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DPT 762 - Pediatrics I > Sam's Notes (Week 4) > Flashcards

Sam's Notes (Week 4) Flashcards

1
Q

What is the NICU, and who does it serve?

A
  • The NICU is an intensive care unit for newborns with medical needs, serving both full-term (37 - 42 weeks) and preterm infants (< 37 weeks).
  • Preterm = infants are at high risk medically and developmentally.
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2
Q

What are some common comorbidities in babies who survive NICU care?

A
  • Cerebral palsy (CP)
  • sensory impairments
  • intellectual learning challenges
  • social/emotional challenges
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3
Q

Describe Level 1 and Level 2 NICUs.

A
  • Level 1 provides postnatal care and stabilization for infants born 35-37 weeks.
  • Level 2 provides care for infants recovering after intensive care and offers CPAP or mechanical ventilation for < 24 hours.
  • care for infants >/= 32 weeks gestation or >/= 1500g who do not need subspecialty care
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4
Q

Describe Level 3 and Level 4 NICUs.

A

Level 3: NICU offers sustained life support and comprehensive care for critically ill infants.

  • < 1500g (3.3lbs) or < 32 weeks

Level 4 includes complex surgeries and advanced neonatal care.

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5
Q

What are some causes of prematurity?

A

Amniotic infection, maternal drug/alcohol use, increased maternal age, poor prenatal care, multiple gestations, preeclampsia, and genetic conditions.

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6
Q

.

A

.

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7
Q

What is the APGAR score and what does it assess?

A

The APGAR score is a newborn screening tool assessing

  • appearance
  • pulse
  • grimace
  • activity
  • respiration

It is administered at 1, 5, and 10 minutes after birth.

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8
Q

What equipment is commonly used in the NICU for temperature regulation?

A

Radiant warmers and isolettes (incubators) are used for infants to regulate body temperature.

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9
Q

Describe gavage tubes used in the NICU.

A
  • Gavage tubes, such as OG and NG tubes, are used to feed infants directly into the stomach.
  • Transpyloric tubes are used for infants with GER or aspiration risks.
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10
Q

What is ECMO and when is it used?

A

ECMO stands for extracorporeal membrane oxygenation, a heart and lung bypass machine used in cases of severe respiratory or cardiac failure.

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11
Q

When does the vestibular nuclei fully develop?

A

fully developed by 20 weeks gestation

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12
Q

Describe the auditory development in infants.

A
  • By 28 weeks gestation, infants can hear at 40 dB.
  • NICU noise should not exceed 45 dB to avoid disruptions in growth and cochlear damage.
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13
Q

What are some environmental strategies for pain reduction in the NICU?

A

Dim lighting, reducing noise, swaddling, kangaroo care, and non-nutritive sucking.

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14
Q

What are the Hammersmith and TIMP assessments used for in the NICU?

A

These assessments evaluate neuromotor development and motor performance in preterm infants to identify any neurological impairments.

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15
Q

What is trauma-informed care in the NICU?

A

It involves understanding that families may be in crisis and aims to provide support that is sensitive to both the infant’s and family’s emotional needs.

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16
Q

What are the signs of infant stress in the NICU?

A

Pale or flushed skin, glassy eyes, gasping for air, grimacing, fussiness, irregular breathing, and fluctuating muscle tone.

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17
Q

What are the key roles of a physical therapist in the NICU?

A

Facilitating neurodevelopmental progress, providing positioning support, and educating families on infant care and therapeutic interventions.

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18
Q

What is Bronchopulmonary Dysplasia (BPD) and its interventions?

A
  • BPD is a chronic lung disease from underdeveloped lungs in preterm infants.
  • Interventions include reducing environmental stimulation and supporting respiration.
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19
Q

What orthopedic issues are common in the NICU?

A
  • brachial plexus injury
  • congenital hip dysplasia
  • metatarsus adductus
  • talipes equinovarus (clubfoot)
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20
Q

What are common PT interventions for infants with orthopedic issues in the NICU?

A

ROM exercises, taping, splinting, and education on proper positioning to prevent contractures and promote motor development.

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21
Q

Describe Moro and ATNR reflexes and their role in development.

A
  • Moro reflex helps with fight-or-flight reactions
  • ATNR assists with developing muscle tone and eye-hand coordination
22
Q

What are retained reflexes and their potential impacts?

A

Retained reflexes may indicate developmental issues, such as motion sickness, poor balance, or delayed rolling if not integrated by the typical age.

23
Q

What are some consequences of an unintegrated ATNR?

A

Poor midline development, difficulty with handwriting, and delayed rolling and crawling, which may lead to skeletal deformities.

24
Q

What is the Spinal Galant reflex, and what issues arise if it is not integrated?

A
  • The Spinal Galant reflex helps with movement in the womb and during birth.
  • If unintegrated, it can cause bed wetting, poor concentration, and scoliosis.
25
Q

Describe the Babinski reflex and its developmental significance.

A
  • The Babinski reflex prepares feet for walking and influences lower extremity muscle tone.
  • Lack of integration may cause issues like flat feet or difficulty walking.
26
Q

What are the two phases of the gait cycle?

A

Swing (foot in the air) and stance (foot contact with the ground).

27
Q

What are the basic tasks of walking?

A

Weight acceptance, single limb support, and limb advancement.

28
Q

What are the subphases of gait during stance?

A

Initial contact, loading response, midstance, terminal stance, and preswing.

29
Q

What are the subphases of gait during swing?

A

Initial swing, midswing, and terminal swing.

30
Q

What factors contribute to the development of typical walking?

A
  • stability in stance
  • foot clearance in swing
  • prepositioning of the foot
  • adequate step length
  • energy conservation
31
Q

What are the prerequisites for independent walking?

A

Adequate motor control, CNS maturation, sufficient ROM and strength, intact sensation, and muscle activation for pelvic stabilization.

32
Q

What are some characteristics of immature walking (ages 2.5 and younger)?

A

Decreased postural stability, decreased single leg stand time, slower walking speed, and a wide base of support.

33
Q

Describe biomechanical factors influencing gait development.

A

ROM, muscle strength, bone structure, and body composition, which all impact muscle activity and joint kinematics.

34
Q

What is a central pattern generator (CPG), and how does it relate to walking?

A

CPG circuits exist in the spinal cord and brainstem and organize the activation of muscles for locomotion.

35
Q

At what age does a mature gait pattern develop?

A

By age 7, with improvements in single stance duration, walking velocity, and step length.

36
Q

How do toddlers (9-15 months) typically walk?

A

Toddlers walk with small steps, increased cadence, wide base of support, and decreased postural stability.

37
Q

What happens to gait characteristics between 18-24 months?

A

Genu varus resolves, heel strike becomes consistent, and dynamic balance and strength improve.

38
Q

What gait characteristics are observed in 3-3.5-year-olds?

A

Narrowed BOS, tibiofemoral valgus, and a more mature heel-toe pattern.

39
Q

What are typical gait characteristics for a 6-7-year-old?

A
  • neutral tibiofemoral angle
  • coordinated visual and vestibular systems
  • mature gait pattern
40
Q

What are the five determinants of mature walking?

A

Single stance duration, walking velocity, cadence, step length, and the ratio of pelvic span to ankle spread.

41
Q

How does body composition affect developmental gait in infants?

A

High fat content in infancy affects balance and muscle strength, which influences walking.

42
Q

What factors limit independent walking in toddlers?

A

Lack of extensor strength to support body weight during single limb stance and poor dynamic balance.

43
Q

How does motor control influence walking in early development?

A

Visual, proprioceptive, and vestibular systems must work together to bring the center of mass back to a stable position.

44
Q

How do visual and vestibular systems mature during gait development?

A

These systems mature between ages 10-12, enhancing postural control and motor activity.

45
Q

What is the significance of calcaneal eversion in toddlers?

A

Calcaneal eversion is present during early walking and resolves as balance and coordination improve.

46
Q

How do toddlers learn to navigate uneven surfaces?

A

They develop dynamic balance and strength, which lowers the center of mass and improves movement over obstacles.

47
Q

What is the importance of quad and gluteal muscle activation in gait?

A

These muscles provide stability in stance and are crucial for tasks like navigating stairs.

48
Q

What changes occur in gait between 3-7 years of age?

A
  • improvements in postural control
  • decreased calcaneal eversion
  • better coordination of the lower extremities
49
Q

What are the benefits of video-assisted gait analysis in pediatrics?

A

It allows for multiple observations, frontal and sagittal views, and the ability to review gait mechanics in detail.

50
Q

How does muscle activation change with independent walking?

A
  • Co-contraction of antagonist muscles decreases.
  • There is more selective activation of muscle groups during stance and swing phases.

DPT 762 - Pediatrics I (21 decks)

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