Torticollis, Cranial Deformation, DDH, Development of MSK System Flashcards
Week 4
What are the key events in trunk alignment development in infancy?
Neonatal kyphosis resolves, spinal curves develop, and postural control emerges through weight shifts and movement.
Why is skull-side weight shifting important in prone?
It promotes lateral head and trunk righting, facilitating early rolling, belly crawling, and reaching.
What are the three primary co-existing processes in postural control development?
Postural control, physiologic adaptation, and functioning muscle couples based on use history.
What is the golden age of skeletal modeling?
The first 2 years of life when bones are highly responsive to mechanical loads and movement patterns.
What key changes occur in the hip during the first year?
Coxa valga decreases, femoral antetorsion reduces, and hip joint congruency improves with weight-bearing activities.
How does the knee alignment change in the first three years?
Newborns have genu varum, which transitions to genu valgum around age 2-3 before stabilizing in adulthood.
What ankle and foot changes support independent walking?
Metatarsus adductus resolves, medial longitudinal arch develops, and ankle dorsiflexion range decreases to functional levels.
What are the key aspects of early walking?
Wide base of support, high cadence, short step length, and lack of heel strike.
How does walking mature over time?
By age 3, children develop narrower bases of support, improved single-limb stance time, and refined heel-to-toe gait patterns.
What role do lateral weight shifts play in gait development?
They allow for efficient limb advancement, weight acceptance, and postural stability in walking and cruising.
What is CMT?
Unilateral shortening of the SCM muscle leading to lateral neck flexion toward the involved side and rotation away.
What are the three types of CMT?
Postural CMT (no PROM restrictions), Muscular CMT (SCM tightness with PROM restrictions), SCM Mass CMT (fibrotic mass in SCM).
What are risk factors for CMT?
Intrauterine positioning, multiple births, difficult delivery, and ‘container syndrome’ from prolonged supine positioning.
What impairments are associated with CMT?
Limited cervical ROM, asymmetric postural control, craniofacial asymmetry, and potential gross motor delays.
What activity limitations may be seen in CMT?
Asymmetrical reaching, rolling, sitting posture, and delayed gross motor skills.
What are red flags indicating referral in CMT?
Poor visual tracking, abnormal tone, inconsistent asymmetry, or lack of progress after 4-6 weeks of PT.
What interventions are used for CMT?
Stretching, strengthening, repositioning, caregiver education, and orthotic interventions (TOT collar if needed).
What is plagiocephaly?
A cranial deformity characterized by asymmetrical skull flattening, often associated with CMT.
What is brachycephaly?
A cranial shape characterized by a short, wide head due to prolonged supine positioning.
What is scaphocephaly?
A long, narrow head shape due to restricted positioning, commonly seen in preterm infants.
How is plagiocephaly classified?
Using the Argenta Classification System, which grades severity based on skull and facial asymmetries.
What interventions help improve plagiocephaly?
Tummy time, repositioning strategies, and orthotic cranial remolding helmets for moderate to severe cases.
What is DDH?
Abnormal development of the hip joint, including subluxation, dislocation, or dysplasia.
What are risk factors for DDH?
Breech presentation, family history, female gender, and first-born status.
What clinical tests assess DDH in infants?
Ortolani test (reduces a dislocated hip), Barlow test (provokes hip instability), and Galeazzi sign (leg length discrepancy).
What is the most effective conservative intervention for DDH?
Pavlik harness, which maintains the femoral head in the acetabulum to promote normal hip development.
When is surgical intervention indicated for DDH?
For infants older than 6 months with persistent hip dislocation or if conservative treatment fails.
How does early intervention impact orthopedic development?
It improves alignment, prevents compensatory movement patterns, and enhances lifelong function.
What is the relationship between CMT and plagiocephaly?
Restricted head movement in CMT can lead to positional plagiocephaly due to prolonged pressure on one side of the skull.
Why is tummy time important in infancy?
It promotes cervical extension, strengthens postural muscles, and reduces the risk of plagiocephaly and CMT.
What principles guide orthopedic assessment in pediatric PT?
Observing alignment in multiple positions, analyzing weight shifts, and screening for developmental delays.
What is the first major postural control milestone?
Head control in prone and supine, achieved by 2-4 months.
How does prone positioning impact trunk development?
Encourages scapular stability, spinal extension, and lateral weight shifting for rolling.
What role do righting reactions play in postural control?
They help maintain head and body alignment in different positions, crucial for sitting and standing.
How does the center of mass shift as a child develops?
Moves from high in the thorax at birth to lower in the pelvis as postural stability improves.
What postural control milestone is key for independent sitting?
Development of trunk extension and rotation by 6-8 months.
Why do newborns have physiologic hip flexion contractures?
Due to intrauterine positioning, gradually decreasing with movement and weight-bearing.
What role does kicking play in lower extremity development?
Strengthens hip extensors and abductors, essential for standing and walking.
How does femoral torsion change in infancy?
Femoral anteversion reduces from ~40° at birth to ~10-15° in adulthood.
What are the three primary factors influencing lower limb alignment changes?
Growth, weight-bearing, and muscle activation.
How does the calcaneus change during early childhood?
Newborns have a valgus alignment that gradually straightens as gait matures.
What are the six determinants of mature walking?
Pelvic rotation, pelvic tilt, knee flexion in stance, foot and ankle motion, step width, and cadence.
How does step width change with age?
Decreases as postural control and balance improve.
What is the typical cadence for a new walker?
High cadence (~180 steps/min) with short step length.
How do initial contact patterns change with walking experience?
Transitions from flat-foot contact to heel strike by 2-3 years.
What are common atypical gait characteristics in early walkers?
Toe-walking, knee hyperextension, and excessive trunk sway.
What are key gait characteristics of children with developmental delays?
Delayed emergence of reciprocal arm swing, decreased push-off, and excessive hip abduction.
What cranial deformity is most commonly associated with CMT?
Plagiocephaly due to preferential head positioning.
What are the three grades of CMT severity?
Mild (postural asymmetry), Moderate (limited rotation and lateral flexion), Severe (fibrotic SCM mass).
How does sternocleidomastoid tightness impact gross motor skills?
Affects rolling, sitting symmetry, and early weight shifts for mobility.
What is the recommended treatment duration for CMT?
Typically 3-6 months, depending on severity and early intervention.
What interventions help address persistent CMT cases?
TOT collar, kinesiotaping, caregiver repositioning strategies, and stretching.
What is the difference between positional plagiocephaly and craniosynostosis?
Plagiocephaly is caused by external forces; craniosynostosis is premature skull suture closure.
What are the risk factors for developing plagiocephaly?
Prolonged supine positioning, CMT, multiple births, and limited tummy time.
What are the clinical signs of severe plagiocephaly?
Asymmetrical ear alignment, forehead prominence, and facial asymmetry.
At what age is cranial remolding orthosis most effective?
Between 4-6 months, when skull growth is most active.
What is a key criterion for referring an infant for a cranial helmet?
Moderate to severe asymmetry (>10 mm difference between skull sides).
How is DDH severity classified?
Mild (hip instability), Moderate (subluxation), Severe (complete dislocation).
What imaging is used to confirm DDH in infants <6 months old?
Ultrasound, as the hip joint is mostly cartilaginous and not well-visualized on X-ray.
What are late signs of undiagnosed DDH in older infants?
Asymmetric gluteal folds, leg length discrepancy, and Trendelenburg gait.
Why is early detection of DDH critical?
Late diagnosis increases the need for invasive interventions like closed reduction and spica casting.
How does Pavlik harness positioning promote hip development?
Maintains hips in flexion and abduction, allowing proper femoral head seating in the acetabulum.
What family-centered interventions are key for early motor development?
Encouraging active movement, caregiver education on positioning, and minimizing prolonged supine time.
What is the impact of early weight-bearing on musculoskeletal development?
Stimulates bone growth, joint alignment, and muscle strengthening.
How does crawling influence musculoskeletal and postural control?
Develops reciprocal limb coordination, strengthens core muscles, and improves trunk stability.
What are common red flags for referral in pediatric orthopedic development?
Persistent asymmetries, delayed gross motor milestones, abnormal muscle tone, and joint instability.
What is the role of PT in early detection of orthopedic conditions?
Screening, parent education, developmental monitoring, and facilitating referrals for medical management.
What is the angle of antetorsion in a newborn vs adult?
Newborn: 40°
Adult: 16°
What are the normal measurements at the pelvis, femur, hip (AOE), and resultant postural in the frontal planes?
Pelvis - AIS ~31°
Femur: Coxa Valga ~150°
Hip Joint: Angle of Entry: 90° (+/- 2°)
Resultant Postural - Femoral Abduction ~9°
What are the Leg Length Rx Guidelines for Tx?
0-2 cm- no treatment
2-4 cm- shoe lift
2-6 cm- epiphyseodesis
6-20 cm- limb lengthening
>20 cm- prosthetic fitting
How does the infant reduce coxa valga?
glute med starting around 3 months of age
