1st Test Flashcards
(128 cards)
1
Q
IDEA
A
Individuals with Disabilities Education Act
2
Q
IFSP
A
- Individualized Family Support Plan
3
Q
IFSP
A
Identifies the strengths and needs of the child and family an
Sets forth a plan for implementation of needed services
Identifies who, what ,when, and specific goals and outcomes
4
Q
IFSP environment
A
Free, appropriate, public education in the least restrictive environment
5
Q
IEP
A
Individualized Educational Plan
6
Q
IEP
A
Identifies the present level of performance
Sets forth a plan for implementation of needed services
Identifies who, what ,when, and specific goals and outcomes
7
Q
Gross Motor assessment
A
ing – propping – turning – sitting – crawling – creeping – kneel standing – pull to standing – squatting – walking
8
Q
Fine
A
Grasping – bilateral manipulation – pinching – placing – inserting
9
Q
Moro reflex
A
develops 24-28 weeks of gestation. Elicited by suddenly lowering infant with a response of straightening the arms and legs to extension
10
Q
Extensor reflexes
A
seen after four weeks of age when body tone is greater in the extensor muscles. Influenced by the position of the head and pressure on the soles of the feet.
11
Q
symmetric tonic neck reflex (STNR)
A
( 1- 4 months) When the face is lifted up, the two upper limbs or arms bend; when the baby looks down the legs straighten.
12
Q
The asymmetric tonic neck reflex
A
ATNR) rotation of the head will produced arm extension on the ipsilateral side of rotation and flexion on the contralateral side of rotation
13
Q
Reflex Stepping
A
pressure on plantar surface causes LE extension
14
Q
Labyrinthine reflexes
A
In supine (lying face-up) extension of the head causes extension of the limbs and hyper-extension of the trunk, in prone flexion of the head causes limb and trunk flexion.
15
Q
Righting reactions
A
return the body into the anatomical position and are mediated by afferent messages from visual, labyrinthine and neck or spinal muscles as well as touch and pressure receptors in the skin, influencing the position of the head in space, the head and neck relative to the trunk, and of the trunk relative to the limbs
16
Q
Parachute reactions
A
vestibular and visually mediated. Begins months after birth. The forward parachute is elicited when the infant is sharply lowered head-first: the arms are extended to cushion the fall. This response also occurs laterally and in extension.
17
Q
Equilibrium reactions
A
Equilibrium reactions are the final stages in the acquisition of balancing skills up to the point of independent walking. Further balancing skills are learned throughout early childhood. Such reactions involved highly coordinated responses of the body as a whole in response to displacing stresses, demanding the brains ability to integrate its widely separated regions
18
Q
Motor Development (1-4 months)
A
Rooting and sucking reflexes are well developed.
Swallowing reflex and tongue movements are immature;inability to move food to the back of the mouth.
Grasp reflex – automatic grasp when object is placed in palm
Landau reflex appears near the middle of this period; when baby is held in a prone (face down) position, the head is held upright and legs are fully extended.
Grasps with entire hand; strength insufficient to hold items. Holds hands in an open or semi-open position.
Movements are large and jerky.
Raises head and upper body on arms when in a prone position.
Turns head side to side when in a supine (face up) position; can not hold head up and in line with the body.
Upper body parts are more active: clasps hands above face, waves arms about, reaches for objects.
19
Q
Team Members
A
Parents / child PT OT ST / SLP MSW Child-Life Therapists Nursing Physicians Othotists
20
Q
Communicating with babies
A
not able to communicate what they feel or want
21
Q
Benefits of positioning
A
Maintenance or improvement of ROM Prevention of or minimization of contractures Maintenance or improvement of strength Facilitation of developmental skills To promote social interaction with peers To promote functional skills
22
Q
Mats
A
for free floor mobility
23
Q
Wedges
A
for prone, supine, side-lying or sitting positions & promotes weight-bearing through UEs & LEs
24
Q
Side-lie
A
– promotes hands to midline for function or positioning purposes, increases visibility of hands to the child
25
Bolsters
good for various forms of therapeutic exercise to stimulates normal postural responces and balance (ie: in a straddle position)
26
Balls
Good for Therapeutic exercise, balance, strengthening, trunk control, stimulates normal postural responces and coordination.
27
Scooter-board
used to promote floor level mobility in prone, strengthening of spinal extensors and UEs, mobility and play
28
Floor level carts
used for floor level seated mobility for young children
29
Support Components
placed strategically to support the trunk or pelvis or provide better alignment of the limbs
30
Prone stander
provides anterior support
| Stimulates postural activation of head & trunk extensors
31
Supine stander
provides posterior support (good for head control)
| Encourages full weight bearing yet provides full support
32
Standing frame
support is anterior to knees, poster to hips and trunk
33
Parapodium
stander/static support feet on pads- allow shuffle
34
Dynamic wheeled standers
supported standing with ability to mobilize by pushing/pulling the wheels
35
Pediatric Orthoses
Provide external support to maintain or correct alignment of extremities or trunk
Allow for greater mobility and function (due to postural stability
Reduce the effects of spasticity through alignment of joints and muscle
36
AFO
ankle foot orthosis
37
KAFO
knee ankle foot orthosis
38
HKAFO
hip knee ankle foot orthosis
39
RGO
reciprocating gait orthosis
40
TLSO
thoracic lumbar sacral orthosis
41
SMO
supramalleolar orthoses
42
Neuro- developmental ( NDT) – Bobath
A form of sensory input to effect changes in motor output
Responses to sensory input can be affected by
Environment
Health
Emotions
43
Inhibition
To decrease motor output
44
Inhibition techniques
```
Use gentle handling
Rocking
Firm but gentle touch
Rhythmic movements
Slow movements
Gentle deep pressure stroking
Consistent sensory input
Soft singing
Warm water
Wrapping or swaddling
Relaxing soft music
```
45
Sensory-motor Integration (SI)
```
Is based on the belief that problems arise when there is faulty integration of sensory input including
Learning difficulties
Attention deficits
Behavioral problems
Visual perceptual problems
```
46
SI Treatments
Treatment includes provision of systematic sensory input to help the child organize motor output
47
MOVE
mobile opportunities via education
48
Developmental Dysplasia of the Hip (DDH)
Poor alignment of the acetabulum and head of the femur in the developing hip
49
Developmental Dysplasia of the Hip Signs / symptoms
```
Asymmetrical hip abduction in flexion
Asymmetrical groin or buttock skin folds
Postponing of affected hip
Apparent femoral shortening on affected side
Positive test for hip subluxation
Usually begins with a limp
Mild pain in groin, medial knee or thigh
Decreased ROM (especially hip abduction and IR
Trendelenburg gait
Thigh, calf, or buttock disuse atrophy
Leg length discrepancy
```
50
During ambulation in the older child
Trendelenburg gait
Decreased hip abduction
Thigh pistoning
51
Bilateral DDH
Lumbar Lordosis
| Swaying (waddling) gait typical of a bilateral Trendelenburg
52
Bracing & splinting to hold hip in flexion and abduction
| under 9 mo
Usually use a Pavlik harness which allows for active kicking which promotes strength and mobility and decreases the occurrence of avascular necrosis of thee hip
53
Bracing & splinting to hold hip in flexion and abduction
over 9 mo
Need abduction orthosis that allows for gait
54
over 18 mo
Traction & surgery
55
Legg-Calve’-Perthes Disease (LCPD)
Usually self-limiting degeneration of femoral head causing
Pain
Decreased ROM
Gait deviations
More common in boys 4 to 7 years of age
LACK OF BLOOD TO FEMORAL HEAD
56
(LCPD) initial stage
failure of femoral head to grow due to decreased blood supply
57
(LCLPD) Fragmentation
Epiphysis appears fragmented
| Revascularization of the femoral head is occurring
58
(LCPD) Re-ossification
bone density returns to normal with changes in shape and structure of femoral head and heck
59
(LCPD) Healed stage
Femoral head and neck retain deformity from the repair process
60
LCPD Etiology:
Disturbance in blood supply to femoral head
Can be result of:
Genetic pre-dispositIon
Trauma
Anatomical variation
Generalized disorder of epiphyseal cartilage
61
Slipped Capital Femoral Epiphysis (SCFE)
Hip deformity related to slippage of femoral epiphysis
62
SCFE Etiology
Hormonal influences
Genetic predisposition (weak growth plates)
Occurs in boys 2 to 3 times more than girls
More common in:
Children who are tall with delayed skeletal maturity
Obesity
In children between 9 and 16 years old
Can occur bilaterally (25 to 30%)
Can be precipitated by trauma
63
SCFE Signs/Symptoms
```
Intermittent limp
Pain in:
Groin
Buttock
Knee
Thigh
Antalgic gait
Trendelenburg (weakened abductors on involved side)
LE held in ER
Decreased ROM
```
64
SCFE Treatment
Goals include
Minimize or reduce slippage of femoral head on neck
Maintain hip ROM & function
Minimize possible future degeneration
Surgery usually required to pin the hip & prevent further slippage in mild to moderate cases
Surgery – Varus - Osteotomy
Bed rest / traction may be used to reduce pain & spasm before surgery
65
SCFE Interventions
Providing appropriate assistive devices (wheelchair/ crutches
Gait & mobility training
ROM (active & passive)
Strengthening exercises
Assessment of home environment to accommodate mobility and safety
Family training for all of the above
Consultation with teachers for campus mobility
66
Juvenile Rheumatoid Arthritis (JRA)
A group of disorders characterized by inflammation of connective tissue including joints and other systems
Classified in children under 16 years of age with condition lasting > 6 weeks
67
JRA Oligo-articular
(<5joints)
68
JRA Poly-articular
(>5 joints)
69
JRA Etiology
unknown (may have several contributing factors
Viral or bacterial infection that triggers the auto-immune response
May be genetically pre-disposed
70
JRA Signs / Symptoms
```
Pain, swelling, stiffness in joints
Fever
Rash (more common in systemic)
Inflammation of the iris of the eye
Myalgia
Involvement of (more common in systemic)
Lymph nodes
Jeart
Liver
Spleen
Pericardium
Lungs
```
71
JRA Medications
```
NSAIDS
Slow acting antirheumatic drugs (SAARDS)
Corticosteroids
Immunosuppressive and cytotoxic agents
Cyclosporing or methotrexate
```
72
JRA Surgical treatment:
```
Synovectomy
Soft tissue releases
Osteotomy
Joint fusion
Total joint replacement
```
73
Osteogenesis Imperfecta Etiology
Genetic
Problems with the amount & quality of collagen in the body
Presents with fragile bones / low bone density
74
Osteogenesis Imperfecta Signs & Symptoms
Frequent fractures
Scoliosis/Kyphosis
Short stature
Hearing loss
75
Osteogenesis Imperfecta Goals
Minimize fractures through protective measures
Joint protection
Promote bone strength
Maximize activity & weight bearing for increased bone strength
Maximize functional skill
76
Arthrogryposis (Multiples Congenita
Non-progressive neuromuscular disorder
Presents with
Multiple contractures (distally > proximally) due to decreased fetal movement
Dislocation at hips or knees
Deformities of joints (fusiform or cylindrical shape)
Joint fusion (in some cases)
Thinning of subcutaneous tissue
Absence or decreased size of muscle groups
Absent skin creases
77
Arthrogryposis (Multiples Congenita) Etiology
```
Unknown
Possible trauma during first trimester
Maternal history of a condition that limits fetal movement
Fevers during pregnancy
MS
Myasthenia gravis
Myotonic dystrophy
Uterine abnormalities
```
78
Pediatric Fractures
Fracture patterns are different due to bones that are more flexible, more porous, and less dense than adult bones
Due to thicker periosteum than adults, there is better blood supply therefore healing is faster (2-4weeks)
79
Pediatric Fractures Etiology
Trauma
Child abuse
MVA
Genetic (Osteogenesis imperfect)
80
Pediatric Fractures Common sites
Distal radius
Tibial shaft
Clavicle
Elbow
81
Pediatric Fractures Signs / Symptoms
```
Redness
Swelling
Pain
Heat and deformity of extremity
Muscle spasm
Crying
Not using extremity
```
82
Ankle / Foot Deformities Etiology
```
Congenital deformities
In-utero positioning
Neuromuscular disorders
Myelomeningocoele
Arthrogryposis
Genetic disorders
```
83
Ankle / Foot Deformities Classification
```
Metatarsus adductus
Talipes Equinovarus (clubfoot)
Calcaneovalgus (dorsiflexion of foot with eversion or valgus of hind-foot)
```
84
Ankle / Foot Deformities Sign/symptoma
Obvious deformities
Gait abnormalities
Delay is gross motor and mobility skills
85
Ankle / Foot Deformities Treatment
Serial Casting
| Surgery
86
ANOXIC ENCEPHALOPATHY
Definition - brain damage due to lack of oxygen
aka
CEREBRAL PALSY
Caused by an insult to the developing brain and resulting in permanent and non-progressive damage
Affects tone, posture, and movement
87
CP Prenatal
Genetic
Viral Infections
Bacterial infections
Drug exposure
88
CP Peri-natal
```
Prematurity’
Low-birth weight
Severe jaundice
Intra-ventricular hemorrhage
Poor nutrition
Asphyxia
```
89
CP Post-Natal
```
Infection
Asphyxia
TBI
MVA
Fall
Shaken baby syndrome
Child abuse
CVA
Near drowning
Brain tumor
```
90
CP Diplegia
```
Both LEs
Trunk and UEs to a lesser extent may be affected
Standing Posture (typical)
Crouched with trunk flexion
Adduction, & IR at both hips
Knees are flexed
Ankles are plantar-flexed
```
91
Diplegia
Typically child has
spasticity / high tone
In both LEs
92
Diplegia gait
Poor disassociation between trunk and legs
Body rotates during gait
UEs held in the “high guard” position for balance
93
Diplegia assissitive devices
Crutches
Walker
wheelchair
94
Hemiplegia Posture
```
Same side UE & LE
Standing Posture (typical)
Shoulders in adduction & IR
Elbow & wrist flexion
IR of hip
Knee extension
Ankle plantar flexion
```
95
Hemiplegia Gait (typical)
Asymmetrical gait pattern
| Circumduction of LE
96
Hemiplegia assissitive devices
Crutch or cane for balance
97
Quadriplegia/Tetraplegia
All 4 extremities are involved
98
Triplegia
3 extremities are involved
| Usually both LEs and one UE
99
CP / ABNORMAL TONE - HYPOTONICITY
Also referred to as LOW TONE / HYPOTONIA
“Rag Doll” / floppy
Soft mushy feel to muscles
DTRs are weak
Likelihood of obesity due to decreased activity
Usually demonstrate impaired speech due to impaired oral motor control and drooling
100
CP / HYPOTONICITY Gait
Wide base of support
Short stride lengths
Impaired balance
101
CEREBRAL PALSY / HYPERTONICITY Signs & Symptoms
HIGH TONE / HYPERTONIC / SPASTICITY
Hyperactive DTRs
Hard, stiff, tight feel to muscles
Persistence of primitive reflexes which prevent development of normal movement patterns
ATNR
STNR
TLR
Usually thin due to excessive energy output
Speech usually impaired due to poor oral motor control, drooling
102
Hypertonic gait
Impaired muscle control
| Impaired balance due to abnormal variations & distribution of muscle tone
103
CEREBRAL PALSY / SIGNS & SYMPTOMS - DYSTONIA
Also referred to as
Mixed tone
Fluctuating tone
Athetosis
104
Dystonia Characteristics
More than one type of tone
Can be mild to severe
In infancy presents as low tone and changes with maturity
Stringy, elastic muscles to the touch
Child is usually thin due to extreme expenditure of energy
Impaired speech as in hypertonia
105
Dystonia gait
Gait is only possible to those who have enough stability to stand or walk
Excessive movements
Impaired balance
Walker or crutches can be used but for the most part these children use a wheelchair
As children grow and become stronger, they can present a challenge with management of transfers etc. to their caregivers / family.
106
Ataxia characterisitcs
Poor balance
Wide base of support and “high-guard arm position” during gait
Tremors
Low postural tone
Poor visual tracking
Distributed throughout the body
ROM usually normal or excessive due to low tone
Hyporeflexia of DTRs, with weak primitive reflexes
Muscles have a soft doughy feel to the touch
107
Secondary Conditions / Impairments of Children with CP
```
Mental retardation (50 – 75%)
Seizures (30%
Visual impairment (50
Speech/language deficits or delays (50%)
```
108
General Principles for PT Interventions / Cerebral Palsy
Intervention is individualized
Intervention is optimal through a team approach with child and family involved in setting goals
109
Pediatric Traumatic Brain Injury (TBI)
An acquired injury to the brain resulting in a change in consciousness or an anatomical abnormality in the brain
110
Pediatric Traumatic Brain Injury Etiology
```
Trauma
Child abuse
In infants, “Shaken Baby Syndrome” is most common injury
MVA
Falls
Sports related Injuries
GSW
```
111
TBI Secondary causes
Increased intracranial pressure due to edema
| Hematoma due to bleeds in the brain from trauma
112
TBI Signs & Sympt
Depends on
Severity
Area of brain involved
Length of time for loss of consciousness (coma)
Other injuries to the body and their severity
113
Sequelae of brain injury can include
```
Motor impairment
Spasticity
Ataxia
Weakness
Contractures and resultant deformities
Cognitive impairment
Language disorders
Sensory impairments
Psychosocial disorders
```
114
SPINA BIFIDA
A group of congenital malformation of the spine, including the vertebrae and the spinal cord
115
SPINA BIFIDA Etiology
Genetically predisposed
Nutritional deficiencies (especially maternal folic acid deficiency)
Environmental (IE: alcohol during first 4 weeks of pregnancy when neural tube closes)
116
Occulta
(not visible) No disability usually
117
Acculta or cystic
visible
118
Meningocele
no disability usually
CSF and superficial tissue protrudes from the spine in a sac at the level of the lesion
Neurological tissue is rarely involved
119
Myelomeningocele
Meninges and parts of spinal cord protrude in a sac at the level of the lesion
There is an abnormality of the spine
Disability includes paralysis with loss of sensation below the level of the lesion
Extent of the disability depends on the level of the lesion and scope of the neurological involvement
120
SPINA BIFIDA / Hydrocephalus
Awareness of potential shunt malfunction ~~~safety issue~~
121
Signs of malfunction: (may require emergency response)
```
Irritability
Headache
Vomiting
Lethargy
Fever
Bulging eyes or fontanel
Change in behavior or level of alertness
Seizure activity
Change in coordination
```
122
Duchenne Muscular Dystrophy
The most common form of congenital, degenerative disease of muscle tissue
Almost always in boys
123
Duchenne Muscular Dystrophy Signs & Symptoms
Muscles appear hypertrophied due to fat and connective tissue replacing muscle tissue
Starts at approx. 2 years of age and progresses till death
Some live to early adulthood
124
Gower’s sign –
Evident by 4 to 7 years of age
When a child uses his hands in a walking motion up the thighs to assist while attempting to stand (hip & knee extensors
125
Contractures develop in
Heel-cords
TFL
Hamstrings
Hip flexors
126
CYSTIC FIBROSIS
Chronic suppurative pulmonary disease which causes the greatest mortality
Median age of survival now is approximately 36 years of age which is an improvement due to newer management strategies and techniques
127
HIPPO-THERAPY PRECAUTIONS/POSSIBLE CONTRAINDICATION
```
Abnormal fatigue
Allergies
Arnold Chiari malformation
Cardiac condition
Diabetes
Heterotrophic ossification Hip
Dislocation
Subluxation
Dysplasia with significant restriction of hip abduction
History of breakdown of grafting over bony/weight –bearing areas
Any child 2-4 yrs of age
Hydrocephalus
```
128
HIPPO-THERAPY / Contraindications
```
Orthopedic:
Acute herniated disc,
Atlanto-axial instability
Coxal arthrosis (degeneration of the hip joint)
Excessive kyphosis or lordosis
Hemivertebrae
Severe osteoporosis
Orthopedic: (cont’d)
Pathologic fractures (osteogenesis imperfecta)
Spondylolisthesis
Structural scoliosis greater then 30 degrees
Unstable spine
```
