lecture 3: atypical development Flashcards by Rebecca Nam

What gait thing happens at age 2 years old?

ARM SWING
Heel strike!

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If you have persistent toe walking past the age of ___, this indicates

past the age of 2: indicates ATYPICAL gait
possibly ITW

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if you have inconsistent toe walking (ITW) past the age of ____,

3, indicates ATYPICAL development

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ITW is a diagnosis of

exclusion

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delays in which domains have been associated with ITW?

language
sensory processing

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atypical development may start out just like typical development, but _____

many typical components are missing!
*babies learn to compensate
*compensations become pathological, cause ABNORMAL or atypical movement postures/patterns

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What is important to get during atypical development exam subjective?

developmental history!

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a 4 month old infant presents with severe L CMT. What mm would be tight?

SCM, scalenes, upper trap, levator scap
left lateral trunk

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Would Apgar be the same as typical baby with 4 month old baby with torticollis?

yes, probably! Just typical components are missing
babies learn to compensate, which become pathological

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What is key question to ask with ITW subjective?

did kid always walk like this since starting walking?
*if it is new –> RED FLAG, may be something else

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When is eye dominance established?
range __ to ___, but by ___ is established

range: 3-4 years
by 6 years eye dominance established

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When is hand dominance established?

range 3-4 years
by 4-6 years CLEAR DOMINANCE usually established

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leg dominance is established when?

range: around 3 years
by 6 years a leg dominance is established

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__% of people are right handed
__% of people are right eye dominant

90% right handed
67% right eye dominant

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How can you test a kid’s eye dominance?

ask them to look through a camera, kaleidoscope, toilet paper tube

(usually will place object up to dominant eye

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before exam starts: what should you know?

child’s age
diagnosis
primary concern
CHART REVIEW! for CLINICAL PICTURE

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what should you include in kid examination for past medical history? EXTRAS not in adult exam

*maternal pregnancy and birth history

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key questions for developmental history:

what age did they sit
what age did they walk
know: chronological age, adjusted age, observed LOF

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functional skills exam:

developmental milestones
methods of play
ADLs
AROM assessed through play
gait

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What are patterns of an immature motor system?

loss of dynamic balance
falling after doing a motor task
inability to control force
inability to maintain rhythm
inappropriate motor planning
lack of/decreased TRANSVERSE PLANE MVMT

With orthotics, when can you get a new pair?

typically every year
little ones: maybe every 6 months
*write down equipment and how old it its

AIMS test is ___ based

observation based

Modified Ashworth Scale (MAS): list the grades

0: normal

1: slight increase in tone: catch & release or minimal resistance at end of ROM

1+ : slight increased tone, CATCH followed by minimal resistance through remainder (less than half) of ROM

2: more increased mm tone through most ROM, but affected parts easily moved

3: considerable increase in mm tone–> passive movements difficult

affected part RIGID in flexion/extension

Clonus grades

0: absent
1: unsustained (few beats)
2. sustained (continuous)
3: SPONTANEOUS/light touch provoked and sustained

DTR grades

0: none 1: lower than normal 2: normal 3: higher 4: exaggerated with clonus

patterns of immature movement:

inconsistency of performance limited planes of motion perseveration: can't stop activity when appropriate extraneous mvmts asymmetry, difficulty with bilateral coordination

What is the FLACC observation scale?

For infants, preschoolers, nonverbal children F: face L: legs A: activity C: cry C: ability to console score 0-2, resulting in total score between 0-10

What are 3 pain assessment scales?

FLACC Wong-Baker Faces PRS (3+) --> 0, 2, 4, 6, 8, 10 Verbal Analog Scale (10+)

atypical infant development: W sitting is an example of

fixing/limiting DOF due to poor underlying control

What are 2 BROAD general types of diagnoses?

MSK Neuromuscular

before initiating PT for CMT, need to rule out ____

NON-MUSCULAR causes of TORTICOLLIS *baby could have CP, cataract, etc.

What are non-muscular causes of torticollis?

1. cervical rib (cervical skeletal malformation)--> should NOT STRETCH 2. posterior fossa tumor 3. Sandifer's syndrome (gastroesoph. reflux) 4. sublux of cervical vertebrae 5. extraocular mm paresis 6. CATARACT (ocular strabismus or nystagmus) 7. Klippel-Feil syndrome, Sprengel's deformity 8. Brachial Plexus Injury/ clavicular injury during forceful birth

__% of all torticollis is NON-MUSCULAR TORTICOLLIS

18%

All CMT should screen for ___ and ___

DDH (10-20% association) plagiocephaly (asymmetry of ears and eyes) feeding, vision, hearing contractures AROM/PROM cervical spine gross motor skills

definition of plagiocephaly

misshapen head can have uneven eyes, ears, etc.

definition of cranial orthosis

NOT A HELMET may only need to wear 2-3 months

brachycephaly

flat head *can have brachycephaly and plagiocephaly

what is scaphocephaly?

elongated head

The posterior fontanelle usually closes by age

1-2 months

the anterior fontanelle usually closes withing

7-18 months

When can cranial orthosis no longer help the child?

18 months earlier the better, especially bc it takes a few months to get it

review Torticollis CPG

1. neck PROM 2. neck + trunk AROM (also screen UE/LE for hip dysplasia, spine asymmetry) 3. symmetry (skin, folds, SCM, hips) 4. environmental adaptations 5. caregiver education

What is a Pavlik Harness?

Treatment for DDH infant less than 3 months old: hip is in flexion and abduction (good for hip development)

If older child, DDH intervention is

surgery + spica cast 3-6 months if brief 3 week trial of pavlik harness doesn't work

What should you monitor children wearing pavlik harness for???

avascular necrosis femoral nerve palsy inferior dislocation

infants over 9 months of age may need to have....

a closed hip reduction and hip spica cast

for dysplasia with/without subluxation, infants more than 9 months old ambulatory can use a

hip abduction orthosis for ambulation *if dislocated between 6-18 months of age, need surgery

When do you need surgery for DDH?

2+ (mandate open reduction)