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17 Cards in this Set

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Pediatric Spinal Cord Injury

•More common in __, with increased incidence of vertebral column injury in 10-16 year old boys

•Lack of standardized nationwide data base has hampered reporting of pediatric SCI
males
Nature of Injury:

•Infant spine:

tremendous flexibiltiy
relatively large ___
increased chance for C-spine injury (esp. between skull and __)
head

C1
Nature of Injury:

•Young Child’s spine (2-10 yrs):

muscles/ligaments strengthen
bones calcify/grow
head/torso relationship changes
increased chance of injury to ___
C5/C6
Mechanisms of Injury
•Kinematics of Traumatic Injury:
Flexion/extension/rotation
Axial loading
___

Seen with: falling
motor vehicle accidents
sports related injuries
birth related injuries
Distraction
Mechanisms of Injury

•Traumatic (cont):
Gunshot wound

•Diseases/Conditions
Chiari malformations
Tumors
Transverse myelitis
Down Syndrome
Stroke
Spinal ___
stenosis
Spinal Column Fracture or Not

•Young children tend to suffer soft tissue injury without “true fracture” of spine

•This can result in Spinal Cord Injury without Radiographic Abnormality (SCIWORA)

•SCIWORA makes up about ___% of all pediatric SCI
20%
Acute Care

•Vital signs stabilized

•Spinal column needs to be ___ and stabilized

Stabilization may require ___ devices such as a Halo brace

Internal spinal ___ may be needed
decompressed

external fixation

fusion
Assessment of Pediatric SCI Patient

•ASIA score: obtained by assessment of sensation and motor function and used to assign an ASIA Impairment Scale grade
ok
PT Role in Acute Care

•Bowel and Bladder Care
•Skin Care/___
•ROM
•Strengthening
Positioning
Physical Therapy Assessment
1) Histories:
a. Present illness
b. Medical
c. Developmental
2) Systems Review:
a. CV/Pulmonary
b. Integumentary
c. Musculoskeletal: ROM, tone, strength, symmetry, posture
d. Neuromuscular:
functional mobility, balance, transfers,
coordination, locomotion
3) Adaptive equipment needs:
a. wheelchairs
b. bracing:
orthotics, KAFOs, HKAFOS, TLSO
c. standing equipment:
parapodium, standing frame, mobile
ok
Common Problems

•Development of joint contractures
some contractures are “helpful”

•Autonomic Dysreflexia

•Spasticity Management
PT, Baclofen, BOTOX

•Skin Breakdown

•Bone ___
Density
Special Concerns for Ped SCI

•Hip Subluxation:
rate higher among children with onset of SCI prior to ___ of age
10 yrs
Special Concerns for Ped SCI

Scoliosis:
incidence of progressive paralytic scoliosis > 98% for patients injured prior to adolescence
bracing prior to curvature of __ degrees may delay/prevent surgery

Development of rotational deformities in LEs
20 degrees
Therapeutic Exercise
•Aerobic/endurance conditioning
•Balance/coordination
•Body mechanics
•Flexibility
•Strength, power, endurance training for trunk, neck, limbs and respiratory muscles
•Gait/LT
•Aquatic therapy
ok
Functional ADL

•School and play activities

•Transport issues
transfers in/out of vehicle
transport of wheelchair

•Dressing, feeding, bathing, etc.
ok
Other Interventions

•___ Electric Stimulation
found to improve palmar grasp, increase pinch force and improve manipulation

•Partial Weight Bearing Systems
Functional
Psychological Outcomes

•Depression/Anger common in ___ with SCI

Associated with perceptions re: reduced quality of life

PT has potential to impact this by enhancing community-based ___ as well as overall health via cardio-pulmonary conditioning
adolescents

mobility