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384 Cards in this Set

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Under what conditions is a brachial plexus injury most likely to occur? (3)
-during a long and difficult labor and vaginal injury
-if the baby is larger (birth weight 3500 g) and mother has a small bony outlet relative to the baby.
-mother has materianl/gestational diabetes
How does a brachial plexus injury occur?
-Traction of the newborn's head or shoulder during delivery in a breech delivery
what is shoulder dystoncia
-the baby's anterior shoulder is not able to pass under the pubic symphysis without manipulation
what does the severity of a brachial plexus injury depend (2)
-number of nerves involves
-degree of injury
what is Erb's Palsy
-C5-C6
what is Klumpke's palsy?
C8-T1
what is Erb-Klumpke palsy
total paralysis of the arm C5-T1
list from most common to least common the types of brachial injuries
-Erbs Palsy (73%-86%)
-Erb-Klumpke (<1%)
_Klumpke (20%)
what is the clinical presenstaion for Erb's Palsy (AKA, and presentation of arm and what is ABSENT)
-AKA waiter's tip position
-arm AD and IR with elbow extension, forearm pronated, wrist and fingers flexed
-Absent Biceps, and raidal reflex
T/F: The grasp reflex is absent in Erb's Palsy
-False, grasp reflex is present, biceps and radial reflex is Absent
what is Klumpke's palsy clinical presentation (presentaion of UE and what is absent)
-complete or partial paralysis of intrinsic mm of hand and long flexors or wrist and fingers
-Grasp reflex is asbsent
T/F: Grasp reflex and Biceps reflex are intact in Klumpke's palsy
False, Grasp reflex is absent and Biceps DTR is intact
what is the clinical presentation of Erb-Klumpke palsy
-complete paralysis
-flaccid arm with absent reflex
T/F: with brachial plexus injuries all of the following will be absent: Moro, ATNR, STNR
False, MAY be absent/asymmetrical or dysfunctional
When do children recover from brachial plexus injury?
-spontaneously in first two months.
-if not completely resolved by 6 months will most likely have permanent UE impairment
For Erb's Palsy: what wil be impaired actively
-shoulder shrugs (C5)
-Biceps curls (C6)
-weakness down the UE on the radial side
For Erb's palsy: what will be impaired passively
-Arm ABduction, ER, elbow flexion, forarm supination, wrist and finger extension
For Klumpke's palsy: what will be impaired actively
-Wrist extension (C8)
-finger AB (T1)
-weakness in hand and ulnar side of UE
For Klumpkes palsy: what will the impaired passively
-flexion of the fingers and wrist
T/F: WIth Erb-Klumpke ALL reflexes are absent
True, because COMPLETE paralysis
What are the components of the PT exam for brachial plexus injury
-birth hx
-medical hx
-PROM/AROM
-strength
-development/functional skills
-standarized testing
T/F: The first 7-10 days work on strength for babies with brachial plexus injury
FALSE, wait till after 10 days because need to wait for the edema to go down.
What factors do you need to consider for positioning a baby with brachial plexus injury
-early on
-affected arm within visual field
-body and head in midline
-prone
-utilize sidelying
-positioning arm in a functional place, not in palsy positon (AB, ER, with elbow flexion and during activities incorporating the arm)
when do you begin PROM in babies with brachial plexus injury and why
-DAY ONE
-as activity returns the arm has the appropriate ROM to use the strength to its fullest capacity
what are some active and active assisted movements appropriate in terms of the developmental sequence one can do with a baby with a brachial plexus injury
-reach and grasp
-hands to mouth
-hands to feet
-activities that move scapula and facilitate NORMAL movement
T/F: You would not integrate prone until the baby has enough strength to be in prone in a baby with brachial plexus injury
FALSE, try to follow the normal developmental sequence and incorporate the affected arm as possible
T/F: tactiale stimulation is not necessary for babies with brachail plexus injury
False, need to integrate sensory awareness and tactile stimulation as much as possible
T/F: don't use Estim on babies with brachial plexus injury
False- according to the notes?!?
If convential physical therapy doesn't seem to work, what other options are available for babies with brachial plexus injury (2)
-Surgery
-Botox
if a baby with a brachial plexus injury does not resolve within 12 months, what is the prognosis
-may have long term impairment
Describe Spina Bifidia
-a neural tube defect that causes neuromuscular dysfucntion (paralysis)
what is the preventative measure that women who are pregnant can take in order to prevent spina bifidia?
-600mg of folic acid during first trimester (all women should take 400mg)
T/F: Most babies with spina bifidia die
False, 90% survival rate. It depends on the level if happened high up C5ish than effects diaphragm
what are the names that are synomous with spina bifida (7)
-myelomeninocele
-meningomyelocele
-spina bifida
-spinia bifida aperta
-spinia bifidia cystica
-spinal dysraphism
-Myelodysplasia
what is the presentation immediatley after birth for spina bifida
-external sac on infants back that contains meninges and spinal cord tissue
where does spina bifida usually occur
-lumbar spine
T/F: the shape, size and content of the sac dictates the degree of impairment
-false
Describe spinia bifida occulta
-nonfusion of halves of vertebral arches but does NOT disturb underlying neural tissue
-midline tuft hair with or without skin pigmentation
-high possibility of tethered cord
-associated urinary tract disorders
Describe Myelocele
-protruding sace containing meninges & CSF
-nerve roots and SC remain intact and in position
T/F: babies with myelocele have motor, sensory deficits
False, the don't have motor, sensory, associated hydrocephalus or CNS dysfunction
Describe Lipomeningocele
-superficial fatty mass in the lumbar/sacral level of the SC
-No signficant neurological deficits
-high incidence of tethered cord, B/B issues
-may have distal leg/foot dysfunction
when does differentiation of neural tube begin in gestation
-day 18, completed by day 24 (cranial) 26 (caudal)
what can be done dx for spinia bifida
-test for leaking of AFP (alpha fetal protein)
-examination of head will have lemon shape because frontal bones will be flat "lemon sign" which will disappear at 24 weeks because hydrocephalus will push it out
what are related impairments to spinia bifiida (11)
-joint deformity
-osteoporosis
-UE dysfunction
-cranial nerve palsies
-spasticity
-seizures
-neurogenic B/B
-skin breakdown/decubitus ulcers
-obseity
-hydrocephalus
-low tone above the lesion
what are common areas of developmental delays in children with spinia bifida
-head, trunk control, righting and equilibrium response with minimal to moderate developmental delay
what are some factors that lead to impaired cognition for children with spina bifida
-tx of hydrocephalus
-episodes of cerebral infection
-CNS abnormalities
what types of cognitive issues are associated with children with spinia bifidia
-low IQ
-arithmetic achievement
-ADD
-poor language development (cant comprehend stories)
-visual-perceptual-organization deficits
-visual-spatial difficulties
-occular dysfunction
How is spinia bifida initially managed
-C-section to minimize trauma to sac
-surgical closure within 72 hours of birth
-monitoring of hydrocephalus because most children begin to develop it after closure
what is Chiari II
-CB herniation thru foramen magnum because of deformitiy of CB, Medulla, cervical SC
-most children with Chiari Ii will develop hydrocephalus
what is the presentation of Chiari II malformation
-sunsetting- downward devitation of eyes and separation of the cranial sutures with a bulging anterior fontanelle
what is the initial management of chiari II malformaiton
-insertion of VA or VP shunt
-VP usually because CSF can be reabsorbed
what is the post op precautions (PT) of a baby with VA or VP shunt
-PT can begin 24-48hours post op
-if have significant hydrocephalus dont handle because unsafe
-ICP can drop dramatically if held upright too quickly can lead to vascular insult
-may be limited to prone or sidelying
When does PT have a role for spina bifida
-at all ages, but is setting dependent
what are the components of the PT exal/exam for baby with spina bifida
-ROM (hip flexors and AD tight)
-MMT (hams)
-sensory
-LE movement
-able to perform antigravity movement
-gross motor appropriate for age
-functional mobility
-posture alignment
what may be a unique presentation in babies with throacic paralysisq
-no activity at hip joint, but movement at knee or ankle that is not volitional
what are the PT interventions that are used in babies post back closure
-ROM (prevent contracture)
-posture (scoliosis is common)
-Family education (testing temperature, skin checks, redness post 30 minutes of skin removal=adjust brace)
-position to facilitate upright and normal development, short periods supine, midline
-AD
-orthortic/bracing
-aquatic therapy
-Adapated PE
-LE WB
-compensatory strategies
-functional mobility
what AD may be appropriate for a child with spina bifida
-gait trainer initally
-rolling walkers, quad canes, lofstrand crutches, wheelchairs
What are symptoms you want to tell the parents to look out for in children with spina bifida
-dropping eyelids (sunsetting)
-UE weakness that is NEW or stiff (hypertonus) because may be hyrdomyelia
-welling around trachea (anaphaletic shock from latex allergy)
what are the PT interventions that are used in babies post back closure
-ROM (prevent contracture)
-posture (scoliosis is common)
-Family education (testing temperature, skin checks, redness post 30 minutes of skin removal=adjust brace)
-position to facilitate upright and normal development, short periods supine, midline
-AD
-orthortic/bracing
-aquatic therapy
-Adapated PE
-LE WB
-compensatory strategies
-functional mobility
what AD may be appropriate for a child with spina bifida
-gait trainer initally
-rolling walkers, quad canes, lofstrand crutches, wheelchairs
what is hydromyelia
-CSF migrates to SC with increased fluid has increase pressure which leads to necrosis of peripheral nerves
What are symptoms you want to tell the parents to look out for in children with spina bifida
-dropping eyelids (sunsetting)
-UE weakness that is NEW or stiff (hypertonus) because may be hyrdomyelia
-welling around trachea (anaphaletic shock from latex allergy)
what are symptoms of latex allergy
-watery/itchy eyes, coughing, hives, rash
what is hydromyelia
-CSF migrates to SC with increased fluid has increase pressure which leads to necrosis of peripheral nerves
what are symptoms of latex allergy
-watery/itchy eyes, coughing, hives, rash
what are some common allergies that babies with spina bifida may have
-latex, bananas, chestnuts, avocados and kiwi
Describe tethered cord
-adhesions anchor the SC
-excessive stretch can cause metabolic changes and ischemia
-leading to changes in gait, tone, strength, pain
IF scolosis is functional what may you see
-Leg length discrepancy
what is non-structural idiopathic scoliosis
-curves correct on lateral trunk bening and usually cause pelvic obliquity, LL discrepancy or medical spasm
what is structural idiopathic scoliosis
-fixed, no correction with mvmnt or traction
what are some common allergies that babies with spina bifida may have
-latex, bananas, chestnuts, avocados and kiwi
Describe tethered cord
-adhesions anchor the SC
-excessive stretch can cause metabolic changes and ischemia
-leading to changes in gait, tone, strength, pain
IF scolosis is functional what may you see
-Leg length discrepancy
what is non-structural idiopathic scoliosis
-curves correct on lateral trunk bening and usually cause pelvic obliquity, LL discrepancy or medical spasm
what is structural idiopathic scoliosis
-fixed, no correction with mvmnt or traction
How is scoliosis names
-region and direction of CONVEXITY
what is the difference between a primary curve and secondary curve
-primary curve is largest curve
-secondary curve can be caudal or cephalad in relation, is in the opposite direction of primary curve and is smaller
T/F: there is rotation that is seen with flexion in scoliosis
True often
what affect does scoliosis have on the vertebral bodies
-rotate toward convex side of surve with SP rotated toward concavity
What are dx tools used for scoliosis
-at school: forward bend test, asymmetries A/P
-Moire topography: NOT x-ray helps show postural asymmetries
-Integrated shape invesigation system- computer image puts in 3 planes to see trunk contours
what metod is often used for measuring angles
Cobb method
What is the PT mangement of scoliosis
-to prevent secondary effects use core strenthening and selective stretching
**(hip flexors, quads and IP may be tight)
what is the management of a scoliotic curve of <25 degrees
-strength/stretch
what is the management of a scoliotic curve of 25-40 degrees
-bracing
what is the management of a scoliotic curve of >40 degrees
-surgery and bracing
what braces are used in order to help with scoliosis
-Milwaukee brace-(neck, pelvic components with 3 point pressure system against curve)
How long do patients have to wear a brace in order to be effective
-18-23 hours a day until skeletal maturity
What are the indicators of spinal surgery for scoliosis
->40 degree curve that will worsen even with conservative management, issues with thoracic activity
what is used for surgery for scoliosis
-harrington rods
-they apply distraction and compression as needed to curve, corrects rotary component, stabilizes the spine and maintains normal lordosis/kyphosis
what is the laymans word for congenital talipes equinovarus
-clubfoot
Describe the position of congenital talipes equinovarus
-ankle plantar flexion, hindfoot varus, and forefoot adduction
-often have neurological component (limited innervation)
what is the most likely cause of congenital talipes equinovarus
-intrauterine position
what is the treatment for congenital talipes equinovarus
-splint/cast to restore alignment and correct deformity if possible
-surgery with splinting or serial casting after
-ponseti boots are for night wear after surgery or can be used conservatively
what is the purpose of ponsesti boots
-pulling the feet out of the direction of ankle plantarflexion, hindfoot varus,and forefoot adduction
T/F: A child will have delayed motor milestones if they had congential talipes equinovarus
-True IF they have delayed WB for a long period of time
what is congenital metatarus adductus
deformation of forefoot in adducted position
what is often the cause of congenital metatarus adducts
intrauterine positioning
what is the treatment for congenital metatarsus adductes
-splint/casting
-surgery with splinting
when does a mild case of congenital metatarus adductus resolve
-4-6 months
(you will be able to correct manually to beyond neutral)
what will you be able to manually correct with a moderate case of congenital metatarus adducts
-correction only to neutral
what will you be able to manually correct with severe case of congential metatarsus adductus
-rigid forefoot, no correction toward midline position
-may have medial subluxation of tarsometatarsal
T/F: with congential talipes equinvarus there may be decreased sensory/motor
TRUE
what are longitudinal deficiencies
- a congenital limb deficiency that is reduced or absent of a limb with in the long axis
T/F: normal skeletal elements may still exist with longitudinal deficiencies
True
what are common longitudinal limb deficiencies
-proximal femoral focal deficiency (PFFD)
-radial deficiency (radial hand)
Describe radial clubhand
-1 in 100,00 births, 50% are bilateral
-can be missing any part or formation on radial side of arm
what can components from the radial side of the arm may be missing in radial clubhand (5)
-radius
-carpals
-metacarpals
-phalanges of 1st ray
-thenar musculature
Describe Proximal femoral focal deficiency
-15% of cases are B
-Class A least involved -Calss D most involved
-absence or hypoplasia of proximal femur
what components may be affected with proximal femoral focal deficiency (7)
-acetabulum
-femoral head
-patella
-tibia
-fibula
-cruciate ligament
-foot
T/F: All forns of proximal femoral focal deficiency includes hip instability
TRUE
with longitudinal deficiencies what may be part of your intervention
bracing
Define Transverse limb deficiency
-a congential limb deficiency that that limb develops normally to a level, but there is NOTHING beyond it
is it more common in males or females and is it more comon left or right
-females
-left 2:1
T/F: Bracing is often used in babies with transverse limb deficiency
False, prosthetic
what types of surgeries are associated with longitudinal deficiencies (5)
-tendon transfers
-realignmnet/repositioning
-osteotomies
-fusions
-lengthenings
Describe a rotationplasty for PFFD
-amputation through knee, foot/ankle turned 180 degrees for use in BK prosthesis
what children are appropriate for rotationplasty for PFFD
-with unilateral involvement
-predicted limb length where the ankle would be at opposite knee ht at maturity
-stable hip
when is foor amputation and proximal reconstruction appropriate for children with PFFD
-more severe cases of PFFD
-before 8 months to fit for prosthesis
When is limb lengthening indicated
-60% for predicted femoral length is present OR limb length discrepancy of <15cm
-NOT for bilateral PFFD or unstable hips
-8-10 years old
what are the two methods of limb lengthening
-ilizarov
-wagner
what is the Ilizarov method
-corticotomy followed by placement of external fixator rings above and below corticotomy site
-telescoping rods lengthened .25mm 4X/day until desired length achieved
what is the wagner method
-osteotomy wtih rapid distraction
-external device until desired length is achieved followed by internal fixation and bone gracting to support the gap created
-new bone grows and fills in gap and fixation removed
-faster than Ilizarov, but requries 3 surgeries
what are other things to consider for congenital limb deficiencies (7)
-serial casting/night splinting
-parent education regarding infection/pin site
-emphasis on increasing ROM
-possible limited WB status
-prevent contractures
-maintain strength in other areas
-gait training
define developmental dysplasia of the hip
-abnormal growth and development of hip joint
what hip anomolies may be included into developmental dysplasia
-disruption of depth or diameter of acetabulum
-disruption of development of femoral head and its shape
-factors that change femoral anteversion
what is developmental dysplasia of the hip caused by
-malposition/in-utero mechanical factors
what could go wrong in utero that cause developmental hip dysplasia (3)
-breech positoin
-hormone induced ligament laxity
-genetics
what is the classification of newborn hips (5)
-normal (no instability)
-subluxatable (femoral head is in acteabulum but can be partially displaced
-dislocatable (head in acet. but can be fully displaced using Barlow maneuver)
-subluxed (head rests partially out of acte. but can be reduced)
-dislocated (head is completely out)
what are the clinical signs of DDH
-galeazzi's sign (apparent uneven femoral lengths)
-asymmetry of gluteal folds
-limited/asymmetical abduction ROM
-trendelenburg (uni)
-waddle (bilateral)
-ambulate with hip ab
-ambulate with circumduction
-ambulate with limp
how is DDH managed
-splinting (6-12 months)
-traction with Pavlik harness (6-12 months)
-abduction orthosis(if ambulatory) (6-12 months)
-closed reduction under anesthesia and hip spica cast
(6-12 months)
-surgeries(soft tissue release, osteotomy of proximal femur to replace head into acetabulum, removal of portion of femoral shaft to decrese forectes on head after relocation, actabulum osteomy)++after 12 months
what are the goals of treatment for DDH
-early treatment to minimize permanent change in femoral head shape and /or acetabular shap
retrun head to normal position and maintain
Describe pavlik harness
-keeps hips at 90-100 flexed
-allws hips to fall into ab(stretch ad)
-worn 24 hours/day
-allows remodeling to occur
what are the complications of pavlik harness
-avascular necorosis
-femoral nerve palsy
-inferior dislocation
Describe Legg-calve perthes
-self limiting disease caused by avascular necorsis that disrupts flow to capital femoral epiphysis
what can set off legg-calve perthese
-avascular necorosis caused by trauma, synovitis, infection, vascular abnormalities, thrombotic insults
what population is most likely to get Legg-calve Perthese
-boys between 3-13 y/o (5-7)
10-20% are bilateral
Name the 4 stages of progression for Legg-Calve progression
-condensation
-fragmentation
-reossification
-remodeling
Describe the following stage of Legg-calve progression:
Condensation
- part or all of femoral head necrotic
-bone growth ceases
-necorsis resorbed and fragmented
-revascularization initiated
Describe the following stage of Legg-calve progression:
Fragmentation
-deformed femoral head and actebulum
Describe the following stage of Legg-calve progression:
Reossification
-due to revascularization
Describe the following stage of Legg-calve progression:
Remodeling
as femoral head grows both head and acetabulum remodel
what is the clinical presentaion of Legg-calve perthes disease (5)
-limp
-pain referred to groin, thigh or knee
-limitation in hip ROM (IR, AB,Flexion)
-trendelenburg
-adductor and IP spasm
what is the medical management for Legg-Calve Perthes
-femoral or innominate osteomy
what types of orthosis may be used for Legg-calve perthes
-petrie cast
-scottish rite orthosis
what is the PT management of Legg-calve perthes
-relieve pain, decrases spasm
-restore ROM
-strength-especially hip extension and abduction
-gait
-partial WB for pain relief
Describe slipped capital femoral epiphysis
-displacement of femoral neck from normal alignment with femoral neck
what population does slipped capital femoral epiphysis often happen in
-african american males after puberty
what is slipped capital femoral epiphysis oftten due to
-stress on growth plate caused by: excessive weight, torsion from trauma, growth plate weakness due to sudden growth
what are the classifications of slipped captial femoral epiphysis
-Acute (pain < 3 weeks)
-chronic (pain > 3 weeks wtih gradual onset
-Acute on chronic (hx of mild symptoms > 3 weeks with recent sudden exacerbation)
what are the different grades assoicated with slipped capital femoral epiphysis
-grade I= fem head displaced up to 1/3 width of neck
-grade II= >1/3 but less than 1/2
-grade III=>1/2
what are the clinical presentations of slipped capital femoral epiphysis
-groin pain
-medial thigh or knee pain
-limp usually with the LE in ER
-limited hip ROM (flexion, AB, IR)
-When asked to flex hip, will ER
what is the management of slipped capital femoral epiphysis
-stabilize growth plate with pin fixation and PT
-surgery prevents secondary complication like arly OA, AVN, chondrolysis
what is the PT management for slipped capital femoral epiphysis
-gait training with AD usually NWB status post up
Describe what the neurological exam for idiopathic toe walking with look like
-WNL, but have soft signs
what are soft signs for neurological exams
-moving "a little" differentq
what is idiopathic toe walking often associated with delays in:
-speech
-language
-fine motor
-gross motor
-sensory processing disorder
what is the clinical presenation for idiopathic toe walking
-toe walking with standing, crusing (which is typically, but decreases drastically in normal)
-MAY have limited AROM, PROM DF
-MAY be able to have heel strike
-MAY have eccentric quad control
-impaired balance
what is idiopthic toe walkers prone to
ankle sprains
what may be a reason for idiopathic toe walking
-to increase amount of sensory input
what conditions may present as idiopathic toe walking that need to be differentiated
-heel cord contracture
-leg length discrepency
-spasticy caused by pathology (CP)
-club foot
what makes up your exam for idiopathic toe walking
-how long child been walking that way
-all the time/periodically
-look at shoes fo type, wear pattern, tolerating
-PROM, AROM
-Functional skills
-Developmental skills
-Functional strength
-Gait
what is the PT management for idiopathic toe walking
-gait training
-stretching
-balance
-HEP
-core strengthening
-serial casting
-bracing/orthotics
-night splinting
what types of bracing/orthotics used for idiopathic toe walking
-high top sneakers/boots with carbon fiber hot dogs or cross trainers wtih carbon fiber hot dogs
-SMOs
-AFOs
why is core stregthening important for idiopathic toe walking
-if increase amount of stabilization than will allow better distal movement
what will happen if conservative measures fail afte 12 months
-operative lengthening
what is the px for idiopathic toe walkers
-ambulation with flat foot or heel-to-toe gait for one year
How many chormosomes does a child with down syndrome have
-47 instead of 46, have 3 copies of chromosome 21
what is mosaicism in children with down syndrome
-only a portion of the cells are affected. These children may have normal intelliect and motor but still exhibit behvaiors such as flapping.
what is translocation in a child with down syndrome, typically happens with what chromosomes
-the extra long arm of the chromosome breaks off and attaches to another.
-14,15,21,22
what medical conditions are pts with down syndrome more at risk for (110
-congenital heart defects
-respiratory problems
-hearing problems
-Alzheimers disease (early onset dementia)
-childhood leukemia
-thyroid conditions
-increased risk for ear infections
-carriers of Hepatitis B
-constipation
-atrioventricular and ventricular septal defects
-orthopedic/musculoskeletal problems
what are seconday medical disorders that may occur with pts with down syndrome (5)
-obesity
-diabetes
-CV disese
-OA
-Osteoporosis
Describe a typical pt with down syndrome (11)
-flattened nasal bridge
-almond eye shape
-flat occiput
-muscle hypotonia
-joint hyperextensibility
-congenital heart disease
-short limbs, short broad hands and feet
-epicanthal folds
-high arched palate; protrusind fissured tongue
-delayed acquidition of gross motor skills
-Simian line
what are secondary impairments that are often associated with down syndrome
-patellar dislocation
-excessive foot pronation
-scoliosis
-hip dislocation
-difficult with midline UE mvmnt
-atlantoaxial instability
-gait abnormalities
what gait abnormaliites will often be seen in pts with DS (5)
-shorter step lengths
-increased knee flexion
-hyperextension in stance
-decreased SLS
-increased hip flexion posture
what test and measures are typically performed in PT with pts with DS (12)
-strength
-tone
-gross motor skills (GMFM and Bayleys)
-congnition
-Cardiopulmonary
-balance
-functional mobility
-gait analysis
-range of motion
-coordination
-posture
-reflexes
why does the SMO help pts with DS (3)
-improve proprioceptive feedback
-improve midline positioning
-facilitates usage of ankle strategy
Describe the postural control capability of most pts with DS
-intact postural mechanisms, but requires additional time and verbal instructions
-do NOT have anticapatory balance responses
what is altanto occipital instability caused by
-ligament laxity
-can't be read on radiograph until 3 y/o
what is the prevalence of altanto occipital instability
10-20%
what do PTs need to look out for with altanto occiptal instability
-neurological sign changes
-torticollis
-neck pain
-limited neck mvmnt
what mvmnts need to be monitored to decrease likelihood of altanto occipital instability (5)
-exaggerated cervical flexion
-cervical extension
-cervical rotation
-joint approximation
-placing child in inverted positon
what is Fragile X
-genetic disorder by genetic mutation in FMR1 gene
what is the scale from normal to full mutation for repeated gene codes
-normal < 50
-premutation 50-200
-full mutation >200
does fragile X present differently in boys and girls
Yes- in girls with full mutation have learning impairments but are able to function and girls with premutation may appear more normal, but delayed. Boys are MUCH more affected because only have one X.
How is fragile X dx
genetic testing
what is the age of concern, professional confirmation and than dx on average
-concern: 13.3 months
-professional confirtmation:20.7
-dx: 31.5 months
What is Fragile X's relationship to Autism
-1/3 of children with Fragile X will have Autism
what are the characteristics for a child with premutation Fragile X
-normal intellect
-prominent ears
-psychiatric problems
-males after 50 may have taxia and/or tremors
-females may have premature ovarian failure
what are the characteristics for full mutation for a child with Fragile X (10)
-moderate to severe intellectual impairment
-language disorders
-learning disabilities
-social/behavioral difficulties: anxiety/social avoidance
-strabismus
-connective tissue dysplasia
-joint laxity
-pes planus
-facial deformities
-macro orchidism in adolescent males
what is strabismus
-when the eyes do not line up the same, therefore look at different objects
what is macro orchidism
-large testes
What sensory symptoms are more commonly found in children with Fragile X than other disabilities
-tactile sensitivity
-poor auditory filtering
-low energy/weak muscle
What is the role of a PT in children with Fragile X syndrome
-recommend geneit testing
-developmental stimulation
-facilitation with attention to adaptive behaviors
-proper response to sensory
-motor planning (knowing how to perform with difficulty and anxiety)
-WB and weight shifting for transitions
-joint laxity- need orthotics
What is hemophilia
-a X-linked blood coagulation disorder that have a factor VIII deficiency (Hemophilia A) or factor VI deficiency (Hemophilia B)
what are concerns with Hemophilia
-sponataneous bleeding
-often affects joints
-recurrent episodes can lead to chronic synovitis and degenerative arthropathy
What are the stages of Hemophilc arthropathy (Don't memorize get the general gist)
-I= no bony abnormailiites, but soft tissue swelling
-II- osteoporosis and overgrowth of the epiphysis but joint integrity is maintained
-III= subchondral cysts visible, squaring of the patella, intercondylar notch of the knees and trochlear notch of the elbow are widened
-IV= joint space is narrowed and cartilage is damaged
-V= fibrous joint contracture, loss of joint space, extensive enlargement of epiphyses, total destruction of the articular cartilage
What are the two common sites of bleeding for pts with hemophilia
-most common in the joint
-second most common in the muscle
how is severity of hemophilia determined
-amount of factor activity, the less factor, the more severe the condition
what is the most diabling consequnce of hemophilia
-joint arthorpathy
T/F: children with mild case can be dx in infancy
-Flase, may not be diagnosed in infancy or childhood
what pecentage of pts wtih hemophilia have the severe form
over 60%
what is prophylactic treatment used for
-decrease/prevent bleeding episodes (including prior to exercise)
when is prophylacitc treatment considred primary
-when started before any joint bleeds
when is prophylacitc treatment considred secondary
-is started after a specific # of joint bleds
what is the medical management of hemophilia
-replacement of deficiet factor
-rest
-immobilization
-avoiding weight bearing
-surgery
The decreased mm function seen in pts with hemophilia is characterized by:
-muslce atrophy (immobilization)
-reflex inhibition of alph mn pool of quads
-deficient ratio of quads:hams (hams stronger, normally hams weaker)
What are considerations for PT for pts with hemophilia
-NO PROM
-isometric mm contractions used
-in supine and sitting encourage full fknee extension
-active resistive exercise may be initated with knee flesion is @ least 90 and there is less than 15 degree flexion contracture
what are the consdierations for strengthening program for pts with hemophilia
-isometrics fo as long as joint is swollen, hot and can't be moved without pain
-active assisted, acitve, resistive then concentric?
-progressively resistive exercises are best done in closed chain
-high reps and low load
-slow speed isokinetics AVOIDED
what is the px for pts with hemophilia
-severe joint deterioration by adolescence unless using prophylaxis relgiously
Define Developmental coordination disorder
-coordination difficult that is NOT due to a general medical condition, does NOT fit the criteria for developmental pervasive disorder
-motor impairment that is chronic/permanent that interfers with ADL/academics/social
T/F: Mental retardation is not present in children with developmental coordination disorder
-False, mental retardation may be present, but needs to be less extensive in comparison to the motor impairment
what are some other names that developmental coordination disorder has been called (7)
-poor muscular coordination
-developmental apraxic and agnosia
-minimal cerebral dysfunction
-minimal brain dysfunction
-minimal cerebral palsy
-developmental dyspraxia
-clumsy child
what issues do children with developmental dyspraxia exhibit
-difficulty integrating informtaion from the bodily senses.
-difficulty with motor sequencing
what is the definition of developmental dyspraxia
-marked impairment in the development of motor coordination
what co-morbid conditions are associated with developmental coordination disorder
-learning disabilities
-attention deficit disorder (ADHD)
-disorder of attention, motor control and perception (DAMP)
-speech and language disorders
what are some possible etiologies for DCD
-prenatal, perinatal and postnatal incidents affecting brain development
-children born at risk (low birth weight, hyperbilirubinemia, respiratory problems, low APGAR)
-clumsines as a family feature
what is the exam findings for children with DCD
-immature mvmnt pattern
-inconcsistent motor response
-delayed/absent postural reactions
-joint laxity
-poor strength: poor trunk extension
-impaired visual perceptual skills
-implications on daily living skills
-implications with academic achievement
-gait impairment
-delayed acquisition of higher motor skills
-distractibility
-difficulty with high level manipulation and coordination skills (ex: buttoning, zipping, typing,make up)
-limited ease in participation for sports/PE
When is DCD identified
-school age mostly
-delayed motor milestone
what is the first indicators of DCD
-delayed milestones
T/F: early intervention is crucial for children with DCD
-True, esepcially for self esteem
what are some treatment approaches for children with DCD
-sensory integration approach
- neurobehavioral approach
-physical education
intervetions under what priniciples often most effective for a child with DCD
-systems theory
-motor learning
-cognitive (problem solving)
what are strategies a practioner can use to facilitate a productive session with a child with DCD (9)
-cogntive strategies
-task specific
-verablizing body position
-cueing of attention to task
-known pattern of words for task
-child centered
-focuses on functional performance increase
-repeated practice
-modeling/demostrations
-don't handle in order to facilitate Independence
what is the goal of PT for children with DCD
-to generalize the skills to multiple environments
Define CP
-nonprogressice neurodevelopmental disorder caused by defect/lesion in the immature brain that are usually by some level of motor and/or cognitive impairment as well as other impairments possibly
when does typcially the lesion occur in the child with CP life
-in utero or shortly after birth
what are possibly causes of CP
-disorders of coagulation
-intrauterine exposure to infection or inflammation
-neonatal encephalopathy
-neonatal oxygen-induced or ventilator-induced lung injury
-insufficient levels of developmentally regulated proactive substances
what are the 3 ways a child with CP can be classified
-mvmnt abnormaility
-area of the body with motor impairment
-level of severity
what mvmnt abnormalities are associated with children with CP
-spastic
-hypotonic
-dyskinetic
-ataxic
-mixed
how can a child with CP by classified in realtion to the area of body with motor impairment
-monoplegia
-diplegia
-hemiplegia
-quadriplegia
what are the levels of severity
-mild
-moderate
-severe
what is the clinical presentation of a child with CP (15)
-progressive musculoskeletal impairments (proximal mm weakness)
-impaired coordination
-delayed postural reactions
-altered mm tone
-persistence of primtive reflex
-delayed motor development
-50-75% cognitive delays or learning disabilities
-speech disorders
-auditory impairments
-visual abnormalities
-hypoextensibility of mm
-weakness
-selective motor control
-impaired anticipatory regulation
-decreased ability to learn unique mvmnts
describe a child with CP mm extensibility
-gives resistance to passive strength at a shortened length in compairosn to what is expected
what is the scale for modified Ashworth scale (0-5)
0: no increase in mm tone
1: slight increase with catch and release
2: slight increase in tone with catch and resist
3: marked increase in tone
4:passive movement is difficult
5: rigid
what types of tone are associated with children with CP
-spasticity
-rigidity
-athetosis
-choreoathetosis
-ataxia
Describe hypertonia
-abnormally increased resistance to externally imposed mvmnt
-velocity dependent overactive stretch reflex
Describe hyperkinetic mvmnt
-excessive mvmnt with voluntary and/or involuntary mvmnt
Describe dystonia characteristics
-abnormal psotures superimposed uon or subsituting for voluntary mvmnt
-postures are repeated
-postures may be sustained or occur briefly
-increse with mvmnt, can be triggered by attempt at voluntary mvmnt
-does not occur at rest
-predictable
-sustained mvmnt
-slower
describe chorea characteristics
-ongoing radom appearing sequence of one or more discrete mvmnts or mvmnt fragments
-individual mvmnts may or may not have a distinct stop/start and end point
-inability to maintain a voluntary posture
Describe Athetosis
-continous smooth writhing mvmnt
-typically invovles distal extremities more than proximal
-may invovle face, neck and trunk
-may occur at rest
-rarely occurs in childhood in isolation
-performed with large ROM
-not as jerky as chorea
what are the medications used for spasticity mangement
-Baclofen
-Diazepam
-Dantrolene
-Tizanidine
What is the action of Baclofen
-acts at GABA receptors in SC
what is the action of Diazepam
-acts at CNS
what is the action of Dantrolene
-acts at skeletal mm beyond myonerual junction
what is the action of Tizanidine
-central acting SC and supraspinal
Describe Botox
-neurotoxin that blocks transmission at the NMJ
when does botox get the best results
-when used for dynamic contractures vs static contractures
describe alcohol blocks
-chemically removes fat which ultimately slows down transmission. lasts up to 18 months
what are the cons of alcohol blocks
-a missed injection can cause sensory components to give a burning sensation
describe how a baclofen pump works
-has a catheter and a pump. The pump is surgicall placed under the skin and delivers baclofen directly into the SC significantly reducing the amount of medication requreid and associated side effects
what populations of children are given baclofen
-dystonia
-moderate to severe spaticity
Describe lengthening surgery
-a cut is made on mm that are high velocity and double jointed.
what are the most targeted mm groups for lengthening surgeries
-iliopsoas
-hip adductors
-semimembraneous
-gracilis
-semitendinosis
-biceps fem
-gastroc-soleus
what are PT treatment approaches for children with CP
-strengthening
-functional motor skills
-medications
-equipment to enhance mobility
-treadmill training: PWB
-lifespan approaches
what impairements are often associated in children with CP
-decresed strength
-spasticity
-hyperreflexia
-hypoextensibility
-poor selective control of mm activity
-impaired anticipatory regulation
what functional limtations are often associated in children with CP
-difficulty performing ADLs
-gait deviations
-decreased mobility
-decreased ability to learn unique mvmnts
-joint malaignment
-abnormal WB
-difficulty ambulating halls at school
-unable to participate in sprots
why is GMFM used in CP population
-assess lying, rolling, sitting, crawling, kneeling, standing, walking, running, and jumping when pts are between 5 months to 14 y/o
What disorders fall under Pervasive developmental disorders
-Autism
-Rett syndrome
-Asperger Syndrome
-pervasive developmental disorder not otherwise specified
what characteristics does the brain of a child with autism have that is different to someone who does not have autism
-increased white matter in brain
-thicker connection between different areas within each hemisphere
-decresed synchrony btwn prefrontal and parietal areas
-smaller corpus callosum
-abnormalities in the limbic system
what is the significance of having a smaller corpus callosum for a child with Autism
-decreased communication between the 2 hemispheres
what are the componets of the limbic system
-amygdala
-hippocampus
what is the purpose of the prefrontal lobe
-planning
-ability to alter strategies
what are movements guided by
-sensory information sent to the premotor cortex
what is within the parietal lobe
-somatosensory center
what is the purpose of the posterior parietal association cortex
-integration of sensory and motor info
what is the clinical presentation for children with Autism
-perservation
-detail oreinted, don;t like big picture
-clumsiness due to abnormal information to brain
-varying degrees of cognitive deficiets
-impaired social interaction
-impaired communication skills
-repetitive actions, body mvmnts
-obsessive interests
-lack of spontanity/make believe play
-persisten fixation on parts of objets
-gross motor deficits
-fine motor deficits
-coordintion deficits
-senosry processing dysfunction
-lack of environmental awareness
-difficulty with chagne in routine or familar surroundings
what are things you would want to know in the subjective exam for a child with autism
-birth hx
-medical hx
-developmental hx
-familys concerns
-familys goals
what makes up the PT exam for a child with Autism
-functional mobility
-safety in environment
-balance
-developmental skill performance
what are concepts that may be part of PT treatment
-developmental skill facilitation
-balance
-motor planning
-coordination skills
-core/posture strenghtening
Who makes up the "team" for a child with Autism
-family
-developmental pediatrician
-school personnel/teachers
-speech language pathologist
-occupational therapist
what gestational age is considered preterm, what age is considered minimal for survival
-<37 weeks
-23 weeks
what are the 3 major weight categories for preemies
-LBW: from 1501 to 2500 g (3-5 lbs)
-VLBW: below 1501 g (3 lbs)
-ELBW: below 1000g (2 lbs and under)
T/F: most neonatal deaths are due to premature death
-True 75-80%
what sensory input to premies miss out on in comparison to full term babies
-cutaneous and somesthetic input from amniotic fluid that fosters flexion, extension modulation for head, trunk and extremities
T/F: a premie may develop a negative response to touch
True- because all of the handeling, sleep disturbance, machinery etc a premie may develop an aversion to touvh
what is the period of witing for a baby
=5-6months of gestation to 1 year.
what are neurological conditions that are high risk and may lead to neurological, behavioral and cognitive issues
-Intraventricular hemorrhage
-periventricular leukomalacia
-neonatal seizures
-hypoxic-Ischemic Encephalopathy
what are cardiac conditions that are high risk and may lead to neurological, behavioral and cognitive issues
-patent ductus arteriosus
-bradycardia
what are pulmonary conditions that are high risk and may lead to neurological, behavioral and cognitive issues
-respiratory distress syndrome (RDS)
-Bronchopulmonary dysplasia and chronic lung disease of infancy
-apnea
what are system immaturity conditions that are high risk and may lead to neurological, behavioral and cognitive issues
-hyperbilirubinemia
-kernicterus
-necrotizing enterocolitis
-gastrophageal reflux
what are sensory conditions that are high risk and may lead to neurological, behavioral and cognitive issues
-retinopathy of prematurity
-hearing impairment
-sensorineural hearing loss
Due to the environment of the NICU, what presentaion may the baby develop
-hypersensitivity, poorly modulated behaviors, and all or nothing response
what interventions may be used for babies in the NICU to facilitate healthy brain development
-positioning
-clustering of nursery care activities
-modification of external stimuli
-individualized development care interventions
what is the purpose of clustering of care for babies who are in the NICU
-reduces the number of times a baby is disturbed so that they are able to get more deep sleep and facilitate growth and brain development
Different pieces of equipment/external stimuli that may be hooked up to a baby in the NICU
-bili lights
-cardiac respiratory monitor
-CPAP
-ET tube
-feeding tube
-incubator
-IV pump
-nasal cannula
-radiant warmer
-satruation monitor
-suction catheter
-umbilical catheter
-ventilator
-ECMO
what is the synactive theory
-states that infant behavior is determined by subsystems, environment, and family interaction
what are the 4 subsystems of infant behavior
-autonomic
-motor
-state
-attention/interaction
what is the role of the PT in NICU
-Idntify the premies sensory, motor, and emotional readiness
-help babt to achieve new levels of functional motor control
-identify best handling techniques for baby
-educate family about handeling technique, sensory, motor issues and how to help when they are alone with child
what requirements must a PT have to work in NICU
-advance training
-mentorship
-further education
-fellowhsip
what is the etiology of Cystic Fibrosis
-mutations in a single gene on chromosome 7
Describe cystic fibrosis
-progressive exocrine gland disorder
-leads to hyperplasia of muscus-producing cells in lungs
-excessive electrolytes secretion by sweat glands
-leads to impairment of lungs and pancreas the most
-significant involvement of the reproductive system, sinuses and sweat glands
How is a child with cystic fibrosis often dx
-parent reports "my child tastes salty to kiss" (excessive electrolyte secretion)
-sweat test
-genotyping
-family history
-nasal potential difference
-chest X ray with complications
what is the clinical presentaitn for someone with cystic fibrosis
-digital clubbing
-limited rib excursion, use of accessory mm of respiration, barrel-chest deformity
-nutritional status usally compromised
-airway obstruction due to excessive pulmonary secretions
what complications are associated with cystic fibrosis
-pneumothorax
-hemoptysis
-atelectasis
-bronchiectais
-cor pulmonale
-HTN
what other complications are associated with cystic fibrosis
-malnutrition/malabsorptions
-chronic inflammation of paranasal sinuses
-nasal polyps
-hepatobiliary disease
-gallstones
-CF- related diabetes
-infertility
-lung transplantation
what test and measures are appropriate for a pt with cystic fibrosis
QOL questionnaires, subjective reports, PFT/spirometry, Schwahman Score
what makes up the Scwahman score
chest radiography, growth, nutrition, pulmonary (physical findings and cough), case history & subjective reports of activity tolerance
what treatment is involved in pts with cystic fibrosis
antibotic treatment of infections, anti-inflammatory and inhaled steriod treatment inflammation, pancreatic enzyme supplements, nutritional therapy, airway clearance, mucolytic, bronchodilators, PT
What are PT issues for pts with cystic fibrosis
alighnment, protracted scapula, kyphosis, elevated shoulders, CV endurance
what are PT chest interventions for pts with cystic fibrosis
conventional (chest) PT which includes postural drainage, percussion, vibration
T/F: postural drainage may need to be modified
True, if pt has GERD
what is vibration timed with
expiration
what is PEP
postiive expiratory mask
what are alternatives to conventional PT
huffing, PEP, flutter and acapella
what is the purpose of flutter and acapella
oscillating positive pressure
what are PT interventions for pts with cystic fibrosis
postural training, WB, ball therapy, strength training, swimming, jogging, cycling
what are the benefits from chest PT for pts
increase peak O2 comsumption, incresed maximal work capacity, improved mucus expectoration
what is the goal for PT for pts with cystic fibrosis
improvement of exercise tolearnce with continued attention to secretion clearnace techniques
Describe osteogenesis imperfecta
congenital disorder of collagen synthesis affecting all tissues in the body that is marked by fragility of bone
what is the clinical presentation of osteogenesis imperfecta
diffused osteopoosis, excessive fractures, bowing of long bones, spinal deformities, mm weakness, ligament laxity, bone healing time is typical although callus is of poor quality
what other clinical featuers are associated with osteogenesis imperfecta
blue sclera, dentinogenesis imperfecta, hearing loss, growth deficiency, bruising, excessive sweating, dislocations
T/F: Osteogenesis imperfecta is genetic
False, there is a genetic type and one that has a spontaneous mutation
Describe the characteristics for OI congenita
most severe, most disabling that may lead to: numerous fx at birth, dwarfism, bowing or deformities of the long bones, blue sclerae, dentinogenesis, poor prognosis, high mortality rate due to intracranial hemorhagge or chronic respiratory infection in infancy
Describe the characteristics for OI Tarda
classified based on the degree of bowing of the extremnities or # of fx,
What are the different classifications for OI tarda and what can they do
OIT I can ambulate but require external support, OIT II most can reach normal height and ambulate
according to the Binder classifications, which children with OI are least mobile
children with the largest heads, shortest trunk, and bowed UE and frequenctly fx UE
According to the Binder classification what is the relationship between anthropometric abnormalities and severe scoliosis and joint laxity
children with the most significant anthropometric abnormalities were also the ones with the most severe scoliosis and joint laxity
What medications are used to manage OI
calcitonin, fluroide hormones, Vitamin C and D (all ineffective). Bisphosphates
what does bisophates help pts with OT do
effective in reducing fx rate and improving bone denisty, some MAY improve function
what are orthopedic manangement for OI
effective in reducing fx rate and improving bone denisty, some MAY improve function
what sports are recommended for pts with OI
bicycling, water sports, thowing/tossing balls on playground, wheelchair aerobics and T-ball (less severe
What are PT management concepts
gait training, braces to improve symmetrical gait, strenous activity (w/brace)
what is the management of a pt with OI in infancy
-pt education
-HEP
what is the management of a pt with OI in preschool
-WB and self mobility
what is the management of a pt with OI in school age to adolescence
-aim to ADLs
-functional mobility
what is the management of a pt with OI in adulthood
-skills necessary for independence
-most use either manual or motorized mobility
what is the etiology of MS
-genetic neuromuscular disease that restults in progressive loss of muscle contractility
-progression of mm weakness, muscle atrophy, contractures, deformity and progressive disability
How is MS dx
-confirmed with clinical exam and lab
-electromyography, mm biopsy, DNA analysis
what criteria is used to classify type of MS
-mode of inheritance
-age of onset
-rate of progression
-localization of mvmnt
-presence of genetic marker and mm morphological changes
what the types of muscular dystrophy
-Duchenne
-Becker
-congenital
-congenital myotonic
-childhood onset
-emery Dreifus
-spinal muscular atrophy
what are the characteristics of a child with Duchennes muscular dystrophy
-seen around 3-5 y/o, 1-4 years
-absent/deformed dystrophin protein
-rapidly progressice
-loss of walking by 9-10 y/o death in late teens, early 30's at best
what is the clinical presentation of Duchennes MD
-significant fatigue
-difficulty with energy conservation
-severe proximal weakness
-postrual instability
-gait deviations
what happens in MD to the mm tissues
-infiltration of mm and deteriorating mm function
what specific gait will be observered in pts with Duchennes MD
-increased lateral sway
-increased BOS
-contracture of calf mm
-in toeing
-limited hip flexion
-retraction of shoulder blades with lack of reciprocal arm swing
For a pt with Duchennes MD what will the PT exam consist of
-functional strength
-functional skills
-developmental skills
-ROM
-subjective (milestones, medical and PT tx)
Treatment interventions for pts with Duchennes MD (10)
-stretching
-braching/orthotics
-compensatory strategies
-energy conservation
-AD, W/C training
-positoining
-posture
-developmental skills
-functional mobility safety
-family/caregiver education
T/F: high resistance and eccentric exercises are benefical to pts with Duchenne's MD
-FALSE, should be avoided and is detrimental
Possible indicators of when a pt with Duchennes MD will no longer be able to walk
-50% reductionin LE strength
-MMT below grade 3 for hip extensors
-MMT below grade 4 for ankle df
-take 5-12 seconds to climb 4 standard steps, cessation of ambulation within 2.4 years
-if takes greater than 12 seconds to walk up 4 standard stairs, cessation of ambulation in 1.5 years
-if knee extensor lag in sitting AND hip extension in prone is greater than 90, cessation of ambulation within months
What changes occur during adolescence in pts with Duchennes MD
-walking becomes more difficult
-increase need of AD
-increase difficulty of ADLs
-mm weakness is more pronounced in trunk and hip muscles
-development of contractures in hip, TFL and gastrcos
what changes occur during adulthood in pts with Duchennes MD
-increased need for assistive care
-breathing exercises with postural drainage
-weak respiratory mm may lead to pulmonary infection
Describe torticollis
-asymmetrical/abnormal posturing of neck and head
(lateral translation of the head on trunk occurs in addition to variable degrees of lateral head tilt and neck rotation)
what is the etiology of torticollis
-direct injury/trauma to SCM
-rupture of mm
-ischemic injury
-infectice myositis
-neurogenic injury
-interuterine compartment syndrome
-hereditary factors
what is a common finding in babies with torticollis
-a fibrotic lumb in SCM between 14-21 days after birth that disappears around 8 months
What are some commonly associated problems with torticollis
-hip dysplasia
-club foot
-metatarsus adductus
-brachial plexus injury
-pelvic asymmetry
-scoliosis
-ear displacement
-ipsilateral mandibular asymmetry
-plagiocephally
what are the two major categories of torticollis
-congential muscular torticollis
-acquired torticollis
what is congential torticollis
-condition cased by unilateral fibrosis of the SCM
what are the risk factors associatd with congenital torticollis
-large birth weight
-male
-breech position
-multiple births
-difficult labor and delivery
-use of vacuum or forceps assist
-nuchal cord
-maternal uterine abnormalities
Describe the three subtypes of congenital muscular torticollis
-unilateral SCM mm contracture and a tumor during 1st 3months of life
-unilateral SCM mm contracture without a tumor
-postural torticollis
describe torticolllis to the Right
-ipsilateral side bend and contralateral rotation (Right side bend and left rotation)
what is the etiology of acquired torticollis
-traumatic with or without bony lesion
-non-traumatic with bony deformatin
-non-traumatic without bony deformation
what will you see with a pt with torticollis
-decreased cervical A/PROM
-limited in contralateral lateral flexion and ipsilateral rotation
-neck mm contracture
-mm strength imbalance
-persistence of ATNR
-impaired postural alignment
-trunk curvature toward the affected SCM
-pelvic asymmetry
-scoliosis
-periscapular tightness with scapular retraction
-skull and facial asymmetries and deformities
what are the functional limitations for a pt with torticollis
-impaired midline orientation
-difficulty achieving midline posture in upright verticle, prone, or supine positions with asymmetry and limitation in ability to weight shift and move
-unable to have purposeful symmetrical movement of head due to neck mm contracture and neck mm strengths imbalance
-neglect of ipsilateral hand
-decreased visual awareness on one side
-lack of symmetrical development of head and neck righting reactions
-delayed propping and rolling over involved side with limited WB ability to ipsi arm
-limited vestibular, proprioceptive, and sensorimotor development
-possible limitation in gross and fine motor movment
-delay in integration of automatic postural reactions/protective responses
what makes up the PT exam for a pt with torticollis
-cervical and trunk A/PROM
-muscle extensibility
-palpatation
-tone
-postural alignment
-gross motor skill performance
-UE function
-UE/LE WB, shifting
-Hip/pelvic alignment-leg length
-developmental reflexes
-skin integrity
-primary behvaioral state: tolerance to strecthing and ability to self regulate
-screen vision, hearing, speech
-subjective (prenatal/birth hx, GERD, time spent in positions, family concerns, goals, when first noticed asymmetry, position of devices/sleeping)
what is the HEP for babies with torticollis
-positioning with stimulus towards the side not looking towards
when is the best time to get management for babies with torticollis
-ASAP, within 12 months for better outcomes
what is part of the treatment for pts with torticollis
-manual
-developmental exercise/treatment
-orthosis fitting/fabrication
-family education
examples of ways to stretch SCM
-hold baby with tight side against elbow
-hold baby to chest with tight side at chest
who would you possbily need to refer out to for a baby with torticollis
-peditration
-cranial orthosis (helmet)
-developmental pedi
what is arthrogryposis, what may contribute to it
-curved or hooked joints
-conditions that impair movements in utero
-not genetic
-not progressive
what is the clinical presentation of arthrogryposis in most cases (shoulders, elbows, wrist, fingers, hips, knees, feet)
-shoulder AD and IR
-elbows /
-wrist and digits flexed
-hips may be dislocated and slightly flexed
-knees extended
-feet equinovarus
describe the clinical presentation for arthrogryposis for leg musculature
-hypoplastic
-featureless
-tubular
-hypotonic
describe the clinical presentation for arthrogryposis for soft tissue
-webbing (ventral aspect of flexed joint)
describe the clinical presentation for arthrogryposis for spine
-scoliotic
describe the clinical presentation for arthrogryposis for long bones
-slender
clinical presentation that can occur with arthrogryposis but rarely include
-microcephaly
-cleft palate
-crytorchidism
-cardiac and urinary tract abnormalities
what are other conditions that may be associated with arthrogryposis
-hemangiomas
-absent or decreased finger creases
-facial abnormalities
-respiratory problems
-abdominal hernias
-typical cognitive development
What are impairments that a baby with arthrogryposis may exhibit
-signficant loss of A/PROM
-contracture
-weakness
-mm imbalance
-insuffcient contractile tissue
what are functional limitations that a child with arthrogryposis may exhibit
-mobility skills throughout development
-ambulation
-posture/alignment
-endurance
What "disabilities" may a person exhibit with arthgryposis
-limited indepedence
-ADLs
-decreased functional mobility
what "social limitations" may a person with arthrgryposis exhibit
-decreased access to the environment
-limited community mobility
-limited peer interaction
-social isolation
how is arthrogryposis dx
-ultrasound
-immunoglobulin study
-thorough medical history
-X-rays
-physcial exam
-blood tests, mm biopsies, EMG testings
what surgeries may a child with arthrgryposis go through
-PMLR- posteriormediolateral release (clubfoot)
-muscle release
-tendon transfers
-bony fusions
-Ilizarov method for limb lengthening
what will a PT exam for a pt with arthrogryposis
-A/PROM
-developmental skill performance
-posture/alignment/positioning
-mobility skills
-function and/or isolated strength
what will be part of the subjective exam for a pt with arthrogryposis
-birth hx
-pregnancy
-compications
-surgical hx
-medical hx
-family goals
-parental percpetions at home skills/needs
-school services
-AD
what are some PT interventions for pts with arthrogryposis
-splinting
-stretching
-serial casting
-positioning
-strengthening
-address developmental skills
-teaching compensatory
-AD
-orthotics and bracing
what are the 3 main types of sensory modulation disorders
-sensory over responsive disorder
-sensory under responsive disorder
-sensory seeking
what are the characteristics for sensory over responsive disorders
-sensory avoider: fearful and cautious/negative and defiant
-quick intense "fight or flight" response to harmless sensations
-AKA defensiveness
what is the most common form of sensory modulation disorders
sensory over responsive
Describe sensory under responsive disorder
-inattentive, self absorbed, disengaged
-slow, sluggish responses to ordinary sensations; lost; loose floppy
-limited perception of pain; poor self protection
-intense sensory input needed to get in gear
Describe sensory seeking disorders
-sensory craver or bumper and crasher
-constant search for sensory
describe sensory discrimination disorder
-sensory jumbler
-difficulty in differentiating among and between stimuli
-difficulty evaluating environmental or body centered sensory input to produce adaptive reponses
-may or may not co exist with SMD
describe sensory based motor disorder
-difficulty with coordination and movement resulting from underlying sensory processing dysfunction
-often co-exist with sensory under responsively and sensory discrimination disorder
describe the postural disorders associated with sensory based motor disorder
-sensory slumped
-difficulty stabilizing body, while moving or resting in response to sensory demands
-difficulty with balance, bilateral coordination and crossing the midline
-loose or floppy body
-may invovle slumping, overflow, and associated movements
-fatigue
describe sensory based motor disorder dyspraxia associated with it
-sensory fumbler
-dysfunction in praxis
-difficulty with motor, language, and emotinal output
-disorganized, delayed, unsucessful interactions with people
-clumsy
-preference for the familiar not novel (b/c have a motor plan for it)
-cant judge external input and adapt to it