Atypical Development

Question 1

How should a therapist support a child with hypertonia?

Answer 1

• Children tend to push against the hand of the therapist.
• Sit behind them and bring the arms around.

Question 2

“Typical” Impairments of the Infant and Child with hypertonia:

Answer 2

• Difficulty with eccentric control
• Decreased stiffness in neck and trunk (sometimes is increased)
• Limited range of motion of certain muscles (soft tissue shortening) (may have surgery) AND ther muscles are overlengthened (the antagonists)
• High risk for scoliosis
• At risk for hip subluxation and/or dislocation
• Poor cardiovascular fitness.

Question 3

Spasticity assessment (muscle tone) is most widely performed using which scales?

Answer 3

• SCALE: Selective Control Assessment of Lower Extremity
• modified Ashworth scale​

Question 4

• *SCALE**: (Selective Control Assessment of the Lower Extremity);
• *Instructions for Grading​**

Answer 4

• Scale used for muscle tone
• The higher the score = “normal”
• Each joint is scored either 2, 1 or 0 points. These are summed for a Total Limb Score. The number of points for each grade is in parentheses. For each joint, check the joint score and all applicable descriptors on the SCALE Score Sheet.

Question 5

“Typical” Impairments of the Infant and Child with hypotonia:

Answer 5

• Extension favored over flexion for function.
• Joints tend to be hypermobile, so the child relies on ligaments for stability
• Decreased breath support and shallow breathing with weak abdominals and diaphragm
• Developmental milestones achieved later
• May skip creeping on hands and knees
• Uses “W” sitting for stability

Question 6

Which type of impairment will be present in a child that never creeps on hands and knees and uses “W” sitting for stability?

Answer 6

hypotonia

Question 7

“Typical” impairments of the infant and child with ataxia:

Answer 7

• Will look “normal” in a still photo.
• Fall continuously, special ataxic CP
• Difficulty timing and sequencing initiating, sustaining, and terminating muscle activation
• Severe postural insecurity; very fearful of movement
• Uses a very wide base to move on the floor independently
• Keeps legs flexed in vertical to lower the center of gravity
• Pace of development tends to be slower owing to poor balance in upright