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Clinical Conditions Exam 1
Terms in this set (280)
Core symptoms of Autism
1. impairment in social interaction and social communication that occur over several contexts
2. presence of restricted and repetitive behaviors
What type of disorder is Autism?
At what age are children normally diagnosed with Autism?
12-36 months of age
Define problems with social interactions
Difficulty perceiving other people's body language and determine how to communicate with others and develop interpersonal relationships
Define problems with social communication
Difficulty communicating (may be due to a language delay, echolalia, or a preoccupation with self)
Other names for Autism
ASD (Autism spectrum disorder) and PDD (pervasive developmental disorder)
What is believed to be the etiology of autism?
Genetics, but there is no single gene involved
Hypothesized causes of autism
abnormalities in brain structure/function, genetics, physiologic, environmental, combination
Where are the purkinje cells located
What is different about the purkinje cells in a child with autism?
they are depleted
What is the function of the cerebellum?
coordination, balance, spatial discrimination, visual spatial relationships, mental imagery, problem solving, emotional regulation, language skill development
What is the function of the frontal lobe?
emotional regulation, decision making (executive functioning), abstract thinking, language processing
What is the function of the temporal lobe?
What is the function of the occipital lobe?
Function of the parietal lobe?
somatosensory processing and proprioception
Parts of the limbic system
amygdala and hippocampus
Function of the limbic system
emotional regulation, memories, language processing
In the case where one person has autism, what is the likelihood that their identical twin would also have autism?
In general population, what is the chance of having autism?
What is the ratio of males to females with autism
3 to 4 male: 1 female
Environmental factors associated with autism
viruses, infections, drugs/alcohol, endocrine factors, carbon monoxide
physiologic abnormalities associated with autism
Gastrointestinal disorders, abnormal digestion of gluten and casein (unproven), increased vulnerability to immune system disorders (lack of research), may not be able to verbalize physical discomfort and pain
What percent of children with autism have GI problems?
What percent of the world population has autism?
How many people in the US have autism?
How has the amount of people with autism changed from 2000-2010?
119.4% increase, 1 in 68 children
What is the fastest growing developmental disorder?
What population of children are more likely to be diagnosed with autism?
How much more likely are boys to receive a diagnosis than girls?
5 times more likely
symptoms of autism
impairment in social interaction, impairment in communication, limited or repetitive play routines, unusual behaviors, difficulty developing friendships with peers, theory of mind limitations, delays in language development, echolalia, motor abnormalities, sensory processing, feeding disorders, co-occuring medical disorders (seizures, sleep, disturbances, GI problems)
Theory of mind
Understanding other people's feelings and thoughts
Levels of autism
Level 1: mild, Level 2: moderate, Level 3: severe
under- or hyporesponsivity in sensory processing
over- or hyperresponsivity in sensory processing
Sensory seeking in sensory processing
sensory craving in sensory processing
difficulties with motor skills in sensory processing disorders
ataxia and postural instability
Who developed sensory integration?
How are sensory processing disorders manifested?
as behavioral problems
What percent of children with ASD have ambiguous hand preference?
What abnormalities in gait are common in children with ASD?
Increased stance time (supporting feet on ground), increased stride length (more hip flexion), walking on toes
ability to plan out motor acts
What type of food selectivity is common in kids with ASD?
refusal to eat any fruits or vegetables
What kind of sleep disturbances can children with ASD experience?
poor sleep quality, resist going to bed, extensive time to fall asleep (may be related to areas of brainstem that regulate sleep and malatonin levels)
Prognosis of ASD
functional improvement with Tx, lifelong, language and IQ predict function, early intervention is key to developmental function
What is the IQ of a child with intellectual disability?
Prevalence of IQ disability
15-20% with some estimates as high as 68%
Best prognostic indicator for ASD
ability to spontaneously, meaningfully, and consistently combine words into phrases before 5 years
What is a good indicator of language outcome in ASD?
how you share your experiences-pointing
ASD Screening instruments
-The checklist for Autism in Toddlers (CHAT)
-The Autism Screening questionnaire
-Pervasive developmental disorders screening test: stage 1
What is needed for a thorough diagnostic assessment of ASD
History, medical history, physical/neurological examination, parent interviewing, parent interview tools (The Autistic Diagnostic Interview; PDDST-II etc.)
What is needed for a thorough assessment of ASD?
Tests in language development (preschool language scales); Test in cognitive development (Bayley scale of infant and toddler development); Test in sensory processing, motor, and adaptive skills (Sensory profile 2, Peabody, Developmental Motor Scales)
Complimentary and alternative medicine for ASD
Supplements; gluten-free, casein free diet; chelation; antibiotic treatment; antifungal treatment
Pharmacological therapies for ASD
Address behavioral dyregulations (hyperactivity, irritability, anxiety, perseveration); Cannot undo the disorder
Approximately what percentage of ID are mild cases?
When does ID originate?
ID is a combo of limitations in what?
Intellectual functioning and adaptive behavior
How is intellectual functioning measured?
using a standardized test, IQ is checked to be classified as mild, moderate, severe, or profound
Someone with ID falls how many standard deviations below normal IQ?
What is adaptive behavior?
the collection of practical skills to function everyday
What are adaptive skills?
conceptual skills, social skills, and practical skills
Children under 5 with significantly low IQ are diagnosed with what?
global developmental delay (GDD)
What percent of children with ID have no defined cause?
What percent of ID cases are due to prenatal conditions?
What percent of ID cases are due to prenatal conditions?
What percent of ID cases are due to genetics?
What percent of ID cases are due to perinatal conditions?
Single Gene Disorder
A specific gene is defective, problem with the quality of the genetic material
problem with the quantity of material, too much or too little genetic material in a specific chromosome
Where are genes located?
in the chromosome
missing either part or total chromosome
Autosomal chromosomal aberration results in
serious neuromotor impairment
What is one of the most common developmental disablities?
What is the prevalence of ID in US?
How much more likely are boys to have ID then girls?
Signs and symptoms of ID
significantly impaired adaptive skills, low intellectual functioning
What are the levels of function for ID?
mild, moderate, severe, profound
Prognosis of ID
Lifelong condition, prognosis depends on cause and access to resources; mild ID live as long as gen. pop; profound ID less likely to reach old age
ID is strongly associated with which mental illnesses?
anxiety and depression
How is ID diagnosed?
1. use of standardized test of IQ 2. Eval of adaptive behavior 3. Adaptive functioning 4. Adaptive behavior measures and scales
Vineland Adaptive Behavior Scale II tests what?
Social skill, communication skills, ADLs
Drug treatment for ID
No drug Tx; Meds may be used for secondary conditions (antipsychotics, antidepressants, antianxiety medications, prevent contratures, tone reduction)
What percent of ID patients have epilepsy?
What percent of people with Down Syndrome have heart defects?
What is one of the most prolific neuromuscular disorders?
protein "glue" holding muscle together
Muscular Dystrophy (MD)
group of heredity diseases resulting in progressive muscle weakness
What causes MD?
defects in muscle protein
6 types of MD commonly seen by OT
Duchenne MD, Becker MD, Limb-Girdle MD, Myotonic MD, Facioscapulohumeral MD,Emery-Dreifuss MD
using hands to push on legs to stand
When is DMD diagnosed?
Who is affected by DMD?
Etiology of DMD
X linked recessive
Cause of DMD
absence or deficiency of DMD
Depressed area on the posterior axillary fold
Valley sign is present in how many males with DMD?
Pattern of muscle weakness for DMS
bilateral, symmetrical, goes alternatively through periods of both rapid progression and slowed or no progression; affects all voluntary skeletal muscles and cardiac/pulmonary muscles; contracture; may have cognitive impairments; progress proximal to distal; LE prior to UE, wheelchair dependent by 12 years
shortening of muscles
Becker MD occurs primarily in
Etiology of BMD?
Onset of BMD
Onset of symptoms
Cause of BMD
dystrophin is partially functional
Prognosis of BD
middle age or late adulthood
Symptoms of BMD
Delayed ambulation, "toe walking"; muscle wasting/weakness progresses proximal to distal; usually symmetric starting in muscles of the pelvic girdle and thighs, eventually to the trunk and upper extremities; facial muscles are not affected; some men become wheelchair dependent in their 30s; lumbar lordosis
Where does BMD start?
etiology of the LGMD
10% autosomal dominant, child inherits normal gene from one parent and an affected gene from the other parent
90% autosomal recessive
Autosomal recessive forms of LGMD compared to autosomal dominant forms
Autosomal recessive form has more severe symptoms with a faster decline and loss of function
Who is affected by LGMD?
males and females
Cause of LGMD
glycoprotein levels are affected
asymmetric muscle weakness; first affects the muscles of the pelvis and shoulders; "waddling" gait; usually slow muscle wasting; positive Gower's sign
Onset of myotonic MD
teen or adult
50% affected live beyond 50 years of age
etiology of MMD
autosomal dominant inherited disorder
Who is affected by MMD
both males and females
progression of muscle weakness is slow; weakness/wasting begins in the face, lower legs, forearms, hands, and neck; "locking up" of muscles common; affects GI system, vision, heart, and/or respiratory system; cognitive impairments may be present
What percent of patient's with MMD die of cardiac complications?
Where does weakness/wasting begin?
face, lower legs, forearms, hands, and neck
Onset of facioscapulohumeral MD
Etiology Facioscapulohumeral Muscular Dystrophy (FSHMD):
autosomal dominant inherited disorder
Who is affected by FSHMD?
males and females
What is initially affected by FSHMD?
facial, shoulder, and upper arm muscles
Symptoms of FSHMD
Weakness is usually not symmetrical; winged scapula; no cardiac complication or cognitive impairments; initially affects facial, shoulder, and upper arm muscles and progresses down the body
Could be X-linked (majority of the time) or could be dominant or recessive autosomal
Who is affected by EDMD?
Symptoms of EDMD
formation of muscle contractures before any significant muscle weakness is recognized; muscle weakness generally symmetrical on the body; may have scoliosis
What are the X-linked forms of MD?
DMD, BMD, and EDMD
Autosomal recessive forms of MD
EDMD, LGMD, Oculopharyngeal, distal, and congenital
Autosomal types of MD
EDMD, LGMD, FSHMD, MMD, Oculopharyneal, distal, and congenital
Most common forms of MD?
Duchenne and Becker
Common links of MD
decreased muscle strengths, muscle cramping, decreased motor skills
Three indicators of MD
Gower's maneuver, Valley sign, proximal muscle weakness
Conditions that mimic MD
-spinal muscular atrophy (SMA)
-myasthenia gravis (MG)
-Charcot Marie Tooth (CMT)
-Amyotrophic lateral sclerosis (ALS)
Spinal Muscular Atrophy (SMA)
motor neuron disease when motor neurons get damaged
Myasthenia gravis (MG)
condition affecting neuromuscular junction making the ACh defective
Charcot Marie Tooth (CMT)
affects mostly peripheral nervous system
3 typical diagnostic tests for MD
blood work for genetic testing; electromyography (EMG); muscle biopsy
What would the creatine kinase look like in someone with MD?
Elevated from 150 IU/L to 6500 IU/L
What does electromyography reveal?
shows electrical function of the muscles
What does a muscle biopsy tell you about MD?
what type of MD the patient has
What is the primary treatment goal of MD?
maintenance of independence for as long as possible
What may the OT/PT work on with MD
1. Self care
2. Stretching contractures
3. Muscle strength while keeping in mind the fatigue factor
4. assistive devices
Drug interventions for MD
Corticosteroids, immunosuppressants, anticonvulsants
Gene Replacement for MD
replacing dystrophin by closely related protein
Gene Modification Therapy for MD
manipulating the protein by making dystrophin partially functional
Drug-based therapy (steroid) for MD
reduces the damage caused by muscle inflammation; promote muscle growth
What type of disorder is ADHD?
Average age of onset for ADHD
7 years old
How much more likely is ADHD in boys than girls
4 times more likely
What are the 3 subtypes
1. combined 2. predominantly hyperactive-impulsive
Inattentive symptoms of ADHD
often gets sidetracked, difficulty managing sequential tasks, avoids tasks that require sustained mental effort, difficulty with sustaining attention, distracted by extraneous or unimportant stimuli
Since DSMV what is the onset of ADHD?
Hyperactive-Impulsive Symptoms of ADHD
often fidgets or squirms in chair; feels restless, runs about; difficulties engaging in leisure activities quietly; talks excessively, blurts out answers before questions have been completed; difficulty waiting or taking turns
Types of ADHD
ADHD combined, ADHD predominantly inattentive, ADHD predominatelyhyperactive-impulsive, ADHD: Other specified or unspecified
What is ADHD combined
exhibit both attention and hyperactive-impulsive symptoms
ADHD predominately inattentive
sufficient inattentive symptoms
ADHD predominately hyperactive-impulsive
sufficient hyperactive-impulsivity symptoms
ADHD: Other Specified or Unspecified
displays some symptoms, but do not meet diagnostic criteria
Who is more likely to have inattention problems?
Who is more likely to experience hyperactivity?
What percent of children in the US have ADHD
Over the past 20 years, what is the diagnostic trend for ADHD?
increase in ADHD
From 2003-2011, what is the diagnostic trend of ADHD?
42% increase in diagnoses
From 2007-2011, what is the trend in medication for treatment
28% increase in use of meds for treatment
What is the most common form of ADHD
co-occurring conditions with ADHD
Sensory processing disorder, substance abuse, learning disorders, anxiety, depression, developmental coordination disorder (d/t ADHD), bipolar disorder, PTSD
What percent of children continue to meet criteria into adulthood?
Clinical presentation over time
overactivity/impulsivity decrease with age; attention, focus, and organization difficulties into adulthood
What percent of children with ADHD receive special education?
No single test; diagnosis based on observations and reports of behavior; Rule out hearing problems, learning disorders, and reports of behavior; Behavior present across multiple contexts; Behavior assessment system for children;Achenbach system of Empirically Based Assessment; genetic testing
Medical and pharmacological interventions for ADHD
stimulant medications, methylphenidate;increased dopamine and norepinephrine in the brain; adderall, concerta, dexedrine,and ritalin
Side effects of pharmacological intervention
decrease appetite, sleep problems, anxiety, mild headache or stomach ache, and irritability
Nonpharmacological and behavioral interventions for ADHD
psychological counseling; teaching problem-solving strategies; accommodations; teaching self-regulation strategies; cognitive-behavioral therapy (CBT); peer or life coaching
plan about providing reasonable accommodations based on rehab act of 1973
Behavior plan for ADHD
teacher can provide tickets and tokens as positive reinforcement
What is SPD?
CNS difficulty to detect, register, and process sensory information
What are the sensations people experience?
visual, auditory, proprioceptive, vestibular,taste, tactile
Subgroups of SPD
sensory modulation disorder (SMD), sensory based motor disorder (SBMD), sensory discrimination disorder (SD)
Types of SMD
SOR, SUR, SC
Types of SBMD
Dyspraxia and postural
Categories of SD
Primary: auditory, gustatory, olfactory, tactile, visual
Position and movement: proprioceptive and vestibular
Etiology of SPD
No identified cause; heredity; prenatal stress; perinatal coplications; alcohol exposure
If a mother has SPD, what is the likelihood her child has it?
If a father has SPD, what is the likelihood his child will have it?
What is sensory deprivation?
when a child doesn't get enough sensory information early in life
Neuronal pruning helps us to do what?
optimize sensory information by eliminating unnecessary information
Population affected by SPD
all age groups, intellectual groups, and socioeconomic groups; minority ethnicity; lower economic status; living with a single parent
Co-occurring conditions with SPD
ASD, ADHD, Learning disabilities
sensory modulation disorder: difficulty regulating and organizing external or internal sensory stimuli
Sensory Overresponsivity: Type of SMD; responses to stimuli are more intense or have a longer duration; activation of the sympathetic system; often demonstrate inflexibility and hypervigilance
Sensory Underresponsivity: Type of SMD; requires more intense and extended duration of sensory stimuli to reach optimal levels of arousal; may be prone to injuries; require a lot of stimulation to get arousal
Sensory Craving: Type of SMD; seek sensory input with an approach that results in erratic, disorganized behavior; "fearless"; often enjoys jumping, climbing, swinging, and twirling
Type of SBMD; challenge processing of vestibular and kinesthetic input to maintain normal postural tone; may be compromised: smooth muscle control and endurance; poor balance reactions; deficits in oculomotor control may be present; typically maintains a slumped position while sitting
Type of SBMD; difficulty motor planning; inability to plan unfamiliar or novel tasks; clumsy, awkward movements; difficulty with timing, grading, and executing movement; may display high verbal skills, may avoid physical education activities
Processing of somatosensation
the ability to differentiate between vestibular and proprioceptive sensations
Dual diagnosis of ADHD and SOR have been found to demonstrate a greater diagnosis of what in comparison to children with only ADHD?
How is SPD diagnosed?
clinical observations; caregiver-generated sensory profiles; screening checks during pediatrician appointments
What might be given to a child with SPD who has sleeping difficulties?
How are decisions made in OT?
-Client Centered approaches
Core Values of OT
Altruism, Dignity, Equality, Freedom, Justice, Truth, Prudence
selfless service; kindness
moral or legal fair treatment
veracity; truthful to every aspect of profession
wisdom; judiciousness in someone's affairs; how to reason for someone; intelligent reflection; rational in thoughts
What is key to providing most effective client-centered care?
basic beliefs about the client
partnership with client
8 philosophical assumptions that guide client-centered therapy
1. Right to meaningful existence
2. Biological and social nature influence
3. can only be understood within context of relationships with family and society
4. participation and periodic relief from social roles
5. right to seek potential through personal choice
6. purposeful interaction with human and nonhuman environment to reach potential
7. functional interdependence toward daily roles
8. intervention is focused on the needs of the individual at any given time
Personalized Medicine core values
What presents the OT's professional language?
When was OTPF revised last?
Domains of OTPF
Areas of human activity (occupations, client factors, performance skills, performance patterns, context & environment)
Process of OTPF
Use of and enhancement of engagement in occupations (Type of OT interventions, Treatment approaches, activity & occupational demands, Types of outcomes)
What are the types of occupations?
ADL, IADL, Rest & sleep, Work, Education, Leisure, Play, Social participation
What are the categories of client factors?
values, beliefs, spirituality, body functions, body structures
What are the categories of Performance skills?
motor skills, process skills, social interaction skills
What are the categories of performance patterns?
habits, routines, roles, rituals
Categories of Context and environment
cultural, personal, temporal, virtual, physical, social
Evidence Based Practice
The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
First step in clinical reasoning process
Understanding the condition
Most cited conditions treated by OT
Neurologic, development, cardiopulmonary, orthopedic, general medical, psychosocial/mental illness
the belief that if the person experiences this then they much also experience that
Stages of adjustment in a person with traumatic disabling condition
1. shock-first stage
Cerebral Palsy cause
injury or lesion of the immature brain (developing brain) during prenatal, perinatal, or postnatal development
Course of CP
CP is not progressive, but since it is a developmental disorder, new symptoms may be seen as developmental milestones are met. It is a lifelong disability
What does CP always affect?
movement, muscle tone, coordination, and sometimes cognition
What is congenital CP?
CP arises prior to birth
What percent of CP is congenital?
2 most significant risk factors of CP
Prematurity and low birth rate
CP Types of Brain injuries
Periventricular leukomalacia (PVL), Hypoxic-ischemic encephalopathy (HIE), intraventricular hemorrhage (IVH), cerebral dysgenesis
Periventricular leukomalacia (PVL)
damage to the white matter in the brain; often premature birth (<32 months)
Hypoxic-Ischemic Encephalopathy (HIE)
perinatal asphyxia; often in full-term infants
Intraventricular hemorrhage (IVH)
bleeding into the brain's ventricular system
brain malformation; not fully developed area
Potential causes of CP
-Meningitis or encephalitis
What is the prevalence if CP?
3.1-3.6 per 1,000 births in the US
What is the most common motor disability?
Is CP more common among boys or girls?
What population is at highest risk for CP?
What is the increase in probability of having CP in twin births?
Types of tone abnormalities
resistance when stretching muscle
decreased tone (flaccid)
Primary reflexes definition
the reflexes we are born with and are present while the brain is still developing, but eventually integrate
What are the primary reflexes?
Morro, rooting & sucking, Asymmetric tonic neck reflex (ATNR), Palmar grasp
In a hypotonic child what would you expect with the reflexes
primitive reflexes are absent
alternate contraction and relaxation
increased reflex response
Reflex abnormalities in CP
absence of primitive reflexes, clonus, hyperreflexia, retained primitive reflexes
Why do children with CP have atypical posture?
Types of CP
spastic, athetoid (dyskinetic), ataxia, mixed
What is the most common form of CP and what is the stat?
Spastic, 80% of CP cases
Characteristics of Spastic CP
Hypertonicity; deep tendon reflexes present; contractures
Characteristics of Athetoid CP
involuntary and uncontrolled movements; slow and writhing movements; fluctuating tone
Characteristics of Ataxia
unsteadiness and difficulties with balance; damage to cerebellum
What is the most common mixed form of CP
spastic and athetoid
What is the least common form of CP
athetoid and ataxia
Symptoms of spastic hemiplegia?
one entire side of the body; UE most affected; initially asymmetrical hand use during first year and dragging one side of the body. Later walks with hemiplegic gait-equinovarus foot, upper extremity in flexion attitude
Symptoms of spastic diplegia?
Both lower extremities; less spasticity in upper extremities, mild coordination, tremors, or less severe spasticity in the upper extremities; lumbar lordosis; hip flexion and internal rotation; plantar flexion of ankles; difficulty shifting weight; dorsal spine kyphosis
Symptoms of spastic quadriplegia?
entire body is affected, less spasticity in upper extremities; arms usually have flexor spasticity and legs usually have extensor spasticity; TLR reflex present; supine position- neck hyperextension and shoulder retraction; Prone position: increased flexor tone
foot is in plantar flexion and inverted walk on toes
Most severe form of CP
Spasticity is a result of damage to what?
The cerebral cortex
Athetosis is a result of damage to where?
Ataxia is the result of damage where?
wide based staggering gait, walk quickly, intention tumors may be present, hypotonicity may be present
How many cases of CP have mild cognitive impairment?
Seizure disorder is more common in
spastic hemiplegia and quariplegia
Visual and hearing impairments
strabismus, nystagmus, homonymous hemianopsia
Drooling is present in how many cases of CP?
10% of cases
Secondary problems in CP
contractures and deformities
People with CP are more likely to die due to _________ and less likely to die due to ___________
more likely-respiratory diseases and less likely accidents
increase motor control; decrease abnormal tone; parent education, handling techniques; botox injections will reduce spasticity for 3-6 months; splinting/orthotics; tendon lengthening: increase ROM; selective dorsal rhizotomy
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Chapter 14 (Neurodevelopmental Disorders)
NBCOT REVIEW: Pediatric Conditions & Interventions
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