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59 Cards in this Set
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- Back
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What is the Asymmetrical Tonic Neck Reflex stimulus, response, result of prolonged influence, implication, onset, and integrated age |
Stimulus: rotation of head to one side Response: flexion of the skull side limbs, ext of the jaw limbs, "fencing posture" Strongest in supine or sitting PROLONGED: can result in scoliosis, hip sublux/dislocation if f marked hypertonia IMPLICATION: if reflex is severe, grasping objects with the extended arm is only possible if patient looks away from the object to lessen the reflex ONSET: birth INTEGRATED: 4-6 months |
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What is the Crossed Extension Reflex stimulus, response, implication, onset, and integrated age |
Stimulus: noxious stimuli to the ball of the foot of extremity fixed in ext; tested in supine Response: Opposite LE flexes, then adducts, extends IMPLICATION: in patient's with hemiplegia, lifting the uninvolved leg off the ground during ambulation results in increased extensor tone in the involved leg -when this reflex is coupled with positive supporting reaction can result in knee hyperextension ONSET: 28 weeks gestation INTEGRATED: 1-2 months |
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What is the Equilibrium reactions stimulus, response, implication, onset, and integrated age |
Stimulus: displace COG by tilting or moving support surface (e.g. with an equilibrium board or ball) RESPONSE: curvature of trunk toward the upright + extesnion and abduction of the extremity on that side +protective ext of opposite (downward) side IMPLICATION: will be absent if there is marked spasticity ONSET: ~6 mo and develops sequentially first in prone (6 mo) then supine (7-8 mo) then in sitting (7-8 mo) then kneeling (9-12 mo) then in standing (12-21 mo) INTEGRATED: persists |
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What is the grasp reflex? stimulus, response, onset, and integrated age |
STIMULUS:Maintain pressure to palm of hand (palmar) or to ball of foot under toes (plantar) RESPONSE: maintain flexion of fingers or toes ONSET: PALMER: birth PLANTAR: 28 weeks gestation INTEGRATED: palmer = 4-6 mo. Plantar = 9 mo |
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What is Landau's Reflex stimulus, response, onset, and integrated age |
STIMULUS: lift the child under the thorax in prone RESPONSE: first the head and then the back and legs will extend. If the head is passively flexed, the extensor tone disappears ONSET: 3 months INTEGRATED: 2 years. Absent in individuals with strong flexor spasticity |
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What is the Moro Relex stimulus, response, onset, and integrated age |
STIMULUS: sudden change in position of head in relation to trunk e.g. drop pt backward in sitting position RESPONSE: extension and abd of UE with hand opening and crying. Followed by flexion, add, and arms across chest ONSET: 28 weeks gestation INTEGRATED: 5-6 mo |
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What is the optical Right reflex? stimulus, response, onset, and integrated age |
STIMULUS: alter body position by tipping body in all direction RESPONSE: head orients to vertical position and mouth horizontal ONSET: birth-2m mo INTEGRATED: persists |
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what is the labyrinthine Right reflex? stimulus, response, onset, and integrated age |
STIMULUS: alter body position by tipping body in all direction with eyes closed RESPONSE: head orients to vertical position and mouth horizontal ONSET: birth-2m mo INTEGRATED: persists |
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What is the positive supporting reaction? stimulus, response, onset, and integrated age |
STIMULUS: contact to ball of foot in upright standing position RESPONSE: rigid ext (co-contraction) of LE with ankle PF and inversion, toes "clawing," and hip IR VARIATIONS: 1. with CP, adductor spasm may occur 2. hemiplegia, may produce hip abduction 3. amb will be disrupted by inability to DF foot or to properly move the leg joints ONSET: birth INTEGRATED: 6 mo
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What is the Protective Extension Reaction? stimulus, response, onset, and integrated age |
STIMULUS: displace COG outside BOS RESPONSE: arms and legs extend and abd to support and to protect the body against falling -protective extension downward (parachute reaction) develops first, then forward, sideward, and backward protective ext ONSET: arms 4-6 months. Legs 6-9 mo INTEGRATED: persists |
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What is the rooting reflex? stimulus, response, onset, and integrated age |
STIMULUS: side of face stimulated with light touch RESPONSE: turns head toward side of stimulation and opens mouth ONSET: present in premature infants INTEGRATED: 3 months |
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What is the Symmetrical Tonic Neck Reflex (STNR)? stimulus, response, onset, and integrated age |
STIMULUS: flexion or extension of the head RESPONSE: 1. with head flexion: UE flexion and LE ext 2. with head extension: UE ext and LE flexion ONSET: 4-6 months INTEGRATED: 8-12 months -can strongly influence ability to assume quadruped as well as ability to crawl (needed to do these activities) |
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What is the Tonic Labyrinthine Reflex? stimulus, response, onset, and integrated age |
STIMULUS: prone or supine position RESPONSE: with prone increased flexor tone with supine: increased extensor tone ONSET: birth INTEGRATED: 6 months SIGNIFICANCE: persistence can prevent pt from turning side-lying from supine bc extensor tone limits flexion of shoulder or hip on one side, which is needed to turn over |
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What is the traction reflex? stimulus, response, onset, and integrated age |
STIMULUS: grasp forearm and pull up from supine into sitting RESPONSE: grasp and total flexion of UE and head will lag behind ONSET: 28 weeks gestation INTEGRATED: 2-5 MONTHS |
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What behaviors are demonstrated at 1 month? |
-lifts head -follows moving object -reflex stepping -positive support reflex -decreased flexion -hands fisted with indwelling thumb -reciprocal and symmetrical kicking -neonatal reaching |
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what are behaviors for 2 months? |
-lifts head 45 degrees in prone -traction reflex -smiles -begins prone on elbows -head bobs in supported sitting |
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what behaviors are typical at 3 months? |
-can prop self into prone on elbows with weight on forearms -coos -chuckles -takes weight with toes curled in supported standing -head elevation to 90 deg |
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what behaviors occur at 4 months? |
-can prop up head and chest for a long tim (pivot prone) -head no longer lags in pull-to-sitting -sits with support -laughs out loud -rolls prone to side -supine to side -optical and labyrinthine head right present -ulnar grasp |
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what behaviors occur at 5 months? |
-roll from prone to supine -head control in supported sitting -weight shifting from one forearm to other in prone |
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what behavior occur at 6 months? |
rolls supine to prone -indep sitting -pulls to stand -prone on hands with elbows extended while weight shifting from hand to hand |
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What behavior occur at 7 months? |
-maintains quadruped -pivots on belly -prone ext position (pivot prone) -assumes sitting from quadruped -trunk rotation in sitting -recognizes tone of voice |
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what behaviors occur at 8-9 months? |
-belly crawls -quadruped creeping -side-sitting -pulls to stand through kneeling -cruises sideways -can stand alone -pincer grasp with thumb and forefinger -can transfer objects from one had to the other -moves quadruped to sitting |
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what are behaviors at 10-15 months? |
-stands and begins to walk unassisted -begins self-feeding -searches for hidden toys -plays patty-cake and peek a boo -imitates -reaches with supination -neat pincher grasp with release |
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What are behaviors at 18-20 months? |
-walks up and down stairs with assistance -ascends stairs with step to pattern -sits on small chair -begins to run more coordinated -jumps off bottom step -plays make-believe
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what behaviors are typical at 2 years? |
-runs well -can go up stairs one at a time (reciprocal) -active -restless -tantrums
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What behaviors occur at 3 years? |
-goes down stairs reciprocally -rides tricycle -begins to catch a ball -jumps with 2 feet -understands sharing -stands on one foot briefly
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What behaviors occur at 3.5 years? |
-hops on one foot -kicks a ball |
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what behaviors occur at 4 years? |
-hops on one foot several times -climbs -throws a ball overhand -stands on tiptoes -relates to friends |
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what behaviors occur at 5 years? |
-skips -kicks a ball well -dresses and undresses self |
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what is the APGAR scoring system? |
-evaluates status of the newborn 1. HR 2. Respiration 3. muscle tone 4. color 5. reflex irritability all measured on a scale of 0-2 at birth and again at 1, 5, 10, and 15 min after birth -total of 7 or more is normal -5-6 = requires some care (ventilation, stimulation or resuscitation) -<4 requires immediate care |
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What is an Upper Brachial Plexus injury? |
Erb's Palsy C5 and C6 stretched during birth process -presentation = "waiter's tip" position -shoulder is adducted and internally rotated -weakness in GH abd & ER, elbow flexion , and supination -neutral positioning of the arm and gentle ROM exercises may be done early -severe cases (e.g. nerve root avulsion) child will not be able to use involved side to hug a doll, drink, zip a coat, etc |
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what is a Lower Brachial Plexus injury? |
Klumpke's Paralysis (like a monkey) -C8 and T1 nerve roots are stretched -weakness of hand and wrist flexors -claw hand appearance -hand function affected |
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What is the definition of premature infant? |
-birth of an infant before 37 weeks' gestation -categorized by birth weight |
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what is the normal neonate posture? |
-symmetrical flexed and abducted posture of UEs and LEs |
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What is the premature neonate postural profile? |
1. hyperextended neck and trunk 2. elevated shoulders 3. scapular retraction 4. shoulders and hip abducted and extended 5. anterior tilt of pelvis 6. decreased midline arm movement 7. weight bearing on toes in upright position |
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What treatment positions should be used for premature infants? |
-sidelying and prone with chin tucked, trunk flexed, shoulders protracted, posterior pelvic tilt, and flexion of Legs -prone makes use of influence of tonic labyrinthine reflex = enhanced flexion -gentle flexion of hips and knees in supine and supported semisitting can also be used |
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What should education of parents of premature neonates focus on? |
1. teach parents to include play activities that bring shoulders forward to counteract retraction 2. suspend toys in front of infant to encourage reaching 3. position the head in midline 4. tilt child to encourage head balance and head righting 5. position in prone or side-lying 6. minimize use of infant jumpers or walker, which increase extensor tone |
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How can therapy (swiss) balls be used in pediatric therapy? |
-helps with automatic reactions (e.g. seat child on ball, displace it backward and child will perform forward right reaction and activate abdominals) |
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what is functional sitting position for child? |
-pelvis in neutral postion with hips and knees at 90 degrees of flexion -various supports and seatbelts or tilting of seat posteriorly while adding a wedge under thighs may be necessary to properly position the child
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how can a child with increased extensor tone be properly positioned in w/c? |
-tilt-in-space w/c seat can be used to maintain 90 degrees of hip flexion |
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what are the functions of standers? |
-can be prone or supine -reduce influence of primitive reflexes -promotes weight bearing -promotes bladder and bowel function |
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What is Cerebral Palsy? |
group of nonprogressive disorders resulting from gestational, perinatal, or postnatal CNS damage -characterized by voluntary movement impairments |
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What are the major causes of CP? |
1. hemorrhage below the lining of the ventricles 2. hypoxic encephalopathy 3. malformations 4. Trauma of the CNS |
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What is common after premature birth? |
spastic paraplegia |
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What are the categories of CP? |
1. spastic 2. Athetoid 3. Ataxic 4. Mixed |
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What characterizes spastic CP? |
1. most common 2. affects UMN with spasticity affecting a. both limbs on one side = hemiplegia b. both legs = paraplegia c. all 4 limbs = tetraplegia d. intermediate between para- and tetraplegia that affects mostly legs = diplegia
-affected limbs have: 1. increased DTR 2. increased mm tone 3. abnormal postures and movement patterns with mass patterns of flexion or ext 4. weakness 5. tendency to contractures -scissors gait and toe walking are common -visual, auditory, cognitive, and oral-motor deficits may be present |
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What are characteristics of Athetoid CP? |
-due to basal ganglia involvement -slow, writhing, involuntary movements may affect the extremities 1. decr mm tone 2. poor functional stability in proximal joints 3. poor visual tracking 4. speech delay 5. oral-motor problems 6. persistance of tonic reflexes (ATNR, STNR, tonic labyrinthine reflex) = blocking functional positions and movements |
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What are charactertics of Ataxic CP? |
1. uncommon 2. due to cerebellar involvement 3. Weakness 4. poor coordination 5. intention tremor (3,4,5 produce unsteadiness) 6. Wide-base gait 7. difficulty with rapid or fine movement |
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What are characteristics of mixed forms of CP? |
+most often spasticity and athetosis -less often ataxia and athetosis |
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What are treatment strategies for CP? |
1. goal is to develop max indep allowed by individual's age, abilities and type of CP 2. utilize principles of motor learning and motor control to facilitate functional motor skills 3. Adaptive equipment and orthotic devices may be required to improve posture, trunk control, function, and socialization |
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What is Down Syndrome and symptoms? |
-congenital chromosomal abnormality, resulting in extra chromosome 21 1. hypotonia 2. decreased mm force 3. congenital heart defects 4. visual and hearing losses 5. laxity of ligaments 6. cognitive deficits -gross motor developmental delay & difficulties in eating and speech development -cognitive and perceptual deficit may result in a delay of fine motor and psychosocial development -forceful neck flexion and rotation activities should b limited due to AA ligamentous laxity and potential for subluxation and/or SC injury |
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What treatments are appropriate for Down Syndrome? |
1. Facilitate gross and fine motor development through positioning, posture, and movement activities 2. Increase stregnth and stability by modifying resistance and gravity in a graded manner 3. consider energy conservation strategies or activities if congenital heart defects are present |
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What is Duchenne's Muscular Dystrophy? |
1. genetic disease affecting males and causes destruction of mm cells 2. progressive weakness from proximal to distal 3. boys 3 to 7 years old 4. Waddling gait pattern 5. toe walking 6. lordosis 7. frequent falls 8. difficulty standing (Gower's sign- child uses UEs to walk up leg) 9. problems climbing stairs (due to weak gluteal and quad mms 10. contractures and deformities due to mm imbalances esp of the heel cords and TFL 11. as disease progresses, child will develop kyphoscoliosis (after 11 years of age) |
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what are treatment strategies for Duchenne's Muscular Dystrophy? |
1. maintain mobility 2. encourage recreational activities to maintain strength and cardiopulm function 3. use positioning devices and orthoses to prevent contractures and maintain joint ROM 4. educate and support the parents and family 5. do not exercise at a maximal level. heavy exercise may injure mm tissue |
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What is Myelomeningocele? |
-aka Spina Bifida -defect in the vertebrae resulting in protrusion of the SC and meninges -after surgical closure, hydrocephalus may become a problem requiring shunting of CSF to decr intracranial pressure |
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What are deficits demonstrated by pts with Myelomeningocele? |
-functional problems varying depending on level of SC defect. possible problems: 1. strength deficits 2. hip flexor and adductor tightness 3. foot deformities, esp club foot or talipes equinovarus 4. bowel and bladder problems 5. sensory loss 6. low tone with poor head control 7. developmental delays |
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What are appropriate treatment strategies for patients with myelomeningocele (Spina Bifida)? |
1. proper positioning 2. orthotic devices 3. standing frames 4. parapodia 5. swivel and rollator walkers for lower thoracic lesions 6. reciprocating gait walkers or orthoses (reciprocating gait orthosis [RGO]) for upper lumbar lesions 7.adapted w/c for upper thoracic lesions 8. AD varies depending upon level of the lesion |
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what is Charcot-Marie Tooth Disease? |
Peroneal Muscular Atrophy -hereditary neurological disorder of the peroneal and distal leg muscles -problems include foot drop and stork leg deformity (wasting of muscles in distal lower leg resulting in thin lower leg) -Orthotic devices that correct for the equinovarus (PF and inversion) deformity
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What is Legg-Calve-Perthes Disease? |
-idiopathic aseptic necrosis of the femoral capital epiphysis -usually unilateral -affecting mostly boys between ages 5-10 y.o Treatment 1. prolonged bed rest 2. mobile traction and slings 3. Casting 4. special hip abduction orthosis (to keep femoral head properly positioned in the acetabulum) |
