Week 12 - MS conditions in Children

Question 1

When does musculosckeletal system begin growth?

Answer 1

First trimester of pregnancy

Question 2

When are all systems formed with tissue and organ differentiation complete?

Answer 2

8 weeks

Question 3

What development is seen in first 4 weeks gestation?

Answer 3

Matrix skeleton laid down

Question 4

What development is seen in the 4rth week?

Answer 4

Limb buds arise

Question 5

What are the 2 genes that convey body plan, position information and limb development?

Answer 5

1. Homeobox

2. Sonic hedgehog

Question 6

When are type 1 and type 2 muscle fibres formed?

Answer 6

type 1 - 12 weeks

type 2 - 30 weeks

Question 7

Describe important dynamic factors of bone in childhood and adolescence

Answer 7

1. Longitudinal at growth plates
2. radial by bone modelling
3. Bone modelling - formation by osteoblast and reabsorption by osteoclasts increasing mass and alters shape
4. bone remodelling - weight bearing or muscle pull stimulate new growth/bone strength by replacing old micro damaged bone

Question 8

When is skeletal growth most rapid

Answer 8

first 2-3 years (1/2 adult height)

Question 9

What is the normal shape of leg up to 18 months?

Answer 9

genu varum

Question 10

What is the shape of the leg 18 months to 4 years?

Answer 10

straight

Question 11

What shape does the leg have at 4 years old?

Answer 11

genu valgus

Question 12

What is the normal shape of leg at adulthood (>7)

Answer 12

Straight

Question 13

What factors form the basis for paediatric physiotherapy treatment implementation of EBP? (5)

Answer 13

SCORR

1. Clinical observation
2. Clinical reasoning
3. Theoretical concepts
4. Research
5. Systematic review

Question 14

What developmental factors should be considered in the 3rd trimester?

Answer 14

1. Greater force on cartilaginous foetal skeleton can lead to musculoskeletal/postural deformation

Question 15

What are the normal alignment of limbs at birth?

Answer 15

1. Kyphosis from c-spine to sacrum
2. hip flexion and external rotation
3. Internal rotation of lower leg
4. inversion of feet

Question 16

What week does heart development finish at?

Answer 16

week 6 embryonic development

Question 17

What week does lower limb development finish?

Answer 17

Week 7 of embryonic development

Question 18

What two areas of the skull does positional plagiocephaly occur and what are their names?

Answer 18

1. lateral deformational plagiocephaly (3 levels of severity)
2. Posterior defermational plagiocephaly (brachycephaly)(3 levels of severity)

Question 19

List the prevention and treatment for Mx of positional plagiocephaly (7)

Answer 19

(educate, 2 positions, in envitonment, assess, treat, refer clinic)

1. Education
2. active positioning
3. counter positioning
4. environmental set-up
5. assess for related factors (torticollis, dev delay)
6. treat the related factors
7. craniofacial clinic - helmet therapy

Question 20

Define and describe congenital muscular torticollis (CMT)

Answer 20

Shortened sternocleidomastoid (SCM) causing ipsilateral flexion onside and contralateral rotation on opposite side

Question 21

What are the 3 causes of CMT?

Answer 21

1. Postural - no PROM limitation
2. musclular - PROM limitation
3. SCM mass - PROM limiation

Question 22

What risk factors associated with CMT? (3)

Answer 22

1. First born
2. Plagiocephaly/facial asymmetery
3. birth trauma

Question 23

list ways of treating CMT (5)

Answer 23

1. Play (env’t set-up)
2. sleep
3. stretching
4. strengthening - sidelying
5. Tummy time

Question 24

Define and describe Neonatal brachial plexus palsy (Erbs/Klumpke)

Answer 24

traction injury to the brachial plexus during delivery contributing BP injury (often large baby, associated with prolonged labour)

Question 25

What treatment is used for neonatal BPP? (6)

Answer 25

1. Positioning and handling for infants (ie. tummy time) 2. Maintain PROM (stretch ER, P/S forearm, extension of elbow), Serial casting if contracture 3. Facilitate active movements by getting to reach for things want to do (task and context specific, progress to elimate gravity then against gravity) 4. Strengthening 5. surgery - nerve transfer (12 months), tendon transfer 6. splinting

Question 26

Define and describe developmental hip dysplasia (DDH)

Answer 26

born with shallow acetabulum which causes a mismatch between head of femur and acetabulum (maybe due to ligament laxity)

Question 27

What are the risk factors associated with DDH? (6)

Answer 27

FFFSIN 1. Intrauterine restriction 2. Females 3. First borns 4. Family hx 5. swaddling - brining hips in 6. Neuro conditions

Question 28

What are signs of DDH

Answer 28

1. Limited ab of hip (major) 2. shortened femoral length 3. asymmetrical skin creases 4. prominent greater trochanter

Question 29

What are the special tests for DDH (3)

Answer 29

1. Barlow 2. Ortolani 3. Hip U/S

Question 30

What is the treatment for DDH? (5)

Answer 30

OPSEH 1. paediatric orthopod 2. pavlik harness/abduction brace 3. surgery - closed reduction + hip spica 4. education 5. handling

Question 31

List the common postural and structural MS conditions of the foot (6)

Answer 31

MA, TCV, TEV, CTEV, CVT, Postural: 1. Metatarsus adductus - MT adducted position (flexible or rigid) 2. Talipes Calcaneovalgus - forefoot lateral, hindfoot valgus, foot dorsiflexion 3. positional talipes equinovarus (PET) - inverted or varus, can stretch out foot passively Structural: 4. Congenital talipes equinovarus (CTEV, clubfoot) - 6-8 weeks post conception 5. Congenital vertical talus (CVT) - dorsiflexion from mid foot (looks like calcaneovalgus) 6. Other deformities - refer to orthod

Question 32

List steps of a foot assessment

Answer 32

1. ROM (50% PF, Eversion, Inversion) - look at creases | 2. Heel bisector line (Metatarsus adducts)

Question 33

What does the Ponseti method treatment for?

Answer 33

Congenital talipes equinovarus (club foot) using series of casts, surgery, bracing (boots & bars) for 23 hours per day for 3 months post-surgery and then 12 hours nightly until age 4

Question 34

How many stages are involved in the Ponseti method and how long does the take?

Answer 34

5 stages taking 4-6 weeks

Question 35

What positional changes occur when treating CTEV?

Answer 35

inversion/adduction to eversion/abduction

Question 36

What factors indicate the foot ready for surgery? (4)

Answer 36

1. >45 deg abduction 2. Lateral head of talus no longer palpable in corrected position 3. heel valgus 4. anterior end of calcaneus out from under the head of talus (calcaneus shifted posteriorly)