Week 6 Flashcards
1
Q
What is cerebral palsy?
A
A group of permanent disorders of the development of movement and posture, causing
activity limitations that are attributed to nonprogressive disturbances that occurred in the
developing fetal or infant brain
2
Q
How is cerebral palsy diagnosed?
A
A clinical diagnosis is made when a child does not reach early motor milestones and exhibits abnormal muscle tone or qualitative differences in movement patterns
3
Q
Even though the cause of cerebral palsy is not completely understood, what is it associated with?
A
Prenatal, post natal, and peri-natal events that may include hypoxic, ischemic, infectious, congenital, or traumatic brain insults
4
Q
What are somethings that may contribute to cerebral palsy?
A
- Premature birth
- Atypical uterine growth
- Multiple birth and genetic factors
5
Q
What are somethings that we look at when diagnosing cerebral palsy?
A
- Assessment of symmetry
- Involuntary movements
- Abnormal primitive reflexes
- Late development of postural reflexes
6
Q
At what age do most clinicians diagnose a child with cerebral palsy and why?
A
Most diagnosis get made between the age of 2-3, because alot of the presentations can disappear or can be associated with something else. Can be made in 6 months or younger
7
Q
The classification of cerebral palsy is based on what?
A
- Impaired area of the body
* Movement abnormality
8
Q
What are the types of cerebral palsy that falls under the impaired area of the body classification?
A
- Monoplegia: one limb affected (rare)
- Diplegia: all limb affected, but legs are more affected than arms
- Hemiplegia: one side of the body is affected
- Quadriplegia: all limbs are affected
9
Q
What are the types of cerebral palsy that falls under the movement abnormality classification?
A
- Spastic: spasticity of the muscles (most common)
- Dyskinetic/athetoid: fluctuating tone/writhing movements. Low tone in the trunk and high in the arms
- Ataxic: balance and coordination problems are common
- Hypotonic: low muscle tone
10
Q
What part of the brain is usually affected in the case of spastic cerebral palsy?
A
Injury to the motor cortex or white matter projection
11
Q
What part of the brain is usually affected in the case of dyskinetic/athetoid cerebral palsy?
A
Injury of the basal ganglia
12
Q
What part of the brain is usually affected in the case of ataxic cerebral palsy?
A
Injury to the cerebellum
13
Q
What part of the brain is usually affected in the case of hypotonic cerebral palsy?
A
Not a single site is affected
14
Q
What is the frequency at which we see cerebral palsy?
A
- Spastic diplegia (38%)
- Spastic hemiplegia (30%)
- Ataxia (11%)
- Dystonia (9.5%)
- Spastic quadriplegia (5.5%)
- Athetosis (5.5%)
- Mixed (2%)
15
Q
____ is the more contemporary way of classifying cerebral palsy.
A
*Gross Motor Function
Classification System* is the more contemporary way of classifying cerebral palsy.
16
Q
What is the Gross Motor Function Classification System?
A
A 5 level, age categorized system that places children with CP in categories of
severity based on performance in functional motor skills such as sitting, walking, and wheeled mobility. Highly reliable, and children usually don’t switch levels that they are in
17
Q
At what age is the Gross Motor Function Classification System highly reliable and valid?
A
Particularly at preschool age and older
18
Q
Around what age does a child being classified on the Gross Motor Function Classification System plateau?
A
Around the age of 5
19
Q
Between what age does a child with cerebral palsy reach about 90% of their gross motor potential?
A
Between the age of 3 and 6
20
Q
What are the body function/structure impairments seen in children with cerebral palsy?
A
- Muscle tone(high or low, spasticity) & extensibility
- Muscle strength
- Skeletal structure
- Selective control, postural control, motor learning
- Pain
21
Q
What are the muscle tone presentations seen in children with cerebral palsy?
A
- Gets worse over time
- Muscle tone might not relax with activity
- Muscle growth often doesn’t keep up with bone growth
- Chronic muscle imbalance
- Abnormal posture/weakness
- Abnormal reflex activity
22
Q
What are the muscle strength presentations seen in children with cerebral palsy?
A
- Unable to generate normal muscle forces
* Activity limitation such as: poor walking speed, poor gross motor function
23
Q
What are the selective control, postural control, motor
learning presentations seen in children with cerebral palsy?
A
• Impairments in muscle strength and extensibility can result in abnormal bio-mechanical forces that affects the bones and joints
- Scoliosis
- Hip subluxation and dislocation
24
Q
What are the selective control, postural control, motor
learning presentations seen in children with cerebral palsy?
A
- Children will have difficulty isolating their muscle and selected pattern
- Difficulty responding to postural changes/challenges
- Problems learning new movements
- Limitations in cognition and perceptual motor skills and a lack of opportunity to practice said skills
25
What are the interventions to be done with an infant with cerebral palsy?
* Educate family/caregivers (most important)
* Handling/positioning: encourage active movements, and normal movements and postures
* Facilitate optimal sensorimotor development: well aligned postural stability, smooth mobility
26
What are the interventions to be done with a preschooler with cerebral palsy?
* Prevent secondary impairment
* Promote play self-care, social skills and communication skills
* Optimize gross motor skills: encourage movement exploration, child initiated solutions to motor task, adaptations to changes in the environment, and repetitive practice of goal related functional task that are meaningful to the child
* Promote mobility
27
What are the interventions to be done with a school age child with cerebral palsy?
* Maintain achieved level of activity, prevent deterioration
* Promote participation in age-appropriate activities
* Start thinking of transition planning: which is characterized by self determination, enhanced knowledge of self and community, problem solving, decision making skills, identification of support system and supportive environment
28
What are the researched benefits of a backwards walker in a preschooler with cerebral palsy?
* Encourage a more upright posture
* Promote a better quality gait
* Decreased energy expenditure
29
What is myelodysplasia?
Defective development of any part (especially the lower segments) of the spinal cord. AKA spin bifida
30
What are the classifications of spina bifida?
* Spina bifida aperta: visible/open
| * Spina bifida occulta: closed or not visible
31
What is spina bifida occulta?
A closed lesion, which can refer to a lipoma. A tuft of hair is commonly seen
32
What is a lipoma?
A small or large subcutaneous masses of fat, which are often associated with abnormal pigmentation of the skin, skin appendages, and dimples above the gluteal cleft
33
What are the different forms of spina bifida occulta?
* Lipomyelomeningocele with paralysis
* Lipomyelomeningocele w/out paralysis
* Lipoma of the filum terminale, usually with no paralysis
* Lipoma of the cauda equina or the conus medullaris with or w/out paralysis at birth
34
What are the different forms of spina bifida aperta?
* Spina bifida with meningocele
* Spina bifida with meningomyelocele
* Spina bifida with myeloschisis (most severe)
35
What is a meningomyelocele?
Open spinal cord defects, that usually protrude dorsally and are not skin covered, and are associated with spinal nerve paralysis.
36
What is a meningocele?
Skin covered spinal cord defect, which is initially associated with no paralysis and usually contain only membranes or non-functional nerves that end in sac wall. So paralysis might be developed overtime
37
What causes spina bifida?
It is thought to occur during neural tube formation, which happens in the 1st couple of weeks after conception
38
What are the parts of neural tube formation?
* Neurulation: the folding of the ectoderm on each side of the primitive spinal cord to form a tube that extends from the hindbrain to S2. Occurs before gestational day 28
* Canalization: when nerve cells fuse together to become the distal end of the spinal cord (distal to S2)
39
What are problems with neurulation associated with?
Encephaloceles and myelomeningoceles, which typically occur from C1- S2. Most spina bifida problems are due to a problem with neurulation
40
What are problems with associated with canalization not occurring properly?
Skin covered meningoceles and lipomas of the spinal cord, which frequently form caudal to L3
41
What are the causes of spina bifida/myelodysplasia?
* Genetics: chromosomal abnormalities and other genetic syndromes
* Teratogens: excessive alcohol intake, and anticonvulsant medications
* Nutritional deficiency: inadequate levels of folic acid
42
How is spina bifida/myelodysplasia diagnosed?
* Maternal serum alpha-fetoprotein screening: gives the family an odds of the child having spina bifida
* Ultrasonography: very reliable in the 2nd trimester. Takes a cross section view of the head and the ventricles, looking specifically with
* Amniocentesis: only done after other test suggests the presence of spina bifida
43
What are the impairments seen in spina bifida/myelodysplasia?
* MSK deformity
* Osteoporosis which may be related to reduced weight-bearing
* Motor paralysis
* Sensory deficits: not often correlated with motor deficits
* Hydrocephalus: excess CSF, can contribute to lemon and banana signs (arnold chiari malformation)
* Cognitive dysfunction, particularly those with hydrocephalus
* Language dysfunction
* Latex allergy
* UE dyscoordination is seen sometimes
* Visuoperceptual deficits
* Cranial nerve palsies
* Spasticity, ranging from flaccid to spastic
* Progressive neurologic dysfunction (look further to see what is going on)
* Seizures (10-30%)
* Neurogenic bowel/bladder (less than 5% don't have this)
* Skin breakdown (esp. in wheelchairs due to pressure in adults and ammonia burns from incontinence in the wheelchair and friction burns in younger children)
* Obesity
44
What are the MSK deformities that are often seen in spina bifida/myelodysplasia?
Spinal and LE deformities like:
• Scoliosis
• Contractures
• Foot orthopedic deformities
45
What are the motor paralysis that are often seen in spina bifida/myelodysplasia?
Lesions can present resembling:
- Complete cord transections,
incomplete lesions
46
What are the possible causes of the progressive neurological dysfunction that is seen in patients with spina bifida/myelodysplasia?
- Seen in children with hydrocephalus, and a CSF shunt and may be due to shunt dysfunction
- Growth of a lipoma on a site of repair
- Subarachnoid cyst of the cord
- Spinal cord tethering
47
What is the focus of the examination of an infant with spina bifida?
Promote parent-child interactions
48
What are the things that we look at when examining an infant with spina bifida?
* Tone (physiological flexion is what we want to see, but we often see hypotonia)
* Dislocated hips & foot deformities, because they are very common in children with spina bifida
* Spontaneous activity and elicited movement, watch what the child does and what the child can do
* Strength, more functional strength through handling
* Sensation
49
What is the focus of the examination of a toddler/preschool child with spina bifida?
Environmental exploration & mobility
50
What are the things that we look at when examining a toddler/preschool child with spina bifida?
* ROM
* Functional strength testing
* Light touch & position sense ( by age 2 and up)
* Fine/gross motor development (standardized testing)
* ADL, including self care skills
51
What is the focus of the examination of a school age child with spina bifida?
ADLs, advanced mobility, socialization
52
What are the things that we look at when examining a school age child with spina bifida?
• Joint alignment, muscle imbalance, contractures, muscle
extensibility, posture (preventing secondary impairments)
• Sensation, coordination, fine motor skills
• Mobility/gait
• Reliable strength testing
• ADL
• Accessibility of environment
53
What is the focus of the examination of an adolescent/adult with spina bifida?
Community mobility &
| independent adult living
54
What are the things that we look at when examining an adolescent/adult with spina bifida?
* ROM
* Strength
* Bed mobility, floor mobility, transfers, they become a problem at this age
* Wheelchair mobility as long as it allows for more independence
55
What are the goals and interventions for an infant with spina bifida?
```
• Family education
• Handling
• Facilitate sensorimotor
experiences
• Prepare for mobility
```
56
What are the goals and interventions for a preschooler with spina bifida?
* Address impairments and avoid secondary impairments
* Promote play & self care
* ID effective means of independent mobility
57
What are the goals and interventions for a school-age child and adolescence with spina bifida?
* Maintain achieved level of activity, prevent deterioration
* Seating, mobility
* Promote participation in age appropriate sport & activities
58
What are some things that may cause deterioration in a chool-age child and adolescence with spina bifida?
* Going through puberty
* Bones growing faster than muscles
* Increased physical demands of living life
59
Autism Spectrum Disorders (ASDs), are a group of neurodevelopmental disabilities. What are the core deficits seen in ASDs?
Core deficits include social, behavioral and communication challenges
60
At what age is Autism Spectrum Disorders (ASDs) diagnosed?
Median age of diagnosis 4.5 to 5.5 years
• Research indicates autism diagnosis at early ages are
reliable, valid, and stable at 2 years
61
What are the benefits of the early diagnosis of Autism Spectrum Disorders (ASDs)?
• Estimated cost to individuals with ASD across lifespan is $3.2 trillion dollars
• Leads to better outcomes for children and increased support for families
Access to community services and resources including early intervention
• Impact continues throughout lifespan
62
What is the etiology of Autism Spectrum Disorders (ASDs)?
* No one etiology, but may be due to genetic predisposition & environmental interactions
* It is also associated with other genetic disorders such as down syndrome, autism or fragile X syndrome
* Brain abnormalities "under connected brain"
63
What are the things that can be seen in a MRI of a brain with Autism Spectrum Disorders (ASDs)?
* Decreased cortical thickening
* Decreased white matter connectivity
* Decreased neuro- chemical concentrations
* Inflammation of the glia, with abnormalities in the cerebellum(may the root cause of clumsiness)
64
How is Autism Spectrum Disorders (ASDs) diagnosed?
DSM V Autism Diagnostic Criteria, which is based on:
• Symptom characteristics
• Severity of disease
• Categories of symptoms
• Types of ASD
• Additional features, including motor deficits, self-injurious behavior, and anxiety/depression
65
What are the symptoms of Autism Spectrum Disorders (ASDs) based on?
The cause/location of the impairment
66
What are the categories of symptoms seen in Autism Spectrum Disorders (ASDs)?
* Social reciprocity
* Communication intent
* Repetitive behaviors
67
What are the symptoms that must be present before a child is diagnosed with social/ communication/interaction Autism Spectrum Disorders (ASDs)?
* Difficulty establishing/maintaining back and forth interactions
* Difficulty maintaining relationships
* Difficulty communicating nonverbally
68
What are the symptoms that must be present before a child is diagnosed with restrictive/repetitive Autism Spectrum Disorders (ASDs)?
* Stereotypes
* Repetitive speech
* Movements or object play
* With excessive adherence to routines or rituals, highly restrictive/abnormal interest
* Hyper/hypo reactivity to sensory input or unusual interest in sensory input
69
What are the terms that are included in the Old DSM-IV: The Umbrella of ASD and is no longer in use?
- Childhood disintegrative disorder
- Rett's disorder
- Autistic disorder
- PDD-NOS
70
What are the co-occurring conditions seen in children with Autism Spectrum Disorders (ASDs)?
* ADHD
* Communication disorders
* Epilepsy
* GI disorders
* Learning disabilities
* Motor planning (4th core deficit of ASD)
* Obesity
* Psychiatric disorders
* Sensory processing disorders
* Sleep disorders
* Tic disorders
* Toe-walking
71
What are some common behavioral problems seen in children with Autism Spectrum Disorders (ASDs)?
```
• Difficulty with transitions ----tantrums, usually described as
“meltdowns”
• Hyperactive and inattentive
• Severe perseveration
• Nonfunctional rituals and routines
• Anxiety/phobias
• Self injurious behavior
```
72
What are some common sensory problems seen in children with Autism Spectrum Disorders (ASDs)?
• Hyper and/or hypo sensitive to certain sounds, textures, tastes, and
smells
• Extremely picky eaters
• May not like feel of clothes, or just socks or tags
• High pain tolerance often reported
• Typical children may have sensory issues or self-stimulatory behavior but these behaviors go beyond typical!!!!!
73
What approach is a PT usually involved in the care of a child with Autism Spectrum Disorders (ASDs)?
Inter-disciplinary approach
74
What is the function of the Ages and Stages ASQ-3 and Ages and Stages ASQ-SE(social and emotional) screens/diagnostic test that is used for patients with Autism Spectrum Disorders (ASDs)?
Screening tools used for development, but they also include a components that might make use come to the conclusion that a child is not properly developing and will lead us to further investigation
75
What is the age range for the use of the Ages and Stages ASQ-3 and Ages and Stages ASQ-SE(social and emotional) screens/diagnostic test that is used for patients with Autism Spectrum Disorders (ASDs)?
* Ages and Stages ASQ-3 (ages 1-66 months)
| * Ages and Stages ASQ – SE (ages 6- 60 months)
76
___ is a great tool to use to identify a child that is at risk for Autism Spectrum Disorders (ASDs), but doesn't give a definite diagnosis
**Modified Checklist for Autism in Toddlers (M-CHAT), age range 16-30months ** is a great tool to use to identify a child that is at risk for Autism Spectrum Disorders (ASDs), but doesn't give a definite diagnosis
77
What are the characteristics of the Autism Diagnostic Observation Schedule – Revised (ADOS-2 that is used in the diagnosis of Autism Spectrum Disorders (ASDs)?
Used as part of an autism diagnosis.
| Standardized tool *gold standard*
78
How long does it take to come to the conclusion/diagnosis of autism from when testing starts?
Approx. a year
79
What should be done if a person is concerned about the presence of Autism Spectrum Disorders (ASDs) in a child?
* Discuss with primary care provider
* Hearing test, because communication is a core deficit
* Refer to early intervention
* Refer to developmental pediatrician or other medical specialist
80
What are some tools that we might use to evaluate how a person with Autism Spectrum Disorders (ASDs) participates in their environment so that we may be able to help enhance their quality of life?
* Children's assessment of participation and enjoyment (CAPE)
* Preferences for activities of children (PAC)
* School function assessment
81
What is the relationship between EBP and ASD in regards to interventions?
There are no concrete interventions but they are:
• Established types of treatment programs that are effective
• Emerging, promising results
• Some interventions we do are unestablished in the literature
• Motor-specific interventions
82
What are the established/effective interventions used for patients with Autism Spectrum Disorders (ASDs)?
• Behavioral/cognitive behavioral programs
83
What are the emerging interventions used for patients with Autism Spectrum Disorders (ASDs)?
Developmental relationship based treatment program and exercise impact outcomes in a positive way
84
What are the unestablished/not enough evidence interventions used for patients with Autism Spectrum Disorders (ASDs)?
Sensory integration, shock therapy, gluten free diets, animal based therapy, and relationship based interventions
85
What is the relationship between motor-specific interventions and Autism Spectrum Disorders (ASDs)?
There are promising results emerging that exercise and motor intervention have positive outcomes.
86
What type of therapy is best for children with Autism Spectrum Disorders (ASDs)?
* They work better in single groups or individual therapy programs, rather than groups
* Effects of cardiovascular and MSK exercise, muscular fitness and weight management is important (aquatics is muy bueno)
87
What is a PT involved in with a child that has Autism Spectrum Disorders (ASDs) as they transition to adulthood?
* Vocational and educational goals
* Leisure and wellness
* Service coordination with referrals to community resources
88
What is the typical presentation of a child with cerebral palsy that falls into the Gross Motor Function Classification System level I?
* Children walk at home, school, outdoors and in the community.
* They can climb stairs without the use of a railing
* Children perform gross motor skills such as running, and jumping but speed, balance, and coordination are limited
89
What is the typical presentation of a child with cerebral palsy that falls into the Gross Motor Function Classification System level II?
* Children walk in most settings and climb stairs holding onto a railing
* They may experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or confined spaces
* Children may walk with physical assistance, a hand held mobility device or use wheeled mobility over long distances
* Children have only minimal ability to perform gross motor skills such as running or jumping
90
What is the typical presentation of a child with cerebral palsy that falls into the Gross Motor Function Classification System level III?
* Children walk using hand held mobility in most indoor settings
* They may climb stairs holding onto a railing with supervision or assistance
* Children use wheeled mobility when traveling long distances and may self propel for shorter distances
* Peak at 8
91
What is the typical presentation of a child with cerebral palsy that falls into the Gross Motor Function Classification System level IV?
* Children use methods of mobility that require physical assistance or powered mobility in most settings
* They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned
* At school, outdoors and in the community, children are transported in a manual wheelchair or use powered mobility
* Peak at 7
92
What is the typical presentation of a child with cerebral palsy that falls into the Gross Motor Function Classification System level V?
* Children are transported in a manual wheelchair in all settings
* Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
* Peak at 6 and a half
93
What are the age categories that is found in the Gross Motor Function Classification System?
* Birth-2
* 2-4
* 4-6
* 6-12
* 12-18
94
What is spina bifida myeloschisis?
When the spinal cord is actually exposed
95
What are some signs and symptoms of a shunt dysfunction as used in hydrocephalus?
- Scoliosis
- Headache
- Nausea/vomitting
- Irritability
- Seizures
- Changes in speech
- Malaise
- Decreased activity level
- Incontinence
- Spasticity
- Decreased grip strength
- Visuomotor/visuoperceptual
- Strabismus
- Visual acuity/diplopia
96
What are the signs and symptoms of a tethered cord?
- Increased spasticity
- Decreased sensation
- Increased muscle weakness above the level
- Increased tripping
- Change in bowel and bladder function
- Decreased UE coordination
