Unit 1 Exam Flashcards
forward protective reaction happens when
5 months
Downward ( parachute) protective reaction occurs when
6 months
Sideways protective reaction occurs when?
7 months
Backward protective reaction occurs when?
9 months
Protective stagger occurs when?
15-18 months
Dorsiflexion reaction occurs when?
15-18 months
Block: Neck Hyperextension and Head/neck Asymmetry: Typical
Typically head and neck hyperextension is being balanced by proximal flexion in the 3rd and 4th month, with midline orientation emerging in all positions
- Active chin tuck serves to elongate the cervical paraspinals
Block: Neck Hyperextension and Head/neck Asymmetry: Atypical
- balanced proximal flexion
- midline orientation
- chin tuck
-prone on elbows - extensors/flexors balance
Block: Neck Hyperextension and Head/neck Asymmetry: Compensations
- shoulder elevation to stabilize
- exaggerate
-ATNR used functionally - Unilateral use of extremities/body
Block: Neck Hyperextension and Head/neck Asymmetry: Consequences
- slip through axilla
- exaggerated neck hyperextension
- Interferes with development of head control, righting reactions, visual
- Posture: scoliosis, hip subluxation, wind- swept deformity
Block: Neck Hyperextension and Head/neck Asymmetry: Interventions
- rotation into trunk to soften
- Core strengthening
- Head control
- Increase tolerance
- Increase extension; rotator muscles, work factors
Shoulder/Scapular Block: Atypical
- poor scapular-humeral rhythm
- poor disassociation
- shoulder elevation
- weight stays on chest
- Shoulder Glued to scapula
Shoulder/Scapular Block: Compensations
- High muscle tone
- prolonged primitive extension
- shoulder girdle instability
Shoulder/Scapular Block: Consequences
- limited functional use of upper extremities
- Hard to transition to quadruped to creeping
Shoulder/Scapular Block: Intervention
Unglue shoulder from scapula
- focus on reaching exercises and strengthening
Anterior Pelvic Tilt Block : Atypical
- decreased abdominal development/activation
- No posterior tilt or lumbar extensor elongation
- no antigravity hip flexion/adduction
- lateral weight shift blocked, normal righting reactions decreased
Anterior Pelvic Tilt Block : Compensations
- frog leg
- wide base of support in all positions
- tummy touching ground
Anterior Pelvic Tilt Block : Consequences
- lack of weight shift
- limited balance learning
Anterior Pelvic Tilt Block : Intervention
- Get out of sitting
- core activation, shoulder girdle, LE
Posterior Pelvic Tilt Block: Atypical
- Unbalanced extension
- Active flexion does not develop
- No dissociated flexion/extension
Posterior Pelvic Tilt Block : Consequences and compensations
Sitting
- tight hamstrings prevent full hip flexion/knee extension
- posterior pelvic tilt
- rounded lumbar spine–> rounded thoracic spine
- sacral sit
- increased knee flexion
- W-sitting
- Bunny Hopping
- difficulty with independent standing
- Narrow adducted base of support
Posterior Pelvic Tilt Block : Intervention
- sit upright
- strengthen
- joint rotation
- dissociation
What is the Scarf Sign?
Tone
- The tone of the shoulder girdle is assessed by taking the baby’s hand and pulling the hand to the opposite shoulder like a scarf
Atypical development 1-3 Months
- tight fisting
- cramped
- synchronous movements
- visual tracking not emerging
-Opisthotonus is a condition that causes a person’s body to arch backward into an abnormal position, with the head thrown back and the neck and spine hyperextended.
Atypical Development 4-6 months
- no head control
- no tummy tolerance
- cortical thumb
- fisting
- no grasp
- no smiling or cooing
- arches in sitting
- obligatory reflexes
- asymmetrical reflexes
- handedness
- slipping through axilla
Atypical Development 7-9 months
- lack bright affect
- enjoys supine position
- presence of any reflexes
- no mobility
- poor sitting quality
- no protective reactions
- no parachute
- no babbling
- does not turn to name being called
- no interest in social game
Atypical Development 10-12 months
- any delays in 0-8 month skills
- no words “mama” or “moo”
- not pointing
- not trying to get attention
Atypical Development 14 months
- no interest in other children
- no imitating
- no pointing
- not using push toys
- no spontaneous meaningful 2 word phrases
Rooting and Sucking Reflex
Onset= 28 weeks gestation
Inhibited= rooting: 3 months/ Sucking = 0-6 months
Characteristics=
- rooting; head turns toward stroked cheek
- sucking; rhythmic sucking
Moro Reflex
Characteristic= 1st head moves post to trunk–> then abduction, extension of limbs then adduction, flexion of limbs
Onset= 28 weeks gestation
Inhibited= 5-6 months
Plantar grasp reflex
Onset= 28 weeks gestation
Inhibited= 0-9 months
Characteristic= flexion after stimulus to feet
Palmar Grasp Reflex
Onset= 10 weeks gestation
Inhibited= 0-4 months
Characteristic= flexion after stimulus to the hand
Spontaneous Stepping Reflex
Onset= 37 weeks gestation
Inhibited= 2 months
Characteristic= reciprocal steps when feet contact surface
Asymmetrical Tonic Neck (ATNR)
Onset= birth- 2months
Inhibited= 0-5 months
Characteristic= flexion on the skull side and extension on the face side (fencing position)
Symmetrical Tonic Neck
Onset= 4-6 months
Inhibited= 8-12 months
Characteristic:
- Neck Flexion= UE neck flexion and LE extension
- Neck Extension= UE extension and LE flexion
Tonic Labyrinthine
Onset= birth
Inhibited= 0-6 months
Characteristic:
- Prone= flexion tone
- Supine= extension tone
Neck On body Righting Reaction
Onset= 34 weeks gestation
Inhibited= 4-6 months
Characteristic= body rotates in line with head
Function = transitions rolling
Body on Head Righting Reaction
Onset= birth-2 months
Inhibited= persists through life
Characteristic= Upright head with body movement
Function= Visual orientation and balance
Body on Body Righting Reaction
Onset= 34 weeks gestation
Inhibited= 4-5 months
Characteristics= Body follows limbs
Function= Learning to roll
Landau Reaction
Onset= 3-4 months
Inhibited= 12-24 months
Characteristics= Head, trunk, hip extension when prone in air
Function= initiate extension tone
Head Neck Reaction
Onset= birth-2 months
Inhibited= persistent throughout life
Characteristic= head vertical when body is lifted
Function= balance reaction, visual orientation
Prone Equilibrium
Onset= 6 months
Inhibited= persistent through life
Characteristic= Body tilt, concave side upward abduct up UE and LE, adduction low UE + LE
Supine Equilibrium
Onset= 7-8 months
Inhibited= Persists through life
Characteristic= Body tilt concave side upward/head rotates to ipsilateral side
Standing Equilibrium
Onset= 12-21 months
Inhibited= persists through life
Characteristic= Body tilt to concave side upward/ UE flex, LE extension, UE abductions
Placenta Abruption
Placenta separates or pulls away from uterine wall
Placenta Previa
Placenta Shifts and drops to opening of the cervix
CP 1st trimester
Brain pathology is more likely etiology
CP 2nd trimester
Causes are more likely hypoxic-ischemic events or infections- this is where cord strangulations occur
CP 3rd trimester
Placenta previa/abruption or positional–> HIE from labor ( baby not getting O2)
Test & Measures : GMFM
- for 5 months - 16 yr
- Evaluates change in gross motor function in kids with CP
Test & Measures : PEDI
- for 12 months - 21 years
- Focus on function and need for caregiver assistance
1- self care
2- mobility
3- social function
Test & Measures : GMA
- for term - 20 week post term
- predictive of CP
- just observational skills
Motor:
1- general/voluntary movement
2- fidgety movement
3- cramped synchronous movement
Test & Measures : TIMP
- for <4 months
- Motor outcome measure
- function performance in daily life
- Identify CP early on
Test & Measures : PDMS
- For 0-6/7 yr
- estimates motor competence compared to normative sample
- Assist planning education programming
Test & Measures : AIMS
- for 0-18 months
- Gross motor delay
- Don’t have to touch baby (parent can)
Test & Measures : HINE
- for 2 months - 2 years
- assess 34 items
- neurological exam
Test & Measures : Modified Ashworth
0=no increase in tone
1= slight increase in tone manifested by a catch and release or by minimal resistance at the end of ROM
1+= Light increase in tone manifested by a catch and release or by minimal resistance at less than half ROM
2= More marked increase in muscle tone through most of the ROM
3= Considerable increase in muscle tone passive movement difficult
4= affected parts in rigid flexion or extension
What is spasticity?
Motor disorder characterized by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated DTR resulting from hyperexcitability of the stretch reflex and lack of descending inhibition
Hypotonicity
Low muscle tone creating
- creating too much movement
Central Hypotonia
Alpha gamma coactivation: fusimotor/gamma system is disordered because the descending pathways are damaged
- Fusimotor/gamma= descending pathway gamma motor m.n. innervates the muscle spindle that sets the tension of the muscle
- Alpha= muscle contracts/shortens activating gamma to set the tension
Hypertonicity
Increase in muscle tone creating too little movement (stiffness)
Periventricular Leukomalacia
(PVL)
- Death or damage and softening of the white matter, the inner part of the brain that transmits information b/w the nerve cells and the Spinal cord as well as from one part of the brain to another
- Grade 1= Increased periventricular echogenicity (IPE) is persisting more than 7 days
- grade 2= IPE develops into periventricular cysts
- Grade 3= IPE developing into extensive periventricular cysts, occipital and fronto-parietal (looks like swiss cheese)
- Grade 4= in deep white matter developing into extensive subcortical cysts
Intra-ventricular Hemorrhage (IVH)
- Based off of radiological findings
- Grade1 = Hemorrhage limited to the geminal matrix area: may be unilateral or bilateral
- Grade 2= blood noted within the ventricular system but not distending it: with blood in 10-50% of the ventricle
- Grade 3= Blood in ventricles with distension or dilation of ventricles: blood in more than 50% of the ventricles
- Grade 4= Periventricular hemorrhagic infarction, cystic periventricular luekomalacia: Intraventricular hemorrhage with parenchymal extension
Hypoxic- Ischemic Encephalopathy ( HIE)
- Results of perinatal asphyxia and due to ischemia and hypoxemia/anoxia
- Preterm and full term babies
- Risk Factors: placenta problems, prolapsed umbilical cord , decreased maternal oxygenation, reduced maternal blood flow to the placenta
Infant Stroke
- Specific areas of neuronal death caused by infarction of specific cerebral arteries
- middle cerebral artery most frequent
- typically unilateral–> spastic hemiplegic CP
Classification by Brain Region: Pyramidal
- spastic type (75-88%) –> corticospinal tracts
- lesions to the motor cortex or white matter
- often includes symptoms of “ central” hypotonia
- corticospinal tract = excitatory
–> lateral tract= crosses- extremities
–> Medial/Ant= ipsilateral- axial/trunk
Classification by Brain Region: Extrapyramidal
- Dyskinetic (15%)
- lesions to the basal ganglia= athetosis
- Lesions to the cerebellum= ataxic (4%)
- Often includes symptoms of central hypotonia
- vestibulospinal tract= excitatory, posture, balance, antigravity UE/LE flexion
- reticulospinal tract= excitatory, Lateral = hypotonicity/ Medial= hypertonicity, spasticity
- Rubrospinal tract= excitatory to flexors/inhibitory extensors, postural tone and FM skills
- tectospinal tract= visual stimulation
Spastic Diplegia
- Most severe
- Lack of inhibition of descending corticospinal tract
- Can walk 2-3 years, has femoral anteversion, knee valgus, tibial torsion, WBOS
- Spastic adductors, posterior pelvic tilt
Causes:
- Prematurity
- Ischemia
- Aspiration
- Infection
- Endocrine/metabolic
Spastic Hemiplegic
- 1/2 body affected
- damage to one side of the brain causing motor disability on the opposite side
- Decrease strength and increase in tone
- Cortical thumb
Causes
- Thrombophilic disorders
- Infection
- genetic/developmental
- periventricular hemorrhagic infarction
Neuropathology:
- stroke in utero or neonatal
- localized HIE/IVH
Extrapyramidal ( athetoid, Ataxic, dyskinetic
- Athetoid: Unwanted movements, withering movements, and difficulty with initiation and cessation of movement
- dysarthria
- Always quadriplegic
- Ataxic= cerebellum- lack of coordination, jittery movement pattern, nystagmus
Causes: - Asphyxia
- Kernicterus
- Mitochondrial
- genetic/metabolic
Neuropathology:
-basal ganglia
- putamen
- globus pallidus
- thalamus
GMFCS Level 1
- Typical looking, some issues on sand or ground
- Children walk indoors and outdoors and climb stairs without limitation
- Children perform gross motor skills but speed, balance, and coordination are impaired
GMFCS Level 2
- need to use handrail on stairs, SLS
- Children walk indoors, outdoors, and climb stairs holding onto a railing but experience limitations walking on uneven surfaces and inclines and walking n crowds or confined spaces
GMFCS Level 3
- Can ambulate short distances, need wheeled mobility for longer distances
- Children walk indoors and outdoors on a level surface with an assistive mobility device
- Children may climb stairs holding on railing
- children may propel a wheelchair manual or are transported when traveling for long distances or outdoors on uneven terrain
GMFCS Level 4
- Have head control, exercise ambulation in classroom
- Children may continue to walk for short distances on a walker or rely more on wheeled mobility at home/school/community
GMFCS Level 5
- No head control can’t use self propel device
- Physical impairment restricts voluntary control of movement and the ability to maintain antigravity head and trunk postures
- All areas of motor function are limited
- Children have no means of independent mobility and are transported
Stahell Test
Hip Flexor Length
Duncan Ely Test
- Rectus Femoris length
(+) if hip rises
Popliteal Angle Test
- hamstring
- > 40 = surgery
- measures hamstring spasticity
Silferskiold Test
- Gastro vs. soleus
- (+) ankle PF
(+) ankle dorsiflexion
Craigs Test
Femoral Anteversion
Tight foot Angle
● Tibial torsion
→Age 1: -27- +20
(means 0)
→Age 3: -15- +25
(means 7)
→Age 5: -5 to +30
(means 12)
→Age 7: 0-+30
(means 18)
→Age 9: 3 to +33
(means 20)
Interventions: Stretching for CP
- BAD
- can only do prolonged functional stretching
Interventions: CP Therex
- Improves balance in children with CP
- 2-3x per week for 6-10 weeks at 65% of max vol. isometric contraction
- Plyometrics
- active develop: strengthening ( yoga/pushing heavy objects) especially hamstrings will help with gait
- Age appropriate play shows functional improvements 10-15 minutes of intense activity for 30-45 minutes of recreational games 2x per week
Interventions: CP positioning
- adaptive equipment
- functional positions to avoid contractures
- Increase muscle length over time
- Prevents asymmetries
Interventions: CP Serial Casting
- Prevents contractures
- Use alone or with conjunction of Botox/surgery
- Restore ROM/muscle length
- Helps gait become more functional
- Worn at least 2-4 weeks
Interventions: CP Orthotics
- Solid or hinged AFO
- PF stop: stops PF and makes hamstrings work harder
- Supramallelolar orthotics (SMO): prevents pronation
- Floor reaction Orthosis: excessive PF and DF
- Anterior Shell: pushes on patellar tendon for extensor mechanism good to use with hamstring, gastroc/soleus spasticity
Selective Dorsal Rhizotomy
- GMFCS 2-3
- 4 hour operation
- sensory nerve fibers in spinal cord usually between bottom of the rib cage and the top of the hips are divided and then the fibers are stimulated and response of of the leg muscles are observed
- the muscle with abnormal or excessive response are severed
Typical Infant Vitals
- > 37 weeks gestation
- Axillary temp 98.6-99.8
- HR 80-140 bpm
- RR 40-60 bpm
- 6-9 pounds
- Physiological flexion/dorsiflexion
- Moro, tonic neck, galant, gag, suck, swallow, plantar/palmar grasp
- Sensory system intact (vision 8 inches)
Premature Infant Vital
<37 weeks gestation
Axillary temp 98.6-99.8
HR 120-160 bpm
RR 60+ bpm
2-5 pounds
Poor physiological flexion
Infant reflexes disorganized
Sensory systems underdeveloped
Transient tachypnea of the newborn
Apnea (shallow breathing) and bradycardia (slowed HR) (A’s and B’s)= this happens because of an immature brainstem/ breathing notification system isn’t working/ largely unregulated
How many weeks until the organ systems are formed and complete in a baby?
by 12 weeks
What is the function of the placenta?
Protect and feed the baby
Heart and neural tube forms during what week ?
4 weeks
What are the functions of the Gyri and Sulci?
To increase the surface area of the brain for growth and development of neuronal connections
What are the goals in PT for premature babies?
-Maintain steady vitals with positioning, calming, self-soothing, non-nutritive sucking
-Developmental positioning to minimize alterations in tone, prevent contracture, minimize reflexes
-Provide optimal positioning for visual, social, fine, gross and cognitive development
Respiratory Distress Syndrome
-Prematurity causes pulmonary immaturity and deficiency of surfactant
-Low surfactant and production results in increased surface tension, alveolar collapse, diffuse atelectasis and decreased lung compliance
-Treatments includes administering surfactant , oxygen supplementation , assist ventilation and ECMO ( extracorporeal membrane oxygenation)
- Fetuses begin to produce surfactant between weeks 24 and 28. By 34 weeks most babies have enough naturally produced surfactant to keep the alveoli from collapsing
Bronchopulmonary Dysplasia (BPD)
-Chronic lung disease→ persistent areas of increased densities on chest radiographs
-VLBW and ELBW infants require ventilation
- Increased airway resistance→ Lots of work to breathe
- Pathophysiology→ interstitial fibrosis resulting from alveolar collapse
- If the baby still has to be on supplemental O2 by 36 weeks they have BPD
Intraventricular Hemorrhage (PIVH)
Grades 1-4
Grade 1= isolated germinal matrix hemorrhage
Grade 2= IVH with normal sized ventricles
Grade 3= IVH with acute ventricular dilation
Grade 4= IVH with hemorrhage into the PV-white
Main ischemic lesion of an infant caused by necrosis of the white matter surrounding the ventricle
Watershed zones/major blood vessels / a lot of vulnerability
Hypoxic Ischemic Encephalopathy (HIE)
- Disorder of reduced umbilical cord blood supply
- Lack of glucose to the brain
- results in energy failure
- oxidative stress
Neonatal Abstinence Syndrome
- Group of problems that can arise if the mother does opioid drugs/cannabis during pregnancy
- Child can have increased impulsivity, hyperactivity, destructive behaviors, memory dysfunction, decreased IQ
- Adolescents have a higher rates of drug use , decreased concentration, decreased memory, depression, schizophrenia, anxiety disorder
- A score 8 or higher on the test the kid will need intervention and follow up
Necrotizing Enterocolitis (NEC)
- An acute inflammatory disease of the bowels
- Occurs most frequently in the first 6 weeks of life (BW <2000g)
Symptoms:
- vomiting
- Abdominal distension
- Bloody stool
- Lethargy
Treatment:
- Broad spectrum antibiotics
Surgical treatment:
- NG tube placement for intestinal decompression
- G-tube placement
- Resection and diversion of necrotic bowel
Retinopathy of Prematurity (ROP)
-Condition of the very low birth weight and extremely low birth rate
-Potentially blinding eye disorder for infants born before 30 weeks gestation
- One of the most common causes of sight loss, life long blindness, visual impairment
Hyperbilirubinemia (Jaundice)
-The accumulation of excessive amounts of bilirubin in the blood
- Part of the red blood cell found in bile and broken down in the liver
- In premature babies the liver is still immature and that’s why the skin color changes
- If not taken care of can move to the brain and cause CP
Neonatal Seizures
-Most frequent and distinct neurological sign
-90% occurs in the first 5-15 days
Caused by:
-HIE
-IBH
-anatomical defects
-hypoglycemia
-Drug withdrawal
Fetal Alcohol Spectrum Disorder (FAS-D)
- Alcohol rapidly crosses the blood brain barrier and the placenta of the fetus
- Syndrome #1 cause of cognitive deficits in the child
- Growth deficiency
- Cardiac defects
-Microcephaly - Dysmorphology
Patent Ductus Arteriosus (PDA)
- PDA should close within 15 hours after birth
- Ovale should close within 2-3 months after birth
- Ductus arteriosus can be more problematic since it connects the pulmonary artery to the aorta
- In premies it can stall out and then surgery is needed to correct the problems
Obstetric Brachial Plexus Injury (BPI)
- Difficult labor→ Erbs palsy → Klumpke’s palsy
- Usually a stretch injury
- Erbs palsy is condition adduction, IR, elbow extension and pronation
–>Nerve roots C5-C6
-Klumpke’s palsy
–> Nerve roots C8-T1
- Causes Adduction, elbow flexion and claw hand posture interossei of the hand very tight fingers, wrist flexion
Risk factors
-Big babies
-Multiple babies
-forceps breech
- Shoulder first
- Prolonged labor
Cystic Fibrosis
-Genetic disorder
- Disorder of mucus → prevents normal functioning of the lungs, pancreas, small intestine, small capillaries in the lungs , bronchi of the lungs
-CF affects how salt and water move into the lungs which affects the glands the make mucus
- Sweat test done in babies
Signs and symptoms :
-Coughing
-Wheezing
-Multiple lung infections
-SOB
-Slow growth
-Big appetite
-Loose stool
-Painful tummies
-Petite kids
Receive lung transplants
Shaken Baby Syndrome
Triad:
1. Subdural hematoma
2. Encephalopathy
3. Retinal hemorrhage
-Child abuse
-Brain in the cavity of the skull gets hurt causing bruising, swelling, damage
What are the 4 main Interventions for Premature babies
Encasement/swaddling
Graded sensory motor input
Non-nutritive sucking
Positioning : prone, supine, side-lying, sitting
Supine positioning in premature babies
Supine→ early WB through the LEs→ towel rolls to decrease the effects of reflexes→ facilitate use of UEs for object exploration, visual regard
Side-lying positioning for premature babies
Side-lying → scapular protraction and trunk elongation, working on subtle WS→ disassociating the upper and lower trunk using a BOB reaction → ideal for HR, RR, BP, O2 saturation (QUIZ QUESTION) → dampens tonic reflexes → better cranial modeling→ proven to help with weight
Prone Positioning for premature babies
Prone→ stretches the hip and knee/rectus femoris→ facilitates active extension and head control→ eye hand awareness and proprioception → breathing may be difficult —> not possible with ventilator babies and cardio-pulmonary issues → improved hip positioning→ nice cranial molding
Sitting positioning for premature babies
Sitting Up right → Active head control→ trunk control→ Wb through spine, UE, LE→ Frees hands for exploration → Disassociation of trunk with UE and LE → Gentle WS with elongation → visual regard changes (tracking) → cognition usually smarter and can see the world through a different perspective
