Conditions Lecture Quiz 1

Question 1

Occupational Science

Answer 1

A basic science; study of occupation; basic science that supports OT (an applied science)

Question 2

Pharmacology

Answer 2

the study of drugs, their actions, dosage, therapeutic uses, and adverse effects

Question 3

Medication Management

Answer 3

An IADL

Question 4

Cerebral Palsy-developmental disability

Answer 4

• Definition: “A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior; by epilepsy, and by secondary musculoskeletal problems.”

Question 5

Cerebral=

Answer 5

brain

Question 6

Palsy=

Answer 6

weakness/affecting muscles

Question 7

Etiology of CP

Answer 7

Injury or insult to the developing brain; prenatal, perinatal, postnatal; upper age limit for postnatal brain injury is 2-8; 70-80% have congenital CP in womb

Question 8

Risk factors of CP

Answer 8

multiple births; prematurity and low birth weight are most common- high risk for infection, infection cuts off blood supply to brain; maternal infections; acquired post-birth- CVAs, infections (meningitis, jaundice)

Question 9

4 types of brain injuries that often result in CP DX

Answer 9

periventricular leukomalacia, intraventricular hemmorrhage, hypoxic-ischemic encephalopathy, ceerebral dysgenesis

Question 10

Periventricular leukomalacia

Answer 10

damage to white matter around ventricles, leave gaps in babies brain, form fluid-filled cyst, 32 weeks gestation

Question 11

Intraventricular hemorrhage

Answer 11

Hemorrhage into ventricular system premature births b/c blood vessels really week. Level 1 and 2 are minimal, deficits don’t persist into adulthood; level 3 and 4 moderate to severe and lead to CP, 30 weeks gestation

Question 12

Hypoxic-ischdmic encephalopathy

Answer 12

loss of oxygen to brain; damage to brain tissue

Question 13

Cerebral Dysgenesis

Answer 13

brain malformation; baby brain not developed appropriately; associated to births 20 weeks gestation; mother may experience own trauma so go into labor early; infection

Question 14

Acquired injury after birth- CP

Answer 14

cerebrovascular accidents; infections; poisoning; trauma-near drowning, strangulation, child abuse; closed head injuries-concussion, blunt force trauma

Question 15

Diagnosis for CP

Answer 15

no definitive test; several factors considered- injury to developing brain, quality of movements is large factor; non-progressive; disorder in sensorimotor development; disorder originates from the brain; life-long disability

Question 16

Prevalence of CP

Answer 16

most common motor disability in childhood; 1:323 children have it; 10,000 infants; highest prevalence among boys and AA children; 77% have spastic CP; many have co-occurring conditions: 41% with epilepsy and 7% with ASD

Question 17

Common co-morbidities (two things exist at one time) with CP

Answer 17

swallowing difficulties; eye muscle imbalance; speech difficulties; epilepsy; blindness; deafness; urinary incontinence

Question 18

Sings/Symptoms with CP

Answer 18

atypical motor performance: tone abnormalities, reflex abnormalities, postural abnormalities, delayed motor development

Question 19

Reflex abnormalities with CP

Answer 19

retained primitive infant reflexes, delay in acquisition of righting and equilibrium reactions, hypertonicity, hypotonia

Question 20

Types of CP

Answer 20

Spastic, athetoid, and ataxia; can see combinations but most often is Spastic and Athetoid

Question 21

Spastic CP

Answer 21

upper motor neuron injury; deep tendon reflexes (knee jerk) present; hypertonicity; 80% of CP cases; types are subdivided anatomically according to parts of the body that are affected

Question 22

Athetoid CP / dyskinetic

Answer 22

basal ganglia of the brain; involuntary uncontrolled motor movements (slow and writhing); in 10-20% of CP cases

Question 23

Ataxia CP

Answer 23

cerebrum affected; unsteady, difficulty with balance when ambulating; least common; 5-10% of CP cases; hard to slow down, run more than walk

Question 24

Spastic CP characterizations

Answer 24

characterized by hypertonicity; retained primitive reflexes in affected areas of the body; slow, restricted movement; contractures: permanent shortening of a muscle/joint-address with splint, adaptive devices

Question 25

Types of Spastic CP

Answer 25

monopleagia, diplegia, hemiplegia, triplegia, quadriplegia

Question 26

Spastic Hemiplegia

Answer 26

involves one entire side of the body; lack of righting and equilibrium reactions on involved side; early signs=asymmetrical hand use during first year or dragging one side of body; prominent 8-12 months

Question 27

Spastic Diplegia

Answer 27

involves both LEs with mild deficits in UEs; LE equilibrium reactions delayed or missing; results in spinal and hip deformities-no strength/endurance; early signs=inability to sit independently and pulling self with arms only, legs stiffly extended should be able to sit alone at 6 months; most children will learn to walk with assistive devices

Question 28

Spastic Quadriplegia

Answer 28

entire body involved; typical presentation = spasticity in flexor muscles of UE and extensor muscles in LE; presence of reflexes; oral musculature affected; likely will have feeding tube; small % will learn to walk

Question 29

Why are postural deformities closely monitored?

Answer 29

incase end up in fixed position, respiration will be affected/lungs

Question 30

Athetosis CP

Answer 30

involuntary movemnt, often fluctuating tone-head, neck, trunk and extremities; not present during sleep; hypermobility present due to fluctuating hypotonicity

Question 31

Ataxia CP

Answer 31

characterized by wide base of support; staggering gait; controlled movements appear clumsy; intention tremors may be present; if cued and thought about too longtremoring starts; hypotonicity

Question 32

Associated disorders with CP

Answer 32

cognitive impairment; seizure disorder; visual/hearing impairments; oral motor deficits; gastrointestinal difficulties; pulmonary complications

Question 33

CP medical management/prognosis

Answer 33

normalizing tone; decreasing spasticity-balcofen, botox-blocks acetylcholine from being released and gives temporary paralysis; orthotics and splinting; average lifespan

Question 34

Gross motor function classification system-CP Test

Answer 34

Level 1: Walks without limitations Level 2: cannot run/jump, may use assistive devices Level 3: stands with no support, sit with little support; use assistive devices for walking Level 4: Walks with use of assistive devices; some support in sitting Level 5: support needed to sit, stand or maintain head/neck control

Question 35

OT Role with CP

Answer 35

varies with age; younger children - gross motor/ fine motor/ speech; school-age children: environment, management of school supplied, continued work on gross motor fine motor and speech; adults: IADLs, ADLs, advocacy

Question 36

Autism Definition

Answer 36

definition: Autism is a complex developmental disability that is the result of a neurological disorder that affects the functioning of the brain, impacting development in the areas of social interaction and communication skills

Question 37

Autism Etiology

Answer 37

o Researchers believe that certain factors are more likely to cause Autism however there is no single documented/proven cause o It is diagnosed based on observed behaviors o Postmortem research, PET scans and MRI’s have revealed structural differences in the brains of those with Autism ♣ Decreased activation of the frontal lobe ♣ Decreased number of Purkinje cells within the cerebellum ♣ Abnormal structure of the amygdala

Question 38

Hypothesized causes of Autism

Answer 38

Vaccinations, genetics, environmental factors-toxin exposure such as lead, diet-gluten

Question 39

Autism abnormalities in brain structure

Answer 39

o Increased Head circumference: typically between ages 3-4 is noted; pediatricians measure based on age o Cerebellum: structural differences; role in response to sensory discrimination o Purkinje cells: neurons found within cerebellum; these individuals have fewer cells in general; near surface important for coordinating and sending messages to other areas of brain o Inferior olives: bonded to the purkinje cells; happens 28-30 weeks gestation; when a purkinje cell dies, the olive dies with it; used for timing and learning of movements o Frontal lobe: increased in size; responsible for executive functioning; decreased activation o Limbic system: emotional control regulation is impacted; amygdala and hippocampus are abnormal in their structure

Question 40

Autism Genetics

Answer 40

o Genes are the brains written instructions for function o Sibling studies: monozygotic (identical) twins (95% chance of other) (10% in fraternal twins) o Second child having ASD is 3-7% if the first is male with ASD, 7-14% if the first child is female with ASD o Higher rate of speech and language disorders o Relatives more commonly display traits of ASD (anxiety, aloofness)

Question 41

Autism environment

Answer 41

o External influences that may cause damage to a person’s internal system if exposed during a period of critical development ♣ Exposure to viruses, infections, drugs/alcohol, high levels of mercury

Question 42

Autism psychologic abnormalities

Answer 42

o Gastrointestinal disorder | ♣ Reflux, gastritis, persistent gas, diarrhea and constipation

Question 43

Autism signs/symptoms

Answer 43

``` o Difficulty with social communication o Restricted and repetitive behaviors o Motor abnormalities o Sensory processing deficits o Feeding disorders o Co-occurring medical conditions- ADHD, anxiety, epilepsy, down syndrome ```

Question 44

Autism prevalence and incidence

Answer 44

o ASD impacts approximately 1% of the world’s population o 1 in every 59 children o Fastest growing developmental disability o Occurs in all racial, ethnic, and socioeconomic groups o 4.5 times more common in boys (1 in 42) than girls (1 in 189) o there has been a 120% increase since 2000

Question 45

Autism Meet diagnostic criteria

Answer 45

Must meet A, B, C, and D

Question 46

Autism Diagnostic Criteria A

Answer 46

o A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: ♣ Deficits in social-emotional reciprocity-initiate and respond ♣ Deficits in nonverbal communicative behaviors used for social interaction ♣ Deficits in developing and maintaining relationships

Question 47

Autism Diagnostic Criteria B

Answer 47

o B. Restricted, repetitive patterns of behaviors, interests or activities as manifested by at least two of the following: ♣ Stereotyped or repetitive speech, motor movements or use of objects ♣ Excessive adherence to routines, ritualized patterns of verbal or nonverbal behaviors, or excessive resistance to change ♣ Highly restricted, fixated interests that are abnormal in intensity of focus ♣ Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

Question 48

Autism Diagnostic Criteria C

Answer 48

o C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) o D. Symptoms together limit and impair everyday functioning o E. These disturbances are not better explained by intellectual disability or global developmental delay

Question 49

Autism Diagnostic Criteria D

Answer 49

Symptoms together limit and impair everyday functioning

Question 50

Autism diagnostic criteria e

Answer 50

o E. These disturbances are not better explained by intellectual disability or global developmental delay

Question 51

DSM V

Answer 51

♣ DSM-5, p. 51 ♣ ” Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.” ♣ A comprehensive diagnostic report should specify the following: ♣ With or without accompanying intellectual impairment ♣ With or without accompanying language impairment ♣ Associated with a known medical condition, genetic condition or environmental factor ♣ Associated with another neurodevelopmental, mental or behavioral disorder

Question 52

Autism Psychiatric differential diagnosis (others)

Answer 52

o Rett Syndrome (gene mutation disorder diagnosed by blood testing)-muscle atrophy o Selective mutism o Social (pragmatic) Communication Disorder o Intellectual Disability o Stereotypic Movement Disorder o Attention deficits/Hyperactivity Disorder o Schizophrenia

Question 53

Severity level 1 of ASD

Answer 53

♣ Still inflexible but do not have coping skills to manage unexpected changes; can communicate but still lack socio-emotional reciprocity; can be employed

Question 54

Severity level 2 of ASD

Answer 54

♣ Can speak in full sentences – not functional for formal communication; can cope in majority of context

Question 55

Severity level 3 of ASD

Answer 55

♣ Deficits in social communication; extreme inflexibility; extreme difficulty with coping skills; limited words in communication; no basic imitation – required/building block for communication; deficits affect them across all contexts (school, home, community)