Peds

Question 1

Myelodysplasia Functional Prognosis

Thoracic-L2

Answer 1

• THKAFO/Parapodium
• WC for all functional mobility, standing and walking for physiologic benefits

Question 2

Primary Walking

Answer 2

• 0-2 Months
• Hold infant in supported standing, tilt trunk forward slightly, reciprocal stepping motions in lower extremities.

Question 3

Protective Extension

Answer 3

• Quick displacement of trunk in downward direction while held or while sitting in forward, sideward, or backward direction results in extension of legs downward and extension of arms in sitting position to catch weight.
  
  • Downward begins at 4 months
  • Sideward sitting at 6 months
  • Backward sitting at 9 months
• These reactions persist through life

Question 4

Neonatal neck righting

(Neck righting on body, NOB)

Answer 4

• 0-6 Months
• Turn head with infant in supine position; body log-rolls toward same side.

Question 5

Palamar Grasp

Answer 5

• 0-4 Months
• Pressure stimulus against palm results in grasping of object with slow release.

Question 6

Rooting

Answer 6

• 0-3 Months
• Stroking of perioral region results in head turning to that side with mouth opening.
• Important feeding reflex.

Question 7

Spina Bifida Occulta

Answer 7

• No spinal cord involvement
• May be indicated by tuft of hair, dimple, or sinus

Question 8

Moro Reflex

Answer 8

• 0-4 Months
• Sudden extension of neck results in flexion, abduction of shoulders, extension of elbows, followed by shoulder adduction and elbow flexion.
• Usually results in crying so test last!

Question 9

Symmetrical Tonic Neck Reflex

Answer 9

• 6-8 months
• Extension of cervical joints produces extension of upper extremities and flexion of lower extremities; flexion of cervical joints produces flexion of upper extremities and extension of lower extremities.
• If reflex persists, it may interfere with development of stable quadruped position and creeping.

Question 10

Dislocated Hip

Answer 10

• Asymmetrical gluteal folds, hip click

Question 11

Placing Reactions

Answer 11

• 0-6 Months
• Drag dorsum of foot or back or hand against edge of table, get placing of foot or hand onto table top.

Question 12

Primary Standing Reaction

Answer 12

• Infant held in supported standing position supports some weight and extends lower extremities.
• If this reflex persists, will intefere with walking by causing extension of all joints of the lower extremity and preventing disassociation of flexion and extension.

Question 13

Asymmetrical Tonic Neck Reflex

Answer 13

• 0-5 Months
• Rotation of head results in extension of face side extremities and flexion of skull side extremities.
• Stronger in lower extremities of neonates.
• If reflex persists, may result in scoliosis or hip dislocation and interfere with grasping and hand-mouth activities.

Question 14

Flexor Withdrawal

Answer 14

• 0-2 Months
• Sharp, quick pressure stimulus to sole of foot or palm of hand causes withdrawal of stimulated extremity.

Question 15

Athetoid Cerebral Palsy

Answer 15

• Generalized decreased muscle tone
  
  • Floppy Baby Syndrome
• Poor functional stability especially in proximal joints
• Ataxia/incoordination when child assumes upright position, with decreae BOS and muscle tone flucuations
• Poor visual tracking, speech delay, and oral motor problems
• Tonic reflexes such as asymmetrical tonic reflex, STNR, TLR, may be persistent

Question 16

Talipes Equinovarus

Answer 16

• Clubfoot
• Ankle in plantar flexion
• Forefoot adduction and supination

Question 17

Sucking

Answer 17

• 0-6 Months
• Touch to lips, tongue palate results in automatic sucking.
• Important feeding reflex.

Question 18

Ataxic Cerebral Palsy

Answer 18

• Low postural tone w/ poor balance
• Stance and gait are wide
• Intention tremor of hand
• Uncoordinated movement
• Ataxia follows intial hypotonia
• Poor visual tracking, nystagmus
• Speech articulation problems
• May occur with spastic or athetoid CP

Question 19

Body-Right Reaction Acting on the Head (BOH)

Answer 19

• Begins at 4-6 months and persists through life.
• Contact of body with solid surface results in head righting with respect to gravity, interacts with labyrinthine righting reaction on head to maintain orientation to head in space.

Question 20

Spina Bifida Cystica

Answer 20

• Visible or open lesion
• Meningocele
  
  • Cyst includes cerebrospinal fluid
  • Cord intact
• Myelomeningocele
  
  • Cyst includes CSF and herniated cord tissue

Question 21

Myelodysplasia Functional Prognosis

L1-L3

Answer 21

• Reciprocating Gait Orthosis (RGO)/HKAFO
• WC for most functional mobility
• Short household ambulation possible
• Standing/walking for physiologic benefits

Question 22

Traction or Pull-to-Sit

Answer 22

• 4-5 Months
• Pull Infant to sitting from supine position; upper extremities will flex, and head will lag until 4-5 months.

Question 23

Klumpke’s Paralysis

Answer 23

• C8-T1
• Involves:
  
  • Intrinsic muscles of hand
  • Flexors/Extensors of wrist/fingers

Question 24

Plantar Grasp

Answer 24

• 0-9 Months
• Pressure stimulus to sole or lowering of feet to floor results in curling of toes.
• Must be integrated before walking occurs.

Question 25

Babinski Reflex

Answer 25

* 0-12 months * Stroke lateral aspect of the plantar surface of foot, get extension and fanning of toes

Question 26

Body-Righting Reaction Acting on the Body (BOB)

Answer 26

* Begins at 6-8 months and persists. * Rotation of head or thorax results in rolling over, with rotation between trunk and pelvis.

Question 27

Waiter's Tip Deformity

Answer 27

* Shoulder Adductor/IR * Elbow Extension * Pronation * Wrist Flexion * Common in Erb's Paralysis

Question 28

Crossed Extension

Answer 28

* 0-2 Months * Sharp, quick pressure stimulus to sole of foot results in withdrawal of stimulated lower extremity and extension of opposite leg.

Question 29

Myelodysplasia Functional Prognosis L3-L4

Answer 29

* KAFO * WC for community mobility * Household ambulation possible

Question 30

Myelodysplasia Functional Prognosis L4-S1

Answer 30

* AFO/Ground-Reaction AFO * Household/community ambulation * May be limited

Question 31

Landau's Reaction

Answer 31

* 4-18 months * Infant held in ventral suspension will extend neck, trunk, and hips.

Question 32

Preterm Postural and Movement Profile

Answer 32

* Do not develop physiological flexion * May exhibit hyperextended neck and trunk * Shoulders may be elevated, abducted, extended, w/ scapular retraction * Hips abducted/extended * Pelvic tipped anteriorly * Decreased midline arm movement * May bear weight on toes when in supported/standing position

Question 33

Myelodysplasia Functional Prognosis S1

Answer 33

* Foot Orthosis (FO)/Supramalleolar (SMO) * Community ambulation

Question 34

Total or Whole Arm Paralysis

Answer 34

* C5-T1

Question 35

Erb's Paralysis

Answer 35

* Involves C5-C6 * May involve * Rhomboids * Levator Scapulae * Serratus Anterior * Deltoid * Supraspinatus * Infraspinatus * Biceps * Brachioradialis * Brachialis * Supinator * Long Extensors of wrist, fingers, and thumb

Question 36

Startle

Answer 36

* 0-6 Months * Loud noise, sudden light or cold stimulus causes a sudden jerking of whole body or extension and abduction of upper extremities, followed by adduction of shoulders.

Question 37

Optical and Labyrinthine Righting

Answer 37

* 1 Month-Throughout Life * Head orients to a vertical position when body is tilted. * Test labyrinthine righting with the eyes blindfolded.

Question 38

Spastic Cerebral Plasy

Answer 38

* Increased muscle tone in antigravity muscles * Abnormal postures and movements w/ mass patterns of flexion/extension * Imbalance of tone acorss joints may cause contractures/deformities, especially hip flexors, adductors, IR, knee flexors, ankle plantarflexors, scapular retractors, glenohumeral extensors, and adductors, elbow flexors, forearm pronators * Visual, auditory, cofnitive, and oral motor deficis may be present * Crouched Gait * Hip Flexion, IR, and knee flexion, may toe walk

Question 39

Galant or Trunk Incurvation Reaction

Answer 39

* 0-2 Months * Sharp stoke along paravertebral line from scapula to top of iliac crest results in lateral trunk flexion toward stimulated side.

Question 40

Tilting Reactions

Answer 40

* Slow shifting of base of support or slow displacement of body in space will result in lateral flexion of spine toward elevated side of support, abduction of extremities on elevated side, and sometimes trunk rotation toward elevated side. * Prine begins at 5 months * Supine begins at 7 months * Sitting at 8 months * Quadruped at 12 months * These reactions persist throughout life.