lecture 4: CMT and ITW, blocks

Question 1

What should parental education for CMT include?

Answer 1

neutral head positioning (feeding both directions, positioning)
*environmental modifications to increase active ROM (crib, high chair placement)

Question 2

infants who play in prone for a total of _____ per day decreases negative effects of Back To Sleep program

Answer 2

60 minutes

Question 3

CMT Classification Scale: Grade 1

Answer 3

severity: early mild
age: 0-3 months
PROM: only postural/mm tightness less than 15 degrees

Question 4

When should infant be referred for CMT?

Answer 4

early! ASAP!

Question 5

CMT classification Grade 2

Answer 5

severity: early moderate
4-6 months
15-30 degree

Question 6

CMT classification Grade 3

Answer 6

early severe
4-6 month
more than 30 degree tight or SCM MASS

Question 7

CMT classification Grade 4

Answer 7

late mild
7-9 months
mm tight less than 15 degrees

Question 8

CMT classification Grade 5

Answer 8

late moderate
10-12 month
less than 15 degrees

Question 9

CMT classification Grade 6

Answer 9

late severe
7-12 months
more than 15 degrees

Question 10

CMT classification Grade 7

Answer 10

after 7 months with SCM MASS
after 12 months with more than 30 degrees tight, SCM mass,
or referred after 12 months

Question 11

What is the treatment plan for ITW?

Answer 11

1. stretch gastroc/soleus
2. strengthen DF/PF
3. with significant tendo-achillis contractures, patients may require serial casting (10 degree DF goal)

Question 12

Should you perform surgery for ITW?

Answer 12

NO VERY RARE
*causes iatrogenic gait deviation, disrupts plantarflexion knee extension couple!

Question 13

true or false: a group of children that have a family history of idiopathic toe walking

Answer 13

TRUE
*autosomal dominant pattern

Question 14

Association between ITW and _____ delays

Answer 14

language!
*need to have speech and language milestones examined

Question 15

children with ____ often exhibit toe walking

Answer 15

autism
sensory integration disorder/issues

Question 16

on-going, random-appearing
sequence of one or more discrete movements
or movement fragments varying in timing,
duration, direction and body location

Answer 16

chorea

Question 17

slow, continuous, involuntary
writhing that prevents maintenance of a stable
posture

Answer 17

athetosis

Question 18

rhythmic back-and-forth or
oscillating involuntary movement about a joint
axis

Answer 18

tremor

Question 19

refers to a gross lack of coordinated
movements that generally originates from
damage to the cerebellum

Answer 19

ataxia

Question 20

When children with neuro disorders “freeze the degrees of freedom” when doing a challenging/new task…what could it mistakenly look like?

Answer 20

SPASTICITY
*need to assess

Question 21

What are blocks?

Answer 21

Compensations that help baby achieve mvmt goals, blocking normal development.

Assist in setting the atypical motor development process
THEY HAVE STRONG EXTENSORS but antigravity flexion components don’t develop well…

Question 22

a lot of the time, babies with “blocks” have ___ tone
learn to hold themselves with “fixing”

Answer 22

hypotonic postural tone even if they have strong extensors!

Question 23

What are the four common blocks?

Answer 23

1. neck
2. shoulder
3. pelvic hip block:APT
4. pelvic hip block: PPT

Question 24

what does neck block look like?

Answer 24

1. neck hyperextension, lack of tucking/midline
2. elevated shoulders to stabilize head

*typical development of scapula is BLOCKED, affecting UE and oral motor development

Question 25

With a shoulder block, what does not develop?

Answer 25

1. scap stability does not develop 2. lack of scap rotation will not allow free UE mvmt 3. lack of forearm WB 4. UE development is blocked

Question 26

What will you see in a neck block later with development? What reflex will b dominated?

Answer 26

Lack of bilateral symmetrical head and neck flexor muscle action, may see dominance by ATNR Blocks bilateral UE development, bilateral ocular development, spine rotates in direction of head, emphasizes spinal extension *poor BUE use, poor body awareness, poor ocular control, maybe scoliosis, hip sublux

Question 27

What is a pelvic hip block APT?

Answer 27

Lumbar extensors and hip flexors are tight shifting pelvis into an anterior tilt. FROG POSITION PRONE increased hip F/ABD/ER increases anterior pelvic tilt and lumbar extension

Question 28

What does APT pelvic hip block cause?

Answer 28

1. block lateral weight shifts, righting reactions 2. immature quadruped, can't dissociate LEs, leads to BUNNY HOPPING 3. sitting: ring sitting

Question 29

What is a pelvic hip block PPT?

Answer 29

pelvis stuck in PPT: hip extensors are tight, pulling pelvis into posterior pelvic tilt, INACTIVE PELVIC MMS often stuck, unable to weight shift, SACRAL SITTING

Question 30

What does a PPT pelvic hip block lead to?

Answer 30

rounded, flexed spine in sitting W-sitting unable to laterally WS creeping: bunny hopping standing: narrow BOS, adduction of LEs (scissoring later) unable to WS or dissociate LEs

Question 31

When child tries to stand/take steps with PPT pelvic hip block, what will you see?

Answer 31

adduction/ scissoring of LEs

Question 32

What bony structure will be affected due to pelvic hip blocks?

Answer 32

HIPS! ACETABULUM did you take x rays of the hip???

Question 33

review the 10 neuroplasticity principles!

Answer 33

1. Use it or Lose it 2. Use it and Improve it 3. Specificity 4. Repetition 5. Training Intensity 6. Time 7. Salience 8. Age 9. Transference 10. Interference