Week 1: Atypical Development

Question 1

Risk Factors for Delivery

Answer 1

• facing foward (because shoulder can get stuck on pubic rim)
• face down, brow down, breech (can cause hip dislocation)
• depressed fetal heart rate from prolonged labor
• birth trauma (having to suction baby out??, forceps delivery)

Question 2

ideal presentation of baby for delivery

Answer 2

facing backwards towards pelvis and down

Question 3

delivery red flags for the mother

Answer 3

• diabetes, hyperthuroidism, hbp, infection, std
• T.O.R.C.H. (infections)
• poor nutrition
  -placenta previa (placenta covers cervix) or abruption (placenta separates from wall or uturus)
• rapid or prolonged delivery
• teratogen (ETOH, Drugs, opiods, radiation
• Neonatal Abstinence Syndrome NAS

Question 4

red flags for neonates during delivery

Answer 4

• prematurity <37 wks
• LBW, VLBW, ELBW (extremely low birth weight <2lbs)
• HIE: hypoxic ischemic encephalopathy
• IVH: intraventricular hemorrhage
• PVL: periventricular leukomalacia

Question 5

Clinical clue: motor domain
- popliteal angle

Answer 5

<90 degrees after 6mo

Question 6

Clinical clue: motor domain
- what does hypotonia look like in newborn

Answer 6

• slipping through the axilla
• scarf sign
• head lag after 4mo
• landau not happening

Question 7

Clinical clue: motor domain
- fisted hands >2mo
- cortical thumb

Answer 7

clue of nervous system

Question 8

opistotonus & treatment

Answer 8

concerning if you lift the babys arm in supine and there is a lot of resistance

put baby in sidelying and then hands can go to midline and knees can come to chest

Question 9

my baby does not want to sit- i pull her to sit, and she just stands up

Answer 9

CLINICAL CLUE: too much extensor tone to allow for sitting posture

Question 10

refuse prone or little tummy time

Answer 10

CLINICAL CLUE of GI issues (should be 3 times/day at most)

Question 11

toe walking all around

Answer 11

clinical clue of autism, low muscle tone

Question 12

when should a baby favor one side/hand

Answer 12

not until kindergarten/late preschool

think of interuterine stroke

Question 13

w sitting: clinical clue

Answer 13

cause low muscle tone; puts hamstring on slack

Question 14

CLINICAL CLUE: bunny hopping after 10 mo

Answer 14

indicator for lack of disassociation of R leg from L leg (reciprocal inhibition)

Question 15

Atypical Development age 1-3 mo

Answer 15

• excessive extension,
• tight fisting
• opisthotonus,
• synchronous movements, cramped,
• visual tracking not emerging

Question 16

Atypical development age 4-6 mo

Answer 16

• obligatory reflexes, asymmetrical reflexes, handedness
• slipping through axilla
• no tummy tolerance
• arches in sitting
• no grasp, cortical thumb
• no smile or cooing
• no head ctrl

Question 17

Atypical development age 7-9 mo

Answer 17

• lacks bright affeect
• enjoys supine
• presence of ANY reflexes
• no mobility
• poor sitting quality
• no protective reactions
• no parachute
• no babbling
• does not turn to name called
• no interest in social games

Question 18

Atypical development age 10-12 mo

Answer 18

• delays in 0-8 mo skills
• no words (mama, moo)
• no pointing
• not trying to get attention

Question 19

Atypical development age 14 mo

Answer 19

no interest in other children
- no imitating
- no use of push toys
- no 2 word phrases - no pointing

Question 20

go to pathways.org to see quiz / exam pics

Answer 20

dont put 5 until you do this

Question 21

summary and sequence of events for low tone

Answer 21

-> baby cannot stabilize
—> learns to hold segments artificially
——> fixing (stabilizing) prevents further mvmt of that segment
———> blocks normal process of stability w mobility

Question 22

four blocks of __ development?

Answer 22

neck block
shoulder/scapular block
pelvic hip block (ant tilt)
pelvic hip block (post tilt)

Question 23

Neck Block

Answer 23

hyperextension &/or ATNR
- low muscle tone
- slipping through axilla
- active chin tuck serves to elongate paraspinals

Question 24

shoulder scapular block

Answer 24

• poor scapulo-humeral rhythm
• poor disassociation
• shoulder elevation
• weight stays on chest

Question 24

Neck Block Intervations

Answer 24

• impart rotation in trunk to soften and activate shoulder girdle and begin increasing core strength and stability
• excessive arch = hold to tolerate flexion
• too much extension= work rotation obliques w/o touching extensors for feedback

Question 25

shoulder scapular block intervention

Answer 25

• increase disassociation of shoulder from scapula
• lay supine w arms over foam roll or towel
  –> have baby reach for toys in this position

Question 26

ant pelvic tilt block

Answer 26

HYPOTONICITY
- no anti gravity hip flexion/adduction
- decreased trunk control
- lateral weight shift blocked, normal reactions decreased

Question 27

ant pelvic tilt block compensation

Answer 27

frog leg persists –> wide BOS in all positions

Question 28

ant pelvic tilt block intervention

Answer 28

get them out of sitting and get them to activate core, shoulder girdle

Question 29

posterior pelvic tilt block

Answer 29

• hammies tight preventing full hip flexion/knee extension
• post pelvic tilt
• sacral wit
• w sitting = BAD
• rounded lumbar spine
• increased knee flexion
• difficulty w independent standing (narrow adducted BOS)

Question 30

Post pelvic tilt block intervention

Answer 30

• sitting upright w/o influence of spastic hammies kicking in
• strength rotation around joint into ER
• sitting on bosu ball to strengthen core and glutes