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32 Cards in this Set
- Front
- Back
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ETIOLOGY
___ deficiency Teratogens Genetic component |
Folic acid
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DIAGNOSIS
Alpha-fetoprotein –___ used test –MSAFP blood test –___weeks gestation Fetal Ultrasonography –Primary screening tool for NTD –18 weeks gestation Amniocentesis –20 weeks MRI |
Most commonly
16 weeks gestation |
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EMBRYOLOGY
NEURAL TUBE CLOSURE FAILURE TO CLOSE |
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CATEGORIES (3)
SPINA BIFIDA ___ ___CELE ___MENINGOCELE |
SPINA BIFIDA OCCULTA - Most common
MENINGOCELE - Least common MYELOMENINGOCELE - Second most common |
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SPINA BIFIDA OCCULTA
___ common, least severe ___ do not fuse Lumbar or sacral spine Spinal cord, nerves not damaged Dimpling or ___ |
Most common
Vertebral arches do not fuse tuft of hair |
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MENINGOCELE
___ common, second in severity Vertebral arches do not fuse Spinal cord intact ___ in skin covered sac Paresis, bowel/ bladder ___ possible |
Least common
Neural elements Paresis, bowel/ bladder incontinence possible |
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MYELOMENINGOCELE
Second most common, ___ Vertebral arches do not fuse Open defect or membranous sac Sac contains CSF, meninges, spinal cord Spinal cord ___ below sac ___, ___ loss, bowel/ bladder dysfunction Usually lumbar Usually bilateral but may be unilateral or asymmetrical |
most severe
Spinal cord damaged below sac Sensory, motor loss, bowel/ bladder dysfunction |
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LEVEL IDENTIFICATION
Motor level is assigned according to last intact ___ found |
nerve root
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ASSOCIATED CNS ABNORMALITIES
Arnold Chiari Malformation |
Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls balance. When the indented bony space at the lower rear of the skull is smaller than normal, the cerebellum and brainstem can be pushed downward. The resulting pressure on the cerebellum can block the flow of cerebrospinal fluid (the liquid that surrounds and protects the brain and spinal cord) and can cause a range of symptoms including dizziness, muscle weakness, numbness, vision problems, headache, and problems with balance and coordination. There are three primary types of CM. The most common is Type I, which may not cause symptoms and is often found by accident during an examination for another condition. Type II (also called Arnold-Chiari malformation) is usually accompanied by a myelomeningocele-a form of spina bifida that occurs when the spinal canal and backbone do not close before birth, causing the spinal cord to protrude through an opening in the back. This can cause partial or complete paralysis below the spinal opening. Type III is the most serious form of CM, and causes severe neurological defects. Other conditions sometimes associated with CM include hydrocephalus, syringomyelia, and spinal curvature.
NINDS Chiari Malformation Information Page |
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CLINICAL SYMPTOMS
Stridor Apnea GERD Vocal cord paralysis –Gargled voice Dysphagia Seizures Nystagmus Problems with feeding –aspiration Ataxia Hypotonia UE weakness |
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SECONDARY DYSFUNCTION
___ deficit Decreased coordination Decreased motor planning Postural insecurity |
Balance
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ASSOCIATED CNS ABNORMALITIES
Hydrocephalus |
Hydrocephalus – head gets enlarged, shunt in 4th ventricle to peritoneum and gets absorbed into the body – furl it up, and as child growths it unfolds.
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CLINICAL SIGNS
Head enlargement Irritability ___ sign of eyes; downward deviation Projectile vomiting |
Sunset sign of eyes
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SECONDARY DYSFUNCTIONS
Visual motor perceptual problems Cognitive deficits “Cocktail party” conversation; ___ IQ > performance IQ |
verbal IQ > performance IQ
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SIGNS OF SHUNT MALFUNCTION
___ Bulging fontanelle - an outward curving of an infant's soft spot (fontanelle). In an infant, the space where two sutures join forms a membrane-covered "soft spot" called a fontanelle (fontanel). The fontanelles allow for growth of the skull during an infant's first year. Vomiting Change in appetite Sunset sign of eyes - Setting-sun sign refers to the downward deviation of an infant’s or a young child’s eyes as a result of pressure on cranial nerves III, IV, and VI. With this late and ominous sign of increased intracranial pressure (ICP), both eyes are rotated downward, typically revealing an area of sclera above the irises; occasionally, the irises appear to be forced outward. Pupils are sluggish, responding to light unequally. Edema, redness along shunt tract |
INFANTS
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SIGNS OF SHUNT MALFUNCTION
___ –Vomiting –Irritability –Headaches –Edema, redness along shunt tract |
TODDLERS
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SIGNS OF SHUNT MALFUNCTION
SCHOOL –AGED CHILDREN Headaches Lethargy Irritability Edema, redness along shunt tract Handwriting changes High –pitched cry Seizures Memory changes Rapid growth of ___ circumference ___ of skin over scalp ___ not previously noted Vomiting Personality changes Changes in school performance |
head
Thinning of skin over scalp Nystagmus not previously noted |
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SKELETAL ABNORMALITIES
___–congenital or acquired Deformity from muscle imbalance ___–talipes equinovarus Hip ___ |
Scoliosis
Clubfoot Hip dislocation |
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NEUROLOGICAL DETERIORATION
1. ___ - refers to an abnormal widening of the central canal of the spinal cord that creates a cavity in which cerebrospinal fluid can accumulate. As spinal fluid builds up, it may put abnormal pressure on the spinal cord and damage nerve cells and their connections. ___ is sometimes used interchangeably with syringomyelia, the name for a condition that also involves cavitation in the spinal cord. In ___, the cavity that forms is connected to the fourth ventricle in the brain, and is almost always associated with infants and children who have hydrocephalus or birth defects such as Chiari Malformation II and Dandy-Walker Malformation. Symptoms, which may occur over time, include weakness of the hands, arms, and legs; and sensory loss in the neck and arms. Some individuals have severe pain in the neck and arms. Diagnosis is made by MRI, which reveals abnormalities in the anatomy of the spinal cord; and electromyography 2. ___ - a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. In children, symptoms may include lesions, hairy patches, dimples, or fatty tumors on the lower back; foot and spinal deformities; weakness in the legs; low back pain; scoliosis; and incontinence. ___ syndrome may go undiagnosed until adulthood, when sensory and motor problems and loss of bowel and bladder control emerge. This delayed presentation of symptoms is related to the degree of strain placed on the spinal cord over time. ___ syndrome appears to be the result of improper growth of the neural tube during fetal development, and is closely linked to spina bifida. Tethering may also develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord. Fluid pressure may cause cysts to form in the spinal cord, a condition called syringomyelia. This can lead to additional loss of movement, feeling or the onset of pain or autonomic symptoms. |
1. Hydromyelia
2. Tethered cord |
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SIGNS OF HYDROMYELIA
Progressive ___ ___ weakness Increased tone |
scoliosis
UE weakness |
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SIGNS OF TETHERED CORD
Progressive scoliosis ___ weakness Increased ___ UTI or incontinence Change in sensation Pain/ irritability Foot ___ |
LE weakness
Increased tone Foot deformity |
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RELATED PROBLEMS
Skin breakdown ___ allergy Obesity Sensory integration problems Neurogenic bladder/bowel Frequent hospitalizations Decreased: –Motor planning –Kinesthetic awareness –Attention –Short term memory –Eye/hand coordination |
Latex allergy
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RED FLAG
Latex allergy –___% present –Watery eyes, itching, hives, rash, anaphylactic shock Examples: –Balloons, pacifiers, beach toys, koosh balls, reflex hammers, stethoscope tubing, crutch axillary pads and tips, swim goggles, wheelchair tires DO NOT USE LATEX PRODUCTS WITH THESE CHILDREN |
75% present
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CLINICAL PRESENTATION
LEVEL: T6-T12 MUSCLE FUNCTION: Upper trunk, abdominals, back, intercostal SECONDARY IMPAIRMENTS: Kyphoscoliosis contractures, hip abd/ER, clubfeet PROGNOSIS FOR WALKING: TLSO WHEELCHAIR STANDING FRAME WHEELED STANDER PARAPODIUM RGO/WALKER ___ AMBULATION |
SHORT DISTANCE AMBULATION
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CLINICAL PRESENTATION
LEVEL: L1 - L3 MUSCLE FUNCTION: Hip flexors, Hip Adductors, possible quadriceps SECONDARY IMPAIRMENTS: hip flexion contractures, hip dislocation, wind swept, scoliosis PROGNOSIS FOR WALKING: ___ AMBULATION OR EXERCISE AMBULATION ONLY STANDER PARAPODIUM RGO/WALKER HKAFO, KAFO, AFO FOREARM CRUTCHES WHEELCHAIR |
HOUSEHOLD AMBULATION
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CLINICAL PRESENTATION
LEVEL: L4 - L5 MUSCLE FUNCTION: Quadriceps, gluteus medius, gluteus minimus, hamstrings, AT, PT, peroneals SECONDARY IMPAIRMENTS: HFC, hip dislocation, lumbar lordosis, calcaneovarus PROGNOSIS FOR WALKING: ___ OR ___ AMBULATION HKAFO, KAFO, AFO CRUTCHES, CANE WHEELCHAIR |
HOUSEHOLD OR COMMUNITY AMBULATION
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CLINICAL PRESENTATION
LEVEL: S1-S2 MUSCLE FUNCTION: Quadriceps, gluteus maximus, peroneals, gastroc, toe flexors SECONDARY IMPAIRMENTS: calcaneovarus, toe clawing, heel ulcers PROGNOSIS FOR WALKING ___ AMBULATION AFO, SMO, FO |
COMMUNITY AMBULATION
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GOALS OF PT
Establish motor level by ___ Provide information to medical team about available ___ Perform periodic MMT for comparison purposes Provide family instruction regarding positioning, handling to prevent deformity Provide family with HEP for motor development Input regarding orthotic and mobility aid Monitor patient for ___ |
MMT
LE movement CNS deterioration |
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ASSESSMENT
ROM Postural alignment Sensory Muscle tone Muscle strength Motor function Balance, postural control Skin integrity |
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FOCUS OF TREATMENT
Infant Age appropriate developmental skills Head / trunk control Postural reactions (protective, equilibrium) Mobility training ___ for upper extremity strengthening Adaptive seating or standing (parapodium) Goal is ___ |
Prone
upright standing |
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FOCUS OF TREATMENT
Preschool Functional upright mobility ___ management Orthopedic intervention Skin care Strengthening Adaptive training |
Orthotic
Preschool – socialize and interact w/ peers – eye level w/ them so stand up |
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FOCUS OF TREATMENT
School –aged Child Energy expenditure Orthopedic intervention Orthotic management Home, school, community ___ Skin care and pressure relief |
negotiation
School-aged – get around high school, get to the lunch room, manage the lunch tray, go to bathroom. Must be educationally relevant. Usually don’t get pt privately anymore. |
