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PTH 635 Peds > Exam 2 > Flashcards

Exam 2 Flashcards

torticollis, CP, hypotonia, DS, DCD, MD (97 cards)

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1
Q

Congential muscular torticollis -CMT- (wry neck/twisted neck) - how does it happen?

A

-most common accepted = ischemia, birth trauma, and intrauterine malposition

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2
Q

Torticollis - prevalence

A
  • 3rd most common anomaly (after dislocated hip and club foot)
  • 0.3-16% of newborns
  • incidence has inc dramatically since “Back to sleep” campaign
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3
Q

“Flathead syndrome”

A
  • plagiocephaly

- ***is reported as a coexisting impairment in 80-90.1% of kids with CMT (toricollis)

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4
Q

plagiocephaly risk factors

A
  • large birth wt
  • male
  • breech position
  • multiple births
  • first delivery
  • difficult labor
  • nuchal cord
  • maternal uterine abnormalities
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5
Q

types of CMT

A
  • sternomastoid tumor
  • muscular torticollis
  • postural torticollis
  • postnatal muscular torticollis
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6
Q

sternomastoid tumor (type of CMT)

A

-discrete mass is palpable within the SCM muscle

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7
Q

muscular torticollis - (type of CMT)

A

-tightness, but no palpable mass

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8
Q

postural torticollis (type of CMT)

A

-no SCM tightness, no palpable mass

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9
Q

postnatal muscular torticollis (type of CMT)

A

-environment, plagiocephaly, positional preference, associated with other birth problems - CP, myelodysplaia, down syndrome etc.

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10
Q

torticollis - decreased neck ROM for?

A
  • ipsilateral rotation
  • contralateral LF
  • contralateral asymmetrical flex/ext

-also: unable to maintain midline alignment

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11
Q

other body impairments associated with torticollis

A
  • anterior neck (platysma, scalenes, hyoids, tongue, and facial muscles
  • trunk curvature
  • persistence of asymmetric ATNR
  • pelvic obliquities
  • shoulder elevation
  • congenital scoliosis
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12
Q

torticollis impact on sensory system

A
  • vision
  • vestibular
  • somatosensation to regulate posture
  • kinesthetic feedback

*overall systems developing asymmetrically and not experiencing normal interactions of each system as the child grows

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13
Q

torticollis - typical activity limitations

A
  • neglect of ipsilateral hand
  • asymmetrical head righting reaction
  • delayed propping-prone
  • delayed rolling over
  • limited vestibular, proprioceptive, sensorimotor
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14
Q

torticollis - impairments related to activity limitations

A
  • limited ROM lead to compensatory mvmts
  • dec neck LF leads to overuse of torso muscles
  • difficult maintaining midline in upright position
  • regaining midline head posture in vertical, prone, supine, with wt shifts, as well as with movement
  • UE wt bearing difficult on involved side
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15
Q

deformational plagiocephaly

A

most common - Left - CMT-right occipital flattening

  • can be same or opposite side to muscular torticollis at birth
  • acquired = develops in first 3 months. Always same side of preferred rotation
  • masticatory mm weaker on affected SCM
  • progression slows around 6 months due to brain growth slow and can sit more.
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16
Q

anterior fontanelle -closes when

A
  • last to close

- close around 9-18 months of age

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17
Q

posterior fontanelle - closes when

A

closes 1-2 months.

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18
Q

TIMP (test of infant motor performance)

A
  • infant 32 weeks gestation.
  • age 4-5 months post term
  • has a good part that assesses infant ability to index. control head position in a variety of spatial orientations
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19
Q

torticollis - interventions

A
  • passive neck ROM
  • AAROM
  • strengthening
  • postural control
  • caregiver education - carrying, positioning, ROM at home

-*overall goals to restore full joint and muscle ROM, prevent contractors, restore strength.

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20
Q

studies about initiating exercise before 1 year of age???

A

-PROM of neck reported as good to excellent with success 61-99%

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21
Q

cranial orthotics

A
  • DOC band
  • hanger band
  • star band

*measurements mod-severe then refer out.

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22
Q

torticollis - anticipated outcomes

A
  • full PROM of neck, trunk, extremities
  • active and symmetric head rotation in all positions
  • active midline head control
  • normal antigravity strength
  • normal head righting
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23
Q

What is Cerebral palsy?

A
  • permanent, non-progressive disorder as a result of a brain lesion within the first 2 years of life.
  • have progressive musculoskeletal problems
  • can also have: cognitive delay, behavioral issues, impaired speech hearing vision, seizures, urinary incontinence, constipation, etc
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24
Q

CP - Diplegia

A
  • both sides of body

- typically legs more affected than arms

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25
CP - hemiplegia or hemiparesis
- one side of body (arm and leg)
26
CP - Triplegia
- 3 limbs
27
CP - quadriplegia or tetraplegia
- 4 limbs
28
Spastic CP
- results from involvement of motor cortex or white matter projections to and from the cortical sensorimotor areas of the brain - spasticity and exaggerated reflexes result in abnormal patterns of posture and movement
29
Dyskinesia CP
- involvement of basal ganglia - atypical patterns of posture and involuntary, uncontrolled, recurring, and occasionally stereotyped movements - dystonic or athetosis subtypes **uncontrolled, slow
30
Ataxic CP
- cerebellar lesion - inability to generate normal or expected voluntary movement trajectories **poor coordination and balance
31
Mixed CP
-symptoms of spastic and dyskinesia may be present
32
Prevalence of CP types
- spastic hemi 30% - spastic diplegia 38% - spastic quad 5.5% - dystonia 9.5% - athetosis 5.5% - ataxic forms 11% - mixed 2% *spastic > ataxic
33
causes of CP
(pre-, peri-, and postnatal) - hypoxic - ischemic - infections - congential - traumatic insults
34
what is the most common cause of physical disability affecting kids in developed countries?
-CP (2-2.5/1000 live births)
35
diagnosis CP
- kid does not reach motor milestones and shows abnormal tone or qualitative differences in mvmt patterns. - neuro imaging - prenatal risk factors
36
determining prognosis in CP
* * sitting independently by 24 months is best predictor of ambulation with or w/o AD by age 8 (if not achieved by age 3 walking is little chance) - cognitive function is a strong predictors - 54% walk independently by age 5 - hemiplegic and ataxic more likely to walk - dyskinetic and bil CP least likely
37
positive factors for CP prognosis
- mild physical involvement - good home support - education - vocational training - good cognitive skills -31% of adults live independently
38
CP - life expectancy
- 2 y/o with severe CP has 40% chance to live to 20 (mild CP = 99%) - decline in mortality of kids with CP in past 20 years due to better management
39
modified tardieu scale
- for tone - measure point of resistance or "catch" to a rapid velocity stretch - good indicator of dynamic neural tone or overactive stretch reflex
40
standardized tests for infants -CP
- TIMP - AIMS - Movement Assessment of Infants
41
hypotonicity definition
-dec resistance to passive stretch | involved in DS, genetic disorders, MD, hypotonia
42
Early warning signs of kids with hypotonia
parents notice excessive floppiness and general inactivity
43
basic problems with kids with hypotonia - consequences
- difficult maintaining a secure posture to interact with the environment - can limit cognitive development - inc self-esteem behavior to fill void of sensory input
44
hypotonia - postural instability
- sink into gravity - limit early random play - poor midline control - lack dynamic muscle control - use either total flexion or extension patterns - lacks graded control of all 3 phases of muscle activity (initiate, sustain, terminate)
45
hypotonia - hypermobility
- lack of ligament, muscle, and tissue resistance toward extreme movement ranges - sustained posturing in extreme joint ranges can cause reduced mobility in the opposing joint range
46
hypotonia - possible deformities
- hip dislocation | - pelvic torsion
47
hypotonia - respiration
- insufficient for sustained vocalization | - breathing is noisy d/t rib cage instability
48
Down syndrome - cause
- additional chromosome (47 total instead of 46) | - commonly trisomy 21 (nondisjunction 95%, translocation/mosaic 5%)
49
down syndrome - incidence and life expectancy
- 1 in 800-1000 - more common in older moms giving birth -life expectancy = 60s
50
down syndrome - neuropathology
- dec wt of brain - microcephaly or microbrachycephaly - secondary sulci reduced-simplicity of convoluted patterns on the brain - motor incoordination - lack of myelination between 2-6 years of age - up to 8% have seizure disorder
51
DS - sensory deficits
- visual (congenital, cataracts, myopia, farsightedness, strabismus, nystagmus) - heading deficits (60-80% mild to moderate loss) - speech impairments
52
DS - cardiopulmonary
- 66% born with congenital heart defects (most common AV canal defects and ventriculoseptal defects) - usually repaired in infancy - if not repaired by age 3 = high association with greater delays in motor skills
53
DS - musculoskeletal linear growth deficits
greatest between 6-24 months of age - leg-length reduction - 10-30% reduction in metacarpal and phalangeal length
54
DS - musculoskeletal - muscle variations
- absent palmaris longus | - lack differentiation of distinct mm bellies for zygomaticus major/minor and levator labii superior of the face
55
DS - musculoskeletal - hypotonia
- found in all muscle groups - ***hallmark feature in kids with DS - major contributing factor for delays
56
DS - musculoskeletal - ligamentous laxity
- another hallmark feature of kids with DS | - collagen deficit
57
DS - musculoskeletal - most commonly see
- pes planus - petallar instability - scoliosis - atlantoaxial instability - hip subluxation
58
DS - distinguishing features
- small head, mouth, palate, eyes, low muscle tone - single deep crease on palm of hand - low set ears
59
how does DS influence calories burned?
kids with DS burn 10-15% less calories
60
Developmental coordination disorder (DCD) - definition
- poorly defined fine and/or gross motor skills - not attributed to a known neurological or medical disorder - unknown pathologic process **
61
DCD is believed to involve what areas of the brain?
cerebellum and basal ganglia
62
diagnosing DCD
- motor impairments and skills delay significant impacts child's activities - adequate opportunities for experience and practice - no other explanations offered for impairments
63
DCD primary impairments
- imp vision, kinesthetics, proprioception - slow and awkward movements. rigid and jerky - inappropriate and ineffective muscle activation and sequence - poor motor learning
64
DCD secondary impairments
- tired | - frequently "off task"
65
DCD activity limitations
-limited fine and gross motor skills Fine: tie shoes, zippers, open food, writing Gross: bike, swing, run, stairs, etc.
66
DCD key questions to ask yourself
- inc or fluctuating tone? - delays more global? - have difficulties been present from an early age? - are motor concerns worsening? - any loss of previously acquired skills?
67
Developmental coordination disorder questionnaire -assessment tool
-parent report
68
teacher reported DCD assessments
- MABC-C and MABC checklist-2 - ChAST - MOQ-T
69
assessment tools - Peabody
-young children
70
assessment tools - BOTMP ("BOT")
- older kids | - measures ability, but not quality of movement
71
assessment tools - MABC
- older kids | - *best assessment tool for DCD in spite of omitting handwriting
72
DCD interventions - bottom up approach
- focus on components of skills | - aimed primarily at changing body structure/function impairments
73
DCD interventions - top down approach
- dynamic systems theory | - emphasis on specific skills not components.
74
Muscular dystrophy (MD) - info
- genetic inheritance - progressive neuromuscular disease caused by destruction of myofibrils - incurable, but treatable
75
MD characteristics
- progressive weakness - atrophy - contractures - deformity and progressive disability
76
Duchene (DMD) - onset, inheritance, course
- onset = 1-4 years - inheritance = X-linked - course = rapidly progressive. loss of walking by 9 y/o. death in late teens. **gower sign
77
Becker (BMD) - onset, inheritance, course
- onset = 5-10 yrs - inheritance = X-linked - course = slow progressive. maintain walking past early teens. life span into 3rd decade
78
Congenital MD -onset, inheritance, course
- onset = birth - inheritance = recessive - course = typically slow but variable. shortened life span
79
Congenital myotonic MD - onset, inheritance, course
- onset = birth - inheritance = dominant - course = typically slow with significant intellectual impairment
80
Childhood-onset facioscapulohumeral MD -onset, inheritance, course
- onset = first decade - inheritance = dominant/recessive - course = slowly progressive loss of walking in later life. variable life expectancy
81
Emery-Dreifus MD - onset, inheritance, course
- onset = childhood - early teens - inheritance = X-linked - course = slowly progressive with cardiac abnormality and normal life span
82
MD - primary impairments
-insidious weakness secondary to progressive loss of myofibrils
83
MD - secondary impairments
-contractures, postural mal-alignments (scoliosis), dec respiratory capacity, fatigability, obesity
84
Duchenne's MD cause and symptoms
- 1 in 3500 births - cause = absence of dystrophin - symptoms = gen weakness and muscle wasting. (prox first) - calves are often enlarged**
85
goal of PT with people with MD.
- prolong independence - slow progression of complications - improve quality of life *focus on mobility and prevent contractors and improve strength
86
MD - to exercise or not to exercise?
- exercise moderately but do not go to exhaustion | - aquatics are good. buoyancy
87
Spinal muscular atrophy (SMA)
- a genetic disease that causes a loss of motor neurons in spinal cord - caused by a deficiency of a motor neuron protein called SMN (survival motor neuron?) - on chromosome 5. is rare X-linked - onset = before birth to 6 months - 4 types. type 1 and 2 most prevalent
88
Most common genetic cause of death in infancy?
SMA - spinal muscle atrophy
89
SMA - symptoms
-generalized muscle weakness, weak cry, trouble swallowing as well as sucking, and breathing distress. cannot sit without support
90
SMA - progression
-very rapidly
91
SMA type 1
(infantile-onset, werdnig-hoffmann disease) - most severe form - cannot sit independently - between birth and 6 month old - 50% die before 2nd birthday
92
SMA type 2
(intermediate SMA) - affect babies before 18 months - may be able to sit unaided or stand with support - shortened life span
93
SMA type 3
(juvenile SMA, Kugelberg-Welander disease) - mildest form - between 18 months and late adolescence - can stand and walk independently for some time
94
SMA type 4
(adult SMA) - adult form of disease - symptoms begin after age 35
95
SMA primary impairments
-muscle weakness secondary to progressive loss of anterior horn cells in spinal cord
96
SMA secondary impairments
- Cranial nerve involvement - contractures - muscle fasciculations - respiratory distress - scoliosis - fatigability
97
SMA - treatment
-focus on feeding, ROM, positioning, respiratory care and selected developmental activities

PTH 635 Peds (4 decks)

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