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USA Child Development Final
Terms in this set (59)
Juvenile Idiopathic Arthritis
A group of chronic inflammatory diseases in children and adolescents that may cause joint or connective tissue damage throughout body.
Prevalence of Juvenile Idiopathic Arthritis
294,000 between 0-17 y.o.
Girls:boys = 2:1
Signs and Symptoms of JIA
Persistent joint pain and swelling.
Stiffness (worse in morning or after a nap).
Rash and/or high fever.
Swollen lymph nodes in neck (if systemic).
systems lasting longer than 6 weeks with periods of flares and remission.
Differential Diagnosis of JIA
Sub-types of JIA
affects 4 or less joints. Has the best prognosis.
Poly-articular: involvement in more than 5 joints.
Girls:boys = 1:1. This one can result in macrophages activation syndrome (life threatening).
Secondary Conditions of JIA
Inflammation leads to capsular hypertrophy, irregular bone growth/osteoporosis.
Stretching of ligaments and joint instability.
Limb length discrepancy.
Ankylosing spondylitis of C-spine.
Medical Management of JIA
NSAIDs, Methotrexate, Corticosteroids, Biological response modifiers, TNF inhibitors.
Physical disability and function (outcome measures) for JIA
Childhood Health Assessment Questionnaire (CHAQ),
Juvenile Arthritis Quality of Life Questionnaire (JAQQ), Childhood Arthritis Health Profile,
a displacement of some tissue in a sac that protrudes through the posterior opening in the vertebra.
Myelomeningocele: protruding sac contains spinal fluid, meninges, and neural tissue.
Spina bifida occulta: small gap in vertebral column but no protrusion or damage to neural tissue (hair turf or skin dimple).
Diagnosis of Spina Bifida
Blood test for AFP (high levels), US, Amniocentesis, X-ray.
Clinical Presentation of Spina Bifida
Loss of motor/sensation below level of lesion, brain dysfunction secondary to hydrocephalus
Signs of Shunt Malfunction
Headache, Irritability, Fever unrelated to illness, Nausea, Increased spasticity in innervated muscles, problems with vision, problems with speech, increased difficulty with postural control, decreased performance in school, decreased level of consciousness.
Babies grow, shunts don't.
Orthosis and Mobility Expectations for Children with Myelomeningocele: Thoracic
LE movement is absent. Possible orthotic: THKAFO, parapodium. Indicated by upright positioning.
Orthosis and Mobility Expectations for Children with Myelomeningocele: L1-L3
LE in hip flexion and adduction. Possible orthotic: HKAFO or reciprocal gait orthosis. Indications: unable to maintain upright posture with extended hips.
Orthosis and Mobility Expectations for Children with Myelomeningocele: L3-L4
LE in hip extension. Possible orthosis: KAFO. Indications: Medial and lateral knee instability, weak quads (<4 MMT).
Orthosis and Mobility Expectations for Children with Myelomeningocele: L4-L5
LE in hip abduction, knee flexion, ankle DF/inv., toe extension. Possible orthosis: AFO. Indications: medial and lateral knee ankle instability, insufficient nee extension moment, lacks/ineffective push-off, inadequate toe clearance, crouched gait.
Orthosis and Mobility Expectations for Children with Myelomeningocele: S1-S3
LE in hip extension, knee flexion, ankle PF/ev, toe flexion. Possible orthotic: SMO or shoe insert orthotic. Indications: prevention of foot deformities or skin breakdown based by unequal weight distribution, medial and lateral ankle instability, or poor aligment of subtalar joint/forefoot/rear foot.
Clinical Manifestations of Spina Bifida
Contractures, congenital hip dislocations, congenital talipes equinovarus, high incidence of scoliosis/kyphosis, risk for osteoporosis.
attaches to AFOs to prevent in-toeing and promote a more neutral LE alignment through rotation of the lower leg in respect to the thigh.
orthotic undergarment with Velcro straps that exert a gentle, passive force to correct alignment.
EBP for Spina Bifida
Infants with SB have less leg activity than age-matched peers.
younger infants = use of ankle weights decreases step rates.
SB children could ambulate 150 m with a walker by 23 mo.
Children with TM group increased 6MWT distance and increased self-report QOL, no change in aerobic function.
A genetic disorder in which the majority of individuals have an extra chromosome on chromosome pair 21 (trisomy 21).
What are the types of Down Syndrome?
Translocation: parts of chromosome 21 are displaced.
Mosaic disorder: faulty cell division.
What is the most common chromosomal disorder?
(1/700 babies are born with DS).
Diagnosis of Down Syndrome
Blood test for PAPPA,
US (nuchal translucency in 11-14 wks gestation), quad screen (16-18 wks gestation), amniocentesis, chronic vili sampling, cell-free fetal DNA screening.
Clinical Characteristics of Down Syndrome
Upward slanting palpebral features,
Epicanthal fold (eyes),
Flattened nasal bridge,
Low set and malformed ears,
Decreased A/P diameter of head,
Mouth open with protruding tongue.
Musculoskeletal abnormalities of Down Syndrome
Shortened stature, barrel chest, broad hands, short fingers, wide gap between first and second toes, hypotonicity, ligamentous laxity.
What medical issues are associated with down syndrome?
Atlanto-axial subluxation, congenital heart defects, binaural hearing loss, eye conditions, dental abnormalities, speech and feeding difficulties, intellectual disability, obesity, sleep apnea.
What is Hirschsprung disease?
Nerves that innervate the intestine don't work well so the muscles that push the stool are not working properly (constipation).
Body impairments due to down syndrome
Hypotonicity, muscle weakness, slow/increased reactions, hyperflexible joints, decreased coordination, delays in developing anti-gravity postures, abnormal postural alignment.
Autism Spectrum Disorder (ASD)
A group of complex disorders of brain development. These disorders are characterized in varying degrees by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors.
What is ASD characterized by?
1) Deficits in social communication and social interaction.
2) Restricted repetitive behaviors, interests, and activities (RRBs).
Levels of ASD
1) Requiring support
2) Requiring substantial support
3) requiring very substantial support
Risks for autism
Advanced paternal age, maternal antidepressant use, shorter time between births, smaller/premature babies, maternal flu during pregnancy, defects in genes 7/8/15/18.
Medical issues associated with ASD
Seizure disorders, GI disorders, sleep disturbances, pica (eating non-food items), mental health issues, sensory integration dysfunction, hypotonia, gait disturbances.
Warning signs of ASD
6 mo. = no big smiles,
9 mo. = no sharing of sounds or facial expressions,
12 mo. = lack of response to name,
16 mo. = no spoken words,
24 mo. = no meaningful two-word phrases that don't involve imitating or repeating.
Characteristics of ADS
impaired social-emotional reciprocity, impaired communication skills, difficulty developing relationships, restricted repetitive behavior movements, insistence on sameness, highly restricted interests, sensory issues, impaired imitation skills, developmental delays, lack of joint attention skills.
ASD Assessment Tools
ADOS-2 (Autism Diagnostic Observation Schedule 2nd edition),
Gilliam Autism Rating Scales-2, Gilliam Asperger's Disorder Scale, Childhoot Autism Rating Scale-2, Asperger's Syndrome Diagnositc Scale, Autism Diagnositc Interview-Revised, Modified Checklist for Autism in Toddlers (M-CHAT)
Key steps for working with patients with ASD
Make it visual, keep it simple, support development of communication skills, use behavioral supports, use sensory supports.
Provided to children 0-3 y.o. for 1-2 hours/wk. Family-centered, in a natural environment. Teaming is common (OT, PT, VT, etc).
Similar to early childhood, but is a private industry.
Provided for all ages and frequency is based on needs in a natural environment. Also family-centered.
Levels of NICU
Level I = Basic Care
Level II = Specialty Care
Level 3 = Subspecialty Care
Role of OT/PT in NICU
Observation, Tolerance to handling, Active movements, Muscle Tone and Reflexes. Parent education.
Acute Care Settings
Children of all ages and dx.
Pediatric Rehabilitation Settings
In-Patient: children dealing with major physical sensory, language, and/or cognitive effects of an injury and are not yet safe to be home. Receive 3 hours of combined PT, OT, SLP 7 days/wk.
Day Hospital: Child can return home but still needs intense therapy. Full day therapy is provided 5 days/wk.
1-3x/wk. Goal is to improve skills/abilities.
Children enrolled in public schools who fit criteria under FAPE/IDEA. Goals for education vs. medical necessity.
Functional vs. Dysfunctional Families
Clearly defined roles (vs. not),
Parent and child match (vs. parent unable to soothe child),
Reciprocal communication (vs. ineffective),
Child's behaviors are a source of joy (vs. a source of stress),
Well-defined value system (vs. overprotective).
Events that influence bonding negatively
Extensive hospitalization, Colic, Negative feelings about past behavior, poor feeding skills, lack of communication, multi-child household, attitude of friends and family, characteristics associated with a disability.
Family Systems Theory vs. Family Centered Approach
Theory = individuals cannot be understood in isolation from one another, family is an emotional unit, and when one family members life changes it affects everyone.
Approach = family-professional collaboration. Enhance the health of the child through partnership with the family and promote quality of life for the family.
Stages of Grief: Kubler-Ross Model
Denial, Anger, Bargaining, Depression, Acceptance.
ADA of 1973
2 federal laws:
Section 504: procedural and substantive rights, institutional change.
Primary federal program that authorizes state and local aid for special education and related services for children with disabilities.
Assures right to education for all children in the least restrictive environment.
IDEA Part B
Extended education to 3-21 years old.
IDEA Part C
Services for children birth-3 years old.
What are the "urgent and substantial needs" IDEA Part C is based on?
Enhance development of child with disabilities.
Reduce educational costs (reduce need for special-ed at school age).
Maximize potential to live independently.
Enhance capacity of families to meet special needs of children.
Enhance capacity of state and local agencies to identify/evaluate/meet the needs of all children.
Individualized Family Service Plan.
Goals related to child and family.
All school-aged children who are individuals with disabilities as defined by section 504 and IDEA are entitled.
Promotes movement from school to post-school activities. Planning begins at 14 y.o. and services begin at 16 y.o.
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