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129 Cards in this Set
- Front
- Back
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what can cause Bronchopulmonary Dysplasia?
3 phases: What does this do to lungs? |
iatrogenic cause, increased time on ventillator, RDS prolonged
1. excessive 02 pressure 2. inflammatory 3. fibroproliferation phase scarring emphysema, alveoli dont multiple, capillaries inflam and distroy |
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Name 2 intrinsic pulmonary diseases
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Congenital heart disease
resp. distress syndrome |
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list some causes of RDS
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decrease surfactant
acidosis atelectasis |
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compliance of lungs is ____ in infants.
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increased
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3 associated conditions with chronic respiratory failure
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CNS disorders like hypoxia, apnea..
congenital airway abnormality intrinsic muscle disease (md or botulism) |
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what pulmonary structure is developed by 16th - 24th week?
when can respiration occur? when does ant lung pouch, tach and esoph seperate? |
bronch epithe, mucus, supportive cartiledge, capillaries with air blood interface.
24th week 24-26 days post conception |
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Alveoli increase in numbers until....
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8 years old and then continue to grow in size and complexity
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what position has increased arterial 02 tension?
what position was decreased arterial tension? |
prone (usually contraindicated)
supine (this is a bad thing) |
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whats the best way to enhance infant ventillation an circulation?
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early ambulation
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3 segmental lung expansion techniques
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sensory feedback
sidely and rocking pressure on opp lobe |
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normal bp in infant (1 month)
6 months = |
85/46
95/53 |
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General PT interventions for cardiac defects
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- assess neuro
- edu precautions - early mob after surgery to prevent complictions |
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Hypoplastic Left sided heart syndrome =
TX = |
malformation of valvue, decreased blood flow
norwood procedure - staged, so right side does all the work. left side does nothing. |
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Pulmonary stenosis is reistance to-
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BF from R ventricle
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what condition gives mixed blood to the body?
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overriding aorta
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palliative repair of tetralogy of fallot =
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anastomosis from subclavian A to pulm A
corrective repair would be to close VSD |
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Describe transposition of great arteries =
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pulm off LV and Aorta off RV
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What is tricuspid atresia?
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congenital lack of tricuspid vlavue (ra --> rv ) decreased BF
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List 4 defects of tetrology of fallot
when should you get surgery? How can PT releieve cyanosis? |
VSD
overriding aorta (straddle) Pulm stenosis RV hypertrophy -turbulance- pulm signs like nail bed clubiing squatt to increase systemic reistance |
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patent =
atresia = |
opened
closed |
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what is coarticulation of aorta?
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constriction of aorta
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Basic mechanism of neonatal cynotic defects-
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r --> L shunting de oxy blood bypass lungs to the body (15- 30% decreased 02)
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List 5 neonatal Cyonotic Defects =
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tetralogy of fallot
transpiosition of great artieries triscuspid atresia pulm atresia hypoplastic L sided heart synd. |
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Timig of VSD surgery depends on?
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tolerance to defect
resp distress wt gain |
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signs of resp distres =
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diaphoresis
fatigue with feeding dec endurance |
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What is patent ductus arteriosis?
results in? |
opened hole shunting L --> R from aorta to pulm A (caused from dialated with hypoxia at birth, commen with primi)
CHF from inc work, bounding pulse |
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Ventrical Septal defect =
prognosis is worse if? |
L --> R shunt during systole (when R vent contracts) ?????????????????
hole is not in muscle???? |
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What is atrial septal defect?
TX = |
foramen ovale opened
( L --> R) suergey B/W/ 4-6 years to prevent heart failure in adulthood. |
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what 3 things drain into the fetal IVC?
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placenta blood
LE blood Liver blood |
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List the route fetal blood takes inside the heart
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right atrium
foramen ovale left atrium left ventricle aorta |
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what fetal shunt communicates between descending aorta and pulm A?
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ductus arteriorosus
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what fetal shunt allowed blood to bypass the body?
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ductus arteriorosus
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what does the ductus venonosus do?
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liver and IVC connection
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what fetal shunt allows blood to bypass lungs?
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foramen ovale
(located between atria) |
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Primary general ped pt
Seconday- |
strength
rom MS integ soft tissue mobs ________________ sensory re edu practice skills in different evnir |
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Cause of congenital heart defects-
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85% unknown (genes and environment combo)
10% associated with other probs like: DS, trisomy 18, turners, vacterl, marfans, maternal DM |
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what pt modality is contraindicated in OI?
what is good? parental edu |
PROM
positioning, inc sensory motor deve, splinting fx, mobility traniing safe handling loos clothes roll off diaper enrich environment |
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List some manafestatinos of OI
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lax joints, weak muscles, Osteoper, blue sclera, hernias, easy bruise, bad teeth, disproportions, inc sweat
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Medical management of osteogensis impoerfects
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maybe diet, resp care, reserach and intramedullary rods
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PT for non ambulating MD patients
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WC fit
foot wear energy conservation a/prom resp problem solve |
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----- = inhereted disorder of connective tissues
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OI (collegen synthesis doesnt go beyond reticular stage- no organization)
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medicla management with mild MD
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corticosteriods to enhance dystrophin expression and protect against fiber damage)
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MD progression into teen looks like
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resp involvement, heart probs and cog issues.
death by 25 |
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onset of MD
signs in first 2-5 years when do they loose ability to walk |
2-6 years
late walking, clumsy 7-12 |
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Discribe progression of treatment for torticollis
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Neonate: manual prom/mfr, control posture, massage, visual stim
3 month: cont above, soft brace, helmet later: surgical length, maybe botox |
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____ - x linked genetic disease with spont or inherited deletion of a portion of X chomosome
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MD
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Theories of cause for congenital muscular torticollis
secondary complications prog |
abn vascular pattern
muscle rupture heredity crowding, intrauterine compartment compression inj _____________ worsened scoliosis plagio ceph sensory motore development hip displasia ______________ 50-70%^ spont recover better with early detection prog = 3.2 months |
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CMT is more commen in what gender?
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males (r > L )
head tilts towards and rotates away |
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List medical management of con limb def
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stump care
phantom limb pain general conditions prosthetics |
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VACTERTL syndrom =
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non random assoc of birth defects with unknown genetic cause
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when during development is embryo most susceptible to teratogens cause limb def?
examples: |
3-7 wk
ex) thalimide, BCP, irradiation, VACTERL |
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in development, when do limb buds appear?
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3-4th week, then differnciate by 7th.
(prox-> distal and ue > Le) |
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list come commen causes of Cong Limb Def (mmost commen type is conge, not aqired)
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- embryonic formation failure
- duplication - over/under growoth - consecutive band theroaty - mengiococal defect - terogenic facotirs |
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What muscle biopsy findigs will you see with AMC?
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fibrous fatty tissue
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AMC commen resting posture =
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flexed and dislocated hip
club foot IR shoulder flexed wrists with up |
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AMC mobility patterns
describe times surgical manegem,ent |
early rolling
later transfer clubfeet- when pull to stand knees - ambulate wrist- last resort |
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List associated characteristics with AMC
AMC is classified based on- describe big difference between the 2 maj |
scoliosis
dimpling over skin with 2 joints hemangiomas absent finger creases congenital heart disease facial abnomalities report rbs abn hernias resting posture 1- ext knee, fex elbows 2- flexed knee, ext elbow |
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Pathophys theories of AMC
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hyperthermia of fetus from materal fever
prenatal viral inf vascular comp uterine fibroid tumer septuim in uterus reductino of amniotic fluid musltiple births |
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Clinical Manafestations of AMC
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- severe joint contractures
- dec muscle dev - amyloplaisia - normal cog and speech - dec body size |
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AMC =
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arthrogyroposis multiplex congenita
non progressive stiffness with contracture in 2 or more joints and weakness or absence of muslce develo assoc with neurgenic and myoplastic disorders |
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mechanisms of contractures in AMC
order of prevalance of body parts effected |
lack of fetal movement
foot wrist knee elbow shoulder |
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negatives for harrington rod
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dec sag plane correction
inc flatten lumbar lordosis |
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positives for Luque rods
negatives |
- inc bone quality
- prevents loss of lumbar lordosis _____________ inc risk of neu probs due to inc flex |
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Myelogram
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tests for CNS abnormality
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Cobb method =
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measures scoliosis of x ray
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treatment of A. i. S (scoliosis) depends on
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skeletal maturity
growth potential curve mag |
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what scoliosis side compressed disc causing degeneration
what side casuses dec lung capacity |
concave
VEX (lung cap is increased on cave side) |
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what type of curve persists when you laterally bend?
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structural
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Commen A i S onset-
theories |
10-18 years (lateral curvature of spine)
- insuf ligaments - assym weakness - unequal fiber types - fam abnorm - genetic? |
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Progression of Post of PT of Erbs Palsy
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0-4 weeks: immob
4-6 weeks: scar massage PROM immob active transfer motor learning after 6 weeks: strengthen discontonue splint dec mvt sunbstitutions |
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what test detects changes in self perception?
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comp - canadian occupational perforamnce measure
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pre surg assessment for erbs palsy
what muscles are commenly transfered? which are commenly released? |
social-cog
current funct: joint integ , length and strength of muscule transfer lats and teres maj pec maj capsule subscap |
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most mobile joint
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shoulder
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How can IGF-1 help erbs?
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(insulin growth factor)
improves muscle region after injury may help preserve degeneration |
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what position do you want to splint erbs arm?
list neuro rec techniques |
supinate
ext rot wrist ext (to allow weight bearing) ____________ forced use with shaping place and hold |
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3 surgery options for neurotmesis
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neurolysis
nerve grafting neurotization |
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whats a good functional assessment test for erbs with ages 4-8
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mallet
and fyi these people favor late rec over early surgery |
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Long term erbs deficits
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cortical chanes in developing NS
- change in neuro presentation - habitual patterns - may lead to disuse |
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List some interventions for ERBS
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prom, splint, tape, NMES, surgery, position, neuro re-edu
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toricollis secondary to erbs can lead to ...
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.visual neglect
muscle tightness plag dec sensorimotor dec body awareness |
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whats a good developmental test for infants?
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AIMS
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3 fuinctional impairments to look for in a 3 month year old
8month- 1 year? |
prone propping
prehension transitional mvt wt bearing with transitions bimanual functioning |
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interview questions about erbs HX
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vaccuum
breech clav fx birth duration degree of initial arm mvt |
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What muscles are commenly compensatory mm for erbs?
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delts and pec maj
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window into infants muscle activation
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reflexes such as ANTR, placing reaction, moro, hand grasp, parachute response
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Horners Syndrome
S/S: |
cerival gang chain injury (symp)
ptosis (dropped eye) miosis (constric pupil) anhydrosis (dec sweat) |
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posture for shoulder dystocia
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waiters tip ( AD IR)
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prognosis if muscle is denervated fir iver 18-24 months
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irreversible motor endplate degeneration and muscle fibrosis
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natural hx of erbs
prognostic factors: |
better in 2 months
but if inc to 3-6 months may need tendon transfer over 6 then micro surg ______________ total envirnment elevated hemidiaphram (phrenic) winged scap (LTN) horners |
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What nerve injury type is reversible
which isnt and req surg? |
neuropraxia
neuroptmesis |
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regeneration AFTER wallarian deg =
what infuences this rate axons cannot regrow if |
1mm/day, 1 inch per month
-scar - connection site mismatch endoneural tube is distroyed |
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nerve plexus avulsion
can this be corrected with surg? |
pregang tear, disrupting rootles
seperating motor cell body from axon (sensory cell body remains connected) NO |
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nerve plexus rupture =
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post gang tear M/S variable with intact
POSSIBLY corrected with surgery |
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perinatal risks for brachial plexis birth palsy
inc birth weight of 2 types of palsy |
fetal macrosonia
rolonged labor mutli preg breech prev palsy hx gestational dm over 4500g avulsion and rupture |
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List nerve roots
erbs klumpes |
c5-c6 (extneded erbs goes to 7)
c8-ti |
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adaptation heirarchy
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- least intrusive to more
- schedule - adaptive materials - provide assistance |
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good test for ambulation deficits
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BOT
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good test for functional activities
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PEDI
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___ = statement of childs present level of edu perforamnce`
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IEP
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for school based PT, child must fit into ....
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catagory set by the state
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good test for motor skill restrictions
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PDSM 2
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5 developmental domains
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cog
physical communication social adaptive |
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child link =
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primary service coordination and assessent and treatment in everything
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IFSP -
IEP = |
individualized family service plan
individualized edication plan |
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IDEA =
discribe three parts |
individual with disabilities edication act
A = general B= IEp and 18-21 C = 0-3 EI |
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who recieved EI
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disability
developmental delays at risk in anyof the 5 domains |
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3 stages of praxis
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idea / goal
plan executeion |
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E stim used for
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strength
muscle facilitation cp |
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praxis =
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organization of sensory input and exceution of a respoinse to it
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____ = rapid scoliosis with sb lesion under t12
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tethered cord syndrome
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Discribe 3 principals of sensory integration
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1. adaptive responses facilitae the integration of sensory stim
2. people seek out sesory motor exp that have organizational effect 3. kids dont passivly absorb, they select most useful |
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inner drive is generated by
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limbic system
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clinical manafestations of tethered cord syndrome-
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change giat
LE hypertonis change urology rapid scoliosis assym mmt lbp ass pain |
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Why do SB ambulators, tend to loose ambulation by adolesence into adulthood?
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change body proportions
decrease neuro status MSK probs bowel and bladder issues |
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List commen SB infant impairments (spina bifida)
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hip dislocation
low muscle tone dec prom (hip and ankle contractures) |
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verbal performance requires-
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fine motor, speed, memorym R and L hemisphere integration
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Who has cocktail personality possibly
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SB
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List some causes of SB UE dyscoordination
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cerebellar ataxia
motor cortex/pry damage from hydroceph delayed develop arnol chiari |
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do SB have sensory deficits?
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yes skipped dermatomes
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A person with SB at L5 would be limited in walking as an adult due to
expected level of function for L1-L3 |
weight gain
most WC |
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S/S of Arnold Chiari
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strider with insp
sleep/cry apnea gerd vocal cord paral dysphag bronch aspir hydro (a deformation of cerebellum, medulla and c-spine and hernation, causing block of csf in 4th vent) |
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S/S shunt infection with kids with SB
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change in gait
fever scoliosis dec grip inc HA dec activity dec school performance weight changes inc incontinence irritability |
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S/S SB occulta
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inc UTI and LBP
inc subacut fat and hirsutism dimples skin pig changes |
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Spinda bifida etiology
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maybe dec folic acid, but no one knows- commen in cletic nations
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list three ventillator weaning stratigies
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1. spont breath trial with cpap
2. PSV- pt triggered breathes 3. simv- breathes are vent or spont |
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major goal for infants on ventillation
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prevent secondary complications
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Atrial septal defect results in:
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R sided elnargement
asymptomatic creshendo/decrecendo need surg to prevent heart failure in adults |
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ventral septal defect results in:
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pulm A enlrges with stenosis
Left sided enlargmement CHF from Inc work TIMING of surgery depends on - tolerance to defect - resp distress - wt gain |
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what is a patent ductus arterioris
results in |
l --> R shunt (aorta to pulm A )
CHF from inc work and bounding pulse |
