L7: Peds Exam Flashcards
(55 cards)
1
Q
Where do you start?
A
- Hx/chart review
- med, fam sx hx
- dev. hx including age of acquisition for motor milestones, APGAR**
- family dynamics, school placement, day-day routine
- ADs/PLOF
- Current LOF/condition, reason for PT
- MEds
- *anti-epilectics, spasticity, attn defs
- allergies
- imaging
- precautions/contraind’s
2
Q
Exam/impairment lvl
Things to remember***
A
NEVER assume pt will be able to comply w/ testing
Formal testing often cannot be conducted due to pts age, cog, compliance
3
Q
Exam/Impairment Lvl
MSK
A
- ROM/Strength
- Strength→ MMT usually becomes accurate around age 3******
- Posture and Alignment
4
Q
How and when does one formally assess strength in the absence of MMT?
A
- Younger than 3, poor cog, lack of isolated mvmt
- Use observation of and description of motor skill abilities OR lack of abilities
- OFten described as “developmental assessment” for younger children
- described as “motor control assessment” in older children
- Use observation of and description of motor skill abilities OR lack of abilities
5
Q
Exam/Impair. Lvl
Neurological
A
- Reflexes
- Tone/Spasticity
- Motor Control
- Coord
- Balance
6
Q
Exam/Impair LVL
Neuro→ Tone/Spasticity
A
-
HypERtonicity
- Ashworth Scale
- Modified Tardieu (R1/R2)
-
HypOtonicity
- no assess’s
-
Dystonia
- fluctuations in tone
-
Barry Albright Dystonia Scale
- 8 body regions → HIGHER= more severe dystonia
7
Q
When ______ is NOT present, _____ cannot be conducted and should not be
A
Isolated mvmt; MMT
8
Q
Motor Control Assessment
(Older children)
A
Qualifies strength
*narrative that breaks down mvmt of limbs by joint→ describes quality of that mvmt
9
Q
Coordination note:
A
- finger to nose
- itsy bitsy spider
- Dysdiadochokinesia (patty cake)
- OR coord assess→ jumping jacks/catching ball
10
Q
Balance tests to note
A
Peds functional reach
TUG for children
Pediatric BERG
*No predictive values for these tests for children!!!
11
Q
Balance must be reported HOW?
A
Objective and reproducible way NOT just good, fair, poor
12
Q
Exam/Impair Lvl
Cardio.
HR trends
A
- Fetal→ 8-10yo=== Avg HR SLOWS as we get older
- 12yrs→14yrs=== Females HIGHER vs males BUT same thing, slows as we age
13
Q
Exam/Impair Lvl
Cardiovascular→ BP
A
BOTH systolic and diastolic BP gets HIGHER as we age
14
Q
Exam/Impair Lvl
Cardiovascular → RR
A
RR gets LOWER as we age
15
Q
Exam/Impair Lvl
Cardiovascular→ Lung capacity/Wall expansion
things to use
A
Inspirometer, bubbles, tape measure, tissue blow, cough strength
16
Q
Exam/Impair Lvl
Cardiovascular → Endurance
Tests to use
A
- Step up test
- 6min Walk Test
- RPE (peds graph)
- time playing
17
Q
Exam/Impair Lvl
Sensation
Things to look @
A
- Lt touch/proprio
- Vision
- Hearing
- Processing→ thru observation of behavior/parent report
- Pain
18
Q
Pain scales to use w/ Peds
A
FLACC Scale (nonverbal children/cog. impaired)
Wong Baker FACES Scale
19
Q
Exam/Impair Lvl
Cognitive/Social
IMPORTANT THINGS TO NOTE***
A
Make eye contact?
Have age approp. play skills?
*if old enough, questions related to self-efficacy, overall perception of health, QoL measures→ PEDS-QL
20
Q
Exam/Impair Lvl
Integumentary
A
- skin integrity
- Skin risks***→ important for certain pops like spina bifida
21
Q
Functional/Activity Limits.
A
Transfers
Mobility: amb, W/C mobiltiy
Stairs
Changes in environ.
22
Q
Function/Activity/Participation Restricts:
A
MANY measures
MOST function on functional mobility, motor skills vs peers, participation capability
23
Q
There are 2 types of measures
A
-
Criterion Referenced
- pts scored for aspects or components of mvmt: changes over time
- cannot compare to peers
-
Norm-Referenced
- Standardized or norm (typical) children and are used to provide a measure of childs function in compare to age matched peers
- not as resp. to change over time***
24
Q
***Test of Infant Motor Performance (TIMP)
Age group:
Looks @/Dx:
Category ICF:
A
- 32wks→ 4mos
- Functional motor activities for very young child diff pos’s
- @risk children in NICU***
- Great to eval infants <4mos w/ torticollis***
- Activity category: Gross Motor
25
\*\*\*Bailey Scales of Infant Development (BSID-2): **Norm ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 1-42mos
* Developmental delay & monitor progress (lang, gross/fine motor, behavior, perceptual)
* **Activity category: Developmental Screening**
26
\*\*\*Denver II→ Norm ref'd
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 1wk→ 6.6yrs
* Developmental problems (behavior, self-care, fine/gross motor, lang.)
* **Participation category:**
27
\*\*\*Batelle Developmental Inventory (BDI)→ **Norm ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* Birth→ 8yrs
* Developmental lvl→ plan intervention/assess effects (personal-social, adaptive, motor, communication, cognition)
* \***looks @ all areas where you can justify rehab**
* **Activity category: Multidomain**
*
28
\*\*\*Movement Assessment of Infants (MAI)→ **Norm ref'd and Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 4→ 8mos: **Norm referenced;** Birth→ 12mos: **Criterion referenced**
* ID motor dysf in high risk infants, monitor PT effects (mm tone, reflexes, automatic rxns, volitional mvmt)
* **Body structure/function category: Reflexes**
29
Alberta Infant Motor Scale (AIMS)→ **Standardized**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* Birth→ 18mos
* Gross motor delay and changes over time
* **Activity category: Gross motor**
30
Peabody Developmental Motor Scale (PDMS-2)→ **Norm ref'd and Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 1→ 72mos
* **Known disabilities: Criterion**
* Determine lvl of motor skill acquisition/delay (Gross motor, reflex, stationary, locomotion, object manip, grasp, visual motor integration)
* **Activity category: Fine Motor**
* **\*MOST commonly used in research/Gold Standard!!!**
31
This FOM especially used for **CP and Down Syndrome\*\*\*\*\*\***
## Footnote
**KNOW THIS!!!**
Gross Motor Function Measure (GMFM)
32
GMFM what should you memorize???
CP and Downs!!!
33
\*\*\*Gross Motor Function Measure→ **Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 5mos→ 16yrs
* **\*\*CP and Downs!!!**
* Change in gross motor skills over time→ current lvl & determine goals (lying, rolling, crawling, sitting, standing, walking, running, jumping)
* **Activity category: Gross Motor**
34
GOLD STANDARD FOR CP AND DOWN SYNDROME
GMFM
35
Test for Gross Motor Development-2 (TGMD-2)→ **Norm ref'd and Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* Norm ref'd for 3→ 10yo
* Criterion ref'd
* Determine acquisition of gross motor skills (locomotion, obj. control)
* **Activity category: Gross Motor**
36
School Function Assessment (SFA)→ **Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* K-6 **children w/ disabilities\*\*\***
* assess function & guide program planning w/in school (Participation, task support, activity performance, phys. tasks, cog/behavioral)
* **Participation category:**
37
Movement Assessment Battery for Children (Movement-ABC)→ **Norm ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 3→ 16yo
* \***Best for coord. dx (ADHD, ASD)**
* Impairments of motor coordination (DCD, ADHD, ASD)
* Manual dexterity, ball skills, static/dynamic balance
* **Activity category: Multidomain**
38
Bruininks Oseretsky Test of Motor Proficiency (BOT-2)→ **Norm ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 4→ 20yo
* Assess motor skills in children
* Balance, coord, speed/agility, strength, visual motor control, dexterity
* ***Looks @ high lvl skills (sit-ups, push-ups, wall-sits, agility)→ NOT good option for neuro pop.*****\*\*\*\***
* **Activity category: Fine Motor and Gross Motor**
39
Pediatric Evaluation of Disability (PEDI)→ **Norm ref'd and criterion ref'd (older kids)**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* 6mos → 7.6yo
* Older children w/ lower functional/cog abilities→ **criterion ref'd**
* Looks @ functional capabilities/performance, monitor progress in functional skill performance and eval outcomes
* **interview format**
* **Activity category: Multidomain**
40
Functional Independence Measure for Children (Wee-Fim)→ **Criterion ref'd**
## Footnote
**Age group:**
**Looks @/Dx:**
**Category ICF:**
* Criterion for:
* **Children w/OUT disabilites 6mo→ 8yrs**
* **Children w/ disabilities 6mo→ 12yrs**
* **Children w/ disabilities and mental age \<7yrs**
* Determine severity of disability, caregiver assist, outcomes of rehab stay
* self care, sphincter control, transfers, locomotion, communication, social cog
* **Activity category: Multidomain**
41
Knowing **Normal Dev. importance**
* Need to know norm for abnorm ID
* Be aware **red flags**
* **Any _regression or loss of previously acquired skills is cause for concern_!!!**
42
PT Eval
* Based on Exam findings
* **Dx**
* **Prognosis:** det'd/predicted outcome lvl
* **POC:** purposed interventions, freq/duration, goals/outcomes, discharge plans
* **Eval is summary of clinical findings and how they impact function/development.**
43
Goal Writing
## Footnote
**ABCD!!!**
* Functional (why important, function pt unable to perform?
* Measurable
* Meaningful
* Realistic
* Time Frame
* Take normal dev. into acct
* age approp?
44
Discharge planning
Setting and type of Dx
* Acute→ likely d/c to home
* Early Intervention→ d/c to school program
* OPPT→ possible d/c to HEP, break in services, back to PCP, community activities
* **NOTE most children we treat have lifelong PT needs→ planning how/when to take breaks is reqd**
45
Class. of tests under **ICF Cats:**
## Footnote
**Body Structure/Function**
**Pain**
* FLACC
* Wong-Baker FACES
* VAS
46
Class. of tests under **ICF Cats:**
## Footnote
**Body Structure/Function**
**Posture/Balance**
* MAI (Movement Assessment of Infants)
* Ryders
47
Class. of tests under **ICF Cats:**
## Footnote
**Body Structure/Function**
**Spasticity**
Mod. Ashworth
Mod Tardieu (R1/R2)
48
Class. of tests under **ICF Cats:**
## Footnote
**Body Structure/Function subcats:**
Pain
Posture/Balance
Spasticity
49
Class. of tests under **ICF Cats:**
## Footnote
**Activity subcats:**
Gross Motor
Fine Motor
Multidomain
50
Class. of tests under **ICF Cats:**
## Footnote
**Activity**
**Gross Motor**
* BOT-2
* Peabody-2, AIMS
* GMFM\*\*\* (CP and Downs\*\*\*\*)
* TIMP
* TGMD-2
51
Class. of tests under **ICF Cats:**
## Footnote
**Activity**
**Fine Motor**
* BOT-2
* Peabody-2
52
Class. of tests under **ICF Cats:**
## Footnote
**Activity**
**Multidomain**
* BSID-2
* BDI
* SFA
* Movement-ABC
* PEDI
* Wee-FIM
* Denver-II
53
Class. of tests under **ICF Cats:**
## Footnote
**Participation**
SFA
54
Goal Writing:
## Footnote
**ABCDF**
* AUDIENCE: who goal directed towards (pt, caregiver, sibling, teacher)
* BEHAVIOR: what do you want child to do (walk, crawl, etc.)
* CONDITION: how you want it to be done (walker, w/out abd sagging, etc.)
* DEGREE: how far (x150ft, x10ft, 80% of time, etc)
* FUNCTION: to be able to walk into bathroom at home, etc.
55
Goal Writing Ex's
1. In 4 wks, Ashley will ind. negotiate 12 stairs reciprocally w/ 1 HR while wearing her backpack ⅔ trials in order to improve her ability to negotiate school hallways safely
2. In 4wks, Ashley will demonstrate an active heel strike 50% of the time over 100 feet of amb w/out verbal cueing ⅔ trials in order to improve gait mechanics and dec tripping incidence
3. In 4wks, Ashley will maintain SLS on either foot for at least 20s w/out excessive sway ⅔ trials in order to improve her ability to participate w/ peers on playground
