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Paeds > MD and DCD > Flashcards

MD and DCD Flashcards

2
Q

What is MD? (3)

A

Hereditary progressive disorder
Most common serious mm disease
MM weakness from birth to late childhood (skeletal mm)

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3
Q

Dystrophin role

A

Dystrophin

  • part of sarcolemmal prtns (dystrophin glycoprotein)
  • Mechanical stability for surface membrane of skeletal mm fibres and some synaptic plasticity in brain
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4
Q

Pathophysiology of Dystrophin

A

Lack leads to segmental necrosis (trunk and legs more prone)

Progressive mm fibre loss with fibrous and adipose tissue replacement

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5
Q

Describe Duchenne type (general - 3; impariments)

A

Most common
X-linked
Late teens to 30s

Primary impariment = progressive weakness after myofibril loss (evident by 3-5 yrs); often intellectual impairment
Secondary impairments = contractures, respiratory infections, fatigue, obesity

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6
Q

DMD - infancy to preschool (general - 4; posture - 2)

A

General

  • no significant functional impairment
  • 50% walking delay (18 months)
  • positive Gowers from 3yrs
  • no ROM limits before 5yrs

Posture

  • may have weak neck flexors (seen with reduced head control)
  • lordotic (weak gluteals) + scapulae winging
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7
Q

What family education for DMD in infacy? (3)

A

Activity

  • avoid fatigue and maintain strength
  • social activities + improve fn (swimming, bike riding)
  • promote respiratory fn
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8
Q

DMD symptoms - Early school age (general, gait, other)

A

General:

  • clumsiness, falling, atypical gait, waddling
  • Gowers after 1 trial of floor to stand
  • pseudohypertrophy of calves (fat, connective tissue)
  • mm weakness in neck flxors, abs, interscapular, hip extn

Gait

  • increased BOS
  • lateral trunk sway
  • toe walking
  • lack of reciprocal arm swing

Other

  • pumonary impairment begins
  • fatigue
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9
Q

Physio for DMD (early school age) - General (2), Assessment (3), Rx (3)

A

General

  • Community mobility limited (Gower’s to get up stairs)
  • Possibly use graded resistance exercise?

Assessment

  • Manual mm testing by 6-8yrs
  • Respiratory function (chest wall excursion, cough, spirometry)
  • Document impairment and progression

Rx

  • submax abs, hip extn/abd, knee extns
  • cycling and swimming encouraged
  • breathing exercises
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10
Q

DMD symptoms at school age (6)

A

Symptoms

  • increased falls
  • general mm weakness
  • more fatigue (walking)
  • calf contracture
  • intoeing
  • pulmonary impairment
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11
Q

Physio for DMD at school age

A

Positioning and ROM

  • For calves and TFL then hip flexors
  • – 1-2 daily; 1-10 reps
  • prone positioning with feet off end of mattress
  • Monitor scoliosis
  • w/c community mobility
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12
Q

DMD in adolescence (general, mobility)

A

General

  • progression of disability
  • consider Sx and orthoses

Mobility

  • lose walking
  • T/Fs and ADLs difficult
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13
Q

How to predict termination of walking (adolescence) (4)

A

Falls
Not getting up from floor
MM strength reduced by 50%
Knee extn lag in sitting

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14
Q

Physio for DMD in adolescence (Rx, equipment)

A

Rx

  • Continued mm and joint ROM
  • Prone lying
  • Knee capsule
  • T/Fs
  • Scoliosis

Equipment

  • Orthoses
  • Power w/c
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15
Q

Define DCD (4) and other relevant factors (2)

A
  1. Daily activity coordination is substantially below expected for chronological age
  2. This disturbance affects academic and ADLs
  3. Not due to a general medical condition and not a developmental disorder
  4. If mental retardation, motor is in excess of normal

Other

  • difficulties from early childhood
  • may have Hx of perinatal complications (prematurity or VLBW)
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16
Q

DCD symptoms (movements - 3; general - 2)

A

Movements

  • Not fluid/poorly coordinated
  • Poor rhythm/timing of mm
  • Poor sequencing of tasks

General

  • slower responses
  • difficulty identifying important details of/analysing/execution a task
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17
Q

Control-based learning theory (COBALT)

A

First time a movement is performed, copy of efferent motor pattern stored in parietal lobe.
Feed forward mechanism using stored pattern and modifying.

May be problem with system in DCD

18
Q

Outcome measures for DCD (2)

A

M-ABC (manual dexterity, ball skills, balance)

Peabody developmental motor scales

19
Q

Self-imposed restrictions with DCD (3)

A

Lower self worth/less competent
More anxiety
Less participation

20
Q

Physiotherapy for DCD

A

Education

  • child, family, teachers
  • behaviours (anger, clowning etc)
  • finding appropriate physical activities
  • self-esteem issues
21
Q

Differential Dx for DCD (4)

A

CP
MD (Gower’s sign)
ADD/ADHD (poor attention)
Visual impairments

22
Q

DCD assessment (7)

A

Typical development (all areas)

  • motor skills (inc quality)
  • Postural control
  • Rhythm and timing (skipping, ball skills)
  • Musculoskeletal exam (LL alignment and foot posture; joint hypermobility; strength)
  • Neurological (soft signs)
  • Auditory skills
  • Occulomotor
23
Q

DCD Rx approaches (3)

A

Motivation (environment to succeed - improved confidence)

Cognitive

  • questions to help identify, analyse, create solutions to motor problem (child verbalises strategy)
  • – Task specification
  • – Motor mnemonic leading to mental image
  • – Body position and movement feeling verbalisation

Motor Learning

  • based on ADL limits
  • therapist analyses task then intervenes with repeated practice in typical environment (verbal, demonstration, modelling strategies)
24
Q

Provide an example of a motor learning approach to DCD with poor stair climbing (3)

A
  1. Underlying problem = poor balance on 1 leg
  2. Procedural intervention = 1 leg on ball, kick ball, steps through ladder
  3. Activity = practise on stairs then variety
25
Q

Task analysis of jumping

A 
Strength
Postural control
Tolerate movement sensation
Motor planning
Adaptability
Change in direction
26
Q

Hopping skill practice (3)

A

As for jumping with shift to single leg

Training

  • Squat to stand at increasing speeds (lengthen mm then contract)
  • Reduce support
  • Trampoline for movement sensation

Paeds (5 decks)

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