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Pediatric Physical Therapy Review

IER Book page 246- O'Sullivan & Siegelman Some flashcards were made into questions to facilitate learning. May contain most of the content in IER book for pediatric physical therapy
STUDY
PLAY
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Muscle spindles
- Muscle starts to differentiate, and tissue becomes specialized
Second trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Muscle spindles
- Motor end plate forms, and clonus response to stretch
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Muscle spindles
- Some muscles are mature and functional, other still maturing
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Touch and Tactile System
- First sensory system to develop
- response to tactile stimulus
Second trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Touch and Tactile System
- receptors differentiate
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Touch and Tactile System
- touch functional
- Actual temperature discrimination at the end of the third trimester
- Most mature sensory system at birth
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Vestibular System
- Functioning at the end of the first trimester (not completely developed)
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Vision
- eyelids fused
- optic nerve and cup being formed
Second trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Vision
- startle to light
- visual processing occurs
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Vision
- Fixation occurs
- Able to focus (fixed focal length)
Second trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Auditory
- will turn to auditory sounds
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Auditory
- debris in middle ear, loss of hearing
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Olfactory
- nasal plugs disappear, some olfactory perception
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Taste
- taste buds develop
Thrid trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Taste
- can respond to different tastes (sweet, sour,bitter, salt)
First trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Movement
- sucking, hiccuping
- fetal breathing
- quick generalized limb movement
- positional changes
- 7 1/2 weeks; bend neck and trunk away from perioral stroke
Second trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Movement
- quickening, sleep states
- Grasp reflex
- reciprocal and symmetrical limb movements
Third trimester
What trimester in the fetal sensory-motor development (1st,2nd or 3rd trimester)?
Movement
- 28 weeks primitive motor reflexes
- rooting, sucking, swallow
- palmar grasp, plantar grasp
- MORO
- crossed extension
1 month
Developmental Sequence Summary at what month(s)?
- decreased flexion
- momentary head elevation with minimal forearm support
- tracks a moving object
- head usually to side
- reciprocal and symmetrical kicking
- positive support and primary walking reflexes in supported standing
- hand fisted with indwelling thumb most of the time
- neonatal reaching
- alert, brightening expression
2 months
Developmental Sequence Summary at what month(s)?
- head elevation to 45° in prone
- prone on elbows with elbows behind shoulders
- head bobs in supported sitting
- does not accept weight on lower extremities (astasia-abasia)
- responds to friendly handling
3 months
Developmental Sequence Summary at what month(s)?
- prone on elbows, weight bearing on forearms
- elbows in line with shoulders, head elevated to 90°
- head in midline in supine, hand on chest
- increased back extension with scapular adduction in supported sitting
- takes some weight with toes curled in supported standing
- coos, chuckles
4 months
Developmental Sequence Summary at what month(s)?
- rolls prone to side, supine to side
- sits with support
- no head lag in pull to sit
- optical and labyrinthine head-righting present
- bilateral reaching with forearm pronated when trunk supported
- ulnar palmar grasp
- laughs out loud
5 months
Developmental Sequence Summary at what month(s)?
- rolls from prone to supine
- weight shifting from one forearm to the other in prone
- head control in supported sitting
6 months
Developmental Sequence Summary at what month(s)?
- prone on hands with elbows extended, weight shifting from hand to hand
- rolls supine to prone
- independent sitting
- pulls to stand, bounces
7 months
Developmental Sequence Summary at what month(s)?
- can maintain quadruped
- pivots on belly. Infant in prove moves body in a circle
- pivot prone (prone extension) position
- assumes sitting from quadruped
- trunk rotation in sitting
- recognizes tone of voice
- may show fear of strangers
8-9 months
Developmental Sequence Summary at what month(s)?
- belly crawls
- quadruped creeping
- moves quadruped to sitting
- side sitting
- pulls to stand through kneeling
- cruises sideways, can stand alone
- reaches with: closest arm, radial digital grasp, radial palmar, 3 jaw chuck grasp, and inferior pincer grasp with thumb and fore finger
- can trasnfer objects from one hand to the other
10-15 months
Developmental Sequence Summary at what month(s)?
- begins to walk unassisted
- begins self-feeding
- reaches with supination, neat pincer grasp, can release, build a tower of 2 cubes
- searches for hidden toys
- suspicious of strangers
- play patty-cake and peek a boo
- imitates
20 months
Developmental Sequence Summary at what month(s)?
- ascends stairs step to pattern (2 feet on each step)
- running more coordinated
- jump off of bottom step
- plays make believe
2 years
Developmental Sequence Summary at what month(s)?
- runs well
- can go up stairs foot over foot (reciprocal stair climbing)
- active, restless, trantrums
3 years
Developmental Sequence Summary at what month(s)?
- rides tricycle
- stands on one foot briefly
- jumps with two feet
- understands sharing
3 years
Developmental Sequence Summary at what month(s)?
- hops on one foot
- kicks ball
4 years
Developmental Sequence Summary at what month(s)?
- hops on one foot several times
- stands on tiptoes
- throws ball overhand
- relates to friends
5 years
Developmental Sequence Summary at what month(s)?
- skips
- kicks ball well
- dresses self
Test of Infant Motor Performance (TIMP)
This is a test that is developed for PRETERM infants as part of an examination. It includes infants of 32 weeks post conceptual age to 3 1/2 months post term.
It evaluates spontaneous and elicited movements to evaluate postural alignment and selective control for functional movement
This test is called?
38-42 weeks
How many weeks are considered to be a normal gestational period?
APGAR
This test developed for full term newborn, infant and child as part of the pediatric examination. It is a screening test administered to newborns at 1 minute, 5 minutes, and 10 minutes after birth. It includes five items such as:
- Heart rate, respiration, reflex irritability, muscle tone and color. Each item is scored 0,1 or 2.
A score of ≥ 7 is considered to be good.
This test is called?
≥ 7
What score is considered to be good in the APGAR test?
Downward
Which protective extension begins at 4 Months?
Sideward sitting
Which protective extension begins at 6 months?
Forward sitting
Which protective extension begins at 7 Months?
Backward sitting
Which protective extension begins at 9 Months?
4-6 months, and persist throughout life
Body righting reaction acting on the head (BOH). At what age does it begins?
6-8 months, and persists
Body righting reaction acting on the body (BOB). At what age does it begins?
6-8 months
Symmetrical Tonic Neck Reflex (STNR), at what age is integrated?
4-18 months
Landau's Reaction, at what age does it begins and integrates?
5 months
Tilting reactions are slow shifting of BOS or slow displacement of body in space that will result in lateral flexion of spine toward elevated side, and sometimes trunk rotation toward the elevated side this reactions persists throughout life. Tilting reactions reactions in prone, at what age does it begins?
7 months
Tilting reactions are slow shifting of BOS or slow displacement of body in space that will result in lateral flexion of spine toward elevated side, and sometimes trunk rotation toward the elevated side this reactions persists throughout life.Tilting reactions in supine, at what age does it begins?
8 months
Tilting reactions are slow shifting of BOS or slow displacement of body in space that will result in lateral flexion of spine toward elevated side, and sometimes trunk rotation toward the elevated side this reactions persists throughout life.Tilting reactions sitting, at what age does it begins?
12 months
Tilting reactions are slow shifting of BOS or slow displacement of body in space that will result in lateral flexion of spine toward elevated side, and sometimes trunk rotation toward the elevated side this reactions persists throughout life.Tilting reactions Quadruped, at what age does it begins?
0-2 months
The following list are neonatal reflexes that are tested as part of pediatric examination, when are these reflexes emerge and integrated?
- Babinski, flexor withdrawal, Cross extension
- Galant or trunk incurvation
- Primary walking and primary standing reaction
0-3 months
The following list are neonatal reflexes that are tested as part of pediatric examination, when are these reflexes emerge and integrated?
- Rooting
0-4 months
The following list are neonatal reflexes that are tested as part of pediatric examination, when are these reflexes emerge and integrated?
- Moro reflex
- Palmar grasp
0-6 months
The following list are neonatal reflexes that are tested as part of pediatric examination, when are these reflexes emerge and integrated?
- NOB (Neck righting On Body)
- Sucking reflex
- Startle reflex
- Tonic Labyrinthine reflex
- Asymmetrical Tonic Neck Reflex (ATNR)
- Placing reactions
Tilting reactions
Defined as slow shifting of BOS or slow displacement of body in space that will result in lateral flexion of spine toward elevated side, and sometimes trunk rotation toward the elevated side this reactions persists throughout life.
ATNR
What neonatal reflex, if persists, may result in scoliosis or hip dislocation, and may interfere with grasping, and hand to mouth activities?
Rooting,sucking
Which two neonatal reflexes are considered to be important feeding reflexes?
Tonic labyrinthine reflex
Which neonatal reflex if persists and it is strong may block or interfere with rolling from supine due to increased extensor tone?
Tonic Labyrinthine Reflex (TLR)
Identify the following reflex
- Prone position results in maximal flexor tone
- Supine position results in maximal extensor tone
if persists and is strong, may block rolling from supine due to increased extensor tone
Plantar grasp
Which neonatal reflex MUST be integrated before walking can occur?
Protective extension
Defined as quick displacement of trunk in a downward direction while held or while sitting in a forward, sideward, or backward direction will result in extension of legs in downward and extension of arms in the sitting position to catch weight. These reactions persists throughout life.
STNR
Which neonatal reflex if persists, may interfere with development of stable quadruped position and creeping?
Denver Developmental Screening Test II
Which pediatric test screens for developmental delay, and tests for: social, fine, gross motor, and language skills from birth to 6 years of age?
Primary standing reaction
Which neonatal reflex if persists will interfere with walking by causing extension of all joints of the LE and not allowing disassociation of flexion and extension?
Alberta Infant Motor Scale (AIMS)
Which screening test is an observational scale for assessing gross motor milestones in infants from birth through independent walking?
Peabody Developmental Motor Scale
Which standardized motor test assesses gross and fine motor development from birth to 42 months, and includes spontaneous, elicited, reflexes and automatic reactions?
Gross Motor Function Test (GMFT)
Identify the following test.
This test was developed to measure change in gross motor function over time in children with Cerebral Palsy. All itmes on this test could be accomplished by a 5 year old with typical motor development.
This test focus voluntary movements in 5 developmental dimensions:
1. - prone and supine
2.- sitting
3.- crawling and kneeling
4.- standing
5.- walking and jumping
Sensory Integration and Praxis Test (SIPT)
This test is a sensorimotor assessment for children between ages of 4 - 9 yrs having mild to moderate learning impairment
It measures the sensory integration processes that underlie learning and behavior. By showing how children organize and respond to sensory input,this test helps pinpoint specific organic problems associated with learning disabilities, emotional disorders, and minimal brain dysfunction. Includes
- balance, proprioceptive and tactile sensation, and control
Bayley Scales of Infant Development
A norm-referenced motor and mental scales for children form birth to 42 months of age. It is a standard series of measurements used primarily to assess the motor (fine and gross), language (receptive and expressive), and cognitive development of infants and toddlers, ages 0-3
Pediatric functional assessments
What are the main function of these two following pediatric tests?
- Pediatric Evaluation of Disability Inventory (PEDI)
- Functional Independence Measure for children (WeeFIM)
Pedriatric Evaluation of Disability Inventory (PEDI)
Identify the following pedriatric test?
It is an interview or questionnaire scale of activities of daily living (ADLs), with or without modification completed by the giver, an instrument for evaluating function in children with disabilities between 6 months to 7.5 years. It measures both functional performance and capability in three domains:
1.- self-care
2.- mobility
3.- social function.
Functional Independence Measure for children (WeeFIM)
Identify the following test
It assesses functional performance in self-care, mobility,locomotion,and communication and social cognition
It also assesses the need for assistance and the
severity of disability in children. IT is the pediatric version of the Functional Independence Measure (FIM), a functional assessmentoutcome measure for adults.
Newborn Individualized Developmental Care and Assessment of Progress (NIDCAP)
Identify the following test
A systematic behavioral observation of preterm of full-term infant in nursery or home during environmental input, care-taking and treatments. note what stresses, consoles infant
Atelectasis
Defined as lack of gas exchange within alveolar due to alveolar collapse
Respiratory Distress Syndrome
This condition is due to atelectasis (collapse of lungs) caused by insufficient surfactant in premature lungs, which may lead to acute respiratory failure and death
Supported side-lying while doing visual (use black, white, and red objects 9 inches away), and auditory tracking and reaching, midline position of head
An appropriate PT intervention/activities to teach parents are play activities and positioning to facilitate shoulder protraction, adduction such as:
Avoid activities which may increase extensor tone such as use of infant jumpers and walkers
An appropriate PT intervention/activities to teach parents to avoid is/are?
Encourage reaching for toys, parent's face
An appropriate PT intervention/activities to teach parents for an infant over 32 weeks' conceptional age is:
Monoplegia
A classification of Cerebral Palsy that involves impairment of one limb is called:
Diplegia
A classification of Cerebral Palsy that involves impairment of two LOWER limbs is called:
Hemiplegia
A classification of Cerebral Palsy that involves impairment of Upper and Lower limbs of one side of the body is called:
Quadriplegia
A classification of Cerebral Palsy that involves ALL four limbs is called:
Spasticity
If a patient with cerebral palsy has increased tone, lesion of motor cortex or projections from motor cortex. This type of impairment will be called:
Athetosis
If a patient with cerebral palsy has fluctuating muscle tone (can be rigid, can be flaccid), lesion of basal ganglia. This type of impairment will be called:
Ataxia
If a patient with cerebral palsy has instability of movement, lesion of cerebellum. This type of impairment will be called:
Spastic diplegia
If a Patient with cerebral palsy has increased tone, and the lesion is in the motor cortex and it involves both lower extremities, this condition is called:
Level 1
Based on the Gross Motor Function Classification, what level would it be if patient is able to walk without restrictions, and limitations is in more adavance gross motor skills?
Level 2
Based on the Gross Motor Function Classification, what level would it be if patient is able to walk WITHOUT assistive devices, limitations: walking outdoors, and in the community?
Level 3
Based on the Gross Motor Function Classification, what level would it be if patient is able to walk WITH assistive mobility devices; Limitations: walking outdoors and in the community?
Level 4
Based on the Gross Motor Function Classification, what level would it be if patient demonstrate self-mobility with limitations: Children are transported or use power mobility outdoors and in the community?
Level 5
Based on the Gross Motor Function Classification, what level would it be if self mobility is severely limited, even with the use of assistive technology?
Spastic cerebral palsy
What kind of impairment of cerebral palsy would the following description indicates?
- Increased muscle tone in antigravity muscles
- Abnormal postures and movements with mass patterns of flexion/extension
- Imbalance of tone across joints may cause contractures and deformities, especially of: LE : hip flexors, adductors, internal rotators, knee flexors, ankle plantarflexors
- Imbalance of tone across joints may cause contractures and deformities, especially of: UE: scapular retractors, Glenohumeral extensors, and adductors, elbow flexors, forearm pronators
- visual, auditory, cognitive and oral motor deficits
Athetoid cerebral palsy
What kind of impairment of cerebral palsy would the following description indicates?
- generalized decrease in muscle tone, floppy baby syndrome
- poor functional stability especially in proximal joints
- ataxia and incoordination when child assumes upright positions with decreased BOS and muscle tone fluctuations
- poor visual tracking, speech delayed and oral motor problems
- Tonic reflexes such as: ATNR, STNR, Tonic labyrinthine reflex (TLR) may persist, blocking functional postures and movements
Ataxia cerebral palsy
What kind of impairment of cerebral palsy would the following description indicates?
- Low postural tone with poor balance
- Stance and gait are WIDE based
- Intention tremor of hands
- Ataxia follows initial hypotonia
- poor visual tracking, nystagmus
- Speech articulation problems
- May occur with spastic or athetoid Cerebral palsy
Tilt wheelchair seat posteriorly
A pediatric patient diagnosed with cerebral palsy, has been given a wheelchair for ambulation. Upon examination, the patient shows increased extensor tone and decreased hip flexion. What wheelchair modification will be appropriate to address this issue?
Decrease extensor tone and maintain hip flexion
What effect has a wheelchair seat tilted posteriorly on a patient with cerebral palsy with severe extensor tone?
Sidelying
Tonic Labyrinthine Reflex (TLR) (0 - 6 Months) is defined as: prone position = maximal flexor tone, and supine position = maximal extensor tone. what position will most likely decrease the effect of TLR?
Posterior rollator walkers
Rollator walkers are often used as part of orthoses in the treatment of CP. What type of rollator walker would be appropriate to help a child maintain upright position and arm position to decrease extensor tone?
Side effects: sedation, weakness, drowsiness, dry mouth
Oral medications such as: presynaptic inhibition of acetylcholine release, benzodiazepines, diazepam (valium), Baclofen (lioresal) are used in the managment of spasticity in patients diagnose with cerebral palsy, what are the side effects of these medications?
Cerebral palsy
Selective dorsal rhizotomy (SDR) is a surgical transection of electromyography (EMG)- selected dorsal sensory rootlets with the goals of facilitating or maintain ambulation or improving ease of care. This procedure will be most likely performed in patients with:
An intensive strengthening program
A patient with cerebral palsy has undergone Selective Dorsal Rhizotomy (SDR) with the goal of maintaining ambulation. After surgery, when ambulation is the goal, an appropriate entry in the physical therapy plan of care includes:
Achilles tendon, hamstrings, iliopsoas, hip adductors
In the orthopedic management of CP lengthening procedures of muscles/tendons are performed to correct deformity or weak muscle(s) to prevent hip subluxation/dislocation. Which muscles/tendons are most often lengthened?
hip adductor transferred to hip abductor
In the orthopedic management of CP muscle transfers are performed to move/change the direction of force to increase function and decrease spascity. Which muscle transfer is most often done?
Spina bifida occulta
Defined as no spinal cord involvement, may be indicated by a tuff of hair, dimple or sinus
Spina bifida cystica
Defined as when the neural tube defect is visible or open lesion. This is called?
Meningocele
Defined as: type of spina bifida cystica, where cyst includes cerebrospinal fluid; cord intact
Myelomeningocele
Defined as a type of spina bifida cystica, where cyst includes cerebrospinal fluid and herniated cord tissue
talipes equinovarus (club foot)
What foot deformity is most likely seen in Spina bifida with neural tube defects at the level of L4-L5?
Myelodysplagia/Spina bifida
Defined as a neural tube defect resulting in vertebral and/or spinal cord malformation
Reciprocating gait orthosis (RGO)
Patients with myelodysplegia at high lumbar levels exhibit paralysis or weakness of hip flexors. what type of orthotic is the only one that makes ambulation possible?
Bowel and bladder dysfunction
Patients with myelodisplasia spina bifida with lesion at level L4-L5 results in what kind of GI dysfunctions?
C5-6
Brachial plexus injury called Erb's Palsy which cord segments involves?
C8-T1
Brachial plexus injury called Klumpke's Palsy which cord segments involves?
C5-T1
Brachial plexus injury called Erb-Klumpke (whole arm paralysis) Palsy which cord segments involves?
Erb's palsy
This characteristic in arm postion is seen in which brachial plexus injury?
- UE is in adduction, internal rotation of shoulder with extension of elbow, pronation of forearm and flexion of the wrist
Decreased shoulder girdle function with 1:1 humeroscapular movement
What functional limitations are observe in patients with Erb's palsy (C5-6) brachial plexus injury?
Decreased wrist and hand function
What functional limitation are observed in patients with Klumpke's palsy brachial plexus injury?
Klumpke's palsy
Upon examination it is observed the following
- lower arm paralysis, involving intrinsic muscles of hand, flexors and extensors of wrist and hand. which brachial plexus is this finding most consistent with?
Erb-Klumpke palsy
Upon examination it is observed the following
- Paralysis of the whole arm
Which brachial plexus injury is this finding most consistent with?
Instrinsic muscles of hand, flexors and extensors of wrist and fingers
With an Klumpke's palsy brachial plexus injury which upper arm paralysis may involve which muscles?
Erb's palsy
Upon examination it is observed the following
- paralysis of upper arm with possible involvement of: rhomboids, levator scapulae, serratus anteior, deltoid, supra/infra spinatus, biceps brachii, brachioradialis, brachialis, supinator, and long extensors of wrist, fingers and thumb
Which brachial plexus injury is this finding most consistent with?
Rhomboids, levator scapulae, serratus anterior, deltoid, supraspinatus,infraspinatus, biceps brachii, brachioradialis, brachialis, supinator, and long extensors of wrist, fingers, and thumb
With an Erb's palsy brachial plexus injury which upper arm paralysis may involve which muscles?
Moro's reflex, bicep's reflex, radial reflex, but grasp is intact
Physical therapy examination of pediatric population with brachial plexus injury what reflexes are likely not to be present?
Down syndrome
Which pediatric population this PT intervention is best described for?
- Avoid hyperextension of elbows, and knees during weight bearing activities
- Prognosis may be correlated with tone. lower tone = the more significant the motor delay
- impairment: Atlantoaxial subluxation/dislocation could possibly be due to laxity of transverse odontoid ligament
Infant Coma Scale
Evaluation of children/infant with TBI uses behavioral scales such as glasgow coma scale and Rancho los amigos scale to assess the child's orientation to time and place and the ability to respond to various stimuli. Which scale is used for non verbal infants?
Duchenne's Muscular Dystrophy
Which pedriatic population the follwing description is best described?
- An X-link recessive inherited by boys, and carried by recessive gene of mother. Lack dystrophin. this gene is missing which results in increased permeability of sarcolema and destruction of muscle cells.
- Collagen, adipose laid down in muscle leading to pseudohypertrophic calf muscles
Positive Gower's sign
Occurs in patients with diagnose with Duchenne's Muscular Dystrophy, and because of weak quadriceps and gluteal muscles, child must use upper extremities to "walk up legs" to rise from prone to standing. This is called:
heel cords, tensor facia latae and lumbar lordosis and kyphoscoliosis
Patients with Duchenne's Muscular Dystrophy develop contractions and deformities due to muscle imbalances. What areas are common for contractures and deformities
Duchenne's Muscular Dystrophy
Which pediatric population this PT intervention is best described for?
- Maintain mobility as long as possible by encouraging recreational and functional activities to maintain strength and cardiopulmonary function
- Maintain joint ROM through the use of active and passive ROM exercises, positioning devices such as prone standers or standing frames
- Gastrocnemius and tensor fascia lata shorten first
- ESTIM for younger children has bee able to increase contractile ability
- Do not exercise at maximal level (no strength training), may injure muscle tissue (overwork injury)
Respiratory insufficiency
The most likely cause of death of individuals diagnosed with Duchenne's Muscular Dystrophy is?
Supine stander
A child needs a stander to help with weight bearing experience and maintaining his hips, knees, ankles and trunk in optimal position, in addition to facilitate formation of acetabulum and aiding in bowel and bladder function. What kind of stander will be prescribed if more posterior support is needed?
Side-lyers
What kind of pedriatric adaptive equipment will help decrease the effects of Tonic Labyrinthine Reflex (0-6 months), and put the hands in visual field?
Steroids (prednisone)
A child has been diagnosed with Duchenne's Muscular Dystrophy. He has been prescribed antibiotics to fight pulmonary infections. What other medication is likely to be prescribed during the lifetime of this child to help increase life expectancy by decreasing pulmonary dysfunction?
Gastrocnemius
A child has been diagnosed with Duchenne's Muscular Dystrophy, is in need for orthopedic surgery to lengthen one of his muscles. which muscle is likely to be lengthened?
Ankle set at 5-10 degrees
AFOs are used to provide support to foot, ankle, knee to provide a stable base of support and reduce effects of spasticity and hypoextensibility of muscles. At what angle is the AFO set at the ankle to decrease genu recurvatum?
Tone reducing AFO
Which orthotic may present with the following benefits?
- Decreases the effects of spasticity, including sissoring by maintained stretch
- Stretches and maintains length of heel cord to prevent or lessen contracture
- provides good mechanical BOS for standing and ambulation
KAFO
Which orthotic may present with the following benefits?
- Used for standing or ambulation
- Knee may be solid at 0 - 5 ° flexion or hinged
- Used by children with spina bifida or muscular dystrophy
HKAFO
Which orthotic may present with the following benefits?
- Used for standing and ambulation
- Swing through gait
- Used by children with spina bifida or spinal cord injuries
RGO
Which orthotic may present with the following benefits?
- HKAFO with molded body jacket
- Cable system allows forward step with lateral weight shift
- Used by children with Thoracic level spinal bifida or spinal cord injuries
Pavlik harness
Which orthotic may present with the following benefits?
- Used for infants with congenital hip dysplagia (congenital or acquired deformation or misalignment of the hip joint)
- Hips are held in flexion and abduction to maintain femoral head in acetabulum
Pediatric Evaluation of Disability Inventory (PEDI) and/ or WeeFIM
Assessment of functional abilities during physical examination of patients with spina bifida is done by which two functional assessment tests?
Increased irritability,increased muscle tone, seizures, vomiting, bulging fontanels, headache, and redness along shunt tract
Signs and symptoms of shunt malfunction include:
Child requires fair (3/5) sitting balance and UE control
A child is going to be prescribed a scooter/three wheeler for mobility aid. What will be the minimum requirement in terms of balance and UE control in order to maneuver this mobility aid safely?
Forward walker or anterior rollator walker
Which mobility aid (walker) provides the following benefits?
- Encourages forward trunk leaning
- Provides maximum anterior stability
Posterior walker or postural control walker
Which mobility aid (walker) provides the following benefits?
- Encourage trunk extension
- Encourages shoulder depression, elbow extension, neutral wrist which may decrease scissoring in lower extremities
Babinsky reflex
Stroke the lateral aspect of the plantar surface of foot and get extension and faning of toes. What is this reflex called?
0-12 months
The Babinski reflex when does it become evident and when it should have been integrated?
Flexor withdrawal
It is a sharp, quick pressure stimulus to the sole of the foot or palm of hand, and get withdrawal of stimulated extremity. What is this reflex called?
0-2 months
When the flexor withdrawal reflex becomes evident and when it becomes integrated?
Cross extension
It is a sharp, quick pressure stimulus to the sole of the foot results in withdrawal of stimulated lower extremity and extension of the opposite leg. What is this reflex called?
0-2 months
When the cross extension reflex becomes evident and when it becomes integrated?
Galant
It is a sharp stoke along paravertebral line from scapula to top of iliac crest results in lateral trunk flexion toward stimulated side. What is this reflex called?
0-2 months
When the galant or trunk incurvation reaction becomes evident and integrated?
Moro reflex
A sudden extension of neck results in flexion, abduction of shoulders, extension of elbows and the enxtension, abductionof shoulders, flexion of elbows. Usually results in crying. What is this reflex called?
0-4 months
When the Moro reflex becomes evident and integrated?
Primary standing reaction
Hold infant in supported standing and infant supports some weight and extends lower extremities. if this reflex persists, it will interfere with walking by causing extension of all joints of the lower extremity and not allowing disassociation of flexion and extension. What is this reflex called?
0-2 months
When the primary standing reaction becomes evident and integrated?
Primary walking
Hold infant in supported standing, tilt trunk forward slightly, reciprocal stepping motions in lower extremities. What is this reflex called?
0-2 months
When the primary walking reflex becomes evident and integrated?
Neonatal neck righting
Neck righting on body, NOB. Turn head when infant is is supine, body logs roll towards same side. What is this reflex called?
0-6 months
When the Neonatal neck righting becomes evident and integrated?
Rooting
Stroking of perioral region results in head turning to that side with mouth opening. This is an important feeding reflex. What is this reflex called?
0-3 months
When the rooting reflex becomes evident and integrated?
Sucking
Touch to lips, tongue, palate results in automatic sucking. This is an important feeding reflex. What is this reflex called?
0-6 months
When the sucking reflex becomes evident and integrated?
Palmar grasp
Pressure stimulus against palm results in grasping of objects with slow release (0-4 months). This reflex is called?
0-4 months
When the Palmar grasp becomes integrated?
Plantar grasp
Pressure stimulus to sole or lowering of feet to floor results in curling of toes. (must be integrated before walking occurs). This reflex is called?
0-9 months
When plantar grasp should be integrated so walking can occur?
Placing reactions
Drag dorsum of foot or back of hand against edge of table, get placing of foot or hand onto table top. This reflex is called?
0-6 months
When Placing reactions reflex should be integrated?
Traction pull to sit
Pull infant to sit from supine: upper extremities will flex and there will be head lag until 4 - 5 months. This reflex is called?
Optical and labyrinthine righting
The head orients to a vertical position when the body is tilted. Labyrinthine righting is tested with the eyes blind-folded (1 month-throughout life). This is called?
Protective extension
A quick displacement of trunk in a downward direction while held or while sitting in a forward, sideward or backward direction will result in:
- Extension of legs in downward and extension of arms in the sitting position to catch weight. This reflex is called?
4 months
Protective extension in downward directions begins at what months? (these reactions persists throughout life)
6 months
Protective extension in sideward sitting begins at what months? (these reactions persists throughout life)
7 months
Protective extension in forward sitting begins at what months?(these reactions persists throughout life)
9 months
Protective extension in backward sitting begins at what months? (these reactions persists throughout life)
Body righting reaction acting on the head (BOH)
Contact of the body with a solid surface results in head righting with respect to gravity, interacts with labyrinthine-righting reaction on head to maintain orientation of head in space. Beings at 4 - 6 months and persists throughout life. This is called?
Body righting reaction acting on the body (BOB)
Rotation of the head or thorax results in rolling over with rotation between trunk and pelvis. Begins at 6 - 8 months and persists. This is called?
Symmetrical Tonic Neck Reflex (STNR)
Extension of cervical joints produces extension of UEs and flexion of LEs.
Flexion of cervical joints produces flexion of UEs and extension of LEs. Integrated (6 - 8 months)
6-8 months
When the Symmetrical Tonic Neck Reflex (STNR) is integrated?
STNR
What reflex if not integrated (persists) could interfere with development of stable quadruped position and creeping in an infant
5 months
Tilting reactions reactions in prone, at what age does it begins?
7 months
Tilting reactions reactions in supine, at what age does it begins?
8 months
Tilting reactions reactions in sitting, at what age does it begins?
12 months
Tilting reactions reactions in quadruped, at what age does it begins?
Thoracic
Impairment and function of myelodysplasia involved different spinal cord levels such as thoracic, upper-mid-lower lumbar, and lumbosacral. Which neurosegmental level the following description represents?
Muscles innervated : Abdominals
Pre-ambulation orthoses: Standing frame
Ambulation orthoses: Reciprocating gait orthosis (RGO)
Assistive devices: Parallel bars, walkers, forearm crutches
Functional progrnosis: wheelchair
Musculoskeletal problems: spinal deformity, decubiti
Upper lumbar
Impairment and function of myelodysplasia involved different spinal cord levels such as thoracic, upper-mid-lower lumbar, and lumbosacral. Which neurosegmental level the following description represents?
Muscles innervated : Above & hip flexors
Pre-ambulation orthoses: Standing frame
Ambulation orthoses: Reciprocating gait orthosis
Assistive devices: Parallel bars, walkers, forearm crutches
Functional progrnosis: wheelchair, possible household or therapeutic ambulation; Standing transfers
Musculoskeletal problems: Hip flexion contractures
Mid lumbar
Impairment and function of myelodysplasia involved different spinal cord levels such as thoracic, upper-mid-lower lumbar, and lumbosacral. Which neurosegmental level the following description represents?
Muscles innervated: Above & knee extensors, hip adductors
Pre-ambulation orthoses: none
Ambulation orthoses: HKAFO, or KAFO (depending on quad strength)
Assistive devices: Parallel bars, walkers, forearm crutches
Functional progrnosis: wheelchair for community, orthoses for house-hold ambulation
Musculoskeletal problems: Hip dislocation, subluxation
Low lumbar
Impairment and function of myelodysplasia involved different spinal cord levels such as thoracic, upper-mid-lower lumbar, and lumbosacral. Which neurosegmental level the following description represents?
Muscles innervated: Above & hip abductors, knee flexors, ankle & foot dorsiflexion, evertors, invertors, toe flexors
Pre-ambulation orthoses: none
Ambulation orthoses: KAFO (depending on quad strength)
Assistive devices: Parallel bars, walkers, forearm crutches or none
Functional progrnosis: Household or community ambulators Musculoskeletal problems: Foot deformities
Lumbosacral
Impairment and function of myelodysplasia involved different spinal cord levels such as thoracic, upper-mid-lower lumbar, and lumbosacral. Which neurosegmental level the following description represents?
Muscles innervated: Above & Ankle plantar flexors, foot intrinsic muscles
Pre-ambulation orthoses: none
Ambulation orthoses: AFO or none, AFO recommended to maintain gait quality & decrease compensatory over-activity of muscles
Assitive devices: Walker or none
Functional prognosis: Community ambulators
Musculoskeletal problems: Foot pressure sores
Standing frame and Reciprocating gait orthosis
Patients with myelodysplasia at the thoracic and upper lumbar level typically need what type of pre-ambulation and ambulation orthoses?
no pre-ambulation orthoses
Patients with myelodysplasia at the mid lumbar level typically need what type of pre-ambulation orthoses ?
HKAFO or KAFO depending on quad strength
Patients with myelodisplasia at the mid lumbar level typically need what type of ambulation orthoses?
none
Patients with myelodysplasia at the low lumbar level typically need what type of pre-ambulation orthoses ?
KAFO or AFO
Patients with myelodisplasia at the low lumbar level typically need what type of ambulation orthoses?
none
Patients with myelodysplasia at the lumbosacral level typically need what type of pre-ambulation orthoses ?
AFO or none, though AFO is recommended to maintain gait quality & decrease compensatory over-activity of muscles
Patients with myelodysplasia at the lumbosacral level typically need what type of ambulation orthoses ?
wheelchair
Patients with myelodysplasia at the thoracic level typically have what functional prognosis in terms of ability to ambulate with/without assistive devices such as wheelchairs, orthoses etc..?
wheelchair, possible household or therapeutic ambulation, standing transfers
Patients with myelodysplasia at the upper lumbar level typically have what functional prognosis in terms of ability to ambulate with/without assistive devices such as wheelchairs, orthoses etc..?
wheelchair for community, orthoses for household ambulation
Patients with myelodysplasia at the mid lumbar level typically have what functional prognosis in terms of ability to ambulate with/without assistive devices such as wheelchairs, orthoses etc..?
household or community ambulators
Patients with myelodysplasia at the low lumbar level typically have what functional prognosis in terms of ability to ambulate with/without assistive devices such as wheelchairs, orthoses etc..?
community ambulators
Patients with myelodysplasia at the lumbosacral level typically have what functional prognosis in terms of ability to ambulate with/without assistive devices such as wheelchairs, orthoses etc..?
Spinal deformity and decubiti
Patients with myelodysplasia at the thoracic level typically experience what type of musculoskeletal problems?
hip flexion contractures
Patients with myelodysplasia at the upper lumbar level typically experience what type of musculoskeletal problems?
hip dislocation, subluxation
Patients with myelodysplasia at the mid lumbar level typically experience what type of musculoskeletal problems?
foot deformities
Patients with myelodysplasia at the low lumbar level typically experience what type of musculoskeletal problems?
foot pressure sores
Patients with myelodysplasia at the lumbosacral level typically experience what type of musculoskeletal problems?
Atlantoaxial ligament laxity
In patients with down syndrome forceful neck flexion and rotation activities should be limited due to what condition?
facilitate lip closure and tongue retrusion
Physical therapy In patients with down syndrome should encourage what type of oral motor function?
short and frequent feedings
What is recommended for patients with down syndrome as an energy conservation technique during feeding?
avoid hyperextension of elbows and knees
What is recommended to avoid for patients with down syndrome during weight bearing of UEs and LEs activities?
the more significant the motor delay
In patients with down syndrome, prognosis may be correlated with tone in terms of motor delay. the lower the tone a patient has the:?
Glasgow coma scale and Rancho Los Amigos scale
For the pediatric population suffering from TBI, what are the two behavioral scales used to assess child's orientation to time and place and the ability to respond to various stimuli?
Infant Coma Scale
For non-verbal infants with TBI which scale should be used?
Children Coma Scale and Rancho Los Amigos scale
Which scale can be used to assess level of consciousness in children with TBI?
Modified Ashworth Scale
Which should be used to determine muscle tone in children with TBI?
Family centered approach
Defined as a type of approach that begins with child's and family's strengths,need, hopes, and results in a service plan which responds to the needs of the whole family. Role of PT is to support, encourage, and enhance competence of parents or caretakers in their role as caregivers. This approach is called?
Early Intervention Programs (EIPs)
Identify by the following description the type of pediatric program
Mandated by public law
- to provide comprehensive, multipdisciplinary early intervention programs
- For infants and childrens from birth to 3 years
- Multidisciplinary assessment
- Individual Family Service Plan (IFSP) developed
- Family is a member of the team