Weekly Questions

Question 1

Why are the 1st 8 weeks of embryological development so important?

Answer 1

“Fundamental Period”; differentiation of endoderm, ectoderm, mesoderm; cardiovascular development (heart begins to beat and 4 cavity heart develops); nervous system development (neural tube closure)

Question 2

A. Why is vision so important for the development of postural control?

Answer 2

It regulates posture for feedback correction and for selection of anticipatory postural strategies. It feeds into motivation for movement. Eye movement contributes to emergence of movement (gaze shifts are preceded by rapid shift in body movement)

Question 3

B. What is the difference between proprioception and kinesthesia?

Answer 3

Posture/position sense (proprioception) vs. movement sense (kinesthesia)

Question 4

C. Why is reaching such an important motor milestone?

Answer 4

One of first motor skills infants perform so provides an early window into their motor control and their interaction with the world OR multiple processes such as postural control, strength, visual acuity, cognition and motivation contribute to the infant’s ability to reach and grasp

Question 5

D. Give one example of postural control sequencing occurring in a cephalocaudal direction
(1 point)

Answer 5

Prone head up then prone head and chest up; Head control before trunk control
Sit alone before crawling on all fours before standing (anything demonstrating a less mature posture/movement then a more mature posture/movement)

Question 6

E. Why do we want to try to get kids up (standing) and moving as soon as possible (with respect to hip joint)? (2 points)

Answer 6

Forces of compression and movement contribute to depth of acetabulum
Weight bearing assists with joint formation and stability
Movement assists with joint formation and stability (mvt allows compressive forces to spread throughout joint surface)

Question 7

F. Name 2 findings on a pediatric evaluation that indicates an upper motor neuron lesion

Answer 7

Cortical thumb after ~ 4 months old
Clonus
(tremors)
Those are not all inclusive but what we specifically talked about in class when talking UMN lesion

Question 8

A.	What are standardized tests? (2 points)
List 2 things we discussed in class that makes a standardized test standardized.

Answer 8

Test manual, fixed number of items, fixed protocol for administration, fixed guideline for scoring, info on validity, reliability, specificity, sensitivity, etc.

Question 9

C. Why is it important for us to understand the relationship between a standardized test and the ICF Model?

Answer 9

The ICF helps us delineate the interrelationships among disease, impairments, and functional limitations (what impact an impairment has on the patient’s life). The model provides the conceptual basis for all elements of patient management provided by a PT so it can direct us to what “tests and measures” to perform and what goals to set and the standardized test we choose is one such “test and measure”.

Question 10

D. What would be the most appropriate Standardized Motor Test to use on a child that has CP that is 6 months, 6 years old, or 16 years old (one test that could be used for all), and how does it relate to the ICF Model?

Answer 10

Gross Motor Function Measure (GMFM) for children with CP 5 months -16 years old
(ICF) Activity-Gross Motor

Question 11

E. What might the persistence of primitive reflexes in a 10 month old infant tell us?

Answer 11

• Persistence of these reflexes could indicate CNS dysfunction
• It may help identify early signs of several conditions
• Persistence interferes with development of postural control, mobility and achievement of motor milestones

Question 12

. What percentage of kids with Down syndrome (DS) has intellectual disability (ID)?

Answer 12

100%

Question 13

What is the IQ cut off for the diagnosis of intellectual disability (according to the American Association on Intellectual and Developmental Disabilities)?

Answer 13

<70 less than seventy

Question 14

Why do such a high percentage of kids with DS have ID (what is the neurological precursor)?

Answer 14

decreased brain volume

Question 15

. List 2 standing posture deviations (think musculoskeletal/joint) that you are likely to find in kids with DS

Answer 15

pes plantus

knee hyperextension

Anterior pelvic tilt

Question 16

. List 3 gait deviations (true gait deviations, not standing posture) that you are likely to find in a kid with DS

Answer 16

Decrease gait velocity

Decrease stride length

Increase step width

Increase knee flexion at initial contact and through stance

Question 17

What is the basis of the “problem” that the hole in the heart from ASD, AVD, or ASVD causes in the kids with DS? In other words, what is the direct result of this “hole” in the heart and what problem could it cause physiologically?

Answer 17

Oxygen rich blood from left side of heart flows back into oxygen poor blood on right side of heart.
This causes an increase of blood to go to lungs which can cause pulmonary hypertension which leads to heart being overworked and enlarging and having a decrease in efficiency.

Question 18

a. At what point in a child’s development does (or can) injury to the brain cause cerebral palsy?

Answer 18

Prenatal, perinatal, post-natal (up to 2 years old)

Question 19

b. What is the most predictive assessment tool available to detect CP in young infants (3-4 months old)?

Answer 19

GROSS MOTOR FUNCTIONAL ASSESSMENT

Question 20

c. Name 2 commonly found skeletal problems that are found in kids with CP that are a result of muscle tone issues and a muscular imbalance around the joint(s).

Answer 20

Torsion of long bones, joint instability, premature degenerative changes in weight bearing joints, scoliosis, subluxed of dislocated hips.

Question 21

Why is sit-to-stand and stand-to sit such a good predictor of independent walking in young children with CP?

Answer 21

Because of the postural control and functional strength needed to perform these

Question 22

e. What is a very common tool used in order to assess/quantify muscle tone and what is its direct relationship to the ICF model?

Answer 22

modified ash worth

Body structure/Function

Question 23

f. What area of the brain when damaged leads to spastic movements?

Answer 23

Motor cortex or white matter projections to/from cortical sensorimotor

Question 24

g. What area of the brain when damaged most commonly leads to dyskinetic movements?

Answer 24

Basal Ganglia

Question 25

h. What is the main purpose of using weights distally or weighting down a walker or using deep pressure/approximation with a kid with a movement disorder?

Answer 25

To increase proprioceptive input/awareness

Question 26

i. What is the primary criterion that distinguishes one level from the next when defining the five-level classification system, Gross Motor Function Classification System?

Question 27

Sitting independently by ______________(what age) is the best predictor of functional independent ambulation by the time the child reaches 8 years old, but if not sitting independently by _____________(what age), there is a low chance of achieving any functional independent ambulation.

Answer 27

24 months

36 months

Question 28

Why is a hip adductor release in a kid diagnosed with CP with very tight hip adductors not always helpful?

Answer 28

The tight hip adductors could be a result of a tight TFL; a consequence of the tight TFL while superimposing movement on that so an adductor release will not help!

Question 29

What one muscle is considered the key to hip and trunk control in these kids with CP that have a crouched gait?(

Answer 29

gluten max

Question 30

What lower extremity muscle group works “over-time” to compensate for more proximal weakness in kids with spastic CP who are in an extender pattern?

Answer 30

quads

Question 31

What types of progressive resistance training are recommended in school aged kids with CP?–please
name 2

Answer 31

Theraband, free weights, isometric, isokinetics, functional movements

Question 32

What is the most common oral medication that we discussed in class that is used for the management of spasticity in kids with CP and what is it mechanism of action?

Answer 32

oral baclefon. causes acetylcholine release

Question 33

What is the most common injectable medication that we discussed in class that is used for the management of spasticity in kids with CP; where is it injected and what is its mechanism of action?

Answer 33

Botox injected directly into affected muscle(s)-interferes with release of acetylcholine at the neuromuscular junction

Question 34

What is one of the few birth defects that actually has a primary prevention strategy and what is that strategy?

Answer 34

Spina Bifida; maternal ingestion of folic acid

Question 35

List 2 signs/symptoms of a VP or VA shunt

Answer 35

Vomiting, redness along shunt site, seizures, sunsetting eyes, headaches, lethargy, irritability, bulging fontanelles, nystagmus

Question 36

What is one therapeutic benefit of aquatic exercise/therapy?

Answer 36

Buoyancy decreases weight bearing; buoyancy allows for increase in mobility, decreased pain; water provides pressure to body/joints that increases proprioception, balance, and trunk stability; good respiratory work out as respiratory muscle work harder when submerged, resistance can be used for strengthening due to the viscosity of the water; warm water can decrease tone in hypertonicity; cool water can increase tone in hypotonicity

Question 37

In the Spina Bifida power point, what is the most important muscle or muscle group identified for community ambulation?

Answer 37

Illiopsoas

Question 38

List 2 common findings as related to joint structure and function that is a result of inflammation in kids with Juvenile Idiopathic Arthritis. (1 point each for 2 points)

Answer 38

Intra-articular effusion, synovial hypertrophy, soft tissue edema, peri-articular tenosynovitis, enlarged bony landmarks, ligamentous laxity, joint instability, irregular joint surface

Question 39

Relative to the ICF model with respect to Activity/Participation, name 2 benefits of adaptive seating (in other words, what are we trying to improve)? (1 point each for 2 points)

Answer 39

Postural stability and control, arm and hand function, oral-motor/speech and communication, mobility, social participation

Question 40

What are 2 things we as PTs need to consider in the selection of an appropriate orthosis for a child?

Answer 40

What neuromusculoskeletal impairment needs correction?
Is the impairment flexible or fixed?
What is the goal or purpose of using an orthosis?
What is the least amount of assistance needed from an orthosis?
How long will the child need the orthosis

Question 41

What is the primary muscle involved in a right torticollis and in position are we likely to find the neck/head?

Answer 41

Right sternocleidomastoid; right lateral flexion and left rotation

Question 42

Name 2 orthopedic conditions that are associated with (not caused by) congenital muscular torticollis

Answer 42

Hip dysplasia, talipes equinovarus (club feet), scoliosis

Question 43

Name 2 associated “issues”/asymmetries than can occur as a result of congenital muscular torticollis

Answer 43

Plagiocephaly, craniofacial asymmetry –recession of facial bone, eyebrow, and zygoma on ipsilateral side, posterior and inferior ipsilateral ear, eye and mouth displacement- eye smaller, canting of mandible on ipsilateral side

Question 44

What purpose does the “high guard” position serve for the new walker?

Answer 44

balance and stability

Question 45

Name 1 reason why a child should NOT “W” sit

Answer 45

Contributes to femoral anteversion, internal tibial torsion, metatarsus adductus, in-toeing, does not allow for trunk musculature to work to hold child up

Question 46

]Name 2 common orthopedic conditions found in children that involve the hip

Answer 46

Legg-Calve-Perthes Disease (or Perthes), slipped capital femoral epiphysis (SCFE), congenital dysplasia of the hip (CDH) or developmental dysplasia of the hip (DDH)