Final part 1

Question 1

The five red flags for language delay?

Answer 1

1. no babbling by 12 months
2. no back and forth gestures (pointing, showing, reaching, waving) by 12 months
3. no words by 16 months
4. no 2-word meaningful phrases by 24 months (imitation and repetition don’t count)
5. ANY loss of speech, babbling, or social skills at ANY age

Autism is a big thing in peds, need to know these language delays – a lot of us forgot that any child who losing a language = RED FLAG

Question 2

How many minutes do they need to be in prone?

Answer 2

81

Question 3

Listing the features of hypotonia?

Answer 3

●	decreased strength
●	delayed motor skill development
●	poor attention/motivation
●	decreased activity tolerance
●	hypermobile joints: increased flexibility
●	lean on supports: rounded shoulders

Question 4

. Stair climbing (What the age range of alternating up with the rail, alternating up without the rail – know up and down)

Answer 4

● alternating up with rail: 24-28 months

● alternating up without rail: 36 months

● alternating down with rail: 35 months

● alternating down without rail: 48 months

Question 5

alternating up with rail:

Answer 5

24-28 months

Question 6

alternating up without rail:

Answer 6

36 months

Question 7

alternating down with rail:

Answer 7

36 months

Question 8

alternating down without rail:

Answer 8

48 months

Question 9

When you have a child that has a hard time lifting head in supine, not be cause of lack of tummy time but lack of their flexors

Answer 9

When you have a child that has a hard time lifting head in supine, not be cause of lack of tummy time but lack of their flexors
Tummy times is prone skills = extension
Sea saw – bottom goes down, head comes up

Question 10

Hemophelia

what joints are affected

Answer 10

a. Elbow
b. Knee
c. Ankle

Question 11

Hemophelia: muscles most affected

Answer 11

a. Illiopsoas
b. Gastrocnemius
c. Forearm flexor compartment

Question 12

Hemophelia: nerves compressed

Answer 12

femoral, sciatic, peroneal

?, ulnar nerve, median

Question 13

Hemophelia: appropriate recreational activities for these kids

Answer 13

swimming, golf, walk, bike+helmet pads

Question 14

OI: skeletal deformities

Answer 14

a. bowing of femur and tibia, anterolaterally; humerus
b. coxa vara, acetabular protrusion
c. apparent knee flexion contracture due to angulation of femur and tibia

Question 15

OI: deformities

Answer 15

a. Ligamentous laxity
b. Fragile bone
c. Spinal deformities
d. Patella femoral dislocation

Question 16

OI: deformities

Answer 16

1. Skeletal Deformities
   - –bowing of femur and tibia, anterolaterally; humerus
   - –coxa vara, acetabular protrusion
   - –apparent knee flexion contracture due to angulation of femur and tibia
2. ligamentous laxity
3. fragile bones: can develop osteoporosis from fracture immobilization
4. spinal deformities
   - –scoliosis
   - –kyphosis
5. patello-femoral deformities: joint dislocation

Question 17

OI:

Contra-indications to PROM

Answer 17

—AROM and functional ROM only: hands to mouth, midline, top of head

—defer goniometry if fractures

Question 18

Arthrogryposis Multiplex Congenita

Definition:

Answer 18

congenital, non-progressive neuromuscular syndrome

there are contractures in at least 2 body areas

Question 19

Arthrogryposis Multiplex Congenita

Body Parts Affected Type 1

Answer 19

Flexed hips
extended knees
clubfeet
IR shoulders
flexed elbows
flexed/ulnar deviated wrists

Question 20

Arthrogryposis Multiplex Congenita

Body Parts affected type 2

Answer 20

Abducted and ER hips
Flexed knees
clubfeet
IR shoulders
extended elbows
flexed/ ulnar deviated wrists

Question 21

Downs Syndrome

Ortho considerations in downs

Answer 21

1. Hypotonia
2. Joint ligament laxity
3. Cervical Spine Instability: AO joint instability*
4. Scoliosis

5. Hip instability (Sankar, Millis, & Kim,
2011)
---Osteoarthritis
---Dislocation
---Fracture

6. Patellar instability
7. Pes Planus/Metatarsus varus

Question 22

Notes on Downs Syndrome

Answer 22

1. orthopedic considerations in DS
2. leukemia common
3. kids with downs are very stubborn

Question 23

Is leukemia common in Downs?

Answer 23

YES

Question 24

A personality trait common in children with downs?

Answer 24

Stubborn

Question 25

CF: most important PT intervention

Answer 25

a. chest PT: percussion, vibration, postural drainage, counter rotation, forced expiration technique/active cycle of breathing, autogenic drainage b. breathing exercises: singing songs, prolonged phonation, blowing bubbles, blowing out candles, balloons, c. chest mobility: ball skills (throwing, catching, dribbling), hitting ball with bat, rolling on a physioball, crawling, prone activities, reaching, yoga

Question 26

Juvenile Idiopathic RA: What assessment tool is only used in this condition

Answer 26

JAFAS: juvenile arthritis functional assessment scale: Measure the child’s performance Only tool that measures the child with JIA’s actual performance

Question 27

Juvenile Idiopathic RA: appropriate activities

Answer 27

a. low impact activities (swimming, pilates, cycling) Doubles tennis, swimming, horseshoes, sailing, cycling, bowling, golf high impact activties are contraindicated

Question 28

Spinal Muscular Atrophy 1. pattern of weakness:

Answer 28

a. PROXIMAL MORE THAN DISTAL: quad weakness b. absent DTRs, hyporeflexia c. respiratory weakness

Question 29

Spinal Muscular Atrophy orthopedic impairment

Answer 29

a. contractures: knee flexion, plantar flexion, elbow flexion, wrist b. kyphoscoliosis: spinal fusion c. fractures d. hip dislocation

Question 30

Spinal Muscular Atrophy mortality

Answer 30

aspiration pneumonia

Question 31

Spinal Muscular Atrophy Common orthopedic impairment

Answer 31

Scoliosis

Question 32

Spinal Muscular Atrophy Motor Scale

Answer 32

Modified Hammersmith Functional Motor Scale --SMA specific

Question 33

Spinal Muscular Atrophy Musculoskeletal vulnerabilities

Answer 33

- Proximal weakness especially in quadriceps - Contracture formation - knee flexion, plantar flexion, elbow flexion and wrist most common ( need night splints) - Kyphoscoliosis - spinal fusions - custom molded seating support - Fractures, hip dislocations

Question 34

Walks Upstairs with ONE HAND HELD

Answer 34

17-19 Months | a yr and 5 months to a yr and 7 months

Question 35

Walks UPSTAIRS holding RAIL both feet on each step

Answer 35

18 months

Question 36

Walks DOWNSTAIRS holding RAIL

Answer 36

18 months

Question 37

Clinical signs or red flags exist to help identify children at risk for language delays and or ASD

Answer 37

1. no babbling by 12 MONTHS 2. no back/forth gestures as pointing/showing/reaching/waving by 12 MONTHS 3. no WORDS by 16 MONTHS 4. no TWO-WORD meaningful phrases (doesnt include imitation/repetition) by 24MONTHS 5. ANY loss `of speech, babbling, or social skills at ANY age

Question 38

Part C EI

Answer 38

0-3 years EI = early intervention Document: IFSP (review every 6 months) not classified 12 months delay or 33% delay or a score at least 2SD from mean in one area of development (2.14 percentile) or 25% delay in two areas or at least 1.5 SD below the mean in 2 areas (7 percentile)

Question 39

Part B CPSE

Answer 39

3-5 years (need to set up meeting 6 months before 3rd bday) section 4410 of Education Law write an IEP Classified: "Preschooler with a Disability"

Question 40

Part B CSE

Answer 40

5-21 years Classified: federal classification system: autism, deaf/blindness, hearing impaired, speech or language impaired, visually impaired, intellectual disability, other health impairments, multiple disabilities, TBI, emotional disturbance, learning disability, orthopedic impairment

Question 41

How often is the IFSP and IEP reviewed? When does IEP testing need to be done

Answer 41

IFSP: every 6 months IEP: quarterly check goals, every year review, retest every 3 years for eligibility

Question 42

what need to show to get ESY

Answer 42

regression take longer than 6 weeks to get the skill back (recoupment) - -degree of preogress - -emerging skill, breakthrough opportunity - -interfering behaviors - -special circumstances

Question 43

Who gets 504

Answer 43

students not eligible under IDEA because do not need special education but still need some assistance to participate fully in regular school (not federal fun)