Pediatrics (4 decks)

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