Pediatrics
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147 terms
Terms | Definitions |
|---|---|
 Hand recogniton in the visual field | 2 months |
| Reflexive grasp replaced by voluntary grasp | 6 months |
| Progression from 6-12 months | ulnar-palmar grasp->radial-palmar grasp->radial digital grasp->inferior pincer grasp-> superior pincer grasp-> and 3 jaw chuck |
| Voluntary release | 7-9 months |
| Transfer objects from one hand to another | 9 months |
| Trun pages in a book, string beads, stack blocks | 2 years |
| Button clothes, open/close jars | 3 years |
| Infants-therapy and play | explore enviornment with their senses, learn to manipulate objects with thier hands, have a large variety of toys available that are boldly colored, visually/auditiorily intersting, easily grasped by little hands and safe to put in the mouth |
| Toddlers-therapy/ play | Parallel play, imitation is key to learning at this stage, like to imitate adult activites such as housework, say "no" frequently as they are exerting their independence, enjoy obstacle courses and ball activites |
| Preschool therapy/play | use of imagination emerges, interaction with peers during play increases->parallesl->associative->cooperative |
| School-aged children (5-9) therapy/play | engage in symbolic play without guidance from adults, use small rewards to motivate(stickers, candy) |
| School-aged children (10-12) therapy/play | prefer group activites, motivated by interesting equipment and competiton with family members, peers, PT or self, use sticker or reward charts to record progress |
| Gestation | divided into 3 trimesters, from the first day if mothers last normal menstral cycle, normal gestational age at birth is 38-42 weeks |
| Therapy strategies | plan how you will use the enviornment and or toys to work on specific goals, facilitate work in a variety of developmental positons, Attempt to mimic the normal, everday routines of the child, |
| Ways to succeed | Always have a back-up plan, any activity can be turned into therapy, provide choices that are within your goals, remember each child is unique, FUNCTION is the key |
| IDEA -Individuals with disabilites education act-2004 | began as education for all handicapped children act of 1975 , has been revised on several occasions with the last reuthorizations in 2004-2006 |
| Federal law Part C | is early childhood intervention programs for infants and toddlers birth to 3 years |
| Federal las Part B | is public education for children ages (3-21) with disabilites |
| The federal program is overseen by the state and implemented at the distreic level | states and districts are always free to implement sticter guidelines than federal ones |
| Each child is gauranteed a free and appropriate public education (FAPE) in their least restrictie enviornment (LRE) What does that mean? | special education is provided to mmet the unique and individual needs of the child, related services (PT) are services required in order for the child to benefit from the special education services he is recieving |
| Requiresments of IDEA | parents cannot be charged for services their child needs to benefit from his education, srvices must be provided to the child in the enviornment that is most like that of his peers and where educational gains can still be met (can't just be used to a " special" school), the cadillac is not required, the Buick is acceptable |
| Physical therapy-IDEA | utilized to assist students in accessing and participatin in school activites, gross motor activities typically worked on include, walking to class/recess/lunch, sitting at a desk, sitting on the floor for circle time, playing on the playground, opening doors, boarding the bus |
| (IEP)-Individualized Education Plan | developed for how the childs services will be provided and evaluated, PT and PTA provide services through direct interventions and collaboration and training of teachers and family. The team is multi-disciplinary and includes family maembers and all service providers. Team- identifies the students needs, sets measurable goals, and determines what resources will be needed to reach those goals, If this child has gross motor needs but the goals can be met without the specialized instruction on the PT, therapy will not be warrantee |
| Etiology of Down Syndrome | gentetic disorder caused by trisomy, translocation, or mosaicism of chromosome 21 |
| 95% of cases are the result of trisomy 21 | every cell in the body has an extra chromosome21, (3) copies of chromosime 21 instead of 2 (47 total instead of 46) |
| 3-4% of cases are termed translocation DS | extra chromosome 21 is attached to another chromosome in the egg or sperm, 25 % of cases occur because one or both parents are carriers, carriers parents can have a normal child, a child who is a carrier, or a child with DS |
| 1-2% of cases present as mosaic DS | occurs after fertilization and only some cells have an extra chromosome 21, physical features and severity of accompanying disorders are usually decrease |
| Incidence of DS | one in 733 live births, making it the most common chromosomal disorder, more than 350.000 people in the US have DS |
| Effects of Age | risk of having a baby with DS increases with the age of the mother (> 35yrs) and may also be influenced by the age of the father, incidence is 1 in 400 births at age 35, 1 in 100 in 35 births for mothers over ae 45 (75 % of babies with DS are born to women under 35yrs |
| Effects of age with Trisomy 21 | women under 40 have a 1% chance of having a second child with DS, after 40, the risk is the same as for any mother of her age |
| Effects of age with Translocation DS | Likelihjood of having a second child with DS is 12% (if the mother is the balanced carrier), or 3% (if the father is the balanced carrier) regardless of the mothers age |
| Characteristics of DS | mental retardation, sezures (common in infancy and adulthood), cardiac malformations and congential heart disease in 40-45%(biggest problem), ligament disorders can cause dislocation in cerviceal vertebra, a potentially life threatening situation |
| Physical characteristics of DS | short stature (average height is 4 1? to 6 feet), decreases muscle tone throughtout thebody leading to hyper-extendable joints, delayed postural reaction and motor development, short, wide hands with a transverse palmer crease |
| Facial feautres of DS | flat profile (short distance between face and back of head), small nose and chin, tongue protrusion, excess skin on back of the neck, small ears or absent earlobe |
| Associated problems of DS | Anlantoawial instability, occurs in an estimated 10-40%, may cause injury to the SC, children are advised to avoid activites that put them at risk, such as tumbling, horseback ridkin, diving, speech-language impairments, heart defecxts and susceptibility to respiratiory infections |
| Life expectancy of DS | average life expectancry is 55 yrs, *0% live longer than age 30 |
| Physical Therapy for DS | Focus on minimizing complications that typically develop as children begin to use abnormal movement patterns to compensate for decreased motor skills, |
| Physical therapy for DS- stengthen proactively | to avoid kyphosis, begin strengthening hip musculature before the child is walking |
| PT-it is more important to ensure a child has quality movement and not simply that he/she can perform the task | most children will begin to walk with ER and ABD hips, hyperextended knees and pronated and everted feet, |
| Goal of PT | to get the child to walk with a normal base of support, demonstaing appropriate joint alignment, quality movement leads to decrease stress on the joints resulting in decrease likelihook or arthrites |
| Learning styles of children with DS are different, so PT will be different | Decrease generlization skills, unable to process the "whole picture", learn best with stucture, toutine, and familiarity, functional learning is more readkily retained, must be successful to want to continue |
| What should our PT look like? | Introduce new skills in small pieces, provide opportunities for child to practice the new skills learned in familiar enviornments, encourage the child to continue toward masteray, combine learned skills to become more function/independant, facilitate generalization of skills |
| Etiology of Cerebral Palsy | Caused by a permanet, non progressive injury to the brain, results from injures to the brain during develompment, at birth, or within the first few years |
| Congential CP (85-90% of cases) | injury to the brain during gestation or during birth |
| Acquired CP (10-15% of cases) | brain injury after birth, but during the first few years of life |
| Prenatal Risk factors | maternal infections, rubella, cytomegalovirus, Toxoplasmosis, Herpes simplex, Maternal diabetes, Rh incompatability, maternal malnutrition, maternal seizures, maternal radations |
| Perinatal(being born) risk factors | premature birth, breach delivery, forceps delivery, multiple births, prolapsed umbilical cord, low birth weight, low APAR scores, Maternal hemorrhaging |
| Postnatal risk factors | Neonatal infection (meningitis, encephalitis), environmental toxins, trauma, near drowning, CVA, Neionatal hypoglycemia, Acidosis |
| Characteristics of CP | Group of disorders characterized by loss of movement or other nerve functions, non-progressive injury therefore symptoms do not increase |
| Spastic/hypertonic (75%) | increased muscle tone, lesion in the motor cortex of the cerebrum |
| Ataxic- | unsteadiness of movement due to a lesion of the cerebellum, poor balance reations, tremors, unsteady gait, loss of coordination, not directly related to tone, but children with ataxia usually have low tone, lesion in the cerebellum |
| Dystonic/Choreoathetosis/Athetosis | fluctuating tone throughtout the face and body due to a lesion of the basal ganglia, involves involuntary movements such a jerking or twisting, lesion in the basal ganglia or cerebellum |
| Hypotonic | "Floppy" hypermoble joints that lack stability, reduced strength and endurance, trouble moving against gravity |
| Mixed- | combinations of a variety of symptoms, unable to classify as one type, Spastic athetosis is a common combination |
| Monoplegia | only 1 limb affected |
| Diplegia | Trunk and Lower extremites affected |
| hemiplegia | 1 side UE usually more than LE |
| Quadriplegia/Tetraplegia | all 4 limbs head and trunk |
| Mild CP | gross motor-independant walker, Fine motor-unlimited function, IQ- >70, Speech->2 words, Overall-independent function |
| Moderate CP | Gross motor-crawler or supported walker, Fine motor- limited function, IQ-50-70, Speech-single words, Overall-needs assistance |
| Severe CP | Gross motor- no locomotion, Fine motor-No function, IQ-<50, Speech-severely impaired, Overall- Total care |
| Ambulatory potential | virtually all children with monoplegia, hemiplegia, and ataxia forms are able to walk, 85-90% of children with diplegia are able to walk |
| Independant sitting by age ____ or crawling by ag ___ are good indicators that the child will be able to walk by age ___ | 2, 3, 8 |
| Persistance of which reflex is associated with decreased likelihood of walking | Tonic neck reflex (ATNR, AND STNR) |
| Impairments other than motor | mental retardation/learning disabilites(50-75%), seizures (25-25%), visual impairments (50%), hearing impairments (10-25%), other sensory deficits, speech deficits (25-50%), oral-motor problems and orthopedic disorders |
| Oral-motor problems- | dysphagia, teeth grinding, excessive drooling |
| Orthopedic disorders | joint contractures, joint dislocations, scoliosis, clubfoot |
| Medical Treatments of Seizures | Depakote, Phenobarbital, and Clonazepam |
| Spasticity-Medical treatments | muscle relaxants, Botulinum toxin (Botox) injections, dorsal rhizotomy |
| Dorsal Rhizotomy | cutting of dorsal nerve rootlets supplying the affected muscles |
| Boulinum toxin | privents release of Ach at neuromuscular junction last 1-4 months, usually given in the Gastroc |
| Contractures-serial casting | series of casts that progressively stretch the limb |
| Z plasty | surgical release of a muscle or tendon |
| PT for CP | family education, parents should be helped to develop skill and condidence in handling and caring for their infants, Parents are taught postioning, carrying, feeding and dressing techniques that promote symmetry, limit abnormal posturing and movement, and facilitate functional voluntary movement, as the child gets older, relay the importance of letting the child do things independently, even if he/she struggles at first |
| Movements that include trunk rotation, weight shifting, WB and isolated voluntary movements should be incorporated into activites | abnormal tone interferes wit functional movement, PROM, by itself, is NOT effective for contracture prevention, splinting or positoning techniques that offer a prolonged stretch throughout the day are needed (>6 hrs per day) |
| Common aresa for contractue with CP | hip flexors, knee flexors, hip adductors, ankle PF |
| factors that influence tone | head and body positioning, emotions, illness, fatigue and temperature (cold-bad) |
| Prognosis for CP | most children with mild to moderate forms of CP have a normal lifespan, Children with severe spastic CP-nearly half die by age 10 of infection, key predictors of a reduced life expectancy are lack of mobility and feeding difficulty |
| Spina Bifida (SB) | congential defect of neural tube closure (usually in the lumosacral region), usually diagnosed prenatally through-> C-section birth and immediate surgical closure, damaged or lost nerve tissue cannot be repaired or replaaced nor function restored to damaged nerves, generally all nerves located below the malformation are affected, assisitive devices such a braces, crutches, walkers or wheelchairs are used. |
| Severity of SB is dertermined by | size and location of the malformation, which spinal nerves are involved, whether or not skin covers it, whether or not spinal nerves proturde |
| Risk factors of SB | genetic predispostion, folic acid deficiency, maternal alchohol use in early pregnancy |
| Incidence of SB | most common neural tube defect in the US, affects 1,500 to2,000 of the more than 4 million babies born in the country each year. |
| Closed neural tube defects | spinal cord is marked by a malformation of fat, bone, or membranes, some patients have few or no symptoms, others have incomplete paralysis with urinary and bowel dysfunction |
| Occulta SB | mildest and most common form, rarely causes disability or symptoms, incomplete fusion of posterior vertebral arch, malformation is covered by a layer of skin, may have abnormal clumb of hair, small dimple, or birthmark at the site. |
| Cystica-Meningocele | meninges protrude into a fluie-filled sace that protrudes through the spina opening, SC remains in the spinal canal, some patients with meningocele have no symptoms while others have bowel and bladder problems or foot weakness, |
| Cystica-Myelomeningocele is the most severe | meninges and spinal cord protrude into the fluid-filled sac that proturdes through the spinal opening, may or maynot be a layer of skin covering the sac, if not, a section of the SC tissue (meninges and cauda equine) is exposed |
| Results in partial or complete paralysis below the spinal opening | flaccid or spastic paralysis, sensation deficits, bowel/bladder dysfunction. |
| Additonal complications | approximately 30% have mental retardation but many have normal intelligence |
| Arnold-Chiari malformation/Chiari 2 malformation | Common in children with myelomeningocele, bainstem and cerebellum protrude down into the spinal canal throught the foramen magnum, can lead to compression of the SC an cause a variety of symptoms |
| Symptoms include | difficulties with feeding, Dysphagia, trobule breathing, choking, arm stiffness |
| Hydrocephalus | seen in 90% of individuals with SB, abnormal buildup of CSF in the brain puts damiaging pressure on the brain, Commonly treated by surgically implanting a shunt in the brain to drain the excess fluid into the abdomen (ventrculo-peritoneal shunt) |
| Shunt precations | avoid placing pressure over the shunt, Don't stretch the neck, child should not be placed in a head down position |
| Signs of shunt malfunction | irritability, changes in seizure activity, vomiting, drowsiness, lethargy, HA and fever (infection present),bulging of the fontanel, also latex allergies, skin problems, GI conditions and depression may occut |
| Many with myelomeningocele develop progressive tethering, or tethered cord syndrome | spinal cord attaches to an immovable structure such as overlying membanes or vertebrae, stretches SC abnormally, causes loss of muscle function to the legs, bowel and bladder. |
| Muscular Dystrophy(MD) | group of genetic diseases characterized by progressive weakness skeletal muscle degeneration, lack of dystrophin (protein) leads to damage of the sarcolemma durning muscle contraction (eccentric contractions are the most damaging) |
| Duchenne MD- Incidence | 13-33 children per 100,000 live births, X-linked recessive disease- males get the disease and females are the carriers |
| Onset and Progression of MD | between 2-6 years and progresses rapidly, most boys become unable to walk at 12 and will need a wheelchair, by 20 use of a respirator is common, death usually occurs in the early 20's from respiratiory dysfunction or heart failure |
| Dystrophin signs and symptoms | normally found in cardiac muscle and brain tissue, most boys have little or no dystrophin in their muscles, consequently the child may have intellectual impairment and cardiomyopathy |
| First signs | grequent falling, difficulty getting up from sitting or lying, waddling gait, weakness begins proximally in the pelvis, upper arms and upper legs |
| Gower's sign | walking hands up thighs to stand up, due to weak quads and hip extensors |
| Pseudohypertrophic muscles | due to an accumpulation of fat and connective tissue in the muscle, hallmark is the apparent enlargement of the calf, Breathing becomes affected during later stages-> respiratiory infections(will kill them) |
| Becker's MD | X-linked recessive, onset is age 5-10, primarily involves the neck, trunk, pelvis and shoulder musculature, Progresses more slowly than DMD, walking is maintained past early teens, patients usually live into their 40's |
| Myotonic MD-onset and progression | most common adult form of muscular dystrophy, varies in tha age of onset, from early childhood to adulthood |
| Signs and symptoms of Myotonic MD | Myotonia (prolonged muscle spasm) in the fingers, feet, neck and facial muscles, floppy-footed, high-stepping gait, cardiac, GI, CNS, visual and endocrine abnormalities, muscle weakness doesn't usually hamper ADL's for years after symptoms appear, require more sleep than the average person, mild mental retardation is present in some people with the disease, mild mental tetardation is poresent in some peoplele with the disease, |
| PT-Myotonic MD | prevent painful muscle contractures and assist with finding orthopedic appliances to support function |
| Facioscapulohemeral | Autosomal dominant (child with one parent affected has a 50% chance) |
| Onset, Signs and progression | onset can be at any age but usually occurs in early adolescence to early adulthood, starts with weakness of facial muscles and shoulder girdle, forward sloping of the shoulders as well as difficulty raising the arms over the head and closing the eyes |
| Progression of Facioscapulohumeral | slowly, with long periods of stabiltiy interspersed with shorter periods of rapid muscle deterioration and incresed weakness, about 50% of patients retain the ability to walk throughout their lives, life expectancy is not usually affected |
| Limb-girdle MD | Autosomal recessive, onset in teens or early adulthood, first affects hips and shoulders and progress to include arms and legs, slow progression wihtin 20 years of onset, walking is difficult, if not impossible |
| PT for all types of MD | strenuous exercise is contraindicated because it increases the rate of muscle fiber breakdown, patiens can benefit from walking and pool therapy programs to improve endurance |
| Spinal Muscular Atrophy | genetic, motor neuron disease caused by progressive degeneration of SC motor neurons, causes weakness and wasting of voluntary muscles, often more severe in legs than in arms |
| SMA type 1 | evident before birth or within the first few months of life, symptoms include floppiness of the limbs and trunk, feeble movements of the arms and legs, swallowing and feeding difficulties and impaired breathing, affected children never sit or stand and usually die before the age 2 |
| SMA type 2 | begins between 3 and 15 months of age, may have respiratory problems, floppy limbs, decreased or absent deep tendon reflexes and twitching of arm, leg or tongue muscles, may learn to sit but will never be able to stand/walk, life expectancy varies |
| SMA type 3 | appears between 2 and 17 years of age,includes abnormal manner of waking, difficulty runningm, climbing steps or rising from a chairm and slight tremor of the fingers |
| Pt for SMA all forms | symptomatic and supportive |
| Brachial Plexus injuries | limp or paralyzed arm, lack of muscle control, feeling and sensation in the arm, hand or wrist |
| Four types of brachial plexus injuries | Avulsion, Tupture, Neuroma, Neuroapraxia |
| Avulsion | most severe type, nerve is torn form the spine |
| Rupture | nerve is torn but not at the spinal attachment |
| Neruoma | nerve has tried to heal itself but scar tissue has grown around the injury, puting pressure on the injured nerve and preventing it from conducting signals to the muscles, |
| Neuropraxia (stretch) | most common type, nerve has been damaged but not torn |
| Prognosis of Brachial Plexus injuries | some may heal without treatment and many children improve or recover by 3 to 4 months of age, for avulsion or rupture injuries, no recovery potential unless early surgical reconnection occurs, for neuroma and neuropraxia injuries the potential for recovery varies with most neuropraxia injuries recovering spontaneiously with a 90-100% return of function |
| Pervasive Developmental Disorders (PDD) | A group of disorders that involve, impairments in social interactions, deficeincies in verbal and nonverbal communication, abnormal patterns of behavior |
| Autism | more common in males, impairments in verbal and nonverbal communicaltion, decreased eye contact and facial expression, preference to be alone, dislike of physical contact, lack of imagination, abnormal responses to sensory stimulation (may be increases sensory response) |
| Abnormal behaviors of Autism | hand flicking or flapping, head banging, spinning or rocking, tantrum due to small changes in enviornment or routine, abnormal play with toys |
| Guidelines for interacting with a child with Autism | speak clearly and keep instruction simple, talk with child facing your, have a consistent routine and warn the child ahead of time of any changes, involve child in social situations to "teach" him how to act with others, be PATIENT, encourage verbal responses, be familar with child behavioral plan |
| Asperger Syndrome | considered a highly functionoing form of Autism, have many of the same traits as children with autism but have better communications skills and can develop "near-normal" behavior, Main problem is lack of social skills |
| Fragile X Syndrome | defect of the X chromosome, occurs in 1 in 1250 males and 1 in 2500 females, causes MR, delayed development, emotional liability and autistic-like behaviors |
| Systemic-JRA | includes inflammation of organs and symptoms of infection (fever, rash), |
| Plyarticular -JRA | affects more than five joints |
| Pauciarticular-JRA | affects less than five joints |
| Osteogenesis Imperfecta "brittle bone disease" | genetic disorder that causes poor collagen synghesis and defective osteoblastic activity |
| Characteristics of Osteogenesis Imperfecta | there are many different forms of this disease with a wide range of severity and prognosis, poor tooth development abnormall thin skin, hypermobile joint, scoliosis and genu varum |
| PT for Osteogenesis Imperfecta | careful positoning and handiling techniques are important for prevention of fractures, PROM is contraindicatied, when applying manual resistance, avoid using long lever arms, Aquatic therapy can be very benefical |
| Legg-Calve-Perthes | trauma, genetics, synovitis, infection and vascular abnormalities |
| Legg-Calve-Perthes characteristics and treatment | degeneration of femaoral head due to lack of blood supply (avascular necrosis), |
| PT for Legg-Calve-Perthes | pain relief, proper positioning and increasing ROM, may require splinting, ambulation training, traction, orthotics or aquatic therapy |
| Developmenral dysplasia of the Hip/Congenital Hip Dysplasia-possible changes include | inutero positioning, exposure to maternal hrmones, presences of spasticity (as baby), more in girls than boys |
| Incidence of Developmental Dysplasia of the Hip/Congential Hip -Incidence | affects children under age 3, mostly girls, develops in last trimester in utero, more common in cultures that swaddle infants LE's in adduction and extension, physcians perform routine screening tests druing well baby visits |
| Characteristics and treatment of Developmental Dysplasia of the Hiop/Congential Hip Dysplasia | involves hip instability and possible dislocation asymmetrically, apparent shortening of the involved extremeity, Positive Ortolani test or Barlow maneuver, treatment may include double diapering or use of a Pavlik harness to maintain hip in a posion of flexion and Abduction to allow tightenign of joint capsule and normal development of acetabulum |
| Tetrology of Fallot | Congential defect (associated with FAS and DS), four abnormalities are present inculding, Ventricular septal defect, Right ventricular hypertrophy, Aortic override of the interventricular septum, and pulmonary stenosis |
| Characteristics and treatment of Tetrology of Fallot | Dyspnea, hypoxia, cyanosis and failure to thrive, Pharmacological intervention or surgery, for therapy, treat the functional limiataions |
| Torticollis | Unilateral contracture of SCM, poor positioning in utero (including breech) and truama at birth, |
| Characteristics of Torticollis | Ipsalateral lateral flexion, contralateral rotation, facial asymmetries, stretching, AROM, and positioning the firs year, if conservative treatment doesn't work, surgical release may be indicated |
| Arthrogryposis Multiples Congenita- What is it and what causes it? | non-progressive neuromuscular disorder that leads to fibrosis of muscles and joints, poor movement in first trimester(either neurological, myopathic, or joint related) |
| Characteristics of Arthrogryposis Multiples Congenita | Little muscular definition in extremities, atrophy of muscles, significant joint contractures throughout body, |
| Treatment of Arthrogryposis Multiplex Congenita | facilitate function through positioning, stretching, ROM stengthening, splinting and adaptive equipment use, HEP for family must be implemented and followed to facilitate functional gains, surgery may be required |
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