Peds Cases Test 2 Flashcards by Alexander Lee

INDIVIDUALS WITH DISABILITIES EDUCATION IMPROVEMENT
ACT (2004), PART C:

Early intervention program for children w/ disabilities

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Meds from Downsyndrome case:

RANITIDINE

and

THYROXINE:

Ranitidine- used for acid reflux

Thyroxine- for hypothyroidism

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What is a ventricular septal defect (common w/ down syndrome)

Hole in the wall (septum) that
separates the lower chambers of the heart

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Precautions for downsyndrome during therapy:

Protect joints from extreme ROM d/t hypotonia and laxity of ligaments

observe for signs of OA instability

Observe for signs of cardiac and thyroid disorders

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what complications can happen with down syndrome during therapy

Behavioral challenges d/t young age and mental disability

OA instability

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down syndrome affects what chromosome?

T or F: the presence of downsyndrome increases w/ maternal age

chromosome 21 (extra chromosome on this one to make 3/trisomy)

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How is downsyndrome detected early?

nuchal translucency (using ultrasound to measure the size of
the clear space in the posterior tissues of the neck of the fetus), and maternal blood tests.

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what are the common physical characteristics of downsyndrome

small ears,

a wide space between the first and second toes,

small internipple distance

Brushfield’s spots (colored speckles in the iris of the eye),

increased nuchal skinfold thickness.

Other reliable and discriminative signs include hypotonia, a flat
face with upward slant of the eye slit, and brachycephaly

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What are the key musculoskeletal problems affecting people with downsyndrome

Ligament laxity

hypotonia

Other problems w/ downsyndrome:

Sleep apnea
Seizures
Leukemia
GI problems

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what are neurological impairments associated with downsyndrome?

reduced brain volume

smaller frontal and temporal areas,

smaller cerebellum

smaller hippocampus (critical for long-term memory).

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easy fatigability; difficulty walking; abnormal gait or a change in gait; neck pain
or torticollis; limited neck mobility; change in hand function; new onset of
urinary retention or incontinence; increase in incoordination or clumsiness;
sensory impairments; and spasticity, hyperreflexia, or a Babinski’s sign.

Signs of OA instability in downsyndrome

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What motor function scale do we want to use for downsyndrome?

Gross Motor Function Measure (GMFM).

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best PT interventions for down syndrome?

Care giver education on modifying home environment

Body-weight-support treadmill training for pre-ambulatory pts 8 mins per day 5 days a week

SMO orthosis

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Children with Down syndrome show delayed development of postural control that is most affected by:

Smaller than normal cerebellum

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What has been shown to help a young child with DS learn to walk independently earlier?

Treadmill training

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(from the downsyndrome case) Poor activity tolerance, as evidenced by the child’s refusal to participate in active play for more than a few minutes, could be a symptom of inadequate management of:

Hypothyroidism

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Polymicrogyria precautions

Increased tone might require pharmalogical management

Adverse drug reactions can occur (monitor for excess weakness or decreased alertness)

Forcing movements against significantly increased tone can cause structural problems (example: mid foot break)

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Polymicrogyria complications interfering with PT

significantly increasing speed/activity can increase tone on hemiparetic side

longterm use of constraint-induced therapy can interfere w/ bilateral limb use

significant tone reduction can negatively affect movement if child is relying on tone for stability

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What is Polymicrogyria

Too many small folds (gyri )in the brain

can be unilateral or bilateral

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What are the two methods for measuring tone?

Ashworth scale and Tardieu scale

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Review

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What did research show about the Winter Classification

That children with minimally affected body structures cannot be classified under this system, there need to be a group 0 added to expand the scale

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T or F: you want PT to occur after Botulinum toxin injections so that a child can learn new motor plans without spasticity

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Children with significant impairments are often recommended a ________ AFO

Whereas children with less significant tone show more functional improvements with _____________

Solid ankle AFO

Dynamic AFO

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All of the following are true regarding children with hemiplegia, except: A. They have an asymmetrical gait pattern. B. They sometimes present with equinus deformity. C. They always need bracing to normalize gait. D. They have involvement of the arm and leg on the same side.

Children who present with increased tone may benefit from all of the following, except: A. Medical management of tone B. Strengthening programs C. Bracing during movement D. Increasing tone for stability

What is gowers sign?

When an individual rises from the floor using a 4-point stance and places hands on knees -> hyperextends knees while pushing, compensation for hip weakness

What is hypercapnia

excessive carbon dioxide in the blood, results from lung disease or impaired ventilation

what is pseudo hypertrophy

increase in size of muscle not due to an increase in muscle fibers, instead muscles are replaced by fibrous tissue and fat ## Footnote sign of DMD

DMD precautions

No resisted or forceful ROM to extremities or trunk d/t high risk of fractures or damage to muscles assistance required during wb activities to dc fall risk close monitoring of skin w/ orthosis

for DMD, symptoms typically present at ____ years, the average age of diagnosis is _______

2.5 years 4.9 years

What signs indicate DMD

Gower’s sign Abnormal muscle function and elevated serum creatine kinase (indicates muscle breakdown) and elevated serum transaminase

What kind of drug is found to sustain neuromuscular function in DMD

Systemic glucocorticoids (corticosteroids)

What physical problems are associated with DMD

Scoliosis contractures of flexor muscles fractures

Children with DMD taking corticosteroids will experience what potential side effects

Increased weight dc height possibly more fractures cataracts

Death in persons with DMD usually results from ____

respiratory insufficiency

What is the Egen Klassification Scale (EK scale)

Measures functional ability for non-ambulatory individuals with DMD to preform daily activities

What are the 5 stages of DMD

1. Presymptomatic 2. early ambulation 3. late ambulation 4. early non-ambulation 5. late non-ambulation

What kind of exercise is supported by research for patients with DMD to delay progressive weakness

assistive bicycle exercise of arms and legs note: also respiratory exercise / glossopharyngeal breathing

What are biphosphonates (drug you take for osteogenica imperfecta)

prevent loss of bone mass

What is typically used to assess fracture risk and bone health

Bone mineral density (BMD), from a DEXA scan

What are the PT precautions for OI?

No passive twisting, rotating, or forceful ROM d/t high risk of fractures close guarding during WB activities Close monitoring of skin w/ AFO

OI is a autosomal dominant mutation effecting _______

type 1 collagen

What is the typical treatment for long bone deformity in OI

Intramedullary rods

what visual analog scale is best to rate a childs pain (in the OI case)

Wong Baker

When working with patients with OI, what kind of exercise do we want to do to initiate weightbearing

in the pool/ aquatic

The most appropriate progression from ambulating with a walker to ambulating without an assistive device for the child with OI would be: A. Transitioning the child to axillary crutches B. Having the child practice taking a few steps at a time with light hand-held assist in a controlled environment C. Ensuring that the child can first walk community distances with the walker D. Check that the child has at least a 4/5 quadriceps strength as tested with manual muscle test

B Avoid axillary crutches!

When would it be appropriate to utilize a partial-weightbearing gait therapy device (e.g., LiteGait) as a therapy intervention for a child with OI who has recently begun weightbearing after a rodding surgery? A. As an alternative to weightbearing in the pool since a partial- weightbearing gait therapy device can also provide unweighting of the LEs B. While ambulating on land instead of using a walker C. A child with OI should never be placed in a partial-weightbearing gait therapy device. D. To increase standing tolerance prior to ambulating on land

C Avoid harness devices, they might cause rib fractures for pt's with OI

A physical therapist is creating a home exercise program for a child with OI who has just begun weightbearing on land following a rodding revision surgery. Which of the following is not an appropriate exercise to strengthen the quadriceps for this child? A. Sit-to-stand transfers from an elevated surface, using a walker for support B. Standing quad sets using a walker for support C. Short arc quads D. Single leg squats holding a walker for support

Section 504 of the Rehab Act of 1973

Ensures access and accommodations for students in public primary and secondary colleges who do not require special education. And for students in college and university, as well as adult employees of the government.

What tool has been found to be reliable to assess adults with CP

Gross Motor Functional Classification System GMFCS

What would be most effective at measuring an adult with CP's cardiorespiratroy fitness

progressive protocol test with cycle ergometer

Anterior kneepain in adults with spastic diplegic CP is most likely due to

Patella alta (associated w/ crouched gait)

What exercise program would be best for the adult with CP in the case study

progressive resistance exercise and aerobic using a stationary bike or cross trainer.

What are 2 conditions commonly associated with SCI

Autonomic Dysreflexia Heterotopic ossification

Precautions in PT due to SCI

Monitor for Autonomic dysreflexia prevent iatrogenic fx when transferring orthostatic hypotension

What is defined as a pediatric SCI?

SCI in the nerve roots of a person between the ages of newborn and 15 years old

A child's spine does not mature until..

8-10 years old

What is a SCIWORA

Spinal cord injury without radiographic abnormality common in children due to the laxity in the vertebrae that may let SCI be injured w/o damage to bones

What does the Ped's textbook call the ASIA exam that we are learning in neuro?

ISNCSCI developed by ASIA

What outcome measure is reliable and valid to assess functional independence for SCI?

SCIM

What is the recommended standing program to prevent bone loss in SCI?

60 minutes per day 5 days a week

What are 2 types of exercise that the SCI case mentioned?

BW supported treadmill cycling with LE FES or NMES to increase muscle volume in children with SCI

Which of the following does not contribute to the potential for SCIWORA? A. Kyphoscoliosis in young child B. Disproportionately large head relative to the child’s body C. Horizontally oriented facet joints in a child D. Motor vehicle collision

D Motor vehicle collision will typically be seen on an MRI

Which of the following tests is used to determine the level and severity of SCI in the pediatric population? A. WeeFIM B. Spinal Cord Independence Measure (SCIM) C. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) D. Functional Independence Measure (FIM)

Which of the following is a true statement regarding autonomic dysreflexia? A. It is always characterized by an increase in blood pressure and a decrease in heart rate. B. It most commonly affects patients with SCI level at or above T12. C. Distention of the bowel or bladder is a common cause. D. Signs and symptoms are more obvious in younger children than in adolescents and adults.

what is chemical meningitis

aseptic meningitis (not due to infection) just due to inflammation

CORTICAL DYSPLASIA:

Congenital malformation of the cortex; a cause of seizures

ventricular catheter vs ventriculoperitoneal shunt

catheter = used during neurosurgery to drain fluid of ventricles from brain shunt= used to treat hydrocephalus, removes fluid from ventricles to the peritoneal cavity

precautions of hemispherectomy/hydrocephalus?

delayed hydrocephalus can develop at any time post surgery. signs can include change in school performance. May indicate need for shunt or shunt revision. Or seizures. Seizures may also indicate need for additional surgery or medication

hemispherectomy has the best outcomes if done before the age of ___

3, this is the critical maturation period where there is the greatest potential to sprout new axons

What 7 things should be noted in the subjective about seizures

1. when the seizures began and why 2. onset and frequency 3. type, dosage, and frequency of AED (anti epileptic drugs) 4. PLOF and milestones 5. types of surgeries and age of child 6. complications 7. potential medical treatments

What scale is used as a valid instrument to assess gross motor, fine motor, and cognitive delays in children ages 1 month to 14 months

Bayley scale of infant and toddler development (Bayley-III)

What type of treatment plan improves motor function and increases use of hemiparetic extremity in a child with a cerebral hemispherectomy

CIMT Constraint-induced-movement therapy

The most common indication for a cerebral hemispherectomy is: A. Cortical tumor B. Medically intractable seizures C. Infarcts leading to hemiplegic cerebral palsy D. Seizures arising from several areas of the brain in both hemispheres

Typical clinical presentation of children status/post hemispherectomy includes: A. Increased spasticity with more involvement in the involved lower extremity as compared to the involved upper extremity B. Visual field cut without sensory deficits in the upper extremity C. Global delays in all areas with more involvement in the involved distal upper extremity D. Increased difficulty in walking recovery for children who walked previous to surgery

C Global delays in all areas with more involvement in the **involved distal upper extremity**

Physical therapy interventions for children status/post hemispherectomy: A. should be novel, task-specific, intense, and repetitive. B. are unlikely to change deficits due to complete disconnection of the involved cerebral hemisphere. C. are only necessary in the acute phase of recovery. D. have been shown to be ineffective when presented in massed blocked sessions.

More marked increase in muscle tone, however affected parts easily moved

Ashworth 2

Considerable increase in muscle tone passive movement diffcult

Ashworth 3

slight increase in muscle tone followed by minimal resistance at end of ROM

Ashworth 1 note: would be 1+ if there was minimal resistance through less than half of ROM

limb rigid in flexion

Ashworth 4

Child w/ knee hyperext and increasing lumbar lordosis during gait

Winter Gage Hicks group III

Child with foot drop during swing, but adequate dorsiflexion during stance

Winter Gage Hicks Group 1

Child w/ both foot drop during swing and more consistent plantarflexion throughout gait cycle due to severe tone

Group II

Child with limited hip movement and significantly increased lordosis

Winter Gage Hicks group 4

What is a valid tool for assessment of participation and activity in elementary school students

School Function Assessment

__________ is especially important during school years to enable children to interact w/ peer and learn from exploring environment

independent mobility

How much BW supported treadmill training is indicated for infants with DS

8 minutes a day 5 days a week often lets them walk 3 months earlier

Peds Cases Test 2 Flashcards

(88 cards)