Peds Final Flashcards
1
Q
When does the Moro reflex emerge and integrate?
A
Emerges at birth, integrates by 4–6 months.
2
Q
What happens if the Moro reflex is retained?
A
Poor balance reactions, hypersensitivity to sensory stimuli.
3
Q
When does the ATNR reflex emerge and integrate?
A
Emerges at birth, integrates by 4–6 months.
4
Q
What happens if the ATNR reflex is retained?
A
Difficulty with rolling, poor hand-eye coordination, poor handwriting.
5
Q
When does the STNR reflex emerge and integrate?
A
Emerges at 4–6 months, integrates by 8–12 months.
6
Q
What happens if the STNR reflex is retained?
A
Poor posture, difficulty sitting still, ‘slumping’ at desk.
7
Q
When does the TLR reflex emerge and integrate?
A
Emerges in utero, integrates by 4 months.
8
Q
What happens if the TLR reflex is retained?
A
Poor balance, toe-walking, motion sickness.
9
Q
When does the Galant reflex emerge and integrate?
A
Emerges at 20 weeks gestation, integrates by 2 months.
10
Q
What happens if the Galant reflex is retained?
A
Poor posture, scoliosis, fidgeting.
11
Q
Purpose of the AIMS (Alberta Infant Motor Scale)?
A
Gross motor assessment for infants birth–18 months.
12
Q
Purpose of the PDMS-2?
A
Assesses gross and fine motor skills birth–5 years.
13
Q
Purpose of the GMFM-66?
A
Measures changes in gross motor function over time in children with CP.
14
Q
Purpose of the HINE (Hammersmith Infant Neurological Examination)?
A
Assess neurologic function in infants 2–24 months; especially high-risk for CP.
15
Q
Purpose of the TIMP (Test of Infant Motor Performance)?
A
Assesses functional motor behavior in infants 34 weeks gestational age to 4 months post-term.
16
Q
At what age should independent sitting typically occur?
A
By 6–8 months.
17
Q
At what age should independent standing typically occur?
A
Around 10–12 months.
18
Q
At what age should independent walking typically occur?
A
By 12–15 months.
19
Q
Red flag if no head control by what age?
A
4 months.
20
Q
Red flag if not sitting independently by what age?
A
8 months.
21
Q
Red flag if not crawling by what age?
A
9 months.
22
Q
Red flag if not standing with support by what age?
A
12 months.
23
Q
Red flag if not walking independently by what age?
A
18 months.
24
Q
Purpose of the BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency)?
A
Assesses motor proficiency in children 4–21 years.
25
What does the PEDI-CAT assess?
Functional skills and caregiver assistance for children birth–20 years.
26
What is the GMFCS used for?
Classifies gross motor function in children with CP into 5 levels.
27
What is the MACS used for?
Classifies manual ability in children with CP.
28
What is the CFCS used for?
Classifies communication function in children with CP.
29
What is the EDACS used for?
Classifies eating and drinking ability in children with CP.
30
What diagnosis is associated with atlantoaxial instability?
Down Syndrome.
31
What heart defects are common in Down Syndrome?
Ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus.
32
What are common musculoskeletal issues in Down Syndrome?
Ligamentous laxity, pes planus, hip subluxation, scoliosis.
33
What is the significance of hypotonia in Down Syndrome?
Contributes to motor delays and balance difficulties.
34
What precautions must be taken for a child with suspected atlantoaxial instability?
No activities placing downward force on cervical spine; medical clearance needed.
35
What gross motor intervention is evidence-supported for toddlers with Down Syndrome?
Treadmill training.
36
What are common characteristics of idiopathic toe walking?
Able to correct to plantigrade gait, no underlying neurologic condition, typically normal strength.
37
What distinguishes toe walking in cerebral palsy from idiopathic toe walking?
CP often has spasticity, impaired selective motor control, difficulty correcting to flat foot.
38
What is the best ROM measure for assessing ankle flexibility in toe walkers?
Ankle dorsiflexion with knee extended and flexed.
39
When should sensory integration therapy be considered?
When a child displays significant sensory modulation or processing difficulties.
40
What are signs of sensory over-responsivity (SOR)?
Withdrawal from touch, hypersensitivity to noise, emotional outbursts.
41
What are signs of sensory under-responsivity (SUR)?
Appearing tired, unmotivated, unaware of surroundings.
42
What are signs of sensory seeking (SC)?
Craving intense sensory experiences, impulsive behavior.
43
What are primary intervention strategies for sensory processing dysfunction?
Sensory diets, environmental modifications, occupational therapy.
44
What is DCD (Developmental Coordination Disorder)?
A motor skills disorder characterized by clumsiness, poor motor planning, and coordination.
45
What assessments are used for DCD?
Movement ABC (gold standard), BOT-2, DCD-Q.
46
Diagnostic criteria for DCD include?
Motor impairment below expected for age, interferes with ADLs/academics, not explained by other disorders.
47
What intervention approaches are best for DCD?
Task-specific training, motor learning strategies, environmental adaptation.
48
Characteristics of children with Autism Spectrum Disorder?
Impaired social communication, restricted/repetitive behaviors, sensory issues.
49
Motor impairments common in Autism Spectrum Disorder?
Hypotonia, poor balance, delayed gross and fine motor skills.
50
What interventions are recommended for motor impairments in ASD?
Structured, skill-oriented sessions; visual supports; proprioceptive input.
51
What is the difference between cyanotic and acyanotic congenital heart defects?
Cyanotic = low oxygenation (blue baby), acyanotic = normal oxygenation but circulatory issues.
52
Examples of cyanotic heart defects?
Tetralogy of Fallot, transposition of great arteries.
53
Examples of acyanotic heart defects?
Ventricular septal defect, atrial septal defect, patent ductus arteriosus.
54
What is plagiocephaly?
Flattening of one side of the skull, often due to positioning.
55
What is CMT (Congenital Muscular Torticollis)?
Shortening of the sternocleidomastoid muscle causing head tilt.
56
What intervention is primary for CMT?
Stretching, positioning, caregiver education.
57
At what age should early intervention referrals be made for developmental concerns?
As early as possible — typically by 6 months if delays persist.
58
What document outlines goals for children receiving Early Intervention services?
IFSP (Individualized Family Service Plan).
59
What does IDEA Part C cover?
Early intervention services for infants and toddlers with disabilities (birth–3 years).
60
What does IDEA Part B cover?
Special education services for children 3–21 years old.
61
What is an IFSP?
Individualized Family Service Plan — outlines Early Intervention goals and services for children under 3.
62
What is an IEP?
Individualized Education Plan — outlines educational services for children 3–21 years old with disabilities.
63
What is family-centered care?
A partnership where families and providers collaborate in planning, delivering, and evaluating services.
64
What is trauma-informed care?
Approach that recognizes and responds to the effects of trauma on a child's development and behavior.
65
What is top-down clinical reasoning?
Focus on desired functional outcomes first, then assess impairments.
66
What is bottom-up clinical reasoning?
Focus on impairments first, hoping they lead to improved function.
67
What is the significance of primitive reflex integration?
Essential for the development of voluntary motor control and higher-level motor skills.
68
What sensory systems are most important for postural control?
Vestibular, proprioceptive, and visual systems.
69
What is the primary brain area involved in motor coordination?
Cerebellum.
70
What is the primary brain area involved in motor planning?
Basal ganglia and premotor cortex.
71
What somatosensory functions are often impaired in DCD?
Proprioception and tactile discrimination.
72
What standardized outcome measure is best for evaluating early infant motor behavior?
General Movements Assessment (GMA).
73
Which outcome measure assesses self-care, mobility, and social function in young children?
PEDI.
74
Which test is best for evaluating gross motor changes in children with CP over time?
GMFM-66.
75
What is the most sensitive measure for early diagnosis of CP in high-risk infants?
HINE + GMA.
76
What are signs of early CP at 4 months?
Poor head control, abnormal muscle tone, asymmetric movements.
77
What motor pattern is common in hemiplegic CP?
Early hand preference, asymmetrical movement.
78
What motor pattern is common in diplegic CP?
Spasticity greater in lower extremities than upper extremities.
79
What motor pattern is common in quadriplegic CP?
Spasticity in all four limbs and trunk; minimal functional movement.
80
What characterizes dyskinetic CP?
Involuntary, uncontrolled movements (athetosis, dystonia).
81
What characterizes ataxic CP?
Poor coordination, wide-based gait, intention tremor.
82
What is the Gross Motor Function Classification System (GMFCS) Level I?
Walks without limitations.
83
What is GMFCS Level II?
Walks with limitations.
84
What is GMFCS Level III?
Walks with hand-held mobility device indoors; wheelchair outdoors.
85
What is GMFCS Level IV?
Limited self-mobility; uses powered mobility or assistance.
86
What is GMFCS Level V?
Transported in a manual wheelchair; severe limitations.
87
When does the plantar grasp reflex emerge and integrate?
Emerges at birth, integrates by 9–12 months.
88
When does the rooting reflex emerge and integrate?
Emerges at birth, integrates by 3 months.
89
What happens if the plantar grasp reflex is retained?
Difficulties with balance and walking.
90
What happens if the rooting reflex is retained?
Problems with feeding and oral-motor control.
91
When does the Landau reflex emerge and integrate?
Emerges at 3–4 months; integrates by 12–24 months.
92
What happens if the Landau reflex is retained?
Poor motor development, weak postural control.
93
What does the Pediatric Balance Scale assess?
Balance abilities in children, adapted from the Berg Balance Scale.
94
What does the Alberta Infant Motor Scale (AIMS) assess?
Gross motor development from birth to 18 months.
95
What are signs of hydrocephalus in myelomeningocele?
Enlarged head, irritability, vomiting, 'sunsetting' eyes.
96
What is the most common cause of CP in preterm infants?
Periventricular leukomalacia (PVL).
97
What is the most common cause of CP in full-term infants?
Hypoxic-ischemic encephalopathy (HIE).
98
What is the difference between perinatal and postnatal causes of CP?
Perinatal = during birth; postnatal = after birth (infection, trauma).
99
What is the primary cause of myelomeningocele?
Failure of the neural tube to close during embryonic development.
100
What maternal factor is protective against neural tube defects?
Adequate folic acid intake before conception.
101
What are common associated conditions with myelomeningocele?
Hydrocephalus, Arnold-Chiari II malformation, tethered cord.
102
What signs suggest shunt malfunction in a child with a VP shunt?
Headache, nausea, vomiting, irritability, decline in function.
103
What is tethered cord syndrome?
Stretching of the spinal cord causing progressive neurological dysfunction.
104
At what age should a child be able to jump with both feet off the ground?
Around 2–2.5 years.
105
At what age should a child be able to hop on one foot?
Around 4 years.
106
At what age should a child be able to catch a ball?
Around 4 years.
107
What outcome measure is best for goal setting in pediatrics?
COPM (Canadian Occupational Performance Measure).
108
What is the PEGS?
Perceived Efficacy and Goal Setting System — child-focused goal setting.
109
What is the primary goal of Early Intervention?
Maximize developmental outcomes and family involvement.
110
What is IDEA?
Individuals with Disabilities Education Act — federal law ensuring services for children with disabilities.
111
What law protects educational access for children with disabilities?
Section 504 of the Rehabilitation Act.
112
What is the hallmark movement impairment in hemiplegic CP?
Involuntary hand preference before 1 year old.
113
What is the hallmark movement impairment in diplegic CP?
Lower extremity spasticity greater than upper extremities.
114
What is the hallmark movement impairment in dyskinetic CP?
Involuntary, purposeless movements.
115
What is the hallmark movement impairment in ataxic CP?
Poor coordination and balance.
116
What is the hallmark movement impairment in quadriplegic CP?
Severe involvement of all four extremities and trunk.
117
What is the significance of selective motor control in CP?
Difficulty isolating muscle activity, leading to abnormal movement patterns.
118
What muscle group is often weak in children with CP and contributes to crouch gait?
Hip extensors and plantarflexors.
119
Why are SMOs used in children with Down Syndrome?
To provide ankle support for improved postural control.
120
What type of orthosis is recommended for flexible pes planus?
Supramalleolar orthoses (SMOs).
121
What type of orthosis is recommended for toe walkers without underlying neurologic cause?
Hinged AFOs (Ankle-Foot Orthoses).
122
What type of orthosis is recommended for crouch gait in CP?
Ground reaction AFOs (GRAFOs).
123
What is 'cruising' and when should it appear?
Walking sideways holding onto furniture; around 9–10 months.
124
At what age should a child run well without falling?
Around 2 years.
125
What outcome measure assesses physical activity participation?
Children's Assessment of Participation and Enjoyment (CAPE).
126
What outcome measure evaluates endurance in children?
6-Minute Walk Test (6MWT).
127
What test evaluates functional strength in pediatric populations?
30-Second Sit to Stand Test.
128
What test evaluates balance using tandem standing and stepping?
Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB).
129
What is the most important factor in developing early motor skills?
Opportunities for practice and experience.
130
What is a good intervention strategy for poor anticipatory postural control?
Weight shifting and transitional movements.
131
What sensory system is primarily responsible for gravitational security?
Vestibular system.
132
What is gravitational insecurity?
Extreme fear of movement or changes in head position.
133
What is hypotonia and how does it present?
Decreased muscle tone; floppy appearance, poor postural control.
134
What is spasticity?
Velocity-dependent increase in muscle tone.
135
What is dystonia?
Involuntary sustained muscle contractions causing twisting, repetitive movements, or abnormal postures.
136
What is athetosis?
Slow, writhing, continuous involuntary movements, especially of the hands, feet, arms, and legs.
137
What is chorea?
Rapid, irregular, jerky involuntary movements, often flowing randomly from one muscle group to another.
138
What somatosensory deficits are common in CP?
Impaired proprioception, stereognosis, two-point discrimination.
139
What is the primary focus of pediatric physical therapy?
Promote participation in age-appropriate activities and roles.
140
What are environmental factors in the ICF model?
Physical, social, and attitudinal environment around the child.
141
What are personal factors in the ICF model?
Child's age, gender, coping styles, experiences.
142
What body structures/functions are often affected in DCD?
Motor planning, balance, coordination.
143
What body structures/functions are often affected in ASD?
Motor imitation, praxis, hypotonia.
144
What is praxis?
Ability to plan and execute novel motor actions.
145
What is dyspraxia?
Difficulty with motor planning.
146
What is the role of the basal ganglia in motor control?
Initiating and regulating voluntary movements.
147
What is the role of the cerebellum in motor control?
Coordination, balance, and timing of movements.
148
What intervention is helpful for motor control impairments in DCD?
Task-specific, goal-oriented activities.
149
What movement pattern would you expect in a child with unintegrated TLR?
Difficulty lifting head in prone; stiff, extended posture in supine.
150
What movement pattern would you expect in a child with retained STNR?
Difficulty crawling and poor postural control in quadruped.
151
What are indicators for Early Intervention referral in infants?
Prematurity, low birth weight, abnormal tone, delayed milestones.
152
What are key predictors of independent ambulation in CP?
Sitting independently by 24 months, mild motor impairments.
153
What is the importance of early detection of CP?
Early intervention improves long-term outcomes.
154
What are signs of spastic diplegia?
LE spasticity > UE, scissoring gait, crouched posture.
155
What are signs of hemiplegic CP?
Early hand preference, asymmetrical crawling, one-sided weakness.
156
What are signs of ataxic CP?
Wide-based gait, intention tremor, difficulty with balance.
157
What standardized outcome measure assesses functional mobility for children with spina bifida?
Pediatric Evaluation of Disability Inventory (PEDI).
158
What is the typical gait deviation in a child with spastic CP?
Crouch gait: hip/knee flexion, ankle dorsiflexion.
159
What is characteristic of idiopathic toe walking (ITW)?
Child can correct to plantigrade, no spasticity or neurologic cause.
160
What type of seating is recommended for a child with poor head/trunk control?
Supportive seating with headrests and lateral supports.
161
What are signs of possible abuse/neglect in pediatric populations?
Unexplained injuries, inconsistent stories, fearful behavior.
162
What is the mandated reporter's role?
Report suspected abuse immediately; not responsible for proving it.
163
What does 'failure to thrive' often indicate in pediatrics?
Possible neglect, chronic illness, or feeding difficulties.
164
What sensory profile is typical in sensory seeking children?
High threshold; seeks intense sensory experiences.
165
What sensory profile is typical in sensory over-responsive children?
Low threshold; hyperreactive to sensory input.
166
What type of play is important for developing motor skills?
Active, exploratory, gross motor play.
167
What intervention can help with poor gravitational security?
Graded vestibular input (e.g., swinging, gentle movement).
168
What activity can improve selective motor control in a child with CP?
Isolated joint movements and dissociation activities.
169
What is 'en bloc' movement in postural control?
Moving head and trunk together without dissociation.
170
When should a child begin stair negotiation without support?
Around 3–4 years old.
171
Which reflex supports early upright postural control?
Landau reflex.
172
What are primary impairments in spastic CP?
Muscle stiffness, weakness, impaired selective motor control.
173
What are secondary impairments in CP?
Contractures, bony deformities, hip subluxation/dislocation.
174
What is a major risk with scoliosis in myelomeningocele?
Progressive respiratory compromise.
175
What early intervention is key for infants with myelomeningocele?
Protect skin integrity, support developmental positioning.
176
What is the purpose of a sensory diet?
Provide structured sensory input to support regulation and attention.
177
What is postural control?
Ability to maintain the center of mass over the base of support.
178
What is anticipatory postural control?
Preparing the body for movement or perturbation.
179
What is the most important predictor of walking in spina bifida?
Neurological level of the lesion.
180
What intervention targets gravitational insecurity?
Slow, predictable vestibular activities.
181
What is the goal of pediatric PT intervention overall?
Maximize participation, independence, and quality of life.
182
What is Duchenne Muscular Dystrophy (DMD)?
Progressive neuromuscular disorder caused by absence of dystrophin; X-linked recessive.
183
What are early signs of Duchenne Muscular Dystrophy?
Gower’s sign, delayed walking, frequent falls, proximal muscle weakness.
184
What muscle groups are affected first in DMD?
Proximal muscles (hips, pelvis, thighs, shoulders).
185
What is Gower’s sign?
Using hands to push off thighs to stand up due to proximal weakness.
186
What is the typical progression of mobility in Duchenne’s?
Independent walking early → loss of ambulation around 10–12 years → wheelchair use.
187
What standardized test is often used to monitor DMD progression?
North Star Ambulatory Assessment (NSAA).
188
What is the role of corticosteroids in DMD management?
Slow progression of muscle weakness.
189
What secondary complications occur in DMD?
Scoliosis, respiratory decline, cardiomyopathy.
190
What is dystonia in dyskinetic cerebral palsy?
Involuntary sustained muscle contractions causing twisting, repetitive movements, or abnormal postures.
191
What is athetosis in dyskinetic cerebral palsy?
Slow, writhing, continuous involuntary movements, especially of the hands, feet, arms, and legs.
192
What is chorea in dyskinetic cerebral palsy?
Rapid, irregular, jerky involuntary movements, often flowing randomly from one muscle group to another.
193
What is the Barlow test?
A clinical test for developmental dysplasia of the hip (DDH) that attempts to dislocate an unstable hip posteriorly with adduction and downward pressure.
194
What is the Ortolani test?
A clinical test for DDH that attempts to reduce a dislocated hip anteriorly with abduction and gentle lifting of the femur.
195
What are red flags for Developmental Dysplasia of the Hip (DDH)?
Asymmetrical gluteal folds, limited hip abduction, leg length discrepancy, positive Barlow or Ortolani test, limp once walking.
196
What is clubfoot (Talipes Equinovarus)?
A congenital deformity where the foot points downward and inward; treated with serial casting (Ponseti method) and sometimes surgery
197
What is the best time window to start helmet therapy for plagiocephaly?
Between 4–6 months old for best results, ideally before 12 months.
