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Lifespan Exam 2 – Pediatric – Flashcards

Elizabeth Hill

7 July 2022

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question

Name the domains of development

answer

Gross motor: using large groups of muscles to sit, stand, walk, run, etc., keeping balance, and changing positions. Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other things. Language: speaking, using body language and gestures, communicating, and understanding what others say. Cognitive: Thinking skills: including learning, understanding, problem-solving, reasoning, and remembering. Social: Interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to the feelings of others

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Early Childhood Special education is delineated in IDEA Part B and applies for children ages 3 - ____ a. 10 b. 12 c. 18 d. 21

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d. 21 Provides services for children 3 years old through 21 years of age & provides: Free, appropriate, public education in the least restrictive environment

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Define Motor skill

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A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups.

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What are warning signs of a developmental delay Discuss behavioral, gross motor, and visual

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Behavioral daily violent behavior rocks body Gross motor has stiff arms and legs clumsy compared to same age children Visual rubs eyes frequently brings objects too close to eyes to see

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What is the grasphing reflex - when does it integrate (or should it integrate)

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Present at birth Seen when a finger is pressed into baby's palm, baby's fingers automatically curl around the person's finger The reflex slowly integrates ; allows the development of more mature grasping patterns - leading to fine motor skills At 4 months, babies will begin to more frequently reach out for toys with arms and hands The reach looks more like a swipe because the baby is learning how to control the arm and hand Over time, babies learn how to make smoother ; coordinated movements with their arms and hands

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What is IEP

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Utilizes the IEP - Individualized Educational Plan Identifies the present level of performance Sets forth a plan for implementation of needed services Identifies who, what ,when, and specific goals and outcomes Services are provided in the educational environment An IEP is an individualized education plan designed to outline a specialized plan for a student according to their special needs in the education environment. It is written by a team of individuals who understand the student's need. Additional assessments may be requested by team members and another meeting is held to discuss results and make adjustments to the IEP as needed. It is a legally binding document. Team members include but are not limited to special education teacher, regular education teacher, parent, child (may or may not attend), psychologist, school administrator, and related service personnel (PT, OT, ST), etc.

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What is a set of functional skills or age-specific tasks that most children can do at a certain age range that encompasses all domains of development

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developmental milestones

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What pathologies might have crouched gait

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Crouched Gait Commonly seen in children with diplegic CP and hamstring contractures. Results in a combination of hip flexion, knee flexion, and ankle equinus

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Your Pt displays the following signs and symptoms? Asymmetrical hip abduction in flexion Asymmetrical groin or buttock skin folds Clicking or popping of affected hip Apparent femoral shortening on affected side Positive test for hip subluxation What do you suspect

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developmental dysplasia of the hip

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What is important to know about ROM in peds vs adults

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Adult ROM values are NOT to be used for comparison with Newborn values. Full term newborns Limited in hip and knee extension Greater dorsiflexion than adults Intrauterine position Flexor muscle tone

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Upright head posture and walking are examples of what domain of development

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gross motor

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How do children learn new physical skills

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Children learn new physical skills by practicing them until each skill is mastered

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What is important to remember about milestones and their associated age level

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Milestones help monitor how a child is developing Although each milestone has an age level, the actual age when a normally developing child reaches that milestone is highly individualized as every child is unique!

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The domain of the development that concerns itself with interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to feelings of others is the _____ domain a. cognitive b. language c. social d. gross motor e. fine motor

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social

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Spiraling and flexible as to when a child reaches and masters a skill - this describes the developmental milestone process True or False

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True

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Where are the muscles for gross motor skills typically found

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Muscles required for gross motor skills are generally found in the arms, legs, back, abdomen & torso Motor skills are deliberate & controlled movements requiring muscle development & maturation of CNS Support Skeletal system must be strong enough to support the movement & weight handling involved in any new activity

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When would we expect a normally developing baby to hold his/her head steady in sitting a. 3 weeks b. 2 months c. 5 months d. 8 months

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2 months - head steady in sitting

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Reaching and grasping of objects are examples of what domain of development

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fine motor

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True or False Current models of development agree that childhood development is linear, but not necessarily sequential

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False, the below is true Current models of development agree that childhood development is sequential, but not necessarily linear Debatable whether one skill in the sequence must be achieved before the next skill may be reached (stair-step)

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You Pt has the meninges and parts of his spinal cord protruding in a sac at the level of the lesion...obvious abnormality of the spine. What type of spina bifida is this a. meningocele b. acculta or cystic c. occulta d. myelomeningocele e. myositis ossificans

answer

d. Others are described below Occulta (not visible) - No disability usually Acculta or cystic (visible) Meningocele - no disability usually CSF and superficial tissue protrudes from the spine in a sac at the level of the lesion Neurological tissue is rarely involved Myelomeningocele Meninges and parts of spinal cord protrude in a sac at the level of the lesion There is an abnormality of the spine Disability includes paralysis with loss of sensation below the level of the lesion Extent of the disability depends on the level of the lesion and scope of the neurological involvement

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At what age do we typically see cruising a. 6 months b. 8 months c. 10 months d. 1 year

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10 months - cruising

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This domain of learning is required for large muscle control of the body

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Gross motor Abilities required for large muscle control of body Walking, running, sitting, crawling & other activities

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What is physiologic flexion

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Physiologic Flexion Full term babies are born in physiologic flexion Due to confinement & position in the womb Hip, knee & ankle flexion contractures Normal neonatal hip flexion contracture of 30 degrees and knee flexion of 20 degrees; ankle is fixed in DF Q&A: Describe the position of the spine & joints of the extremities

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At what age would we expect a baby to sit without support a. 3 months b. 6 months c. 10 months d. 1 year

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6 months - sits without support

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Between ages 1 and 3, hip and knee angles change from ____ to ____

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varus to valgus

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Which of the following is not a pediatric neuromuscular disorder a. Duchenne Muscular Dystrophy b. Myotonic dystrophy c. Limb-girdle Muscular Dystrophy d. Arthrogryposis e. Charcot-Marie-Tooth Disease

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Anticipatory (feed-forward) motor control strategy is typically used by children with what diagnosis?

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postural adjustments used by children with cerebral palsy and typically developing children to counteract self-generated motions that disturb balance.

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What is Section 504 of the Rehabilitation Act of 1973

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Some children may not qualify for services under IDEA yet qualify under section 504 Section 504, a civil rights law, prohibits discrimination on the basis of disabling conditions by programs and activities receiving or benefiting from federal financial assistance. This statute does not require the federal government to provide additional funding for students identified with special needs. Schools must provide these children with reasonable accommodations comparable to those provided to their peers under the rulings of Section 504.

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Anti-gravity extension

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Antigravity Extension Voluntary, active movement against gravity First seen at the neck then the trunk In prone, begins with lifting of the head In prone, extensors strengthen & flexion contractures decrease Active extension movement occurs first as the extensors have been in a lengthened position and are prepared to move before flexors.

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A child with developmental hip dysplasia is learning how to walk, how might this present in your pt How might this look different in an older child?

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A painless waddling limp may be noted as a child learns to walk. If bilateral hip dislocation is present, limping with marked swayback become noticeable during gait. Signs / Symptoms (cont'd) During ambulation in the older child: Trendelenburg gait Decreased hip abduction Thigh pistoning Bilateral DDH Increased lumbar lordosis Swaying (waddling) gait typical of a bilateral Trendelenburg

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Who is included on the IEP team

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Services include: Special education Appropriate related services (; possible members of the IEP team) PT OT ST Transportation Psychological services and counseling Medical, dental, hearing, or optical services needed in support a child's education

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Older children are normally more flexible than younger children T/F

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False

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When is walking achieved? How does walking pattern evolve

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Standing & Walking - 1 to 2 years (usually b/w 9 -15 mos) LEs - Begins with cruising and wide base stance UEs - High Guard Position Stands Independently ~ 10.5 mos. Takes first steps ~ 11 mos. Walks independently ~ 11.5 mos.

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Anti-gravity flexion

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Antigravity Flexion Develops in supine first Foot-play, head lifting The baby has been in a flexed position, but once they spend time in prone, the trunk flexors are now in an elongated (stretched) position and are being strengthened- working to overcome gravity

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What is Developmental Dysplasia of the Hip

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Poor alignment of the acetabulum and head of the femur in the developing hip

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Lateral flexion and rotation

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Lateral flexion activity -- Crawling (amphibian) and rotation - rolling

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Examples of reasonable accommodations include all the following except? a. adapted seating b. additional testing time c. additional time to walk in the hall between classes d. memory foam pillows for nap time

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At what age can children develop hypotheses and theories (formal thinking)

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13-18 years

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You are working with a 2 year old that sorts objects and turns pages. She cannot match colors. Is this normal development

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Yes on the sorting objects and turning pages but not on the inability to match colors

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Gait pattern begins to resemble adult gait pattern at age

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What is part of the treatment regimen for developmental dysplasia of the hip

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Treatment Some physicians will just allow for the process to occur with no intervention (natural course of healing) Monitoring through radiographs Limitation of contact sports Non-weight bearing activities such as swimming are encouraged Use of crutches (non-weightbearing) in more extensive cases Positional splinting (IR/abd) Surgery Bracing & splinting to hold hip in flexion and abduction Children under 9 months usually wear a Pavlik harness which allows for active kicking; promotes strength and mobility and decreases the occurrence of avascular necrosis of the hip Children over 9 months need abduction orthosis that allows for gait Traction & surgery Usually done after 18 months Therapeutic Interventions Measuring and fitting for bracing ROM Strengthening Encourage kicking in infants Encourage transition Sit to quad Pull to stand Encourage pre-gait activities Crawling Creeping

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By ___ years, gait pattern is assessed like an adult a. 2 years b. 3 years c. 5 years d. 7 years e. 10 years

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7 years

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Gait pattern is like that of an adult at age

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You are doing a skin assessment of your Pt (a baby)...you note hair along their spine...what do you suspect

answer

spina bifida occulta Signs & Symptoms Spina bifida occulta Skin depression, dark tuft of hair, hemangioma, subcutaneous mass Meningocele or myelomeningocele Sac on the back Weakness and paralysis possible if nerves involved Hydrocephalus, often requiring surgery Hypotonia

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Discuss the difference between how toddlers walk compared to adults...

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3 yrs. of age is when a child's gait pattern begins to resemble that of an adult. Initially there is a wide-based stance with rapid cadence and short steps. Toddlers have a broad-based gait for support, and appear to be high-stepped and flat-footed, with arms outstretched for balance. Legs are externally rotated, with a degree of bowing. Heel strike develops at around 15-18 months with reciprocal arm swing. School-aged children, demonstrate a step length increase and step frequency slows. Adult gait and posture occur around the age of 8 years.

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At what age would you expect a toddler to be able to run and change direction?

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After the age of 2, running and change of direction occur.

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what is not one of the 4 components of the AAC a. Aids and devices—actual physical devices: handheld devices, computers, and dedicated devices b. Symbol sets—visual or auditory representation of language concepts c. Communication techniques—methods of transmitting messages: access methods, scanning output d. Strategies—methods to increase effectiveness of communication: rate enhancements, role playing e. all of the above

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e. all of the above

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At what age might you see heel strike emerging a. 9 months b. 12 months c. 15 months d. 24 months

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24 months

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Name this pathology Etiology Genetic Problems with the amount ; quality of collagen in the body Presents with fragile bones / low bone density 4 types (Type I, II, III, IV)

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Osteogenesis imperfecta

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Which of the following is not true regarding developmental dysplasia of the hip? a. Usually develops in the last trimester of pregnancy b. May be affected by female homone (relaxin) and tight fetal position in utero, or by breech positioning c. More predominant in males (6 to 8 times) d. Affects the left hip twice as often as right hip e. Can be caused by swaddling and carrying infants with hips in extension and adduction (some cultural practices)

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c. it is actually more predominant in females

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Shaken baby syndrome can result in ++++++ a. cerebral palsy b. traumatic brain injury c. osteogenesis imperfecta d. spina bifida

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question

Define steppage gait

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Steppage Gait The entire leg is raised at the hip to ensure adequate ground clearance (a foot drop gait). It can be seen with peripheral neuropathies, spina bifida and polio.

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Distinguish between reflexes vs. primitive reflexes vs. abnormal reflexes

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Reflexes Basic unit of movement in the hierarchical theory of motor control Involve the combination of a sensory stimulus ; a motor response Primitive Reflexes Typically present at birth Normal for young infants Usually integrated in the first 9 months of life Abnormal Reflexes Persistent, abnormal, or asymmetrical usually indicate early brain damage and will affect future normal development Contemporary theory recognizes that reflexes alone do not contribute to the dynamic and adaptive nature of early infant motor behavior Fiorintino 1963-81 believed our total postural behavior is the result of interaction of reflexes and the relative strength of each one of them

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What is not true about emotional development a. plays a role in regulation of muscle tone b. can be a motivation to participate in therapy c. plays role in adherence to performance of activity d. all of the above are true

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d. belief in importance of the activity and its relationship to life confidence toward the PTA

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The following describes a _________ team Discipline specific roles are well defined (role definitions are relaxed) Emphasis on teamwork Therapy services may occur in isolation; however team discusses at regular intervals during team meetings Individuals from different disciplines work together cooperatively to: Plan Implement And evaluate services

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interdisciplinary

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What is necessary to achieve standing skills?

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What is necessary to achieve standing skills? Adequate body proportion Adequate ROM Adequate strength, and motor control Coordination of visual, proprioceptive ; vestibular systems for balance (TE-text)

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What type of child would benefit from AAC

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Children born without the ability to communicate or have experienced trauma causing them to loose the ability to communicate, would benefit from some form of Augmentative ; Alternative Communication systerm

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What pathologies often have a Trendelenburg gait in pediatric patients

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Trendelenberg Gait Typically caused by weakness of the hip abductors. The feet, hips and knees are externally rotated, and when weight is borne on one leg, the opposite side of the pelvis drops, rather than rising as normal. Commonly seen in slipped capital femoral epiphysis, Legg-Calve-Perthes disease (idiopathic osteonecrosis of the femoral head), hip dysplasia and inherited myopathies, as well as spina bifida and cerebral palsy. If bilateral sides are affected, the patient exhibits a rolling gait.

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What is spastic gait? What pathologies typically have this gait pattern?

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Spastic Gait Associated with inversion of the foot and foot dragging. It occurs in diplegic and quadriplegic cerebral palsy and stroke

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What is likely not a major goal for a patient with osteogenesis imperfecta a. Minimize fractures through protective measures Joint protection b. increase running endurance c. Promote bone strength d. Maximize activity ; weight bearing for increased bone strength e. Maximize functional skill

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The most common physical disability in children, anoxic encephalopathy, is also known as

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Anoxic Encephalopathy Brain damage due to lack of oxygen aka

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What exactly is cerebral palsy

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Damage to the cerebrum resulting from: ischemia, hypoxia / anoxia, birth defects, injury or infection CEREBRAL PALSY Most common physical disability of childhood Caused by an insult to the developing brain and resulting in permanent and non-progressive damage Pathology Group of motor disorders caused by cerebral damage during gestation, time of birth, or early childhood Etiology Prenatal Genetic Viral Infections Bacterial infections Drug exposure Etiology Natal Prematurity Low-birth weight Severe jaundice Intra-ventricular hemorrhage Poor nutrition Asphyxia Etiology Post-natal Infection Asphyxia TBI MVA Fall Shaken baby syndrome Child abuse CVA Near drowning Brain tumor

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CP is diagnosed when a child does not reach motor milestones and exhibits abnormal muscle tone or qualitative differences in movement patterns (i.e. asymmetry) (Campbell, 2006). The degree of severity of CP varies greatly, and the designations of mild, moderate, severe are applied within types. T/F

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True

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Cerebral Palsy effects ____, posture, and ____.

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Affects tone, posture, and movement

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What pathologies typically exhibit toe walking

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Toe Walking Habitual toe-walking is not uncommon, and if asked the child can usually walk normally. Persistence of the symptom with failure of heel contact is seen in diplegic cerebral palsy or more rarely, a lysosomal storage disease.

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What muscle tone may a child with cerebral palsy have

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Classified by muscle tone: spastic / high tone, athetoid, ataxic, mixed

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What is Erb's Palsy

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Paralysis or weakness of the muscles of the arm that is caused by damage to the brachial plexus Upper arm paralysis Involving C-5 & C-6

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What strengthening would be least likely to be included with a Pt that has DDH a. Encourage kicking in infants b. Encourage transition (i.e. sit to quad, pull to stand) c. Encourage pre-gait activities such as crawling and creeping d. Teach caregiver PROM

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question

Why is aggressive passive stretching not advised in the patient with JRA

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the risk of joint subluxation

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Define scoliosis

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Scoliosis is a lateral curve in the normally straight spine

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Awareness of potential shunt malfunction must be a consideration for patients with spina bifida hydrocephalus. What are some signs of malfunction (requires emergency response)

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Awareness of potential shunt malfunction ~~~SAFETY ISSUE~~~ Signs of malfunction: (may require emergency response) Irritability Headache Vomiting Lethargy Fever Bulging eyes or fontanel Change in behavior or level of alertness Seizure activity Change in coordination

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What is juvenile rheumatoid arthritis

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A group of disorders characterized by inflammation of connective tissue including joints and other systems Classified in children under 16 years of age with condition lasting > 6 weeks Etiology - unknown (may have several contributing factors) Viral or bacterial infection that triggers the auto-immune response May be genetically pre-disposed

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What is not an appropriate strategy when working with a child and family who have ESL a. Raise your volume to ensure that patient and family member can hear you b. Speak with slightly slower pace so that the patient/caregiver can process the information c. Use natural but animated facial expressions, gestures and body language while looking at the patient d. Use short simple sentences and avoid medical jargon and figurative expressions e. Repeat, paraphrase, and summarize important information

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question

A Pt you are treating had a traumatic birth that involved the following....what diagnosis might you expect Excessive stretching of the fetal head and neck in opposite directions during delivery Pulling on the infant's shoulders during the delivery or excessive pressure on the baby's raised arms during a breech (feet first) delivery Two potentially harmful forces during labor: Natural expulsive force of the uterus Traction force applied by obstetrician Labor is typically long and difficult. The infant is usually... High birth weight Sedated Hypotonic Separation of bony segments Overstretching Soft tissue injuries

answer

Erb's Palsy

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A baby is considered premature at no later than what age a. less than 40 weeks b. less than 37 weeks c. less than 35 weeks d. less than 30 weeks

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question

Define motor development

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The study of changes in human motor behavior over the lifespan, the process that underlie these changes, and the factors that affect them (Umphred, 2014) All periods of development are valued equally Dynamic, nonlinear process with periods of stability and instability Influenced by intrinsic and extrinsic factors Important as a PTA to understand this process for proper assessment and intervention of impairment/functional challenges encountered at any age stage

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What happens if primitive reflexes remain present past 6-12 months

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Are succeeded by the postural reflexes [inhibited by the frontal lobes] which enable the maturing child to interact effectively with his environment (Goddard, 1996) If present beyond 6 to 12 months of life, they are termed aberrant ; may result in immature patterns of behavior Despite the acquisition of later skills, may cause immature systems to remain Older children or adults with atypical neurology may retain these reflexes IE: patients with cerebral palsy If there is a cluster of primitive reflexes remaining, CNS will be dysfunctional in some way Primitive reflexes may reappear in adults b/c of certain neurological conditions including, but not limited to: Dementia Head Trauma Strokes

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What is the dynamic system theory

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An individual uses all possible strategies to accomplish a task and as physiological systems are modified, the motor behavior changes (Umphred, 2014) A more holistic approach; process rather than product; self-organizing process An interactive model where both intrinsic and extrinsic variables impact motor skill development and acquisition Each subsystem develops at its own rate ; may be a strength or constraint for development of movement Dynamic interaction among the subsystems create modifications in motor behavior (i.e. Musculoskeletal, Neuromuscular, Cardiovascular, Pulmonary and Cognitive systems)

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Which of the following is not an unaided system of communication a. gestures b. vocalizations c. eye-gaze boards d. sign language e. speech

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c. eye-gaze board Unaided systems include: gestures vocalizations speech sign language Aided systems include: physical, mechanical, and electronic devices adapted keyboard communication boards eye-gaze boards computers

question

Babies are born with a curved spine including lumbar curves (True or False)

answer

False 0-12 months Changes from the physiologic flexed ; rounded posture with the emergence of cervical and lumbar curves (lordosis) Provides increased stability of the back and neck 1-6 years Curves continue to increase 1-2 years - standing and walking

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Growth spurts can cause an elongation of the muscle as the bone grows until the muscle has time to catch up T/F

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True Growth spurts can cause an elongation of the muscle as the bone grows until the muscle has had time to catch up

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What are aided communications

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Aided communication uses symbol sets to represent language. These sets follow a hierarchy from concrete to abstract Real objects - actual objects Miniature objects - smaller replica of objects used with children who can't interpret a photo or has limited vision and need tactile feedback Photographs - color or black and white images used to represent objects, verbs, people, activities, or places (cont'd to next slide) Line drawings (color) - used to represent a concept that the child may wish to discuss Line drawings (black and white) Symbols/icons - various types (i.e. Minspeak, Picsyms) Traditional Orthography (written language) - written characters (i.e. Braille, Morse code)

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What is not a postural reaction a. Righting reactions b. Equilibrium reactions c. Protective reactions d. Associated reactions e. Pusher reactions

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What is not one of the 3 important elements of motor control a. neural circuit b. motor plan c. the parasympathetic system d. the environment in which the movement occurs

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c. Study of how the CNS regulates the musculoskeletal system and environment in regard to movement for the attainment of a specific task 3 important elements of motor control Neural circuit—underlies the processing of input/output Motor plan—effector of output of the neural circuit The environment in which movement occurs—shapes the play between the neural circuit ; the motor plan Stresses task specific learning - all movements are goal oriented Takes into account both neuromuscular control processes ; environmental constraints

question

Name types of primitive reflexes

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Palmar ; Plantar grasp Asymmetrical tonic neck reflex [ATNR] Symmetrical tonic neck reflex [STNR] Tonic labyrinthine Galant Babinski Suck / swallow Flexor withdrawal Crossed extension Rooting Stepping Positive Support Moro Startle

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Your 3 y/o Pt presents with Signs / Symptoms Pain, swelling, stiffness in joints Fever Rash (more common in systemic) Inflammation of the iris of the eye Myalgia Involvement of (more common in systemic): Lymph nodes Heart Liver Spleen Pericardium Lungs What do you suspect

answer

Juvenile Rheumatoid Arthritis

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What is not a type of scoliosis? a. Retrograde b. Congenital c. Neuromuscular d. Degenerative e. Idiopathic

answer

question

What is dissociation

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Rotation/Dissociation = balanced control of flexors and extensors ; dissociation between body segments Dissociation - ability to move one body part separate from another associated body part Breaking up of this mass pattern; separating movement in one body part from an associated movement in another body part

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Anti-gravity flexion...what is the progression

answer

Supine to sit Flexion Progression In Supine: 1. Head ; neck --- 2. lower abdominals / hips------ 3. sitting What muscles must have strength to maintain sitting? Trunk flexors or extensors?

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What is not a motor control strategy a. feedback b. motor contact c. motor program d. motor plan e. motor skill acquisition

answer

b. Definitions of the motor control strategies are below Motor program - a set of pre-structured muscle commands that end up producing coordinated movement / learned task / carried out without influence of peripheral feedback Motor plan - overall strategy for movement Feedback - afferent information sent by sensory receptors to control centers with constant updates that allow for corrections shaping the ongoing movement ; allows motor responses to be adapted to the demands of the environment Motor-skill acquisition - behavior is organized to achieve a goal directed task with active problem solving needed for the development of the motor program, plan, and learning ; is adaptive to the specific demands of the environment CNS recovery - reorganization is dependent on experience - practice is required to regain lost skills, ; ability to retain ; generalize re-learned skill to other similar tasks or to apply in other environmental contexts Feed-forward - prepares the system in anticipation of responses required for movement and adjusts the system for incoming sensory feedback for future movements Anticipatory (feed-forward) postural adjustments used by children with cerebral palsy and typically developing children to counteract self-generated motions that disturb balance.

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A Pt presents with Signs ; Symptoms Frequent fractures Scoliosis/Kyphosis Short stature Hearing loss What do you suspect? a. osteogenesis conundra b. SCFE c. osteogenesis imperfecta d. akuna matata

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What does sit to creep demonstrate

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Demonstrates weight bearing, weight shifting, and rotation/disassociation

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How might a Pt with hemiplegic cerebral palsy ambulate and how would they look

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Same side UE ; LE Standing posture (typical) Shoulders in adduction ; IR Elbow ; wrist flexion IR of hip Knee extension Ankle plantar flexion Trunk may also be affected Gait (typical) Asymmetrical gait pattern Circumduction of LE Assistive devices for mobility may include a crutch or cane for balance

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What do postural reactions do

answer

Assist the child with orienting body in space in the upright position Develop in infancy to early childhood Include: Righting Reactions Protective Responses Equilibrium Responses Emerge as primitive reflexes Emerge to help the infant or child cope with demands of a gravity-based environment Provide the basis for the control of automatic balance, posture and voluntary movement Are complex postural responses that continue to be present throughout adulthood

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Name this pathology Non-progressive neuromuscular disorder Presents with: Multiple contractures (distally ; proximally) due to decreased fetal movement Dislocation at hips or knees Deformities of joints (fusiform or cylindrical shape) Joint fusion (in some cases) Thinning of subcutaneous tissue Absence or decreased size of muscle groups Absent skin creases a. spina bifida b. juvenila rheumatoid arthritis c. osteogenesis imperfecta d. arthrogryposis

answer

d. Arthrogryposis aka multiplex congenita Etiology Unknown Possible trauma during first trimester Maternal history of a condition that limits fetal movement Fevers during pregnancy MS Myasthenia gravis Myotonic dystrophy Uterine abnormalities

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What is not a neuromuscular cause for scoliosis a. cerebral palsy b. spina bifida c. bone collapse d. conditions that result in paralysis

answer

c. is a degenerative cause of scoliosis not neuromuscular Congenital - bone abnormality at birth Neuromuscular - abnormal muscles or nerves spina bifida cerebral palsy conditions that result in paralysis Degenerative - results from traumatic injury or illness bone collapse major back surgery osteoporosis

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At what age do babies have normal physiologic flexion

answer

Basic Principles: ; one year have normal physiologic flexion

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What is not a thing to consider prior to treatment intervention as it relates to cognitive/social/emotional development: a. patient's cognitive understanding of a task b. attitude toward the activity c. confidence/trust child has in PTA d. all of the above

answer

d. all of the above should understand the cognitive and emotional level at which the patient interacts is not expected to evaluate or analyze motor performance issues but should appreciate their existence and how they impact movement problems should recognize when patient changes behavior or motor responses and if they are better or worse and communicate findings to the PT

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Righting vs Protective postural reactions

answer

Righting Reactions Orient the head & body in space Involve head & trunk movements Protective Responses Used in response to rapid displacement of the body as a result of an outside force Involve the movement of the extremities in the direction of the displacement

question

What would you not expect of a baby that has cerebral palsy a. increased joint mobility b. motor control problems c. DTR scores of 4 d. extra soft feel to muscles e. decreased activity may lead to obesity

answer

c. I would expect weak or absent reflexes

question

What is IDEA

answer

Individuals with Disabilities Education Act Yielded from 1954 Supreme Court case Brown vs. The Board of Education which was based in the racial inequality of "separate but equal" schools at that time. Later, the findings that "separate was not equal" came to include children with disabilities being denied education In 1975 IDEA was passed and became law. It entitles every child with a disability to have a free appropriate public education (FAPE) designed to meet their needs. "This law governs all special education services and provides some funding to state and local education agencies to guarantee special education and related services for those students who meet the criteria for eligibility in a number of distinct categories of disability, each of which has its own criteria" Council for Exceptional Children, 2002

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What must be done to determine if a child really has ADHD

answer

Many situations and conditions may trigger symptoms that mimic ADHD but are not ADHD Examples: Death, divorce, learning disability, ear infections, anxiety, depression, undetected seizures, sudden change in lifestyle ***To have a definitive diagnosis of ADHD, the behaviors must appear before age 7 and continue for at least six months. The symptoms must also create a real handicap in at least two areas of the child's life—in the classroom, on the playground, at home, in the community, or in social settings.

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Name this pathology A group of congenital malformation of the spine, including the vertebrae and the spinal cord Etiology Genetically predisposed Nutritional deficiencies (especially maternal folic acid deficiency) Environmental (i.e. alcohol during first 4 weeks of pregnancy when neural tube closes) Posterior spinous processes of vertebral column does not close during development in utero Gap can permit meninges, spinal fluids ; spinal cord to herniate, neurological impairment results Meningocele - meninges and spinal fluid protrude through bony defect Myelomeningocele - herniation of spinal cord, nerves, meninges, spinal fluid Most serious form Neurologic impairment

answer

Spina Bifida

question

Describe Torticollis

answer

Derived from 2 Latin words Tortus = twisted Collum = neck Describes abnormal neck position Occurs in 2-3% of all live births (Graham), equal male to female (Chan) 3rd most common congenital muscular anomaly in infants 1st = hip dysplasia 2nd = club foot 2 types (Karen Karmel-Ross, 1997) Congenital Muscular Torticollis (CMT) Acquired Torticollis Persistent cervical lateral flexion to one side Generally rotation of the head to the opposite side Most commonly involves sternocleidomastoid muscle More incidences of right torticollis than left (Chan) In 2002, Graham noted more incidence of left torticollis 2° 67% of fetuses descend into birth canal with left occiput transverse

question

If casting was required for your Pt, what will you need to do to help this Pt return to previous level of function (PLOF)

answer

strengthening and stretching

question

How do you name torticollis

answer

Named after which side laterally flexed to i.e. left lateral cervical flexion = left torticollis

question

Why is working with children different from working with adults

answer

One must keep in mind that children are not little adults Stage of development in all domains must be taken into consideration One must be creative ; appeal to the interest of the child One must be able to win the trust of the child ; parent One must involve the parent / family / caregiver at all times One must use a variety of techniques and be flexible One must know how to make treatment "FUN" One must be willing to work as a collaborative team

question

What are etiologic factors of congenital torticollis

answer

Etiology Not always clear More description of presentation than cause Unilateral fibrosis of SCM "Kink" or "crush" to SCM with subsequent ischemia Fetal malposition Increase incidence in twins Bottom vertex fetus (Twin A) more involved (Littlefield et al) Uterine compression Fused cervical vertebrae causing abnormal neck posturing

question

Acquired torticollis is from non-muscular conditions that result how....

answer

Non-muscular causes account for 18% of all cases of torticollis Subluxation of C1 on C2 Hematoma in SCM Osteoblastoma Clavicular fracture from forceful delivery Cervical skeletal malformation Subluxation of cervical vertebrae Hemivertebrae Herniated disk Posterior fossa tumor Extraocular muscle paresis Ocular strabismus or nystagmus Gastroesophageal reflux (GERD) Prolonged positioning (breastfeeding or bottlefeeding only on one side

question

Which of the following would not be included in your intervention with a patient that has cerebral palsy secondary to hypotonicity a. Support all limbs to prevent injury b. Prevent hyperextension at elbows ; knees c. Vigorous passive and active movement to stimulate increased muscle output d. Promote active weight-bearing to stimulate postural reflexes e. all of the above are true

answer

e. per slide 75

question

What is Autism Spectrum Disorder

answer

A developmental disability resulting in social, communication, and behavioral challenges. Symptoms begin in early childhood and continue throughout the lifespan. A variety of disorders fall under 1 umbrella categorized as ASD. Causes are unknown, can be environmental , genetic, or biological. Motor skills are impaired. Motor coordination, postural control and imitation skills are limited. Planning and completing new motor tasks is challenging. Delayed social skills

question

Signs and Symptoms of Autism

answer

Signs and Symptoms Vary widely, presented in various ways across a spectrum (mild-severe) Typically noticed by parents before a child's first birthday Often times parents notice functional delays by age 2 Starts early in childhood and lasts a lifetime; can be improved with intervention Diagnosis Not a definitive way to diagnosis ASD Assessment tools assist with diagnosis confirmation (i.e. the Autism Diagnostic Observation Schedule, 2nd edition (ADOS- 2), and the Autism Diagnostic Interview-Revised (ADI-R) A child's behavior and specific development must meet certain criteria to receive an ASD diagnosis

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What are 2 major signs of ASD

answer

2 major signs that indicate a child may have ASD Difficulties in social communication and interaction Examples: avoiding eye contact Enjoys playing alone Lack of social interaction with peers Lack of understanding boundaries and personal space Repetitive speech on a preferred topic or speaks words repetitively A tendency to engage in restricted, repetitive patterns of behavior Examples: Performs self-stimulating behaviors (spinning, rocking, etc.) Irritated by minor changes or upset due to change in normal routine Short attention span Decreased safety awareness Unusual reaction to touch, smell sound, movement or taste Difficulty imitating movements or controlling posture Decreased coordination and balance

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Hypontonicity in your Pt with cerebral palsy may lead to all the following in regard to gait EXCEPT a. Narrow BOS b. Wide BOS c. Short stride lengths d. Impaired balance

answer

a. Narrow BOS

question

Cephalocaudal development

answer

Development occurs from head to toe Head is disproportionately larger than the other parts of the infant's body Describes the typical direction of development of postural responses Muscular control develops from the head downward First the head & neck Upper body and the arms Lower trunk and the legs Development occurs from the center of the body outward (mid-line first to provide a stable base upon which the head & extremities may move) The head and trunk develop before the arms and legs, and the arms and legs before the fingers and toes Trunk is the stable base Not a cause-and-effect relationship between proximal and distal functions

question

Fine motor movements occur before gross motor movements T/F

answer

False

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Whole body movements develop before selective movement & before disassociation occurs True or False

answer

True

question

What is muscular dystrophy

answer

Pathology Genetic muscle diseases characterized by progressive weakness & atrophy of skeletal muscles Many types - Duchenne MD and Becker's MD are the most common

question

What is a trans-disciplinary team

answer

Decreases the number of professionals that families must encounter on a regular basis while meeting the needs of the child Professionals committed to teaching, learning, and working with others across traditional disciplinary boundaries Role release Transference of information and skills specific to one discipline to other team members of different disciplines Team members work together to conduct assessments, program plan, develop goals and implement treatment plans

question

When treating a 10 year old child, the PTA should address the a. parent b. 10 year old

answer

b. child

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What might still be present in your cerebral palsy patient that is hypertonic?

answer

Persistence of primitive reflexes which prevent development of normal movement patterns ATNR STNR TLR

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What are some intervention strategies when treating a patient who is using aided communication

answer

Work with other team members to ensure a child has a way to communicate, spoken or written, to express their wants and needs Gain an understanding of the child's communication system so that it is used effectively during treatment session Will help minimize patient and therapist frustration Show families that therapist sees the child as a whole and supportive of their additional needs Encourage family/caregivers to allow practice opportunities with the AAC device or communication system across environments to promote carryover Be creative in treatment design incorporating activities that the child can understand and express using their communication style

question

Your Pt fractured their R tibia. This Pt is 3 years old. What assistive device do you give this Pt. a. quad cane b. walker c. crutches d. Lofstrand crutches

answer

b. walker

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What is the loading response of the gait cycle

answer

loading response --corresponds to the gait cycle's first period of double limb support

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What is terminal stance

answer

Terminal stance- heel rises from the ground

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What is pre-swing

answer

Preswing—corresponds to the gait cycle's second period of double limb support

question

Compensations for torticollis include

answer

Compensation for torticollis by production of cervical scoliosis with lateral shift of the head to involved side Spontaneous involuntary compensation for torticollis by elevation of the shoulder on the involved side Leads to head alignment perpendicular to the support surface

question

What is ESL

answer

English as a Second Language

question

What is likely NOT included in treatment of patients with osteogenesis imperfecta a. Construct or provide appropriate orthotic devices Splints b. Body jackets for protection c. Aggressive passive ROM to improve ROM d. Devices to promote WB and to prevent deformity Active stretching

answer

c. Therapeutic Interventions Construct or provide appropriate orthotic devices Splints Orthotics Body jackets for protection Devices to promote weight bearing and to prevent deformity Strengthening exercises ROM Positioning Active stretching SAFETY -- AVOID aggressive passive stretching due to high risk of fracture or joint subluxation

question

Discuss the swing phase of gait

answer

Initial swing begins at toe off and continues until maximum knee flexion (60 degrees) occurs. Midswing is the period from maximum knee flexion until the tibia is vertical or perpendicular to the ground. Terminal swing begins where the tibia is vertical and ends at initial contact.

question

What is the best way to talk about a patient a. my patient with spina bifida b. my spina bifida patient

answer

a. Communicate to families using "People First Language". Put the person before the disability. Disabilities are not persons and they do not define people. Examples: Use - "she has autism"; Don't use - "she's autistic" Use "he has a physical disability"; Don't use - "he's a quadriplegic"

question

Name this pathology A genetic disorder in which babies are born with an extra copy of chromosome 21. The extra copy of chromosome 21 changes the typical development of the baby's brain and the body, causing mental and physical challenges. Occurs in 1 in 800 live births _________may be detected during pregnancy by screening or diagnostic tests. If not detected before birth, it usually is detectable at birth by the baby's physical characteristics, including: Low muscle tone A single deep crease across the palm of the hand A slightly flattened facial profile, and an upward slant to the eyes Smaller size head with flattened neck and nose Mental impairment in varying degrees

answer

Down Syndrome Signs and Symptoms Additional symptoms that develop into adolescence & adulthood include: Poor language development and language use Hearing and visual problems Intellectual disability Compression of the spinal cord and potential misalignment of bones

question

You are treating a child with ESL...what is not an appropriate communication strategy a. Use words, pictures, photographs, charts, media, or any other kind of supplemental information b. Ask "Wh" questions to gather information c. Use open-ended questions d. Use teach back or show me models to ensure patient understands instructions e. Contact translator if previous methods are unsuccessful

answer

c. You should actually use yes/no questions

question

Describe developmental delays that may result from torticollis or why delays may occur

answer

Infants COG unstable & affects ability to move Infants vertical axis is NOT perpendicular to the horizontal axis affecting ability to perform midline activities Developmental skills most affected Righting & postural reactions Prone skills Sitting balance Visual tracking Symmetrical weight bearing both in UE & LE Symmetrical weight shifting Symmetrical transitions

question

Name critical elements of family centered care

answer

Respect for each child and his or her family Honoring racial, ethnic, cultural, and socioeconomic diversity and its effect on the family's experience and perception of care Recognizing & facilitation choice for the child and family even in the difficult and challenging situation Facilitation & supporting the choices of the child and family about approaches to their care Ensuring flexibility in organizational policies, procedures and provider practices so services can be tailored to the needs, beliefs, and cultural values of each child / family Sharing of unbiased and honest information with families on an ongoing basis and in ways they find useful and affirming Providing and enduring formal and informal support for the child and parent and or guardian during pregnancy, childbirth, infancy, childhood, adolescence, and young adulthood Collaborating with families in the care of their individual child at all level of health care including professional education, policy making, and program development. Empowering each child and family to discover their own strengths, build confidence, and make choices and decisions about their healthcare. PT/PTA assessment of patient/caregiver compliance and carryover throughout treatment regimen will assist in optimizing function and producing effective outcomes One must understand that families respond to their child's illness, injury, or condition in different ways which can be impacted by Stress within the home Due to sadness, fear, loss, disappointment, embarrassment Financial / socio-economical issues Relationships / family dynamics Lack of information or ignorance about the condition or about the future of the child Conflicts between health care providers and the family Cultural differences / perceptions The age of the child or the severity of the condition

question

Arthrogryposis is also known as

answer

multiplex congenita

question

Pediatric gait cycle

answer

Still 60% stance phase and 40% swing Refer to (Mansfield/ Neumann) Essentials of Kinesiology for the PTA 2nd Edition Text Ch 11 pg 305 & 12

question

Discuss stance phase of pediatric gait cycle

answer

Loading response begins with initial contact, the instant the heel contacts the ground. Loading response ends with contralateral toe off, when the opposite extremity leaves the ground. Midstance begins with contralateral toe off, ends when the center of gravity is directly over the supporting foot. Terminal stance begins when center of gravity is over the supporting foot and ends when the contralateral foot contacts the ground. Pre-swing begins at contralateral initial contact and ends at toe off.

question

What pathology do you suspect with these Signs & Symptoms Loss of muscular strength, lack of coordination, progressive deformity, eventual disability Muscles become hypertrophied w/ connective tissue Gower's sign Weakness spreads distally and to lungs Start at approximately 2 yrs old and then progresses until death

answer

Muscular dystrophy

question

What is likely not a concern when treating a pediatric Pt who has Down Syndrome a. Hypertonia b. Muscle weakness c. Poor coordination d. Sensory perceptual problems

answer

a. hypotonia is the actual concern...along with resulting joint laxity

question

Your patient is bow-legged and age 14...what are the potential contributing factors

answer

When not a part of normal development, bow-legs are a symptom of a disease or injury such as... Problems with metabolism Problems with nutrition Fractures that heal incorrectly Rickets or Blounts Disease http://www.youtube.com/watch?v=HMYSys-T3Rs http://www.youtube.com/watch?v=rogGfR5ZENI Genetic bone growth abnormalities Pediatric orthopedic surgeon. (2014)Bow leg and knock knee. Retrieved from: http://www.childrensorthopaedics.com/BowlegandKnockKnees.html

question

What is not one of the 6 stages of adjustment to disability a. Shock b. Anger c. Denial d. Euphoria e. Depression f. Acknowledgement g. Adjustment

answer

d. Euphoria Shock- Overwhelming depersonalization, a sense of loss, or psychological numbness. Produces anxiety, panic, confusion in thinking, fear of death, uncertainty about the future, and purposeless over activity. Denial- a problematic form of coping strategy against painful realization of a long term effect of a disability of disease. Often experiences wishful of unrealistic recovery. Depression- a natural grief reaction to loss associated with feelings of distress, helplessness and hopelessness Anger- characterized feelings of guilt. Can result in self destructive behavior and suicidal ideation. Hostility, often directed toward others or the environment, believed to be responsible for the condition in an attempt to retaliate. Acknowledgement & Adjustment- acceptance phase characterized by the individual's readiness to be realistic about functional limitations and self worth as a person with a disability. Is ready to start making use of new discoveries and potentials for a productive life. These stages will occur when a disease/condition is acquired or even congenital once a child/adolescent realizes that they are different than everyone else or unable to perform as well as their peers.

question

Your PT wtih osteogenesis imperfecta is least likely to do which of the following a. walk b. swim c. run d. navigate in a w/c

answer

c. Therapeutic Interventions Provision of assistive devices for mobility Wheelchairs / customized seating systems Crutches Walkers Low impact endurance activities Swimming Walking Provision of any needed adaptive equipment for ADLs

question

Tell me more about AAC

answer

Often associated with Assistive Technology and communication Team approach is used to conduct AAC assessments; however the SLP is typically the team lead Team includes (OT, PT/PTA, parent, educator, seating specialist-may be a therapist) Team must determine the best device or communication system suited for the child's language capabilities, cognitive and developmental level, seating & positioning needs, motor access, and position for optimal access Used across a variety of settings (schools, rehabilitation facilities, home, etc.) Communication limitations may be permanent or temporary. Children in ICU who have been intubated may have temporary communication issues; where as children with CP or a degenerative musculoskeletal disease may have permanent communication needs.

question

What is augmentative and alternative communication

answer

The American Speech- Language -Hearing Association (ASHA) defines AAC as follows: " an area of clinical practice that attempts to compensate temporarily or permanently for the impairment and disability patterns of individuals with severe expressive disorders" (Angelo, 1997).

question

What is a multidisciplinary team

answer

Multidisciplinary Team Discipline specific roles are well defined Professionals work independently but recognize and value contributions of other disciplines Little or no interaction or ongoing communication occurs among professionals Treatment occurs in isolation for remediation of weaknesses Fragmentation of reporting occurs Overlap and gaps in services may occur and child may not be visualized as a whole

question

What is Gower's Sign

answer

Gower's sign evident by 4-7 years of age. When a child uses his hands in a walking motion up the thighs to assist while attempting to stand. (hip and knee extensors) Contractures develop in heel cords, TFL, hamstrings and hip flexors.

question

what are some intervention strategies for the child who suffered a fracture

answer

Crutch training or other compensatory strategies Use of a walker if under the age of 5 Strengthening exercises Balance training Endurance exercises ROM/stretching Splinting/casting Pain management

question

What might you advise a parent with a child that has osteogenesis imperfecta as far as diaper changes

answer

Avoid holding baby by ankles during diaper changes. Support head and trunk region and not on long bones of extremities Therapeutic Interventions Parent/family training & education Proper positioning How to safely transfer / handle child Avoid holding baby by ankles during diaper changes How to safely hold and support child Support at the head and trunk region and not on long bones of extremities

question

What is the acronym SMART in relation to pediatric PT

answer

S - Support Families with information, education, understanding , and resources M - Measure The effectiveness of programs through qualitative and quantitative outcome measures A- Ask The right questions. Determine the individual needs of the patient and family. This will decrease the tendency to make biasing generalizations R - Respect That individual differences between the child, family and therapist do occur and that they may be different from our own. T - Train Early on in the health care profession, and recognize that the training is lifelong and ongoing (Taken from page 10 - "Pediatric Physical Therapy" IV'th Edition by Jan Tecklin, Lippincott Williams & Wilkins)

question

Name this pathology The most common life-limiting genetic disorder affecting Caucasians and African-Americans to a much less degree A generalized disorder of endocrine glands producing High sweat electrolyte concentrations Pancreatic enzyme deficiency / GI issues including: Malabsorption Constipation GERD Growth failure due to malnutrition Chronic suppurative pulmonary disease which causes the greatest mortality Median age of survival now is approximately 36 years of age which is an improvement due to newer management strategies and techniques

answer

cystic fibrosis

question

What is not a great communication strategy for children a. engaging the child through play b. utilizing the senses in treatment c. Using a one-page handout in large font, so it's easy to read d. Using visual, auditory, tactile and olfactory techniques during treatment

answer

Engaging the child is critical Creativity is needed to keep the child engaged usually through play Utilizing the senses in treatment to engage the child Visual (seeing) Auditory (hearing) Tactile (touching) Olfactory (smelling)

question

Children who have family involvement clearly have better outcomes T/F

answer

True One must involve the parent as they are with the child most of the time shaping their environment and providing stimulation Parent training and education are crucial for carry over from the clinic to the home and community environments & success Examples of caregiver training Bed mobility skills & transfer techniques Safety skills with ambulation, balance & coordination activities Wheelchair management skills HEP supervision Evidence clearly shows that children who have family involvement clearly have better outcomes.

question

Name settings in which a PTA might treat a child

answer

Medical: Neonatal units Hospitals Rehabilitation centers Outpatient clinics Educational: Early intervention programs Schools Vocational programs

question

What is Part C of Idea

answer

Early Intervention

question

The grasp reflex is present at a. birth b. one month c. 4 months d. 6 months

answer

a. birth

question

What is not true about Part C of IDEA a. Provides services for children under 2 years of age b. Provides for family directed services c. Services occur in the child's natural settings if possible d. Utilizes the IFSP - Individualized Family Support Plan e. Identifies the strengths and needs of the child and family

answer

a. is not true...it's for children under 3! these are also true Sets forth a plan for implementation of needed services Identifies who, what, when, and specific goals and outcomes Services are provided in the child's natural environment (home, daycare, preschool, head-start, or other areas in which children without disabilities are normally seen

question

Postural reactions of infants with torticollis

answer

Upright tilt - NO response on non-involved side Ant./Post. Tilt - asymmetrical axial head to trunk alignment Prone - unable to lift head & rotate to clear airway Supine - ATNR develops toward rotated side only Protective extension Unable to abduct & flex at shoulder of involved side Unable to activate shoulder girdle of involved side for a supported weight bearing response Equilibrium response Difficulty with weight shifting through the pelvis with rotation in the t/s Difficulty with transferring weight with dissociation of the head, to shoulders, to trunk for correct timing & sequencing

question

T/F Boys are typically less flexible than girls

answer

True

question

Walking is normally achieved at what age a. 9 months b. 1 year c. 14 months d. 2 years

answer

b. 1 year

question

Name this pathology Usually self-limiting degeneration of femoral head which causes: Pain Decreased ROM Gait deviations More common in boys 4 to 7 years of age Typically occurs bilaterally 20% of the time Disturbance in blood supply to femoral head Can be the result of: Genetic predisposition Trauma Anatomical variation Generalized disorder of epiphyseal cartilage a. Osgood Schlatter's b. Legg-Calve' Perthes Disease c. DDH d. Slipped Capital Femoral Epiphysis

answer

Legg-Calve'-Perthes Disease (LCPD)

question

What does a baby typically use to explore the environment in the first few months? a. hands/fingers b. toes/feet c. eyes d. butt

answer

c. eyes

question

What is the grasp reflex

answer

Seen when a finger is pressed into baby's palm, baby's fingers automatically curl around the person's finger The reflex slowly integrates & allows the development of more mature grasping patterns At 4 months, babies will begin to more frequently reach out for toys with arms and hands The reach looks more like a swipe because the baby is learning how to control the arm and hand Over time, babies learn how to make smoother & coordinated movements with their arms and hands

question

Describe Slipped Capital Femoral Epiphysis

answer

Hip deformity related to slippage of femoral epiphysis Etiology Hormonal influences Genetic predisposition (weak growth plates) Occurs in boys 2 to 3 times more than girls More common in: African-American and Polynesian cultures, children who are tall with delayed skeletal maturity, obese children; children between 9 and 16 years old Can occur bilaterally (25 to 30%) Can be precipitated by trauma

question

All about HIPAA

answer

Provides consumers with important privacy rights and protections with respect to their health information Recognizes circumstances arise where health information may need to be shared to ensure the patient receives the best treatment and for other important purposes, such as for the health and safety of the patient or others. The Rule is carefully balanced to allow uses and disclosures of information—including mental health information—for treatment and these other purposes with appropriate protections. HIPAA defers to state law to determine the age of majority and the rights of parents to act for a child in making health care decisions, and thus, the ability of the parent to act as the personal representative of the child for HIPAA purposes. See 45 CFR 164.502(g). Exceptional situations when parents would not be a minor's personal representative under the Privacy Rule. When a minor consents to care and the consent of the parent is not required under State or other applicable law. When a minor obtains care at the direction of a court or a person appointed by the court. When, and to the extent that, the parent agrees that the minor and the health care provider may have a confidential relationship. However, the parent may have access to the medical records of the minor related to this treatment when State or other applicable law requires or permits such parental access. Parental access would be denied when State or other law prohibits such access. If State or other applicable law is silent on a parent's right of access in these cases, the licensed health care provider may exercise his or her professional judgment to the extent allowed by law to grant or deny parental access to the minor's medical information. A provider may choose not to treat a parent as a personal representative when the provider reasonably believes, in his or her professional judgment, that the child has been or may be subjected to domestic violence, abuse or neglect, or that treating the parent as the child's personal representative could endanger the child.

question

Which of the following is not true about fractures in the pediatric population? a. common etiologic factors are trauma, child abuse, MVA, genetic (osteogenesis imperfecta b. healing takes 6-8 weeks c. fracture patterns are different than in adults due to bones being more flexible and porous d. Children's bones have thicker periosteum than adult bones

answer

b. healing takes 2-4 weeks due to better blood supply Fracture patterns are different due to bones that are more flexible, more porous, and less dense than adult bones Due to thicker periosteum than adults, there is better blood supply therefore healing is faster (2-4weeks) Etiology Trauma Child abuse MVA Genetic (Osteogenesis imperfecta)

question

What is not a common site for a child's bone fracture a. Distal radius b. Tibial shaft c. patella d. Clavicle e. Elbow

answer

c. patella

question

Your Pt presents with the following S and Sx...what do you suspect? Signs & Symptoms Unable to move upper arm Decreased grip strength Unable to externally rotate shoulder Partial or complete arm paralysis Loss of motor and sensory function Lateral proximal upper arm Clinical Manifestation Adduction Internal rotation Elbow extension Forearm pronation Wrist flexion

answer

Erb's Palsy

question

What is typically involved in the treatment of Erb's Palsy

answer

Treatment Rest 7-10 days to allow hemorrhage & edema to decrease Partial immobilization across upper abdomen Physical Therapy Maintain ROM Gentle passive exercises

question

Name S and Sx of bone fracture in the pediatric population

answer

Redness Swelling Pain Heat and deformity of extremity Muscle spasm Crying Not using extremity

question

Name therapeutic interventions in the pediatric population

answer

Crutch training or other compensatory strategies Use of a walker if under the age of 5 Strengthening exercises Balance training Endurance exercises ROM/stretching Splinting/casting Pain management

question

What is a normal progression from rollling to walking

answer

Rolling Creeping Pull to stand Standing Cruising Walking O'Sullivan

question

Describe Duchenne muscular dystrophy including the typical age of development

answer

Duchene MD begins with muscle loss in the pelvis, upper arms, and legs. 1st signs and symptoms of DMD develop between ages 2 to 5 years. Symptoms include: Difficulty walking, such as lateness in learning how to walk (older than 18 months), having a waddling gait, or walking on the toes or balls of the feet Difficulty running or jumping because of weakness in leg muscles Frequent falls, stumbling, and difficulty climbing stairs Difficulty standing from a lying or sitting position Reduced endurance Enlarged calf muscles Mild mental retardation (in some patients)

question

Your Pt presents with the following Signs and Symptoms Limp with ambulation Trendelenburg gait Mild groin pain, or medial thigh or knee Decreased ROM Most noted in hip abduction and internal rotation Leg length discrepancy Disuse atrophy from buttocks, calf, thigh Presents in 2 to 4 stages Initial - failure of femoral head to grow due to decreased blood supply Fragmentation Epiphysis appears fragmented Revascularization of the femoral head is occurring Re-ossification - bone density returns to normal with changes in shape and structure of femoral head and heck Healed stage - femoral head and neck retain deformity from the repair process What might they have

answer

Legg-Calve's-Perth Disease

question

What is not true regarding intervention for the Pt with scoliosis? a. electrical stimulation is not beneficial in preventing progression of scoliosis b. postural education is useful c. stretch the convex side of each curve d. stretch the concave side of each curve

answer

c. is not true Intervention Electrical stimulation, manipulation, and exercise programs are NOT beneficial in preventing the progression of scoliosis however, THEY SHOULD STAY ACTIVE AND FIT! Stretch tissues on the concave side of each curve Strengthen muscles on convex side Bracing Soft tissue mobilization Postural education

question

How is scoliosis treated in a child

answer

Treatment Child is observed at regular intervals Bracing Halts progression of curve Child typically has a 25-40 degree curvature Used if bones are still maturing TLSO—thoracic- lumbo- sacral orthosis is custom made and used to help maintain control of spinal posture. It helps to prevent further curve progression. The Boston brace is the ideal brace for idiopathic scoliosis. It is typically worn 18-23 hrs per day. Surgery Spinal fusion 40- 50 degree curvature Ensures curve does not get worse Will not straighten perfectly Stops growth of fused spine Brace must always be worn

question

Therapeutic interventions for DDH (continued

answer

Therapeutic Interventions (cont'd) Mobility training Gait, stairs, ramps, transfers Functional skill training Patient / parent training for all of the above Brace application Positioning (hips in flexion/abduction) Mechanics of lifting & carrying (maintaining position) Mobility training, home exercise program, etc. Provision of sensory input to promote normal experiences Consultation with teachers to assure mobility and inclusion on campus Promotion of other developmental skills

question

What signs and symptoms might you expect in a patient with the diagnosis slipped capital femoral epiphysis

answer

Intermittent limp Pain in: Groin Buttock Knee Thigh Antalgic gait Trendelenburg (weakened abductors on involved side) LE held in ER Decreased ROM

question

Pediatric ROM

answer

See chart on slide 47 of motor development ppt.

question

What is part of the treatment regimen for someone with SCFE

answer

Treatment Goals include: Minimize or reduce slippage of femoral head on neck Maintain hip ROM & function Minimize possible future degeneration Surgery usually required to pin the hip & prevent further slippage in mild to moderate cases Surgery - Femoral Varus Osteotomy Bed rest / traction may be used to reduce pain & spasm before surgery Therapeutic Interventions Providing appropriate ADs (wheelchair/ crutches) Gait & mobility training ROM (active & passive) Strengthening exercises Assessment of home environment to accommodate mobility and safety Family training for all of the above Consultation with teachers for campus mobility

question

What is the progression in genu development?

answer

Genu varus, genu valgum & the normal growth process Normal children are typically born with genu varus because of their flexed position in the uterus Increases until the age of 18 months, and then the legs straighten on their own. At age three or four, genu valgus develops straightens by about age six, leaving the normal to slightly knock-kneed adult alignment.

question

Automatic movements in babies occur in response to

answer

Occur in response to a stimuli & often involuntarily

question

What is the significance of automatic movements

answer

Significance: Initial appearance demonstrates functioning subcortical primitive centers These early reflexes eventually diminish reflecting maturation of the nervous system with increased control of the cortex

question

Name signs and symptoms of DMD

answer

Signs & Symptoms (cont'd) Skeletal deformities Scoliosis Lumbar lordosis Kyphosis Cardiac myopathy Mild to moderate progressive intellectual impairment Progressive gross motor skill impairment Difficulty walking, such as lateness in learning how to walk (older than 18 months), having a waddling gait, or walking on the toes or balls of the feet Difficulty running or jumping because of weakness in leg muscles Frequent falls, stumbling, and difficulty climbing stairs Difficulty standing from a lying or sitting position Reduced endurance Enlarged calf muscles Mild mental retardation (in some patients)

question

What are primitive reflexes

answer

Largely automatic, consistent, stereotypical A predictable motor response to a specific stimulus Emerge in the fetus & present at birth Provide an indication of the status of the CNS Circuitry is at the spinal cord or brain stem level Carried out w/o involvement of the cortex of the brain Serve some sort of movement purpose Slowly inhibited during the first year of life Ensure the baby's survival in early months of life & provide a training platform for many later voluntary skills Should have a short life-span & should be inhibited or controlled by higher centers of the brain Functionally, contribute to the development of emerging mobility

question

Factoids about scoliosis that is idiopathic

answer

Idiopathic - MOST common form No identifiable cause Strong evidence of condition being inherited Adolescence 10-16 years of age Seen more in girls than boys Progresses through growth spurt Does not usually progress through adults years

question

Name the diagnosis you expect Your Pt presents with the following Signs & Symptoms Related to motor functions: Lack of coordination Exaggerated reflexes Contractures Impaired mobility and strength Developmental delay Speech and swallowing difficulties Seizures Mental retardation The medical history shows that the Pt had an uneventful birth but suffered a TBI shortly after being born

answer

Cerebral Palsy

question

Therapeutic interventions for the Pt with arthrogyposis include

answer

Therapeutic Interventions Provision of UE & LE splints & orthotic devices To maintain or increase ROM Increase function Provision of body jackets and other braces To maintain neutral trunk posture Prevent progression of scoliosis Provision of assistive devises for mobility Canes walkers Standers Gait trainers Adapted strollers Wheelchairs / customized seating systems Therapeutic Interventions Functional & mobility training Rolling Bottom scooting Crawling Gait training Power wheelchair training Strengthening exercises through developmental activities Prone on elbows Sitting Reaching for toys Rolling Kneeling & standing Therapeutic Interventions Parent training / education Daily stretching Positioning ROM Developmental activities

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How might your Pt with diplegia CP present include posture, position of hips/knees/ankles

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Signs & symptoms depend on distribution of motor involvement Both LEs Trunk and UEs to a lesser extent may be affected Standing posture (typical) Crouched with trunk flexion Adduction, & IR at both hips Knees are flexed Ankles are plantarflexed Typically child has spasticity / high tone in both LEs Trunk can also be affected

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What are inhibition and facilitation techniques

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These techniques are specific movements or positioning of the child to decrease or increase the child's sensory motor responses to gravity, position in space, and movement -may include use of toys, hippotherapy etc.

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Talk to me about ankle foot deformities in the pediatric population

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Etiology Congenital deformities In-utero positioning Neuromuscular disorders Myelomeningocoele Arthrogryposis Genetic disorders Classification Metatarsus adductus Talipes Equinovarus Calcaneovalgus

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What is cerebral palsy dystonia also known as

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Mixed tone Fluctuating tone Athetosis

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What are the 2 most common types of muscular dystrophy a. Guillain and Barre b. Duchenne and Parker c. Duchenne and Becker d. Duchenne and Bernard

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c. There are nine major types of MD affecting people of all ages, from infancy to middle age or later. The two most common types of MD that affect children are Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Both DMD and BMD affect boys almost exclusively; girls are rarely affected. MD is a sex-linked recessive disease. It typically passes from a mother (who has no symptoms) to her son.

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What is cerebral palsy dystonia

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Characteristics More than one type of tone Can be mild to severe In infancy presents as low tone and changes with maturity Stringy, elastic muscles to the touch Child is usually thin due to extreme expenditure of energy Impaired speech as in hypertonia Poor stability in midline Writhing, athetoid" (worm-like) movements Constant movement within the extremes of available range creating excessive ROM in extreme cases Usually occurs throughout body including face Persistence of primitive reflexes preventing development of normal movement including: ATNR STNR TLR

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What does gait look like for someone with cerebral palsy dystonia

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Gait is only possible to those who have enough stability to stand or walk Gait characterized by: Excessive movements Impaired balance Walker or crutches can be used, but for the most part these children use a wheelchair As children grow and become stronger, they can present as a challenge with management of transfers etc. to their caregivers / family.

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What does calcaneovalgus look like

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(dorsiflexion of foot with eversion or valgus of hind-foot)

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What is involved in the treatment of muscular dystrophy

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Treatment No known successful cure has been developed yet; possibility of stem cell therapy Orthopedic devices ; surgery to address deformities Medications if necessary to address seizures and infections as needed Maintain strength and function as long as possible, while avoiding overexertion Equipment and adaptive device consultations, changing as disease progresses Team approach with OT and SLP

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What AD would you recommend for a Pt with diplegic cerebral palsy and what gait pattern would you anticipate

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Gait (typical) Poor disassociation between trunk and legs Body rotates during gait UEs held in the "high guard" position for balance Assistive devices for mobility may include Loftstrand crutches Walker Wheelchair

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Summary of purpose of primitive reflexes etc

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Serve some sort of movement purpose Slowly inhibited during the first year of life Ensure the baby's survival in early months of life & provide a training platform for many later voluntary skills Should have a short life-span & should be inhibited or controlled by higher centers of the brain Functionally, contribute to the development of emerging mobility See Supplemental Handout on Primitive Reflexes

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Signs and symptoms of children with ankle/foot abnormalities

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Signs/Symptoms Obvious deformities Gait abnormalities Delay is gross motor and mobility skills Treatment Serial Casting Surgery

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When stretching a pt who has ankle foot deformities, what should avoid while stretching the gastroc/solus

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Stretching To supplement splinting or bracing for minor deformities To counter the deformity CAUTION - it is important to stretch the gastrocnemius/soleus while avoiding the mid-foot ligaments

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What are developmental delays

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There are many types of developmental delays. Some areas include problems with: language or speech vision movement -- motor skills social and emotional skills thinking -- cognitive skills

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Name some interventions for the child with ankle/foot deformitites

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Sensory stimulation (when out of cast) To promote normal sensory sensitivity and proprioception awareness Promotes motor output Types of sensory input Rubbing with textured material Water play Sand play Massage Weight-bearing

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You are treating a Pt who has cerebral palsy and resulting hypertonicity...what gait pattern do they likely have

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Children have difficulty with LE dissociation during gait. A scissoring gait pattern is often seen in these paients.

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Talk to me about therapeutic interventions for the Pt who has cerebral palsy hypertonicity

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Therapeutic Interventions Stretching / ROM (prevention of contractures) Positioning Passive Active or active-assistive Positioning to inhibit strong reflexive extension Position hips and knees in > 90 degrees of flexion Use midline, symmetrical positioning to inhibit abnormal reflexes Therapeutic Interventions Use gentle, rhythmic movement to encourage controlled movement Promote active weight-bearing with aligned limbs & trunk to allow optimal independence in motor skills Use tone techniques that result in calming and relaxation

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What are characteristics of cerebral palsy ataxia

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Ataxia is distributed throughout body Characteristics Poor balance Wide base of support and "high-guard arm position" during gait Tremors Low postural tone Poor visual tracking ROM usually normal or excessive due to low tone Hyporeflexia of DTRs, with weak primitive reflexes Muscles have a soft doughy feel to the touch

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Mobility before stability

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Margaret Rood presented the concept of mobility before stability, followed by controlled mobility, followed by emergence of skill

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Kinesiologic concepts

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Mobility = Movement Stability = Holding a posture Postural Control = relationship b/w mobility & stability Proximal Stability = Ability to stabilize in anti-gravity positions which leads to: Functional Mobility Symmetry = position/posture characterized by correspondence in relative position of parts on opposite sides of the body Present at birth to ~ 4 months Asymmetry = a lack of this correspondence Co-contraction = Balance between flexors & extensors allows for higher level of function

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Common secondary complications from spina bifida

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Meningitis Hydrocephalous Orthopedic deformities: Club feet Bowed long bones Hip flexion contracture Hip dislocations Scoliosis / kyphosis Cleft palate Obesity Orthopedic cont'd. Osteoporosis Incontinence of bowel and bladder (above S2) Skin breakdown due to impaired sensation Learning problems Visual / perceptual problems Hyperverbal behavior Seizures Developmental delays Abnormal tone (usually flaccid below level of lesion) Tethered cord

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What are therapeutic interventions for someone with cerebral palsy ataxia

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Therapeutic Interventions Encourage midline, symmetrical posture for maximal function Provide sensory input to encourage special orientation Tactile Proprioceptive Auditory Visual Therapeutic Interventions Try weighted vest or belts to increase proprioceptive feedback and improve balance Use aids to assist with balance Weighted walker, crutches, canes.

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What are the 4 major components of motor learning

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"The study of how individuals acquire, modify, and retain motor memories so they can be used, reused, and modified during functional activities" (Umprhed, 2014). Four major points of motor learning Learning is a process of acquiring the capability for skilled action Learning results from practice or experience Learning can't be measured directly Learning produces relatively permanent changes in behavior Ex. Of functional motor memory patterns (rolling, sit to stand, walking , feeding, etc.) Learning isn't measured but inferred based on an individual's behavior Alterations of short-term movement patterns aren't considered motor learning. Motor learning occurs with emergence of interaction between the need to perform/complete a task and the environment in which the task should be performed

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Lifespan Exam 2 – Pediatric – Flashcards

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