Therapeutic Paradigms

Question 1

what extrinsic and intrinsic factors affect fetal presentation at birth

Answer 1

Extrinsic- gravity, Muscle pull, Dynamic stress

Intrinsic- Biomechanical structure, growth potential, physical properties

Question 2

what are the 4 fetal positions at birth

Answer 2

• longitudinal lie vertex pres
• Longitudinal lie breach pos
• Transverse Lie shoulder pos
• oblique lie

Question 3

Why is fetal lie significant

Answer 3

Cord prolapse- babys umbilical cord arrives before the baby does (most associated w oblique and transverse lies)

In utero constraint- increased internal stress

FLAG- if baby is known to have a difficult lie and the mothers water breaks

Question 4

What is positional plagiocephaly

Answer 4

the change of head shape from positional pressure

-can apply to the head, face, leg, hip, knee and rib cage

Question 5

what is shoulder dystocia definition

Answer 5

both shoulders should go thru with the head in the span of one contraction (ideally)

Question 6

facial nerve palsy birth injury: incidence, risk, prog

Answer 6

0. 2 incidence
   risk: use of forceps, primiparity and baby being over 3500 g
   - -results in baby not being able to properly latch on to the mothers breast so alternative feeding postures may have to be adopted

prog: 89% have full recovery

Question 7

Injuries to brachial plexus during birthing (5)

Answer 7

• Avulsion injury- Nerve root torn near spinal cord (more serious)
• Rupture injury- Nerve torn within the plexus
• Neuroma injury- Injuries causing scar tissue within nerves
• Stretch injuries- Neuropraxia are most common, usually heals on its own
• Contusion injuries- conduction blockage

Question 8

what roots are erbs palsy, duchenne-Klumpke and Klumpkeys palsy

Answer 8

Erbs- C5 & C6 roots
Duchenne-Klumke- All roots
Klumpkes Palsy- C8 + T1

Question 9

What is a SCIWORA and how is it caused

Answer 9

spinal cord injury w/o radiographic abnormality of trauma

• -longitudinal distraction/flexion and or extension of vertebral column
• -cord injury w/o spinal fracture or dislocation

Question 10

when do lumbosacral plexus injuries occur

Answer 10

occurs w:

• Sacral and pelvic fx
• S/I disruption

Question 11

What is malignant vs torticollis

Answer 11

Torticolis- where SCM has injuury which leads it to shortening

Malignant- abnormal pres due to mild birth positioning/trauma (results in lat flex and extension KISS)

Question 12

what is kinematic imbalance due to suboccupita strain (KISS syndrome)

Answer 12

Newborns upper serve spine can be injured during birthing process

• limited range
• behaviour signs with normal handling suggest strain/sprain

Question 13

What are the 3 prenatal periods

Answer 13

ovum- 0-14 days
Embryo- 14d- 9 weeks
Fetus- 9w- birth

Question 14

what does order of myelation refer to

Answer 14

Reflects the idea that the nervous system develops over a period of 40weeks and continues after birth
–there is continuous synaptic development of this time

Question 15

reflexes at birth

Answer 15

vital functions stabalize
Sucking
rooting
grasp
swallow
cry
startle

Question 16

5 weeks post conception reflex development

Answer 16

blinking
sucking
grasp
visceral function
tendon reflexes

Question 17

When are APGAR scores taken

Answer 17

taken at 1 and 5 mins post birth and is a measure of breathing function and spontaneous mvmt