Pediatrics Flashcards
(175 cards)
1
Q
According to the principles of motor development, motor development occurs in a ______ to _____ direction.
A
proximal to distal direction
cephalocaudal
2
Q
What is the normal gestational period?
A
38-42 weeks
3
Q
At what gestational period is an infant considered as premature?
A
Born earlier than 37 weeks
40 weeks is typically used when determining corrected age
4
Q
When during the gestational period does the muscle start to differentiate and the tissue becomes specialized?
A
first trimester
5
Q
When during the gestational period do motor endplates form?
A
second trimester
6
Q
When during the gestational period does a clonus response emerge to stretching?
A
second trimester
7
Q
When during the gestational period does the first sensory system develops?
A
first trimester
8
Q
When during the gestational period does a reponse to tactile stimuli emerge?
A
first trimester
9
Q
When during the gestational period do the touch and tactile system receptors start to differentiate?
A
second trimester
10
Q
When during the gestational period does functional touch and temperature discrimination occur?
A
third trimester
11
Q
(true/false) The vestibular system does not start functioning until the second trimester
A
False - starts to function at the end of the first trimester
12
Q
When during the gestational period does the startle reflex emerge?
A
second trimester
13
Q
When during the gestational period does visual processing emerge?
A
second trimester
14
Q
When during the gestational period does visual fixation occur?
A
third trimester
15
Q
When during the gestational period is there response/turning to auditory stimuli?
A
second trimester
16
Q
When during the gestational period is there debris in the middle ear leading to decreased hearing?
A
third trimester
17
Q
What is the most mature sensory system at birth?
A
touch and tactile system
18
Q
When during the gestational period when do nasal plugs disappear and olfactory perception emerges?
A
third trimester
19
Q
When during the gestational period do the taste buds develop?
A
first trimester
20
Q
When during the gestational period does the infant respond to different tastes?
A
third trimester
21
Q
When during the gestational period does sucking occur?
A
first trimester
22
Q
When during the gestational period does hiccupping occur?
A
first trimester
23
Q
When during the gestational period does fetal breathing start?
A
first trimester
24
Q
When during the gestational period does quick, generalized limb movement start to occur?
A
first trimester
25
When during the gestational period do positional changes start to occur?
first trimester
26
When during the gestational period does the fetus start to bend their neck and trunk?
week 7.5
| first trimester
27
When during the gestational period do sleep states start to emerge?
second trimester
28
When during the gestational period does the grasp reflex emerge?
second trimester
29
When during the gestational period do reciprocal and symmetrical limb movements start to emerge?
second trimester
30
What is the Test of infant motor performance (TIMP) used for?
Evaluation of spontaneous and elicited movements to postural alignment and selective control for functional movements
| 32 weeks after conception to 3.5 months after birth
31
What is the APGAR screening test used for?
Evaluation of the following at 1 minute, 5 minutes, and 10 minutes after birth:
- Appearance (color)
- Pulse
- Grimace (reflex irritability)
- Activity
- Respiration
## Footnote
Keeps being administered every 5 minutes if infant is having difficulties after the 10 minute test
32
What bone may fracture during birth?
clavicle
33
(true/false) An infant's hip can dislocate during birth
true
34
(true/false) It is normal for kyphosis to be present at birth
true
## Footnote
Abnormal findings: scolisos, spina bifida (tuft of hair and/or dimple), visible pigmentation
35
What is the Pediatric Evaluation of Disability Inventory (PEDI) used for?
Functional assessment for ADLS
| self-care, mobility, social functioning
36
(true/false) The PEDI can be modified by the caregiver
true
37
What does the WeeFim assess?
Functioning in:
- self-care
- mobility
- locomotion
- communication
- social cognition
| Functional Independence Measure for Children (WeeFim)
38
When during an infant's life is an Early intervention program implemented?
0-3 y/o
39
What kind of treatment utilizes therapeutic handling as the primary intervention strategy?
Neurodevelopmental Treatment (NDT)
## Footnote
Also focuses on important components of motor learning and sensory input
40
How are preterm infants categorized other than by gestation period at birth?
birth weight
41
(true/false) A preterm infant can develop the physiological FLX of a full-term newborn.
False
## Footnote
Postural and movement profile:
- hyperEXT of neck and trunk
- shoulder Elevation, ABD, and extension
- scapular RET
- Hip ABD and EXT
- anterior pelvic tilt (lumbar lordosis)
- decreased midline UE movement
- WB on toes when in supported standing
42
What causes Meconium Aspiration Syndrome?
Bowel movements in utero that mixes with amniotic fluid - the infant inhales the substance
43
What can meconium aspiration syndrome develop?
Respiratory distress
44
What treatment plan should be kept in mind with infants who have meconium aspiration syndrome?
Treat in a silent environment due to hypersensitivity to environmental stimuli
| 20% of cases present with developmental delays that can last up to 3 y/o
45
# diagnosis
Symptoms include rapid, shallow breathing and a sharp pulling in of the chest below and between the ribs with each breath
respiratory distress syndrome (RDS)
46
What causes respiratory distress syndrome?
Development of atelectasis caused by surfactant not developing in the lungs at 24 weeks
--> lungs are not ready for air until 26 weeks of gestation
| Can lead to acute respiratory failure and death
47
What can chronic RDS lead to?
bronchopulmonary dysplasia
## Footnote
When the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the alveoli
- predisposes the infant to respiratory infections and developmental disability
48
What are the treatments for RDS?
- oxygen supplementation
- assisted ventilation
- surfactant administration
49
What are the causes of bronchopulmonary dysplasia?
- mechanical ventilation
- oxygen administration
- chronic RDS
50
What are the treatments for bronchopulmonary dysplasia?
- respiratory support
- infection control
- bronchodilators
51
What is periventricular leukomalacia (PVL)? What is the cause?
necrosis of white matter adjacent to the ventricles of the brain
causes:
- systemic hypotension
- ischemia
52
What can periventricular leukomalacia (PVL) result in?
Cerebral palsy
53
# diagnosis
Bleeding into the immature vascular matrix
periventricular-intraventricular hemorrhage
54
What grades of periventricular-intraventricular hemorrhage can result in cerebral palsy?
Grades II-IV
55
What causes retinopathy of prematurity (ROP)?
combination of low birth weight and high O2 levels
| abnormal vascularization of the retina that causes visual deficits
56
What is done in the NICU to infants who develop retinopathy of prematurity (ROP)?
Infant eyes are covered to prevent exposure to bright light
57
What is necrotizing enterocolitis?
ischemia resulting in inflammatory, bowel infection
58
What is patent ductus arteriorsus (PDA)?
An opening between two blood vessels (pulmonary artery and aorta) leading from the heart resulting in **non-oxygenated** blood being circulated
## Footnote
The ductus arteriosus (temporary vessel between the pulmonary artery and aorta) should close soon after birth
59
Premature infants lack adipose tissue and the CNS is unable to control the body temperature prior to ___ weeks of gestation
32 wks
## Footnote
- keep infant warm to decrease energy expenditure and increase the energy needed for other body functions
60
If an infant was premature, what should activities and positioning focus on?
1. Facilitating shoulder PROT and ADD while doing visual and auditory tracking and reaching
- ex: supported side-lying
2. Supervised side-lying and prone positioning to promote FLX
3. sleeping in supine
61
What activities should you avoid when an infant is premature?
Those that can increase extensor tone
| ex: jumpers and walkers
62
When can CP manifest?
Until 2 y/o
63
What can cause non-progressive encephalopathy?
1. hemorrhage below ventricle lining
2. hypoxic encephalopathy
3. malformation
4. trauma of CNS
64
What is the most common impairment of CP?
movement disorders:
- spastic
- athetosis
- ataxia
- dystonia
- hypotonia
- mixed movement disorders
65
# definition
fluctuating muscle tone, involuntary slow writhing movements
athetosis
66
Where is a lesion present when athetosis is present?
basal ganglia
67
Where is a lesion present when spasticity is present?
motor cortex
68
# definition
instability of movements
ataxia
69
Where is a lesion located when ataxia is present?
cerebellum
70
# definition
involuntary movements with sustained contractions
dystonia
71
What is level 1 of gross motor coordination for cerebral palsy?
- walking without restrictions
- limitation in more advanced gross motor skills
72
What is level II of gross motor classification for CP?
- walking without AD
- limitation with community ambulation and outdoors
73
How many levels of gross motor classifications for CP are there?
5
74
What is level III of gross motor classification for CP?
- walking with AD
- limitation while ambulating outdoors and in the community
75
What is level IV of gross motor classification for CP?
- self mobility with limitations
- children are transported or using power mobility device when outdoors or in the community
76
What is level V of gross motor classification for CP?
- self mobility is severely limited with use of assistive technology
77
What is hemiplegia?
one side of body affected
78
What is diplegia?
both LEs are affected
79
With what type of CP is there presentation of crouching gait?
spastic CP
80
Describe crouching gait.
walking with hip FLX, ADD, IR and knee FLX
81
# Type of CP
- abnormal posture and movement with patterns of FLX/EXT
- imbalance of tone across joints (can cause contractures)
- visual, auditory, cognitive, and oral motor deficits
- decreased ability to learn unique movements
- insufficient force generation
spastic CP
82
# Type of CP
- generalized decreased muscle tone (floppy baby syndrome)
- poor functional stability (especially proximal joints)
- ataxia and incoordination when in upright position with a decreased BOS and muscle tone fluctuations
- poor visual tracking, speech delay, and oral motor problems
- decreased ability to learn unique movements
- insufficient force generation
athetoid CP
83
# Type of CP
- low postural tone with poor balance
- wide BOS
- intention tremor of hands
- uncoordinated movements
- poor visual tracking and nystagmus
- speech articulation problems
- hypotonia --> ataxia
ataxic CP
84
Initial hypotonia can be followed by _____ when CP is present
ataxia
85
Ambulation with athetosis, diplegia, and mild quadriplegia can be attained with the use of what assistive devices?
Rollator and/or crutches
86
What orthotics are commonly used with CP?
- AFO
- submalleolar orthosis
87
How should a person with CP be positioned when seated in a WC?
- Trunk upright
- hips, knees, and ankles at 90 degrees
- posterior tilt
- hip ABD if spatic ADD is present
88
Why should posterior tilt be used in those with CP?
Decreases extenor tone and maintains hip FLX
89
What is the recommended amount of time for a person with CP to WB through their LEs to improve bone mineralization?
>5 hrs/wk
90
What reflexes may be persistent and block functional postures and movements in those with CP?
Tonic reflexes
## Footnote
- ATNR
- tonic labyrinthine (TLR)
- STNR
91
# -
What position will help decrease the effect of tonic labyrinthine reflex?
side-lying
92
What type of rollator helps maintain an upright position and decrease extensor tone within the UEs?
posterior rollator
93
(true/false) all children with CP will not be able to ambulate.
False
## Footnote
Those with spastic hemiplegia, moderate spastic CP, and mild ataxia will be able to ambulate.
94
A good prognosis for ambulating with CP is when what happens?
the child can sit independently 2 y/o
95
What does intrathecal baclofen (ITB) do?
Delivered to a specific segment of the spine and controls spasticity below that segment
--> catheter in the subarachnoid space of the spinal cord
| holds 1-4 month supply (refill every 3 months)
96
What does Diazapam (Valium) act on and what does it do? What is a con of the medication?
- Acts on the CNS to Improve motor control
- Con: difficult to maintain steady state
97
What does baclofen (lisoresal) act on and what does it do? What is a con of the medication?
- Acts on the CNS to decrease muscle spasticity
- cons: decreased stength leading to postural control
98
What does anasthetic/diastnostic nerve blocks do? What is a con of the medication class?
| procaine and lidocaine
- decreases local spasticity, contractures, and dystonia
- improves motor control
Con: not permanent
99
What does neurolytic nerve blocks do? What is a con of the medication class?
| ethanol and phenol
- decreases spasticity contractures, and dystonia
- improves motor control
Con: not permanent
## Footnote
Ethanol and phenol requires experience for injection and increases the risk of parasthesia
100
How long can botulism toxin last after injected?
4-6 months
101
What are possible side effects of baclofen?
- drowsiness
- dizziness
- fatigue
- weakness
- ataxia
- confusion
102
# Procedure:
dorsal sensory nerve rootlets are stimulated and those responding abnormally are severed
- decreases spasticity, improves motor control, and not reversible
- Cons: irreversible, sensory loss, not effective for dystonia
selective dorsal rhizotomy (SDR)
103
How long do peripheral nerve blocks commonly last?
3-6 months
104
What are the common tendons that are lengthened with lengthening procedures?
- achilles
- hamstrings
- iliopsoas
- hip ADD
105
(true/false) muscle lengthening procedures increase contractility of muscles.
false
| decreases contractility
106
# procedure
Cutting, removing, or repositioning of bone to facilitate normal alignment and prevent subluxation/dislocation
osteotomies
107
# diagnosis
neural tube defect resulting in vertebral and/or spinal cord malformation
spina bifida/myelodysplasia
108
What form of spina bifida is characterized by a tuft of hair, dimples, or sinus?
spina bifida occulta
109
What form of spina bifida does not have spinal cord involvement?
spina bifida occulta
110
What form of spina bifida has visible or open lesions?
spina bifida aperta/cystica
111
What are the types of spina bifida aperta?
1. myelomeningocele
2. meningocele
112
What is a meningocele?
Cyst that contains cerebral spinal fluid
113
(true/false) Myelomeningocele has no spinal cord involvement
False: meningocele has an intact spinal cord whereas myelomeningocele has herniated spinal cord tissue
114
What are neural tube defects linked to?
- decreased maternal folic acid
- infection
- hot tub soaking
- exposure to teratogens (alcohol and valproic acid)
115
(true/false) hydrocephalus is significantly related to closure of a neural tube defect.
True
## Footnote
shunting relieves pressure
116
What is arnold chiari malformation?
cerebellum and brain stem are pushed through the foramen magnum
117
What can occur if a neural tube defect is not corrected shortly after birth?
meningitis
118
What makes ambulation possible if the hip flexors are weak or paralyzed?
Reciprocating gait orthoses (RGO)
119
When does spina bifida aperta have to be closed?
In utero OR 24-48 hours postnatally
120
What tests should be used for evaluation of functional abilities in those with spina bifida?
PEDI or WeeFIM
121
What are the signs of possible shunt malfunction?
- irritability
- decreased muscle tone
- Sz
- vomiting
- bulging fontanels
- HA
- redness along the shunt tract
122
When do brachial plexus injuries commonly occur?
- During birth
- Cervical rib abnormality
123
What is klumpke's paralysis?
Brachial plexus injury with C8-T1 involvement
## Footnote
Involvement of intrinsic muscles of the hand, finger flexors, and finger extensors
--> also weakness of FCU
124
What nerve roots are affected with erb-klumpke palsy?
C5-T1
125
What impairments are present with Erb's paralysis?
- sensory deficits
- decreased shoulder girdle function (1:1 humeroscapular movement)
| Functioning of hand is spared
126
What impairments are present with klumpke's paralysis?
- decreased wrist and hand function
- sensory deficits
127
What is the characteristic positioning of Erb's paralysis?
Shoulder: ADD and IR
Elbow: EXT and PRON
Wrist: FLX
Fingers: waiter's tip deformity
128
When is surgical nerve repair warranted for avulsion injuries of the brachial plexus?
If not resolved after 3 months
129
What reflex tests should be tests on infants for brachial plexus injury?
- Moro
- biceps
- radial reflexes
- grasp
| Moro, biceps, and radial reflexes are not present; grasp is intact
130
What needs to occur immediately after brachial plexus injury to prevent further injury?
Partial immobilization across the upper abdomen for 1-2 weeks
## Footnote
--> initiate gentle ROM after period of immobilization
131
# diagnosis
Chromosomal abnormality caused by breakage and translocation of a piece of chromosome onto a normal chromosome
down syndrome
| trisomy 21
132
What are the 3 types of down syndrome?
1. standard (95%)
2. translocation
3. mosaic (rare)
133
Those with down syndrome have (decreased/increased) brain, brain stem, and cerebellum weight
decreased
134
What are other impairments of down syndrome?
- hypotonia and decreased force generation
- visual and hearing loss
- congenital heart defects (primarily septal defects)
- AA subluxation/dislocation (due to laxity of transverse dens ligament)
- gross motor developmental delay
- eating and speech development deficits
- cognitive and perceptual deficits
135
What are s/s of transverse odontoid laxity (AA subluxation/dislocation)?
- decreased strength and ROM
- decreased DTRs
- decreased sensation
- head tilt
- increased muscle tone
136
What movements should be avoided if AA ligament laxity is suspected?
Forceful neck FLX and ROT
137
What must you do for muscle testing on a child < 3 y/o?
Observe developmental postures and movements
138
What should you do to promote oral motor function?
- facilitate lip closure and tongue retrusion
- short, frequent feeding sessions
139
What joint movements must you avoid in a patient with down syndrome during activity?
hyperextension of knees and elbows
## Footnote
Avoid all traction on extremities and spine
140
When should radiographs be taken in a person with down syndrome?
Every year starting at the age of 3
## Footnote
XR unable to image AA subluxation before 3 y/o - treat patient as though they have AA instability until XR can be taken
141
(true/false) plagiocephaly is associated with gross motor delays
true
142
How long are helmets supposed to be worn when correcting plagiocephaly?
20-23 hours/day for 2-7 months
143
The best outcomes of cranial remolding is when the helmet is started by what age?
4-6 months
144
Once the child is ___ months old, the cranial sutures fuse and cranial helmets are no longer useful
18 months
145
What behavioral scales should be used to assess a child's orientation to the time, place, and ability to respond to various stimuli after they experience a TBI?
- rancho los amigos coma scale
- GCS
146
What coma/TBI scale should be used to assess a child's orientation to time, place, and ability to response to various stimuli if they are **nonverbal**?
infant coma scale
147
What medications can be used for control of intracranial pressure?
- barbiturates
- diuretics
- sedatives
- paralytics
148
Is duchenne's X or Y linked? Is the father or mother the carrier?
X-linked carried by the recessive gene of the mother
149
When is the diagnosis of duchenne's normally determined?
between 3-6 y/o
150
What are the early signs of duchenne's?
- progressive weakness
- delay with ambulation
- diffuculty rising from supine and sitting positions
- proximal shoulder weakness and/or pelvic weakness occurs before distal weakness
151
What is the Gower's sign?
"walking up the legs" when transitioning to a standing position
| Commonly observed with duchenne's
152
What are the functional limitations of duchenne's?
- delayed developmental milestones
- decreased ambulation ability
- progressive cardiopulmonary limitations
- contractures/deformity
- weakness
153
what medication has been shown to increase life expectancy of a child with duchenne's?
Steroids (prednisone)
| decreases pulmonary dysfunction (treats pulmonary infection)
154
Autism spectrum disorder (ASD) develops within the first ______ years of life and affects the brain's normal development of social and communication skills
develops within the first 3 years of life
| Linked to abnormal biology and chemistry in the brain
155
What is the cause of ASD?
unknown
| Genetic link is suspected
156
What impairments are seen in those with ASD?
- difficulty with verbal and nonverbal communication, social interaction, and atypical play skills
- sensory integration issues
- decreased coordination
- decreased balance
- decreased strength and ROM
- delayed gross motor skills
157
Are boys or girls commonly seen with ASD?
boys
158
How early can some cases of ASD be diagnosed?
6 months old
159
_____% of children with ASD have above average intelligence
40%
160
What adaptive equipment is used to decreased scissoring extension pattern? (hip EXT, ADD; knee EXT; PF)
abductor pad
161
What degree should an AFO be set in to decrease genu recurvatum?
5-10 degrees DF
162
What kind of AFO should be used for reciprocal or swing-through gait?
KAFO
| used by children with spina bifida or spinal cord injury
163
What type of AFO is used for swing-thorugh gait?
HKAFO
| used by children with spina bifida or spinal cord injury
164
What is a reciprocating gait orthosis (RGO)?
HKAFO with a molded body jacket that uses a cable system allowing a FWD step with lateral weight shifting
165
What AFO is commonly used by children with thoracic level spinal bifida or SCI?
Reciprocating gait orthosis (RGO)
166
What is the reason for a pavlik harness to be used?
For infants with congenital hip dysplasia
| Holds the hips in FLX and ABD to keep femoral head in the acetabulum
167
How early can a power WC be used by a child?
As early as 18 months
168
What mobility aid provides maximum support to the upper extremities and the trunk?
gait trainer
169
What AD encourages shoulder depression, elbow extension, neutral wrist, and may decrease scissoring?
posterior walker
170
What is the single most important constant and environmental factor when treating a pediatric patient?
Family
171
(true/false) EIP programs are not mandated by public law
false
| they are mandated (IDEA/Individuals with disabilities act)
172
What age population can can IEP (individual action plan) be used for?
| Free and appropriate public education for all children with disabilities
3-21 y/o
173
(true/false) The family is a member of the EIP team
true
| Individual family service plan (IFSP) was developed
174
What intervention program is used for infants and children from birth to 3 years?
EIP
175
What is the least restrictive form of early intervention and eduation setting?
individual education plan via school system
