Pediatrics

Question 1

what is early intervention?

Answer 1

ages 0-3
mandated by IDEA
IFSP

Question 2

what is individuals education plan (IEP)?

Answer 2

ages 3-21
all children with disabilities are entitles to a free and appropriate public education
mandated by IDEA

Question 3

what is torticollis? treatment?

Answer 3

SCM tightness.
SCM flexion, ipsilateral side-bending, contralateral rotation
treatment: stretch into extension, contralateral side bed, ipsilateral rotation

Question 4

what is plagiocephaly?

Answer 4

prolonged positioning created pressure on skull
parallelogram-shaped skull with ipsilateral occipital flattening and contralateral bulging

Question 5

interventions for plagiocephaly?

Answer 5

education about prolonged supine positioning and CMT
neck AROM and PROM
use positioners, seats, and swings

Question 6

how long is a helmet prescribed for cranial remolding?

Answer 6

worn 20-23 hours per day for 2-7 months
(no longer useful at 18 months - skull is fused)

Question 7

what are the primary causes of nonprogressive encephalopathy?

Answer 7

hemorrhage under ventricles, hypoxic encephalopathy, malformation or trauma of CNS

Question 8

what are the classifications of CP by area of body?

Answer 8

monoplegia: one limb
diplegia: bilateral LE
hemiplegia: UE and LE of one side
quadriplegia: all 4 extremities

*trunk can be involved in all 4

Question 9

what is spasticity? where is the lesion?

Answer 9

velocity dependent increased tone in antigravity muscle
lesion in the motor cortex

Question 10

what is dystonia?

Answer 10

involuntary movements with sustained contractions
(hypertonic: PROM stiffness)

Question 11

what are the characteristics of gait with spasticity?

Answer 11

crouched gait (hip flexors and IR and knee flexors) or toe walkers

Question 12

what is ataxia?

Answer 12

coordination or timing disorder
-lesion of the cerebellum; instability of movement
can occur with spastic or athetoid CP

Question 13

what are the characteristics of gait with ataxia?

Answer 13

low postural tone with poor balance; WOB

Question 14

what is athetoid movement?

Answer 14

slow writhing (wormlike; involuntary)
fluctuating muscle tone- come hypertonic some hypotonic

Question 15

what is rigidity?

Answer 15

resistance at low speeds; not dependent on movement velocity

Question 16

common MSK problems with CP

Answer 16

tight TP and soleus
insufficient force generation
tone abnormalities
poor selective control of muscle activity
primitive reflexes persistent
increased difficulty with precise movements
presence of random involuntary movement
able to perform voluntary movements but lack coordination

Question 17

interventions and goals for pts with CP

Answer 17

prevention of contractures and scoliosis
maximize gross motor functional level

Question 18

what is the normal increase in ROM following serial casting?

Answer 18

5-7 degrees after one round

Question 19

timing/duration for use of prone and supine standers for CP?

Answer 19

minimum of 5 hours per week

Question 20

what is the pathology of spina bifida?

Answer 20

neural tube defect resulting in vertebral and/or SC malformation
linked to maternal decreased folic acid intake, infection, or excessive alcohol and/or drugs

Question 21

characteristics of Arnold Chiari malformation?

Answer 21

stridor, apnea, difficulty swallowing, ataxia (possibly seizure)

Question 22

S&S of shunt malformation?

Answer 22

irritability, vomiting, decreased muscle tone, seizures, headache, redness along shunt

Question 23

what is myelomeningocele?

Answer 23

contains CSF, SC tissue, and nerve fibers
(most severe)
tissue attachments that limit the movement of the SC within the spinal column

Question 24

what is menigocele?

Answer 24

cyst includes CSF but SC is intact
can lead to tethered cord syndrome

Question 25

S&S of tethered cord syndrome

Answer 25

scoliosis, urinary incontinence, LBP worse with activity and relieved with stress

Question 26

what is spina bifida occulta?

Answer 26

closed lesion; no SC involvement can be a visible sign over the defect, such as atypical skin pigmentation, large dimple, or tuft of hair

Question 27

impairments seen with spina bifida?

Answer 27

-muscle paralysis and imbalance from deformities and contractures -kyphoscoliosis, shortened hip flexors and add, flexed knees, pronated feet -sensory loss -cognitive impairments -latex allergy common (itchy, watery eyes, sneezing, hives, rash)

Question 28

common impairments seen with tethered cord syndrome?

Answer 28

spasticity, increased tone, buttocks pain, increased scoliosis, and weakened leg muscles

Question 29

what is seen with L4-L5 lesion spina bifida?

Answer 29

club foot bowel and bladder dysfunction

Question 30

what is arthrogryposis?

Answer 30

nonprogressive condition -multiple (2 or more) joint contractures and muscle weakness throughout body at birth

Question 31

what is the pathology of autism spectrum disorder?

Answer 31

developmental disorder that appears within first 3 years of like affects brain's normal devlopment of social and communication skills

Question 32

what impairments are seen with autism spectrum disorder?

Answer 32

social communication skills: unable to develop peer relationships, nonverbal and verbal communication difficulties, atypical play skills and social interaction sensory processing issues: hyposensitive or hypersensitive repetitive behaviors dyspraxia decreased coordination, balance impairments, hypotonia

Question 33

what is dyspraxia?

Answer 33

inability to imitate movement; disconnect between idea of movement and motor execution

Question 34

pathology of down syndrome?

Answer 34

extra copy of 21st chromosome - trisomy 21 increased risk with increased age of mother lower brain weight and lighter cerebellum and brain stem than normal

Question 35

common impairments seen with down syndrome

Answer 35

hypotonia, ligament laxity delayed motor milestones deficits in memory and expressive language congenital heart defects impairments in postural control and coordination decreased strength of quads and hip abds

Question 36

S&S of atlantoaxial instability

Answer 36

decreased strength and ORM, hypo reflexive, decreased sensation in extremities, persistent head tilt

Question 37

pathology of Duchenne muscular dystrophy

Answer 37

x-linked recessive inherited disorder affecting males dystrophin gene missing results in increased permeability of sarcolemma and destruction of muscle cells collagen and adipose deposited in muscles leads to pseudohypertrophic claves

Question 38

impairments seen with DMD?

Answer 38

pseudohypertrophic calves gowers sign dilated cardiomyopathy, arrhythmias, CHF decreased respiratory function contractures and deformities

Question 39

early S&S of DMD?

Answer 39

progressive weakness (proximal muscles starting at age 3) delayed walking frequent falls difficulty rising from supine or sitting position

Question 40

what is gowers sign?

Answer 40

due to weakness of quads and glutes

Question 41

interventions for DMD?

Answer 41

maintain mobility as long as possible maintain ROM used prone standers and standing frames sterois do not exercise at maximal levels

Question 42

what is Becker muscular dystrophy?

Answer 42

slower version of DMD WC by 27 years death around 42 years

Question 43

pathology of brachial plexus injury?

Answer 43

traction or compression injury to the unilateral brachial plexus during the birth process or cervical rib abnormality

Question 44

what is erbs palsy?

Answer 44

involvement of C5-C6 nerve roots position: shoulder adducted and IR, elbow extended, forearm pronated, wrist flexed "waiters tip"

Question 45

what is klumpke palsy?

Answer 45

involvement of C8-T1 nerve roots affects intrinsic muscles of hand and wrist; wrist extended fingers flexed "claw hand"