Week 12 - MS conditions in Children Flashcards
When does musculosckeletal system begin growth?
First trimester of pregnancy
When are all systems formed with tissue and organ differentiation complete?
8 weeks
What development is seen in first 4 weeks gestation?
Matrix skeleton laid down
What development is seen in the 4rth week?
Limb buds arise
What are the 2 genes that convey body plan, position information and limb development?
- Homeobox
2. Sonic hedgehog
When are type 1 and type 2 muscle fibres formed?
type 1 - 12 weeks
type 2 - 30 weeks
Describe important dynamic factors of bone in childhood and adolescence
- Longitudinal at growth plates
- radial by bone modelling
- Bone modelling - formation by osteoblast and reabsorption by osteoclasts increasing mass and alters shape
- bone remodelling - weight bearing or muscle pull stimulate new growth/bone strength by replacing old micro damaged bone
When is skeletal growth most rapid
first 2-3 years (1/2 adult height)
What is the normal shape of leg up to 18 months?
genu varum
What is the shape of the leg 18 months to 4 years?
straight
What shape does the leg have at 4 years old?
genu valgus
What is the normal shape of leg at adulthood (>7)
Straight
What factors form the basis for paediatric physiotherapy treatment implementation of EBP? (5)
SCORR
- Clinical observation
- Clinical reasoning
- Theoretical concepts
- Research
- Systematic review
What developmental factors should be considered in the 3rd trimester?
- Greater force on cartilaginous foetal skeleton can lead to musculoskeletal/postural deformation
What are the normal alignment of limbs at birth?
- Kyphosis from c-spine to sacrum
- hip flexion and external rotation
- Internal rotation of lower leg
- inversion of feet
What week does heart development finish at?
week 6 embryonic development
What week does lower limb development finish?
Week 7 of embryonic development
What two areas of the skull does positional plagiocephaly occur and what are their names?
- lateral deformational plagiocephaly (3 levels of severity)
- Posterior defermational plagiocephaly (brachycephaly)(3 levels of severity)
List the prevention and treatment for Mx of positional plagiocephaly (7)
(educate, 2 positions, in envitonment, assess, treat, refer clinic)
- Education
- active positioning
- counter positioning
- environmental set-up
- assess for related factors (torticollis, dev delay)
- treat the related factors
- craniofacial clinic - helmet therapy
Define and describe congenital muscular torticollis (CMT)
Shortened sternocleidomastoid (SCM) causing ipsilateral flexion onside and contralateral rotation on opposite side
What are the 3 causes of CMT?
- Postural - no PROM limitation
- musclular - PROM limitation
- SCM mass - PROM limiation
What risk factors associated with CMT? (3)
- First born
- Plagiocephaly/facial asymmetery
- birth trauma
list ways of treating CMT (5)
- Play (env’t set-up)
- sleep
- stretching
- strengthening - sidelying
- Tummy time
Define and describe Neonatal brachial plexus palsy (Erbs/Klumpke)
traction injury to the brachial plexus during delivery contributing BP injury (often large baby, associated with prolonged labour)
What treatment is used for neonatal BPP? (6)
- Positioning and handling for infants (ie. tummy time)
- Maintain PROM (stretch ER, P/S forearm, extension of elbow), Serial casting if contracture
- Facilitate active movements by getting to reach for things want to do (task and context specific, progress to elimate gravity then against gravity)
- Strengthening
- surgery - nerve transfer (12 months), tendon transfer
- splinting
Define and describe developmental hip dysplasia (DDH)
born with shallow acetabulum which causes a mismatch between head of femur and acetabulum (maybe due to ligament laxity)
What are the risk factors associated with DDH? (6)
FFFSIN
- Intrauterine restriction
- Females
- First borns
- Family hx
- swaddling - brining hips in
- Neuro conditions
What are signs of DDH
- Limited ab of hip (major)
- shortened femoral length
- asymmetrical skin creases
- prominent greater trochanter
What are the special tests for DDH (3)
- Barlow
- Ortolani
- Hip U/S
What is the treatment for DDH? (5)
OPSEH
- paediatric orthopod
- pavlik harness/abduction brace
- surgery - closed reduction + hip spica
- education
- handling
List the common postural and structural MS conditions of the foot (6)
MA, TCV, TEV, CTEV, CVT,
Postural:
1. Metatarsus adductus - MT adducted position (flexible or rigid)
2. Talipes Calcaneovalgus - forefoot lateral, hindfoot valgus, foot dorsiflexion
3. positional talipes equinovarus (PET) - inverted or varus, can stretch out foot passively
Structural:
- Congenital talipes equinovarus (CTEV, clubfoot) - 6-8 weeks post conception
- Congenital vertical talus (CVT) - dorsiflexion from mid foot (looks like calcaneovalgus)
- Other deformities - refer to orthod
List steps of a foot assessment
- ROM (50% PF, Eversion, Inversion) - look at creases
2. Heel bisector line (Metatarsus adducts)
What does the Ponseti method treatment for?
Congenital talipes equinovarus (club foot) using series of casts, surgery, bracing (boots & bars) for 23 hours per day for 3 months post-surgery and then 12 hours nightly until age 4
How many stages are involved in the Ponseti method and how long does the take?
5 stages taking 4-6 weeks
What positional changes occur when treating CTEV?
inversion/adduction to eversion/abduction
What factors indicate the foot ready for surgery? (4)
- > 45 deg abduction
- Lateral head of talus no longer palpable in corrected position
- heel valgus
- anterior end of calcaneus out from under the head of talus (calcaneus shifted posteriorly)
