Treatment Flashcards
(154 cards)
1
Q
Co-existing problems with flaccid paralysis
A
- can have cognitive problems
- obesity
- pressure injuries
- fractures
- speech and swallow
- bladder and bowel disturbances
2
Q
Co-existing problems with hypotonia
A
- can have cognitive
- respiration difficulty
- poor cardiac health
- strabismus
- pain from joint instability
- hypermobility
- GIT problems (low tone in sphincters)
- swallow and speech
3
Q
Co-existing problems with Rett’s syndrome
A
- mental functions (seizures, sleep apnoea)
- sensory function and pain (hand-mouthing)
- skin rashes (from hand-mouthing)
4
Q
Co-existing problems with fluctuating tone
A
- lower IQ associated with brain injury
- epilepsy
- pain
- anxiety and mood
- respiratory (especially if born pre-term)
- speech and swallow
5
Q
Co-existing problems with hypertonia
A
- may have decrease IQ
- epilepsy
- pain
- contracture
- respiratory
- speech and swallow
- non-ambulant
- hip displacement (grade 4 and 5)
- non-verbal
- behaviour disorder
- bladder incontinence
- sleep disorder
- vision and hearing problems
6
Q
Criteria for Autism
A
- social disturbances (eye-contact, facial expressions, gestures, sharing)
- Language communication (mute, delayed, refuse, repetitive, lack of imaginative speech)
- Behavioural (restricted patterns of movement, preoccupied, abnormal focus of intensity of focus, inflexible to routine changes)
7
Q
3 Groups of Autism
A
Aloof
- mute
- cut off socially
- mod-sever intellectual impairment
- repetitive and restrictive behaviour
Passive
- more social (have a happy place)
- better language - but still repeat
- mild-mod intellectual impairment
- less marked behavioural issues
Active but odd
- social
- communication is good but often one sides
- behaviour - have weird interests, may be aggressive, don’t consider other people’s feelings.
8
Q
4 groups of sensory threshold people
A
High threshold
- sensory seekers
- low registration
Low threshold
- sensation sensitivity
- sensory avoiders
9
Q
Signs of a sensory seeker
A
- loud music
- like bright colours
- like to taste everything
- touches everything and likes tight hugs
- smells everything
10
Q
signs of sensory avoider
A
- covers ears when things are loud
- don’t like touching things (clothes, messy room)
- complains of smells
- picky eater
11
Q
BS&F issues in autism (seekers and avoiders)
A
- postural control (incorrect weighting of sensory information)
- sensory processing issues cause difficulty with modulation, timing and safety
- sensory hypersensitivity can induce infant patterns
12
Q
WATCH principles for low registration group
A
- make them aware of danger
- increase activity for health and fitness
- challenge their postural control
- get them involved (they’re passive)
- work on social skills
- get more input into sensory system
13
Q
WATCH principles for sensory seekers
A
- have a very safe environment
- settle them
- channel movement into functional activity
- slow down and control movements to challenge postural control
- control the use of sensory info
14
Q
WATCH principles for sensation sensitivity
A
- have non-confronting environment
- allow child to pace themselves in activities
- reduce hypervigilance to allow reweighting of sensory information to have better PC
- increase awareness of prop and decrease reliance on vision
- self initiated exploration
15
Q
WATCH principles for sensory avoider
A
- non-confronting environment
- may need desensitisation program
- gently increase motion and variety of senses
16
Q
What are the 5 levels of GMFCS
A
- walks without limitations (stairs)
- walks with limitations (needs rail up stairs)
- walks using hand-held mobility device
- may walk for short periods at home but mainly in wheelchair, have head control
- wheelchair all the time, trouble with head and trunk control
17
Q
5 levels of Manual ability classification scale
A
- handles objects easily and successfully
- handles most objects but with reduced quality and speed
- handles objects with difficulty, needs help to prepare and modify activities
- handles a limited selection of easily managed objects in adapted situation
- doesn’t handle objects and severely limited ability to perform simple actions
18
Q
Functional communication classification system (FCCS)
A
- independently and easily communicated with most people in most settings
- independently and easily communicates with familiar people, some difficulty with uncertain people and places
- independent with familiar people and places, needs help with unfamiliar
- can communicate daily routine and needs with familiar people, but needs help with everything else
- rarely communicates well with anyone
19
Q
Risk factors for spina bifida
A
- genetic
- environmental (maternal diabetes/obesity, anti-epileptics, fever early in pregnancy)
- nutritional - decreased folic acid intake
20
Q
Development of spinal cord
A
- notochord (day 18)
- neural plate
- neural groove and folds (day 20)
- neural folds fuse (day 22-23)
- neural tube (day 23)
distal end of neural tube formed by 28-48 days
21
Q
Causes of neurological deterioration in Spina Bifida
A
- SC impairment
- tethered SC
- syringomyelia
- Arnold-Chiari malformation
- hydrocephalus (VP shunt malfunction)
22
Q
Level of lesion in spina bifida outcome (muscles that work)
A
L2- hip flexors and adductors L3- knee extension L4 - knee flexors, dorsiflexors and invertors L5 - hip abductors S1- hip extension and weak PF S2 - strong hip extension and PF S3 - foot intrinsics
23
Q
Signs of tethered cord syndrome
A
- decrease strength
- changes in gait/function
- scoliosis
- back/LL pain
- spasticity
- change in sensation
- change in urinary
24
Q
Signs of Arnold-Chiari Malformation (infants and child)
A
Infants
- snoring
- chewing and swallowing changes
- stridor
- recurrent aspirations
- apnoea and cyanosis
- sweating and skin discolourations
- nystagmus
- tonal changes
Child
- sleep changes
- nystagmus
- headache
- neck pain and stiffness
- weakness
- spasticity
- balance problems
- decrease sensation
- UL dysfunction/ataxia
- change in urinary system
25
Management of Arnold-Chiari Malformation
- monitor VP shunt
| - posterior fossa decompression
26
Signs of hydrocephalus (infant and child)
Infant
- tensing/bulging fontanelle
- increased head circumference
- sunset eyes
- irritable
- poor feeding/vomitting
- drowsy
- swelling along shunt line
- separation of suture lines
- prominent scalp veins
- papilloedema
- seizures
- asymmetrical postures
child
- irritable
- change in personality
- seizures
- headache, nausea, vomitting
- swelling along shunt
- decreased coordination and balance
- decrease school performance
- pain at site
- blurred vision and pappiloedema
27
Causes of delayed gross motor function in Spina Bifida
- hypotonia
- slow development of automatic postural responses
- delayed independent sitting
- delayed head control and equilibrium
- poor hip stability and crawling
28
causes of delayed fine motor function in spina bifida
- weak grip strength
- abnormal hand position sense and proprioception
- difficulty with usual motor integration
- poor motor quality
- poor coordination
29
other associated problems with Spina Bifida
- memory
- motivation and initiation
- understanding consequences of actions
- comprehension
- problem solving
30
Spina bifida functional mobility scale (6 levels)
1. wheelchair
2. walker of frame
3. crutches
4. sticks.
5. independent on level surfaces
6. independent on all surfaces
31
What to consider when parent asks if child willl walk? (Spina bifida)
1. benefits vs costs of ambulation
2. factors influencing ambulatory outcome
3. Factors influencing decline in ambulation
4. walking will be delayed
5. preparing child for ambulation
32
Benefits vs Costs of ambulation in Spina Bifida
Benefits
- independence
- reduce risk of fractures
- reduce risk of pressure injuries
- increase bladder and bowel function
- increase cardiovascular fitness
- reduce risk of lower limb contractures
- increase spatial organisatin
- improve psychosocial development
Costs
- cost of orthoses, Orthopaedic surgery and therapy
- time and resource commitment
- energy cost
difficulty maintaining ambulation into teen years
33
Factors influencing ambulation (Spina bifida)
- level of lesion
- quads strength
- parental compliance
- early ambulation
- access to physio and orthotics
- motor milestone achievement
- level of ambulation at 5 years old
- cognition
34
Factors relating to ambulation decline (spina bifida)
- neurological deterioration
- energy cost
- slow speed
- spasticity
- increase body weight
- skin breakdown
- orthotic limitation
- toileting issues
- immobilisation after surgery
- motication
- pain
- scoliosis surgery
- fracture
35
How to prepare for ambulation (spina bifida)
- proximal stability
- postural reactions
- UL coordination and strength
- motor planning
- increase strength of lower limb
36
Other health concerns in Spina bifida
- pressure injuries
- obesity
- risk of fracture
- shoulder pain
- latex sensitivity
37
Stages of pressure injuries
1. red/discoloured skin - monitor and stay off it
2. epidermis/dermis loss - blister, clean and monitor - stay off it
3. full dermis and subcutaneous tissue - stay off, debridgement, professional advice and graded seating program
4. full dermis and muscle +/or bone - same as 3 management
38
Argenta classification of Plagiocephaly
1. flat spot
2. ear shift
3. forehead deformity
4. cheek, face and jaw deformity
5. vertical and temporal deformity - fontanelle
39
Risk factors for Plagiocephaly
- intra-uterine constraints
- multiples
- first born or premature
- long supine sleeps
- poor neuro-sensory-motor functioning
- lack of sidelye/prone when awake
- low activity level
40
Cranial index
lateral diameter / AP diameter
>80% = brachycephalic
75-80% = normal
<75% = scaphocephalic
41
Modified cranial vault index (which direction is positive and which direction is negative)
(L-R) / shorter x 100 = %
more than 3.5% = asymmetrical
positive = right PP
negative = left PP
42
Ways to measure Plagiocephaly
- measuring tape
- flexicurve
- digital imaging
43
What is active head righting Ax
- Right body on head (L SCM)
- Left body on head (R SCM)
- Right body on head reverse (L SCM)
- Left body on head reverse (R SCM)
- right head on body (R SCM)
- Left head on body (L SCM)
44
Management of plagiocephaly
A - active baby - position in different play positiong and encourage active head movement
B - balanced handling - carry on both sides and promote passive head repositioning
C- corrective strategies - reposition head to unfavoured side when sleeping and encourage them to turn to both sides when playing
45
When are helmets successful in plagiocephaly?
- used early (4-5m)
- room to grow
- 23 hours / day
- used with therapy
46
Torticollis assessment
- active head righting assessment
- PROM
DDx - structural deformity (Klippel feil, Sprengel's shoulder), sensory abnormality, inflammatory or traumatic condition
47
Associated conditions with torticollis
- positional plagiocephaly
- facial/mandible deformities
- hip dislocation
- metatarsus adductus
- talipus equinus varus
48
Management of torticollis
- parent education (facilitate AROM to end range, position to encourage movement into limited ROM, carrying to lengthen contractures, stretches)
W- 10 in the bed and the little one said rollover
A - looking to toy (carried)
T- head movements in functional position for their age
C - teach carrying positions
49
Hypotonia wheel - 4 cornerstones
1. identify activity and participation goals
2. assess environmental facilitators and barriers
3. include parents and caregivers
4. ensure child is actively involved and positively engages
50
Criteria for DCD
1. ADLs that require motor coordination delayed for age and cognition level
2. disturbance significantly interferes with academic achievement or ADLs
3. disturbance not related to medical condition
4. if mental retardation is present, the motor coordination is worse than expected
51
Concomitant conditions with DCD
- ADHD
- OCD
- Depression
- anxiety
- autism
- concentration problems
- tourettes
- learning problems
- speech problems
52
Ax findings for DCD
- low tone
- infant patterns when fatigued
- ocular-motor control difficulties
- poor timing
- poor proprioception
- poor FM and GM
- poor postural control
- poor tactile
- poor vestibular
- poor motor planning
- immature strategies
- gait (toe walking, heavy flat feet)
- poor activation and recruitment of muscles
53
Viking Speech scale (4 item scale)
1. speech isn't affected
2. imprecise speech but unfamiliar can understand
3. unclear speech, unfamiliar can't understand
4. no understandable speech
54
Risk factors for early brain injury
- Maternal (thyroid, pre-eclampsia, bleeds, infection, intrauterine growth restriction, placental abnormalities, multiples
- born premature
- encephalopathy
55
Signs and symptoms of Duchenne Muscular Dystrophy
- Gower's sign
- muscle weakness and atrophy
- hyperlordosis
- pseudohypertrophy of calves
- scoliosis
- poor postural control
- awkward gait
- difficulty with synergistic patterns
- fatigue
- pneumonia
- breathing difficulties
56
Management of Duchenne
- steroids to reduce muscle loss
- medication for heart function
- stretching
- position to avoid contractures
- splinting and orthoses
- encourage activity
- maintain strength and flexibility
57
4 types of Spinal muscular atrophy
1. Werdnig-Hoffman disease (die before 2)
2. Dubowitz disease (dies after 2, can sit independently)
3. Kugelberg-Welander disease - dies as adult, can walk short distances
4. adulthood - walks normally
58
Management of spinal muscular atrophy
- long term palliative
- orthopaedic/musculoskeletal
- respiratory
- equipment prescription
- mobility
59
Ossification of foot
- hindfoot - calcaneus - 23 weeks gest
- talus - 28 weeks gest
- midfoot - cuboid - 6-7 months
- navicular 9 months -5 years
- cuneiforms - 3 months to 2.5 years
- phalanges - birth
60
Position of foot in congenital talipus equinus varus
- plantarflexion of talocrural joint
- adducted and inverted subtalar and midtarsal
- navicular tuberosity close to medial malleolus
- metatarsals are adducted
Bony detail
- decreased talo crural angle
- moderate stacking of metatarsals
- varus hindfoot and forefoot
61
Management of postural TEV
- stimulate muscles that will correct position
- try and correct passively
- check other packaging issues
- AROM into DF and eversion
- taping
- no chance of relapse
62
Pirani and outerbridge evaluation
-posterior contracture - posterior crease, empty heel, rigid equinus
-medial contracture- medial crease, curved lateral border, lateral part of the head of talus
0=normal 0.5= mod 1= severe
63
Order of ponseti-casting for TEV
1. extend first MTP to reduce cavus
2. abduct foot and evert
3. dorsiflex
64
Postural talipes calcaneovalgus presentation and management
```
presentation - ankle held in DF, heel in valgus
Mx if postural
- gentle PROM
- active PF and inversion
- dorsolateral splint
- once corrected no relapse
```
65
congenital vertical talus presentation
- hindfoot is PF, talus is vertical, talonavicular joint is subluxed, forefoot is abducted and DF
- rocker bottom foot
66
Causes of Brachial plexus palsy
exogenous- clinician during delivery
| endogenous- uterine forces
67
Erb's palsy presentation
Upper trunk - C5/C6
Waiter's tip - IR, elbow Ext, pronation, wrist and finger flexion
Loss of sensation in C5/C6
68
Klumpke's palsy presentation
Lower trunk - C8 and T1
"Claw hand"
Horner syndrome - pupil constriction and droopy eyelid
happens when arm came out first
AROM loss = hand intrinsics, FCU and 1/2 FDP
69
Risk factors for brachial plexus palsy
- malposition
- induced labour
- operative vaginal delivery
- shoulder dystocia (predicted by 4-5kg baby, previous shoulder dystocia)
70
Different levels of brachial plexus palsy
```
Avulsion
- seddon's classification 1
- no repair possible
- lose sensory and motor
Rupture
- Seddon's classification 1
- can repair
- lose sensory and motor
- pain and dyesthesia
Neuroma
- Seddon's classification 1
- repairs itself (scar tissue puts pressure on nerve)
- lose sensory and motor
Neurapraxia
- Seddon's classification 3
- heals itself
- temporary loss of sensory and motor
-numbness, tingling and burning
```
Recovery - Upper arm 4-6 months, lower arm 7-9 months
71
Assessment of Brachial Plexus palsy
- alertness
-suckling and swallowing
-pain and discomfort
-registration
-posture at rest
-mallet classification (7 items AROM) 0=no funciton 5 = normal
= posture
= ER
=shoulder abduction
=hand to neck
=hand to spine
=hand to mouth
=supination
72
Treatment of Brachial plexus palsy
Pain - 3 S's
1. alert parent to poor sensation
2. teach parent how to support arm
3. teach parent safe positioning for sleep and play
maintain ROM - e P's
1. promote AROM
2. passive ROM in mallet's direction
3. position to avoid contracture
73
When to get surgery in BPP?
if total paralysis at 3 months, or if partial paralysis but biceps hasn't returned by 3 months.
Good outcome in Erb's if antigravity biceps or deltoid at 3-4 months
74
Brighton criteria (hypermobility spectrum disorder)
```
- need 1 major and 2 minor, or 4 minor
Major
- 4+/9 on Beighton score
- chronic joint pain in 4+ joints for 3+ months
minor
1-3/9 on Beighton score
- chronic joint pain in 1+ joint for 3+months
Marfanoid habitus
-more than 1 joint dislocation
- abnormal skin
-eye signs (droopy eyelid or myopia)
- varicose vains
```
75
Management of hypermobility spectrum disorder
- joint stability and strengthening in mid range
- low impact exercise to reduce pain (pilates)
- lifestyle modification
- pain management
- improve proprioception
76
Ehlers Danlos Syndrome
- Generalised joint hypermobility
- systematic manifestation of general CTD and familiy history
- musculoskeletal complications
- absence of unusual skin fragility
- skin hyperextensibiility
77
Associated conditions with EDS
- subluxation
- finger deformities
- scoliosis
- joint and tissue deformities
- pain
78
Management of EDS
- protect joints (strengthening and bracing)
- pain Mx (rice and low impact strength)
- facilitate optimal functioning
- post surgical care
79
Problems associated with EDS
- poor tissue strength for surgery
- blood vessels are fragile
- delayed/incomplete wound healing
80
Presentation of Marfan syndrome
- generalised joint hypermobility
- long limbs and fingers
- pectus excavatum
- scoliosis
- cardiac and ocular features
81
Management of Marfan syndrome
- pain (rice and low impact strength exercises)
- improve postural alignment and motor function
- surgery for pectus excavatum
- monitor heart
- post surgery management
82
Presentation of Achondroplasia (general, upper limb and lower limb)
```
General
- disproportionate short stature
- large frontal bodding, prominent chin, midface hypoplasia
- TLx kyphosis
Upper limb
- trident hand
-rhizomelic shortening of humerus
- short fingers
- decrease elbow extension
- decrease supination
Lower limb (TRAVELS)
- trident pelvis
-rhizomelic shortening of femur
- acetabular angle reduced
- Genu varum
- expanded metaphysis at knee
- long fibula
-short toes
```
83
Secondary conditions with Achondroplasia
- cervicomedullary compression
- decreased cranial-cervical junction can increase intercranial pressure
- respiratory and sleep disturbances
- middle ear infection
84
Management of achondroplasia
medically - growth hormone
- bracing
- address functional limitatioins
- delay sitting until independent
- protect newborn Cervical spine
- limb lengthening
- adapted equipment
- school access and performance
85
Associated conditions with Osteogenesis imperfecta
- blue sclerae
- loose joints
- lax ligaments - dislocations
- weak muscles
- scoliosis
- short stature
- abnormal skull shape
- hearing problems
- pelvis shape
86
Types of osteogenesis imperfecta
type 1 : good quality, not enough collagen
type 2: bad quality, not enough collagen
type 3: bad quality, there is enough collagen
type 4: good quality, not enough collagen
Type 5: good quality, not enough collagen
87
Management of osteogenesis imperfecta (MDT)
pharmaceutical - biphosphates
Orthopaedic - osteotomy of long bones and brace, Cx spine surgery, scoliosis surgery
Physio - gentle to avoid fractures, increase strength and flexibility, increase endurance, positional changes to avoid contracture, hydrotherapy, physical aids, monitor and educate
88
What is arthrogryposis?
Congenital condition, where amyoplasia (muscle replaced by fat) occurs. Caused by abnormal movement before birth (extrinsic - uterine forces, or intrinsic - muscular or neurological). Position is symmetrical UL IR, elbow extension, pronation and wrist and finger flexion and ulnar deviation. Lower limb is flexed, externally rotated + clubfoot + scoliosis.
89
Consequences of arthrogryposis
- severe contracture
- weak, fibrotic muscles
- poor motor and postural control
- lung hypoplasia
- abdominal hernias
- growth retardation
- normal cognition and language
90
Management of arthrogryposis
- manage LL contracture
- parent education
- increase AROM and PROM
- review goals and management
- UL function
- mobility aids and technology
91
Why are kids more susceptible to brain injury?
1. head to body ratio
2. thinner cranial bones
3. less myelinated brain
4. haemorrhagic shock
92
What are secondary injuries following ABI
- intercranial haemorrhave
- increased intercranial pressure
- haemorrhagic shock
- seizure
- infection/sepsis
- electrolyte imbalance
93
Measurements of brain injury severity
```
GCS, PTA, LOC
mild
- 13-15 GCS
- less than 30 minutes LOC
- less than 1 hour PTA
moderate
- 9-12
- LOC 30-60 minutes
- PTA <24hours
severe
- <8 GCS
- more than 60 minutes LOC
-PTA more than 24 hours
```
94
What predicts outcome following ABI
- severity of injury
- type of injury
- reaction from child
- secondary complications
- age
95
Complications following ABI
- neuroendocrine dysfunction
- respiratory complications
- nutrition and oral feeding
- bladder and bowel
- central autonomic dysfunction
- heterotrophic ossification
- sensory deficits
- post traumatic epilepsy
- dysautonomia
- sleep/wake cycle
96
Signs and management of dysautonomia
signs
- increased HR and BP, vasodilation, spasms, dilated pupils
Management
- remove noxious stimuli, change position, monitor, check for any problems, support, manage pain and spasticity
97
Physio management of ABI
- prevent further damage
- maintain ROM
- maintain respiratory function
- arousal - only relevant stimuli (change their position so they can look at different things)
- increase consciousness
98
Signs and management of Post traumatic amnesia
- confused/disorientated in time and place
- confused speech
- labile
- emotional
- wandering and distracted
- can't remember new things
- poor concentration
- "islands of memory"
Management
- ensure secure environment and reduce noise
- encourage communication
- educate family and staff
- use memory cues
- have structure and routine
- increase activity tolerance
- orient them to the environment
- consider other sequelae
99
4 sequelae in ABI management
physical (GM and FM problems, balance and coordination, response time, spasticity and rigidity, hearing and sensory loss etc)
psychosocial (behavioural changes, decrease in social skills, emotional and mood changes, change in roles and expectations, impact on families)
communication (motor speech, processing time, word finding, reading and writing, social skills, higher level language)
Cognition (arousal and attention, memory and learning, agitation, information processing, visuoperception)
100
Measurement scales (outcome measures) for dyskinesia
- Barry albright dystonia scale
- dyskinesia impairment scale
- hypertonia assessment tool
Assess - severity, duration, trigger, disability, and movement range of involuntary movement
101
Treatment options for dyskinesia
-deep brain stimulation
- intrathecal baclofen
- Botox
- physio
= postural control (move to midline, decrease internal perturbations)
= gross motor
=fine motor
=strength and endurance
=ROM
= sensory integration and modulation
102
How to measure pain in kids
- face pain scale
- observe (HR, resp rate, general)
- FLACC scale (face, legs, activity, crying, consolability)
- CHEOPS (children's hospital of eastern Ontario pain scale)
103
Assessment of developmental dysplasia of hips
```
Birth
- unequal thigh crease
- difficulty abducting hips
- paediatrician does assessment
- difference in leg length
2-4 weeks
- observe function
-ultrasound
3 months
- X-ray
- hip abduction less than 60degrees
- leg length difference
unequal thigh crease
```
104
Management of DDH
-reduction - maintain reduction until stability obtained
- splint in flexion and abduction
- 6 months to 2 years - closed reduction and then hip spica
18 months -2 years - open reduction and then hip spica
105
How would a kid present with Legg-Calve Perthes disease
- painful limp
- limitation of IR and abduction
- 4-8 year olds
106
How would you treat Legg-Calve Perthes disease?
- maintain full ROM
- surgery - derotation osteotomy of proximal femur
physio post op
- weakness and stiffness in hip abductors
- gait retraining
- posture and balance
-hydrotherapy
107
Presentation of slipped capital femoral epiphysis
- limp and hold in ER
- chronic hip pain
- if missed leads to avascular necrosis or premature closure of physis
108
Classification of limb reconstruction
International society of prosthetics and orthotics (ISPO)
| transverse & longitudinal
109
Causes of limb loss
1. congenital
2. infection
3. trauma
4. tumour
110
How would a kid present with an osteosarcoma
- sever joint/bone pain
- pain at rest
- swelling in bones and joint
- won't weight bear
common areas - distal femur, proximal tibia, proximal humerus, proximal femur
111
Assessment of lower limb reconstruction
- pain
- extent of deficiency
- AROM and PROM of surrounding joints
- muscle imbalance and control
- motor skills
112
Reconstruction of Limb physio management pre and post op
```
reconstruction = osteotomy, lengthening, consolidation
pre op
- ROM
- strength
- functional mobility
post op
- ROM
-strength
-functional mobility
-pain
-encourage normal gait and weightbearing
```
Be aware when lengthening - pain, sleep disorders, pin site infection, nerve entrapment, weight change
113
Risk factors for patellofemoral stress syndrome
- hypermobile pattelar
- smaller cross-sectional area on MRI
- swelling
- reduced eccentric knee control
114
Presentation of acute hematogenous osteomyelitis
- infants and children
| - pain, limp, fever
115
Management of apophysitis
- deload and rest structure
- monitor strength and flexibility
- may experience symptoms until finished growing
- if avulsion # then surgeon
116
Management of osteochondritis dissecans
- activity modificatin
| - internal fixation or abrasion chondroplasty
117
Physical activity recommendations
0-1 - supervised floor play
1-5 = at least 3 hours of physical activity
5-12 = at least 1 hour of mod-vigorous activity including aerobic and 3x strength
13-17 = at least 1 hour of mod-vigours phyical activity including aerobic and 3x strength per week
118
Sedentary behaviour recommendations
```
0-2 = no screen time
2-5= less than one hour screen time
5-12 = less than 2 hours screen time and break up long periods of sitting
13-17 = less than 2 hours screen time and break up long periods of sitting
```
119
Factors that decrease physical activity in kids
- access to facilities and equipment
- physical ability
- cognitive ability
- health conditions
- lack of motivation
- lack of time
- lack of transport
- feel isolated
- behavioural or learning difficulties
120
What is the pain cycle
pain- fear of injury - fear of movement - don't move - deconditioning - pain
121
Presentation of JIA
- pain
- swelling
- limited ROM
- joint warmth
- pain with motion
- tenderness
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Assessment of JIA
- pain
- swelling
- ROM
- contracture
- muscle length
-CV fitness
JAMAR - juvenile arthritis multidimensional assessment report
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How does JIA affect other systems
- risk of uveitis
- fever
- rash
- hepatomegaly
- splenomegaly
124
Treatment of JIA
COTREAT
- monitor pain,
- restore mobility
- increase strength
- increase fitness
- increase endurance
- increase postural control
125
Presentation of haemophilia
- pain
- swelling
- limited ROM
- tenderness
- joint warmth
- pain with motion
126
Assessment of haemophilia
- pain
- contracture
- ROM
- CV fitness
- swelling
Haemphilia quality of life questionnaire
127
How does haemophilia affect other systems
- intracranial or extracranial haemorrhage
- bleeding in muscle and associated neuropathy
- neck swelling (emergency)
- develop inhibitor antibodies, so they become unresponsive to coagulation factor - increased risk of arthropathy
128
Treatment of haemophilia
COTREAT
- replacement therapy
- restore joint mobility
- maintain fitness
- increase strength
- endurance
- postural control
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Fractures in kids (and how they differ from adults)
- thick articular cartilage - strong and can't see on Xray
- thick periosteum - rapid healing
- more cancellous bone - simple fracture pattern
- increased collagen content - fracture easier
- stronger ligaments - bone fails first
- bone is more porous and vascular than adults and the periosteum is thicker and stronger than adults
130
How can the growth plate be injured
- infection
- tumour
- ischaemia
- trauma
131
Salter-harris classification of growth place injuries
1. straight through physis
2. through physis with metaphyseal fragments
3. through epiphyses but not into metaphyses
4. through epiphyses and metaphyses (bad)
5. stress injury
6. crush injury
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Management of fracture options
- immobilise
- manipulate with plaster of paris
- manipulate with wiring
- ORIF
- traction (femur # in Tobruk splint)
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Signs of non-accidental injury
- inconsistent/varying injury
- delayed presentation
- recurring injuries
- soft tissue injuries
- long bone fractures are common
- use skeletal survey if suspicious
134
Where are problem fractures
- elbow - Gunstock elbow
- knee
- forearm in teens
- femoral neck
135
What are possible complications of fractures
- malunion
- avascular necrosis
- compartment syndrome
- growth plate injury
- nerve/artery injury
- infection
- fixation failure
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Presentation of congenital scoliosis
- partial unilateral failure of formation
- complete unilateral failure of formation
- unilateral failure of segmentation
-bilateral failure of segmentation
+/- rib deformity
- 3D deformity of spine
- risk of neural compromise
137
Why can early onset scoliosis be dangeroud
- lungs are still developing and a curve greater than 80 degrees can result in restrictive lung disease. Alveoli are still being added until 8 years old and then still undergo hypertrophy until maturity.
138
Difference between structural and postural adolescent idiopathic scoliosis
structural won't correct in posture changes and can't be resolved when you get rid of the cause (LBP ect).
Structural will show on Adam's forward bending test = rib hump
139
Things not to miss with scoliosis (bad signs)
- structural scoliosis in males
- painful scoliosis
- neurological symptoms
- onset when child, not teen
- rapidly progressing
140
How do you check skeletal maturity and why is it significant in scoliosis management?
Risser's sign - 0-1 = still skeletally immature, 4-5 = skelatally mature and has stopped growing.
When still growing, surgeons can use growth friendly techniques to correct the curve as you grow and keep it mobile. When you are skeletally mature the curve won't get any worse, but you've missed the opportunity to use a growth friendly option and will have to fuse.
141
What will you find on assessment of scoliosis
- observe - cafe spots of Marfan's signs
- trunk asymmetry,
- positive Adam's forward bending
- look at gait and ambulatory status
- neurological Ax
- X-ray
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What are growth friendly surgical options for scoliosis
Growth rods
| Anterior vertebral body tethering
143
How is halo traction implemented and when is it used
- large rigid curve or neurological deterioration
| - used for weeks to months for 23 hours a day as an outpatient.
144
General management guidelines for scoliosis
10-25 degrees = watch and wait
25-40 = brace 23 hours/day if skeletally immature
40+ = surgery (or 50+ if mature)
145
When is surgery indicated for scoliosis
- more than 40 degrees in skeletally immature
- more than 50 degrees in mature
- relentless progression
- cardiopulmonary compromise
- functional improvement
146
What is the impact of neuromuscular scoliosis on the person
```
- affects
sitting
breathing
ADLs
GIT
heart
ambulation
```
147
Possible outcomes of surgery in neuromuscular scoliosis
- improve sitting balance
- easier position changes
- improved respiration
- improves nutrition
- less pain and discomfort
- increased self-esteem
148
Post op management after scoliosis surgery
Day 0 - respiratory and circulatory care, bed mobility
Day 1 - respiratory and circulatory care, stand and march, sit out of bed for 30 minutes a day
before discharge - 6MWT, home program (postural control, walking and respiratory function), 4 weeks off school
149
Scoliosis outcome measures
AIS - scoliosis research society questionnaire
EOS- early onset scoliosis questionnaire
adult back and leg pain - Oswestry disability index
150
Treatment of spondylolisthesis
- Lx flexion to reduce pain
- ab and glute activation and reducing pelvic tilt when walking
- core stability, general fitness, weight loss, stretching
151
What is Scheurmann's and how should it be managed?
Seen in teens for 6 months to 3 years, involves inflammatory pain that is worse at night. It stops when they stop growing but leaves a stiff kyphosis (worse when inferior Thx spine). Often associated with tight hamstrings. Exercises should include strength, posture and flexibility.
152
4 subgroups of illnesses in palliative care
1. treatment option but might fail (e.g. cancer)
2. treatment to prolong life (complex cardiac disease)
3. progressive illness with no cure (SMA1)
4. irreversible illness where complications will be fatal (CP)
153
Describe a child's understanding of death as they age
0-2 years - death = abandonment, they feel despair from disruption or caretaking
2-6 years- death is temporary and a punishment, they don't understand the reason they dies
6-11 years - gradually understanding death is permanent and can comprehend the cause and effect relationship of death
11+ - good understanding
154
What must you address when treating a child in palliative care?
- physical concerns
- psychosocial concerns
- spiritual concerns
- planning for EOL
- practical concerns (how does a MDT work)
