Exam 3

-Trial a stander -While a stander may have other benefits, it does not facilitate walking. -Place a small stool between Carlos and the coffee table so that he can transition to sitting on the stool before doing a sit to stand from short sitting -Compensations are OK in this population, and often provide increased independence. The option with the stool will provide a way for Carlos to bridge the gap between the floor and standing without the need of additional hands.

2) All of the following are strategies to consider to address walking with Carlos except: -Trial a rolling push-toy -Trial a stander -Trial a gait trainer -Trial a posterior rolling walker 3) In your session, you're working on pull to stand at the coffee table. Which of the following strategies would facilitate independence with the transition? -Work on sit to stands from your lap with UE support on the coffee table -Place a small stool between Carlos and the coffee table so that he can transition to sitting on the stool before doing a sit to stand from short sitting -Place a pillow between Carlos and the coffee table for him to kneel on before rising to stand -Focus on working in half-kneel and facilitating the transition to stand by lifting him under his bottom

-Type I C. Increased Tone -False

Osteogenesis Imperfecta: --Quick Questions: -What type of OI is the most common? -Children with OI will present with all of the following impairments except: A. Joint Laxity B. Muscle Weakness C. Increased Tone D. Impaired Posture -T/F: A formal strength assessment using MMT should begin at age 5 for a child with OI.

-fractures -density -mobility -skills

Osteogenesis Imperfecta: --Take-Home Points: -Positioning, handling and prevention of ____________ are important. -Active play and exercise can improve bone ___________ -Safe ___________ -Developmental and functional _________

-Position Carlos over a boppy or blanket roll -Due to the elbows being in an extended position, elevating Carlos on the boppy is the best position to have success in prone.

(Q's 1-3) Carlos is an 18-month-old with Arthrogryposis Multiplex Congenita (AMC) and presents with bilateral hip abduction, ER, equinovarus, knee flexion, shoulder IR, and elbow extension. He has night splints for his wrists and feet. Carlos can now sit by himself and scoots on his bottom for mobility. When held under his axilla, Carlos is able to take a few steps and is starting to push furniture across the room. His parents have noticed that he is trying to pull to stand, but is not able to do it on his own. 1) When Carlos was younger, what strategy would be recommended for improving prone tolerance with his joint alignment in mind? -Position Carlos over a boppy or blanket roll -Provide very brief bouts of tummy time -Position Carlos on the floor without a boppy or blanket roll -Provide a mirror and toys to increase engagement

-Oligoarticular JIA -Inflammation of 4 joints describes Oligoarticular JIA.

(Q's 4-6) Jessa is a 4-year-old who has been complaining of bilateral knee pain for the last few weeks. Her mother is concerned and brought her to the pediatrician who has ordered some tests. In the meantime, the MD referred Jessa to PT, and she is on your eval schedule today. Upon exam, her knees are swollen and painful, but not red. She also complains of bilateral wrist pain. She required assist to get up from the floor and max encouragement to participate in the session. Prior to the onset of pain, she was developing typically. 4) What is Jessa's likely diagnosis? -Septic Arthritis -Oligoarticular JIA -Polyarticular JIA -Transient Synovitis

-people // contact -sharing -babbling // gestures // response -words -two

Autism Spectrum Disorder: --Signs (Babies and Toddlers): -By 6 months: No social smiles or warm, joyful expressions directed at __________ // Limited or no eye __________ -By 9 months: No __________ of vocal sounds, smiles, nonverbals -By 12 months: No ___________ // No use of __________ to communicate // No __________ to name when called -By 16 months: No ________ -By 24 months: No meaningful, ______-word phrases

-Zippie Lightweight Manual Wheelchair -Ben has good UE use and trunk control, and would be most mobility in a lightweight manual chair. -Supine Stander -The supine stander is best for those with decreased head control, but still provides the benefits of standing.

Ben is a 10-year-old with spina bifida, level L2/L3. He is ready for the transition to seated mobility, and wants something easy to manage at school. His UEs are strong, and he has good trunk control. Which piece of equipment will be best to meet Ben's needs for school? -Power Wheelchair -Zippie Lightweight Manual Wheelchair -Tilt in Space Wheelchair -Rifton Pacer Gait Trainer Shay is a 2-year-old with spastic quadriplegic cerebral palsy, GMFCS level V. She has limited head control, and requires total assistance for all transfers and mobility. The family is interested in a piece of equipment to work on standing and upright tolerance. Which piece of equipment is best for Shay? -Supine Stander -Pacer Gait Trainer -Prone Stander -Mobile Stander

-Waiter's -Shoulder // extension // pronation // flexion -Affected Muscles -grasp -sensation -extension

Brachial Plexus Injury: --C5-C6 Presentation (Erb's Palsy): -___________ tip deformity -UE Resting Position: ___________ extension, IR, and adduction // Elbow ____________ // Forearm ____________ // Wrist and finger __________ -What are: Rhomboids, levator scapulae, serratus anterior, rotator cuff, deltoid, biceps, brachialis, brachioradialis, supinator, long extensors of forearm -Intact ________ -____________ may be impaired or absent -Elbow and finger ____________ is compromised if C7 is involved

-Inherited -11 -I, III, IV, V, VI, XI

Osteogenesis Imperfecta: -__________ disorder of connective tissue (Type I Collagen) leading to fragile bones -How many types? -Which ones should we know?

-blood -Treatment -common -90 // 60-70 -chemo // participate // maintaining -Inpatient // Early

Pediatric Oncology: --Leukemias: -Cancer of the _________ (Acute lymphoblastic (75%) // Acute Myeloid (20%) // Juvenile Myelomonocytic // Acute Promyelocytic // Chronic Lymphoblastic // Chronic Myeloid) -__________ includes chemo, radiation, Car-T, and Stem cell transplants -Most __________ type of pediatric cancer -Survival of Acute Lymphoblastic in first remission? Survival of Acute Myeloid? -PT Management: Coordinate with ________/radiation schedule if possible // Often need max encouragement to ___________ // Focus on _____________ strength, endurance, functional mobility/play -Discharge: _________ Rehab if severely conditioned // Most or all will benefit from outpatient PT or _________ Intervention // Onco follow-up clinic

-ROM -flexion -abduction -side -supination -extension

Brachial Plexus Injury: --PT Intervention (After 10 days): -Gentle _______ -Shoulder __________, scapula stabilized -Shoulder ___________, scapula stabilized -ER and IR with elbow at ________ -Elbow flexion with forearm ___________ -Wrist and finger ____________

-First B. Introduce a stool or other elevated object to make the task easier

Arthrogryposis: --Quick Questions: -AMC occurs in the _________ trimester. -Ana is learning to climb onto the couch. Which of the following describes the PT's focus in working toward this functional activity? A. Focus on performing the task independently with use of volitional strength and movement B. Introduce a stool or other elevated object to make the task easier C. Teach the child to ask a parent to help them onto the couch when they want to climb up.

-joints -muscles -fractures -bowing -blue -teeth -Bruising -sweating

Osteogenesis Imperfecta: --Signs and Symptoms: -Lax _________ -Weak __________ -Osteoporosis, Recurrent ___________ -__________ of Long Bones, Scoliosis -________ Sclerae -Graying of _________ (Dentinogenesis Imperfecta) -Deafness -Hernias -Easy ____________ -Excessive ____________

-non-progressive -contractures // weakness // fibrosis // bilateral // lesser -Amyoplasia

Arthrogryposis: -Congenital, _____-__________ neuromuscular syndrome -Characterized by 2+ joint __________, muscle ___________, and _________ // Most severe contractures are at the ankle, knee and hip and are __________ // Also affects the UE but to a _________ degree -Most common is ____________ (Other types include neuromuscular syndrome, congenital anomalies, chromosomal abnormalities, contracture syndromes and distal arthrogryposis.)

-Early -Family -Individualized -Environments -Functional

Autism Spectrum Disorder: --Effective Interventions: -_________ Intervention -__________ Involvement -____________ Programming -Systematic Intervention // Structured/Predictable ____________ -____________ Approach to Behavior

-deficits -function -real -Family -interests -emotional

Autism Spectrum Disorder: --Interventions (Motor Specific): -Exercise and PA: Can improve behavior, motor, social _________ -Sensory Integration: Sensory-based symptoms that impact __________ can be addressed (Weighted vests, Brushing and exposure to stimulus, Fidget toys, Therapeutic Listening) --DIR/Floortime: -Learning occurs in _______-life situations (Better for higher functioning) -__________ involvement is key -Based on the child's __________ -Improvements in __________ functioning (Reciprocal communication, Behavioral Organization, Relationship forming)

-Hypotonia -milestones -balance -awareness -social -Sensory

Autism Spectrum Disorder: --Interventions: -Address ____________ -Promote developmental ___________/gross motor skills -__________, coordination, stability -Body ___________ activities (Pushing and pulling games) -Practice _________ interactions -__________ Integration

-Girth measurements -Taking girth measurements is an important component of the exam in JIA. -Gait Deviations -Gait deviations are a secondary impairment related to the other options listed.

5) What component of your exam would allow you to track inflammation in the joint over time? -Girth measurements -ROM -Strength -Palpation 6) All of the following are primary impairments of body, structure, and function found during Jessa's exam except: -Decreased Endurance -Gait Deviations -Decreased ROM -Decreased Strength

-recovery -3-8 (could be 12 if only upper nerve root involvement) -improvements -better -Active -conservative

Brachial Plexus Injury: --Neurosurgery: -Reserved for the 5-10% that don't exhibit significant spontaneous ___________ -Typically done between ___-___ months of age (some authors report 75-95% have improvement) -Children with C5-T1 lesions are reported to have no significant _____________ post-op -Children with C5-C6 lesions have slightly __________ shoulder function post-op -Nerve resection plus grafting may yield better outcomes than neurolysis only on the ___________ Movement Scale -There is no conclusive evidence to support benefits of surgery over ___________ PT only

-Recommend a HEP for kids over 5 only -All of these are recommendations from the CPG except an HEP for kids over 5 only. The recommendation is for all kids with DCD to have an HEP, regardless of age.

All of the following are recommendations for working with children with DCD except: -Recommend a HEP for kids over 5 only -Recommend that they attend PT and/or other activities 2-5 times per week -Recommend Supplemental Activities such as Soccer or Taekwondo -Focus on Task-Oriented Activities

-Stretching // Strengthening -Early -play -3-5 // 3-5 // 60 -Splinting -Mobs -parents

Arthrogryposis: --PT Intervention (General): -Family education that it is non-progressive, but daily ___________, positioning and ___________ can prevent impairments. -_________ intervention program -AROM/PROM // Muscle strengthening through ________ --PT Interventions (Stretching Program): -___-___ times daily, ___-___ reps per set // Each rep held for at least ____ seconds for each joint involved -___________ may maximize stretching -Gentle Joint ________ -Teach __________ stretching HEP

-range // hips // knee -Problem -Mobility -stretching -Splinting -Compensations

Arthrogryposis: --PT Intervention (Mobility): -Functional muscle strength within available __________ // If 3/5 in hip extensors, then brace above _______ // if 3/5 in knee extension, then brace above ________ -___________ solving (self care) -Independent ___________ (walker, wheelchair) -Continue ___________ program -____________ as appropriate -Endurance -_____________ as needed for function ***More interventions in pic

-unclear -first -movement // contracture // anterior // fibrosis -muscle -Imbalance

Arthrogryposis: --Pathophysiology: -Etiology _________ but maternal risk factors include fever during first trimester, viral infection, fetal/maternal vascular compromise -Occurs during the _______ trimester -Lack of fetal _____________ // Motor weakness immobilizes the fetal joints leading to _____________ // Possible degeneration of the ___________ horn cells // Periarticular soft tissue ___________ -If the __________ does not function, the joints lack movement causing stiffness and deformity in the fetus. -____________ of muscle strength also causing contracture

-Prone -scooting // Quadruped -neutral -standing -Prone // scooting -15 -Stand -Ambulation

Arthrogryposis: --Positioning/Handling (Frog-Like): -________ difficult because of extended elbows (use Boppy) -Bottom __________ okay // ____________ may be okay -Keep hips in __________ rotation -Hip and knee extension and neutral hip extension needed for __________. May need surgery --Positioning/Handling (Jack-Knife): -Encourage ________ to extend hips // Bottom ___________ okay -Obtain independent sitting around ____ months -________ when placed, difficulty with transition to stand -____________ 2nd year (May be delayed or not functional due to dislocated hips)

-ER -Flexion -Equinovarus -IR -Extension -flexion // ulnar

Arthrogryposis: --Presentation (Frog-Like): -Hips _____ and abduction -Knee __________ -__________ (clubfoot) -Shoulder _____ -Elbow ____________ -Wrist _________ and ________ deviation

-dislocation -extension -Equinovarus -IR -flexion -flexion // ulnar -extension

Arthrogryposis: --Presentation (Jack-Knifed): -Hip flexion and _____________ -Knee ____________ -_____________ (clubfoot) -Shoulder _____ -Elbow __________ -Wrist ___________ and _________ deviation •Cervical ____________

-neuromuscular -Improvements in motor and social deficits -cardiorespiratory // attention // behavior -delays // reward // alternative -modest // parents

Autism Spectrum Disorder: --Interventions: -Combination of aerobic, resistance and ____________ training led to 37% improvement in overall symptoms -What are the benefits of physical activity? -High-Intensity: Improvement in ______________ fitness // Improvements in positive behaviors and ___________ to task // Parent-reported improvements in ___________ -Applied Behavior Analysis: •Great for children with significant __________ over the age of 3 // __________ system; distraction from negative behaviors // Provide an ____________ behavior // ABC (antecedent - behavior - consequence) -TEACCH: Treatment and Education of Autistic and Communication Children's Handicaps // __________ empirical evidence // Relies on _________ in the home environment as the Teacher and Co-Therapist // Uses picture schedule

-54 -boys -school -nonverbal // intellectual -4

Autism Spectrum Disorder: --Overview: -CDC estimates prevalence as 1 in _____ children in the United States. •4x more common in _______ -An estimated 70,000 to 111,000 teens with autism become adults, and lose _________-based autism services each year •Around one third of people with autism remain ___________. // Around one third of people with autism have an ____________ disability. -Average age of diagnosis is ____ years; as early as 2 years of age

-age -integration -social

Autism Spectrum Disorder: --PT Goals: -Achievement of ______-appropriate gross and fine motor skills // Improved strength, coordination, balance -Desensitization/Sensory ___________ -Improved _________ Interactions

-milestones -motor -gait // planning -patterns // fine -tone -multi

Autism Spectrum Disorder: --Presentation: -Delayed ___________ in infants -Delay or lack of ________ imitation -Deficits in _______ and postural control // Deficits in motor __________ -Immature movement ___________ // Poor _______ motor skills -Low muscle ________ -Unable to perform _______-step tasks // Dyspraxia

C. Calmly redirect focus to a different activity -False -Building Strong Relationships

Autism Spectrum Disorder: --Quick Questions: Brandon is a 7yo boy working with you in your outpatient clinic. During your session, he has a behavioral outburst in which he throws the items from your obstacle course, and then bangs his head on the floor repetitively. The gym is empty, and no one was nearby to be hit by any of the equipment. What is your next move? A. Reprimand him for his behavior B. Gently restrain him to stop the behavior C. Calmly redirect focus to a different activity D. Ignore his behavior E. Ask his Mom for help -T/F:High-Intensity Exercise is good for children with ASD, but has no effect on ASD-specific behaviors. -What is the key to working with children with ASD?

-False -False -True b. Impaired planning and sequencing of movement

Autism Spectrum Disorder: --SC Questions: -T/F: ASD is caused by a neurological insult. -T/F: The M-CHAT is a tool to diagnose ASD. -T/F: High-intensity exercise can improve attention in kids with ASD. -What is dyspraxia? a. Impaired coordination b. Impaired planning and sequencing of movement c. Impared handwriting skills d. Impaired fine motor skills)

-loss -contact // alone -feelings -delayed -Repeats -changes -interests -repetitive -reactions

Autism Spectrum Disorder: --Signs (Any Age): -Any _______ of any previously acquired speech, babbling or social skills -Avoids eye __________ and prefers to be _________ -Struggles with understanding other people's ___________ -Remains nonverbal or has __________ language development -__________ words or phrases over and over (echolalia) -Gets upset by minor __________ in routine or surroundings -Has highly restricted ___________ -Performs ___________ behaviors such as flapping, rocking or spinning -Has intense __________ to sounds, smells, tastes, textures, lights and/or colors

-Prone Stander -A prone stander is not a mobility device, and will not allow him to explore his environment. The best choice is likely a gait trainer that will assist with LE positioning. -Adaptive Stroller -The Adaptive stroller is the most portable option that does not require manual effort from Jenny.

Billy is a 4-year-old with spastic diplegic cerebral palsy, GMFCS level III. He has significant scissoring of his LEs in standing. The family is interested in a piece of equipment that will help him explore his environment in a standing position. All of the following options could address the family's goals and Billy's current presentation except: -Gait Trainer -Reverse Rolling Walker -Prone Stander -Mobile Stander Jenny is a 3-year-old with SMA type II. The family is interested in a seating system allowing them to go on long family outings like the zoo and Disney Land. They are looking for something portable that Jenny does not have to self-propel. What is the best option that will meet the family's and Jenny's needs? -Manual Wheelchair -Activity Chair -Adaptive Stroller -Power Wheelchair

-Combined // total -varies -Rare // sweating // pupillary // colors

Brachial Plexus Injury: --C5-T1 Presentation (Global/Erb-Klumpke): -____________ injury to upper and lower roots resulting in _________ arm paralysis and loss of sensation -Pattern of motor loss _________ --T1 Presentation (Horner's Syndrome): -________ and results in deficient ___________, recession of the eyeball, abnormal ____________ contraction, myosis, ptosis, and different iris __________

-supination // flexed // extended -Paralysis -grasp -unimpaired

Brachial Plexus Injury: --C8-T1 Presentation (Klumpke Palsy): -UE Resting Position: Forearm in ____________ // IP joints ___________ // MCP joints ____________ -___________ of wrist flexors, extensors and hand intrinsics. -Impaired ________ -Shoulder and elbow are ____________

-movement -extent -avulsion -diaphragm

Brachial Plexus Injury: --Diagnosis: -UE Position and/or lack of active UE ____________ at birth -EMG to determine __________ of involvement (May be used as pre-op base line) -MRI/CT to detect ___________ of roots -US to determine if the ___________ involved (C4 Phrenic Nerve >> Ipsilateral hemiparesis)

-mouth -transferring -shifting -Quadruped -Sitting -Reaching -heavier -two -uninvolved

Brachial Plexus Injury: --PT Intervention (Older Babies/Children): -Active hand to _________ -____________ objects -Weight ___________ on propped UE in prone -__________ if old enough -_________ with hands in front if old enough -__________ for toys -Hold "________" toys to help strengthen -______ handed activities -Sidelying on ___________ side to avoid stress on involved arm and free up weak arm

-Rest -decrease -immobilization -parents -uninvolved -Educate

Brachial Plexus Injury: --PT Intervention (Up to 10 Days): -________ for 7-10 days after birth -Allow hemorrhage and edema to ___________ -Partial ____________ (arm placed gently across chest, include in swaddle) -Show __________ how to dress and bathe -Demo ROM on _____________ UE -___________ about possible sensory loss and contracture

-False -B. Klumpke's Palsy // C. Global Palsy -C. Mallet Classification -C. Quadruped Play

Brachial Plexus Injury: --Quick Questions: -T/F: Diagnosis of BPI requires imaging. -Which presentation(s) will have impaired grip? A. Erb's Palsy B. Klumpke's Palsy C. Global Palsy D. Horner's Syndrome -You are observing Annabelle on the playground, and note significant difficulties reaching and climbing for the equipment. If you suspect a brachial plexus injury, what will you use to score her movement? A. Active Movement Scale B. MMT C. Mallet Classification D. Observational ROM Assessment -Which of the following is the best choice for an intervention with a 2yo who had a perinatal BPI? A. PROM B. Stretching C. Quadruped Play D. Massage E. E-Stim

-10 -active -progress

Brachial Plexus Injury: --Take-Home Points: -Teach stretching/ROM exercises that will start ____ days after birth -In older babies, encourage _________ use of the involved UE, and weight bearing -Monitor __________ with an objective measure of active movement

-infants // changes // 1 -3 // Reliable // mimic

Brachial Plexus Injury: -Active Movement Scale: Specifically for _________ with BPI // Captures subtle _________ // Good interrater reliability and validity to measure motor function of the UE in infants < ___ year -Mallet Classification: For children older than ____ // __________ in this population // Child has to be able to ________ movements

-UE -breech // lateral -unilateral -1 // 66-90

Brachial Plexus Injury: -Paralysis or weakness of _____ following mechanical trauma to spinal roots C5-T1 -Shoulder Dystocia: Traction to shoulder during delivery of head in ________ OR __________ traction of head and neck in vertex presentation -Usually ___________ but can be bilateral -Recovery: ___ mm of axon regrowth/day (4-6 months in Upper arm, 7-9 months in lower arm) // ____-____% recovery rate without surgery

-ADHD -Difficulty Climbing // Slow Gait -False

Developmental Coordination Disorder (DCD): --SC Questions: 1. All of the following are risk factors for DCD except: -ADHD -VLBW -Walking at 17 months -Born at 28 weeks gestational age 2. Which of these are potential activity limitations in a child with DCD? -Avoiding play with peers -Difficulty climbing -Sensory processing deficits -Slow gait 3. T/F: Working on accuracy during a target task like tennis is recommended

-Consult -Activity -return

Developmental Coordination Disorder (DCD): --CPG (Discharge): -__________ with primary physician, parents, specialists -Provide __________ recommendations -Provide families with guidelines on when to _________ to PT

-Refer -Goal // Perceived -quality -limitation -Motor -impairments // structures

Developmental Coordination Disorder (DCD): --CPG (Exam and Referral): -_________ if DCD suspected or other red flags present -Participation Outcomes: ________ Attainment Scale // ___________ Efficacy and Goal Setting Program (PEGS) -For Observational Movement Analysis Focus on movement __________ -Activity ___________ Questionnaires -Examine _________ Performance (Movement Assessment Battery for Children (MABC) // Bruininks-Oseretsky Test of Motor Proficiency (BOT)) -Examine _____________ of Body functions and ____________

-Task -Small -2-5 // 9

Developmental Coordination Disorder (DCD): --CPG (PT Interventions): -_______-Oriented (Motor Skill Training // Core Stability // Endurance // Motor Imagery) -_________ Group or Individual Sessions (Recreational activities such as soccer, taekwondo) -HEP -Dosage: High-frequency practice: ____-____x/week distributed between PT sessions and recreation // ____-week bouts of PT

-gait -motor -handwriting -Delayed -work -Slow -strong -both

Developmental Coordination Disorder (DCD): --Presentation (Activity Limitations): -Awkward, slow _______ -Delayed/poor quality of fine and gross _________ skills -Poor ____________ -__________ oral-motor skills -Difficulty completing ________ on time​ -________ with most activities​ -Intellectual and language skills may be _________​ -Difficulty with activities that require coordination of ________ sides of the body, or upper/lower extremities

-Primary: Sensory // Motor // Control // Learning -Secondary: Physical // Social -Environmental Factors -Personal Factors

Developmental Coordination Disorder (DCD): --Presentation (Impairments): -Primary: _________/perceptual deficits // _________ deficits (balance, posture, hypotonia) // Motor __________ deficits (activation, sequencing) // Motor __________ deficits (limited repertoire, translation of skills) -Secondary: __________ (slow, awkward movements) // _________/Emotional/Behavioral (off-task, avoidance of new tasks) --Factors: -What are: Reduced participation in PE, sports​ // Poor written communication​ // Other language, social, academic impact -What are: Depression​ // Decreased self-esteem and self-confidence​ // Lack of motivation​ // Difficulties coping with change, resistant to changes in routine // Avoids socializing with peers (especially on the playground)​ // Associates with younger children // Frustration with seemingly easy tasks​ // May seem dissatisfied with their performance

-development -interest -Avoid -speed -rules -isolation -confidence -social

Developmental Coordination Disorder (DCD): --Presentation (Participation Restrictions): -Decreased opportunities for physical, social, cognitive _____________ -Decreased __________ in physical activity -_________ motor and sports activities -Decreased _________ moving through school, on playground -Difficulty understanding ________ of a game -Social ___________ due to poor performance -Decreased ____________ -Impaired understanding of _________ situations

-outgrow -anxiety // satisfaction // compromised

Developmental Coordination Disorder (DCD): --Progression: -Children do not "_________" DCD -Adults have been shown to have Increased levels of of depressive symptoms and __________ // Decreased quality of life and life __________ // Motor skills and executive function continue to be ___________ in adulthood

-spacing -sizes -long -gripping -math -imitate -bumps -falls -cutting -spatial -basic

Developmental Coordination Disorder (DCD): --Signs (Grades 3-7): -Writes with poor ___________ between letters and words -Writes letters in different _________ -Takes a _______ time to write -Has trouble ___________ a pencil and forming letters -Struggles to line up columns when doing _________ problems -Finds it hard to ___________ movements in gym class or extracurricular sports -Frequently __________ into people -Often trips and ________ -Has difficulty ___________ foods -Has trouble with visual-_________ tasks, like moving game pieces on a board -Struggles with _________ routines, like packing a backpack or getting dressed

-puzzles -writing -scissors -bumps -Moves -buttons -drops -jumping -dominance -copying -letters -bike -self-care

Developmental Coordination Disorder (DCD): --Signs (Grades K-2): -Struggles with __________ and building blocks -Has trouble holding a pencil for __________ or drawing -Fumbles with ___________ and struggles to cut out shapes -Often _________ into people and things -__________ awkwardly and slowly, and may trip and fall a lot -Struggles with __________ and zippers -Often ________ things -Has trouble __________, hopping, and skipping -Hasn't developed left- or right-hand ____________ (using one hand for most activities) -Has a hard time ____________ notes from a board or other paper -Doesn't correctly form ___________ or space them on the lines -Is slow to learn how to ride a _______ without training wheels, or doesn't learn at all -Has trouble with ______-_______ routines like getting dressed and brushing teeth

-utensils -hold -pedal -throwing -ball -roughly -motions -still

Developmental Coordination Disorder (DCD): --Signs (Preschool): -Has trouble holding and using __________ -Has a hard time figuring out how to _______ a bowl and scoop out the food -Has trouble learning to ________ or steer a tricycle or bike with training wheels -Has trouble ___________ a ball -Is afraid to play _______ games, like tossing a soft or squishy ball back and forth -Plays too __________ or often bumps into or pushes other kids by accident -Has trouble making hand ___________ and actions that go along with songs like "The Wheels on the Bus" and "Head, Shoulders, Knees, and Toes" -Has trouble sitting upright or ________

-spatial -hand-eye -falls -bumps -open -typing -simple -drive -sports

Developmental Coordination Disorder (DCD): --Signs (Teens and Tweens): -Struggles with the visual-_________ aspects of math, like geometry -Has trouble with sports that involve _______-______ coordination, like softball or table tennis -Trips and ________ more often than other teens -Often ________ into people and things -Struggles to ________ the latch on a locker or use a combination lock -Avoids or struggles with texting and __________ -Struggles to prepare _________ foods, like a sandwich -Has trouble learning to _________ (maneuvering a steering wheel or judging distances, like how close another car is when changing lanes) -Shies away from activities like _________ or dancing

-smaller -performance -environment -coordination -individual -distractions -skill -positioned

Developmental Coordination Disorder (DCD): --Take-Home Points: -Modify task if necessary // Break down motor activities into __________ parts (part to whole) -Knowledge of ____________ may work better than Knowledge of Results // Give lots of positive feedback​ -Provide a predictable _____________​ -Include activities that require ___________ of arms/legs -May have more success with ___________ sports (swimming, biking, cross country, skiing) rather than team sports​ -If interested in team sports, then review rules and routine separately without other ____________​ -Target tasks can be frustrating // If interested in target tasks, then focus on the _______ (throwing, kicking) rather than accuracy -In the classroom - ensure that the child is ___________ well in chair/table. Feet flat on floor and desk at appropriate height.​

-movement // academic // play -Risk Factors -Co-Occurring Conditions

Developmental Coordination Disorder (DCD): -Overview: -Marked impairment in the learning and execution of __________ skills given the person's chronological age and opportunity for skill acquisition and use, that significantly and persistently interferes with activities of daily living and impacts on __________/school productivity, pre-vocational and vocational activities, leisure and _________ -What are: Very low birth weight (<1500 g) // Very preterm (< 32 weeks) // Male // Independent walking at 15 months or later // Postnatal exposure to steroids -What are: ADHD // ASD // Dyslexia // Language Disorders // Sensory Processing difficulties // Anxiety & Depression // Obesity/Overweight // Joint Hypermobility // Decreased Fitness Level

-history // limitations // length // changes -goals // support // improvement // Setting // interaction -previously // trials // justification -components

Equipment: --Letter of Medical Necessity Components: -Diagnosis/physical condition: Developmental _________ // Functional ____________ // Impairments: PROM, tone, strength, posture, etc. // Prognosis // Expected ________ of use // Potential height or weight _________ -Purpose of equipment: Therapeutic and functional _________ // How does equipment __________ goals? // Expected _____________ in self-reliance, independence, etc. // ___________ equipment will be used in // How will equipment affect ___________ in these environments? -Selection Process: ____________ purchased equipment // Previous _______ with equipment // ___________ for equipment -Comprehensive list of accessories: Justification for all _______________

-need // justify -vendor -physician

Equipment: --Letter of Medical Necessity: -Letter written by physical therapist to verify a medical ________ for equipment // Required by most insurance companies to _________ purchase (CANNOT be justified simply due to 'convenience') -Discuss with __________ beforehand (Some insurances require prior authorization before moving forwards with process) -May be written or signed by ____________ (Some sign it as their 'prescription')

1. recommendations 2. prescription 3. Letter 4. vendor 5. simultaneously

Equipment: --Obtaining New Equipment: 1. In clinic, discuss _____________ for equipment (Trial equipment if available // Include entire team) 2. Acquire physician ____________ 3. Write _________ of Medical Necessity (LMN) 4. Send both LMN and prescription to __________ (Vendor will contact insurance for authorization) 5. May meet with vendor and patient _______________ for appropriate fitting, to discuss recommendations, etc.

-All are appropriate interventions -In kiddos with DCD, we want to break down the activity and encourage reciprocal movements and those that involve both the upper and lower extremities. -Proprioceptive -Jimmy's tackling hugs are a way to increase his proprioception or sense of his body in space. He is seeking increased input to "fill his cup".

Jon is a 5-year-old with Developmental Coordination Disorder. All of the following would be effective intervention strategies except: -All are appropriate interventions -Work on trapping a soccer ball before dribbling it to the goal -Work on bounce passes, dribbling, and then shooting a basketball -Work on climbing the ladder to the slide with reciprocal UE and LE movements Jimmy is a hugger! He loves to hug everyone at school, but sometimes his hugs are so strong that he knocks others over. Which sensory system is most likely impaired based on Jimmy's hugs? -Proprioceptive -Visual -Vestibular -Tactile

-5 -27-56 -girls -inflammation -painful -blindness

Juvenile Idiopathic Arthritis (JIA): --Oligoarticular JIA: -Inflammation in fewer than ____ joints -____-____% of children with JIA (majority) -Mostly ________ between 2 and 4 years of age -Low-grade ____________ (In Knee, Ankles, or Elbows) -Swollen and warm, may NOT be ___________ -Iridocyclitis may lead to ____________ (30% of children develop // Frequent exams by an Ophthalmologist)

-ROM -inflammation -heat -warm -Land -Gait -Strengthening -Balance -Splinting

Juvenile Idiopathic Arthritis (JIA): --PT Management (Acute): -Maintain Joint ______ and functional mobility -PRICE to decrease _____________ and swelling -Avoid _______ (Increases intra-articular inflammation) --PT Management (Subacute): -Aquatics (_______ water) (Decrease load on joints) -Daily _______-based Exercise (Encourages WB) -_______ Training -___________/Weight Bearing -Flexibility, _________/Coordination/Agility -__________ and Orthotics as needed

-understood -Environmental -Inflammatory -Cell -cycle

Juvenile Idiopathic Arthritis (JIA): --Pathophysiology: -Poorly ______________ -Genetic & ______________ components -Autoimmune _____________ disorder activated by external trigger in a genetically pre-disposed host -_______-Mediated Pathogenesis (Altered immunity // Abnormal immunoregulation // Cytokine production // Inflamed synovium) -Disease progresses in a ________ causing more problems (see pic)

-more // Rheumatoid -2-4 // 6-12 // late -girls -progressive -red -nodules

Juvenile Idiopathic Arthritis (JIA): --Polyarticular JIA: -Inflammation in 5 or _______ joints (large, small, cervical, TMJ) // AKA Juvenile _____________ arthritis -Positive Rheumatoid factor has early peak at ___-___ yrs, and a later peak at ___-___ yrs // Negative if onset is ______ in childhood or adolescence -2 - 28% of children with JIA, mostly _________ -Insidious onset with ____________ joint involvement -Joints are swollen and warm but rarely ______ -May develop rheumatoid __________ on elbows, tibial crest

-Joint // morning -atrophy // endurance -Iridocyclitis -Mobility // contractures -aerobic -Growth // osteoporosis -ADLs // Gait

Juvenile Idiopathic Arthritis (JIA): --Primary Signs and Symptoms: -________ swelling, pain, stiffness, especially in the ___________ -Muscle _________, weakness, and decreased ___________ -This is inflammation of the iris and ciliary body // Most common in Oligoarticular JIA --Secondary Signs and Symptoms: -Limited joint __________ // Soft tissue ____________ -Fatigue, Decreased __________ capacity/exercise tolerance -_________ abnormalities // Osteopenia, _____________ -Difficulty with ________ // ________ Deviations

-False B. Polyarticular -False

Juvenile Idiopathic Arthritis (JIA): --Quick Questions: -T/F: JIA can easily be diagnosed based on bloodwork. -Mia has inflammation in her knees, ankles, and right elbow. Which type of JIA is most likely? A. Oligoarticular B. Polyarticular C. Systemic D. Rheumatoid -T/F: Heat should be avoided in the subacute phase for a child with JIA.

-fever -age // equal -102.2 -Rash -Systemic

Juvenile Idiopathic Arthritis (JIA): --Systemic JIA: -Characteristic arthritis that develops with ________ // 4 - 17% of children with JIA -No specific _____ onset, _________ incidence -Fever of ______ once or twice daily with rapid return to normal between spikes -________ on trunk or limbs (can also be on face, palms, soles of feet) •Pleuritis, pericarditis, myocarditis, hepatosplenomegaly, lymphadenopathy -__________ disease may precede arthritis by several months or years

-inflammatory -Unknown -common -16th -number // type

Juvenile Idiopathic Arthritis (JIA): -Group of autoimmune ____________ diseases -_________ etiology; Diagnosis of Exclusion -Most ___________ rheumatic disease in children and adolescents -Begins before the _____th birthday and lasts for at least 6 weeks -Severity and duration of symptoms depends on __________ and _______ of affected joints, pain, functional limitations, and joint deformity

-"You scored a goal 4 out of 10 times" -It's best to provide knowledge of performance rather than knowledge of results. The option about how many goals were scored is an example of knowledge of results, and would not really be helpful to a child with DCD who is learning to put together the components of playing soccer. -Recommend that he play an individual sport, such as golf, instead -If a kiddo wants to play a team sport, it would not be patient-centered to recommend something else. Instead, focusing on breaking down the skills required, as well as reviewing the rules, are important ways to help David reach his goal of playing flag football.

Lila is a 7yo girl with DCD. One of her PT goals is to be able to play soccer in a recreational league with her neighbors. You are working on soccer skills during your session today. All of the following are examples of appropriate feedback for a child with DCD except: -"You scored a goal 4 out of 10 times" -"Be sure to look at the goal and then at the ball before kicking" -"Slow down your run a bit so that you can make contact with the ball" -"Bring your leg back a bit more before kicking the ball" David is an 8yo boy interested in playing flag football with his friends. He has DCD, and you are working on helping him reach his participation goal of playing flag football. All of the following are appropriate components of your intervention except: -Recommend that he play an individual sport, such as golf, instead -Work on running agility skills -Review the rules of flag football -Focus on throwing mechanics rather than accuracy

-curvature // puberty -unknown -ROM // Cardiopulmonary -bend // Cobb -Bracing // Fusion

Orthopedic Conditions: --Adolescent Idiopathic Scoliosis: -Presentation: Trunk, shoulder, and/or pelvic asymmetries due to lateral and rotational ___________ of the spine // 3-Dimensional // At or around onset of ___________ // Structural or Flexible -Cause is __________ (idiopathic) -Functional Consequences: Impaired ______, endurance, strength // Consequences for ______________ function with progression -Assessed W/: Adam's Forward _______ Test // _______ Angle on x-ray // Risser Sign -Intervention: __________ if curves between 25-45 deg in immature spine // Spinal ________ if >45 deg

-Laterally -Anteversion // Pathological -Knee // planus // running -distance // measurement -plate

Orthopedic Conditions: --Angular Conditions (Genu Valgum): -Presentation: Lower leg is angled __________ in reference to the femur (Concern after age 7 or 8) -Cause: Obesity // Significant Femoral ____________ // ____________ (Cerebral Palsy (CP) // Osteogenesis Imperfecta (OI) // Osteochondrodysplasia // Rickets // Growth Plate Injury due to Trauma // Congenital Hemimelia (limb deficiency)) -Functional Consequences: Anterior _______ pain // Pes _________ // PTF Instability // Difficulty ____________ -Assessed: In standing with knees lightly touching, measure ___________ between medial malleoli // Hip-knee-ankle ______________ -Intervention: Stapling of the distal medial femoral growth ________ in teenage years // Femoral Osteotomy

-medially -Tibial // trauma // vara // fluoride -fracture -together // condyles // measurement -KAFOs // Surgical // Amputation

Orthopedic Conditions: --Angular Conditions (Genu Varum): -Presentation: Lower leg is angled ___________ in reference to the femur (Concern after age 4) -Cause: Congenital _________ hemimelia // Osteochondrodysplasia // Partial physeal arrest due to _________ // Rickets (Vitamin D deficiency) // Tibial _______ (Blount's Disease) // Excessive prenatal __________ ingestion -Functional Consequences: __________ risk and pain -Assessed: Standing with feet ___________ // Measure distance between femoral __________ or knees at the joint line // Hip-knee-ankle ______________ -Intervention: HKAFOs and ________ // __________ correction is rare // ____________ in very severe cases

-Varus // IR // unilateral -growth // medially -Gait -2 // Monitored -night // surgery

Orthopedic Conditions: --Blount's Disease (Tibia Vara): -Presentation: _________ deformity of the Tibia // Flexion and _____ of the Tibia // Limb shortening in __________ cases -Cause: Deceleration of ________ at the posteromedial proximal tibial physis // Excessive compressive forces __________ // Obesity -Functional Consequences include ______ deviation and pain. -Assessed: Initially identified by observation; concern with varum after age ____ // ___________ by x-rays -Intervention: HKAFOs or KAFOs, even at ________ // __________ (better outcomes before age 4)

-Moderate Genu Varum // Legs Straight // Physiologic Genu Valgum // Legs Straight -135-145 deg // 125 deg -25-30 deg // 8-16 deg -5-10 deg internal // 20-25 deg external -1-6 deg valgus (w/ WB) // 0-3 deg Varus

Orthopedic Conditions: --Bony Development: -Knee Alignment for Newborns? // Alignment at 1 1/2 to 2 yrs? // Alignment at 2 1/2 yrs? // Alignment at 4-6 yrs? -Femoral inclination angle for infants? // Adults? -Femoral anteversion for infants? // Adults? -Tibial Torsion for infants? // Adults? -Calcaneal Varus/valgus for infants? // Adults?

-head // anteriorly // chronic // Knee // ER -Anterior // Pain -Separation // loose // condyles // talar

Orthopedic Conditions: --Causes of Limping (10-15 yrs) -SCFE: Displacement of the femoral ________ relative to the neck and shaft // Femoral neck and and shaft actually displace ___________ and superiorly // Can be acute or _________ // _______ pain may be primary complaint, keeps LE in _____ -Osgood-Schlatter: __________ knee pain at tibial tubercle due to repetitive traction of patellar tendon // ________ with running, jumping, kneeling -Osteochondritis Dissecans: __________ of subchondral bone from articular surface with localized necrosis // Can become a __________ body in the joint, swelling or locking of the joint // Typically at femoral ___________ (medial), elbow (capitulum), and _______ dome

-Necrosis // Males // groin // referred -filled // clicking // ROM -Overuse // Heel -exclusion // common

Orthopedic Conditions: --Causes of Limping (5 to 10 yrs): -Legg-Calve-Perthes: __________ of the Femoral Head // ________ 4-5x more likely, activity-related pain localized to ________, anteriorly or over greater trochanter // ___________ pain to anteromedial thigh and knee -Discoid Lateral Meniscus: Center area of typical "C" shaped meniscus is __________ in, meniscal rim thicker // Snapping, ___________, locking and limited ______ -Sever Disease: Calcaneal apophysitis due to __________ at the insertion of Achilles // ________ pain with running and jumping, local tenderness, pain with resisted PF -Growing Pains: Dx of __________, bilateral, most ___________ cause of pain in 3-12yo // Shin, calves, thigh, popliteal fossa

-sudden // tenderness // chills -joint // cartilage // 48 -hip // ROM // Males -Fractures

Orthopedic Conditions: --Causes of Limping (Birth to 5 yrs): -Osteomyelitis: Infection of bone caused by staphylococcus aureus, _________ onset // Localized bone ___________, swelling and pain over metaphysis, fever and ________ -Septic Arthritis: Infection of ________ by bacteria // Destruction of articular __________ and deformity // Joint could be destroyed within ____ hours -Transient Synovitis: Transient inflammation of the synovium of the ______ // Limited ______, History of URI, more common in _________ -Can also be due to ___________ and Tumors

-fracture -Age -density -Positioning -Alignment -Mobility -Aerobic -independent -Whole Body Vibration -Aquatics

Osteogenesis Imperfecta: --PT Management: -Education on __________ Care & Safe Handling -______-Appropriate Developmental Skills -Weight-bearing activities to improve bone __________ -___________ with Seating, Standers -Good skeletal ______________ -Alternative __________ early -Strengthening, and __________ Activity -Maximize ___________ mobility and function -This has good results, but is contraindicated in those w/ telescoping rods or joint subluxations. -This is a safe, gravity-eliminated environment

-Hip // position -dislocation // Neuromuscular // Birth // crowding -delayed -Abduction -Spontaneous // Pavlik // surgery

Orthopedic Conditions: --Developmental Dysplasia of the Hip (DDH): -Presentation: Subluxed and/or Dislocated ______ // Left > Right due to intrauterine __________ with L hip posteriorly against Mother's spine, limiting abduction -Cause: Fetal __________ // ___________ condition // Breech position at ________ // Intrauterine ____________ -Functional Consequences: Dislocations, __________ GM skills, Pain -Assessed By: Barlow, Ortolani, Galeazzi Sign, Limited ____________ -Intervention: ___________ recovery in 50% // _________ Harness // Traction and __________ w/ a spica cast

-adductus // varus // equinus // small -tarsals // ligaments // muscles // crowding -Delayed // ROM -PROM -cavus // achilles // manipulations // rigid

Orthopedic Conditions: --Foot Deformities (Club Foot): -Presentation: Forefoot ___________ // Hindfoot ________ // Ankle _________ // Hypoplasia of the limb and _______ calf -Cause: Deformity of the __________ // Thickened ___________ // Hypoplastic __________ // Teratogens // Intrauterine ___________ -Functional Consequences: __________ gross motor skills (all that involve WB on foot) // Pain // Limited ______ -Assessed: Observation and ________ -Intervention: Ponsetti method (serial casting and bracing) corrects _______ deformity first, then equinis, and most will require ___________ tenotomy w/ bracing // Daily _____________ in the French Method (gentle mobilization & stretching) // Complex surgery required for ________ clubfoot

-without // exclusion -shortening // severity // AFOs -Neuro // ROM // Gait // Motor -Functional // serial // Gait -10 // Heel-Toe // Gait // HEP // Age // Reassess

Orthopedic Conditions: --Idiopathic Toe Walking (ITW): -Walking with bilateral toe-toe pattern __________ any reason/pathology // Diagnosis of ___________ -Key Recommendations: Early identification/treatment can prevent adaptive ___________ and changes in gait mechanics // Efficacy of treatment depends on __________ and age of intervention // ______ are often helpful to improve heel strike -Exam: Rule out ________ // Measure _______ (knee flexed and extended) // _______ Assessment // Gross _________ Skills/Balance/Coordination -Treatment: PROM/AROM, ___________ activities // Orthotics and/or _________ casting // Stretching // _______ training -Goals: Ankle DF ≥ ____ degrees with knee extended // ______-_____ ambulation greater than 75% of gait // Improvement in Observational _______ Score // Independent with _______ // ______-appropriate GM Skills // __________ with growth if ITW returns

D. Genu Valgum B. No concern at this age, this is normal.

Orthopedic Conditions: --Quick Questions: -In-toeing can be caused by all of the following except: A. Femoral Anteversion B. Internal Tibial Torsion C. Metatarsus Adductus D. Genu Valgum -Your friend asks you to take a look at her 2yo's legs, as she is worried that the child is "bow legged". Which is the most likely result of your assessment? A. Somewhat concerned, continue to monitor B. No concern at this age, this is normal. C. Very concerned, refer to MD for surgical consult D. Somewhat concerned, refer to PT

C. A game that includes lots of a squat <> stand D. Legg-Calve Perthes

Orthopedic Conditions: --Quick Questions: -Which of the following activities would be best for a 6yo being seen for Idiopathic Toe Walking? A. Passive stretching into DF B. Gait training down an incline C. A game that includes lots of a squat <> stand D. Ballet poses/practice -A 10yo comes to your outpatient clinic with new onset of a limp. During your exam, he localizes the pain to his groin. Which is the most likely cause of his change in gait? A. Sever Disease B. Growing Pains C. SCFE D. Legg-Calve Perthes

-midline // -5 -Anteversion // Internal // Adductus -tripping -Torsional -Spontaneous // braces // W // foot // surgical

Orthopedic Conditions: --Torsional Conditions (In-Toeing): -Presentation: Feet or toes point toward __________ during gait, typically bilateral // Concern after age 5 if > ____° -Cause: Femoral ____________ // __________ Tibial Torsion // Metatarsus ____________ -Functional consequences include __________ and pain -Assessed by ____________ profile (Foot progression Angle, Femoral version, Tibial torsion, foot alignment) -Intervention: ____________ improvement occurs in most cases // Some anecdotal reports of improvement with _________, twister cables, orthotics // Avoid _____-sitting // Stretching may help if pathology is in the _______ // __________ Correction (Derotational osteotomy)

-away // 20 -ER // Femoral // External // valgus -gait -Torsional -Derotational

Orthopedic Conditions: --Torsional Conditions (Out-Toeing): -Presentation: Feet or toes point ________ from midline during gait, typically bilaterally // Concern if > ____° -Cause: _____ of the hip // __________ Retroversion (rare) // ___________ Tibial Torsion // Calcaneo________ -Functional Consequences include pain and difficulty with _______ -Assessed by ____________ profile (Foot progression Angle, Femoral version, Tibial torsion, foot alignment) -Intervention: _____________ osteotomy if due to extreme tibial torsion

-I: Blue // fragility // loss // short // fractures // common -III: Severe // short // respiratory -IV: deformity // short // severity // excellent

Osteogenesis Imperfecta: --Classification (Types): -I: _______ Sclerae, Osteoporosis with bone _________, joint hyperlaxity, hearing _______ (Classic Signs) // ________ (not as short as others), may have __________ at birth (10%) // Most _________ (50% of OI Population) -III: ________, and presents with a progressive deformity of the long bones, skull, and spine // These children are very ________ of stature // These children may have severe kyphoscoliosis, which results in ___________ compromise and often death in early childhood -IV: Mild to moderate __________, postnatal ________ stature, variable __________ of fractures // Prognosis for ambulation is ____________

-V: severe // calcification // pronation -VI: rare -XI: fragility // contractures

Osteogenesis Imperfecta: --Classification (Types): -V: Moderate to _________, hypertrophic ____________ of fractures and surgical sites // Calcification of interosseous membrane of the radius and ulna, limiting forearm ___________ and supination -VI: Extremely _______ with moderate to severe deformity, similar to Type IV -XI: Clinically similar to Type III with extreme bone __________ // Progressive deformity resulting in joint ____________

-Fracture -milestones -AROM // MMT -Posture -Gait // Balance -Bracing

Osteogenesis Imperfecta: --PT Eval: -History and __________ History -Gross motor development/timing of ___________ (Standardized Assessment) -ROM/Strength: ________ is safer than passive (we don't do PROM, because don't want to cause fracture) // Caution with formal _______; observational assessment -_________, Endurance -______/Mobility // Coordination/___________ -Pain // Assistive Devices/__________

-type -fracture -Growth -mobility -turnover -calcium -marrow -rods // fusion

Osteogenesis Imperfecta: --Progression: -Dependent upon ________ -Dependent upon __________ management/healing -__________ patterns play a role in subsequent impairments -Many children use assistive devices for __________ --Medical Management: -Biophosphonates inhibit osteoclast activity, decreasing normal bone ____________ -Vitamin D assists with __________ absorption -Bone ___________ transplant may improve collagen and mineral content -Possible surgery including Intramedullary _______ and spinal _________

-sensitive // responsive // Big // more -sensitive // responsive // little // small

Sensory Integration: -Under-Registration: hypo-___________ // hypo-____________/under-responsive // These children have a "______ Cup", meaning that they typically require ________ sensory input to elicit a response -Over-Registration: hyper-__________ // hyper-___________/over-responsive // These children have a "________ Cup", meaning that a _______ amount of sensory input will cause a response

-movers -system -combination -like // behavior -Consult

Sensory Integration: --Proprioception Over-Registration: -These children are great __________, and typically aren't seen for PT --Take-Home Points: -Can be difficult to tease out which __________ is impaired -Can be a ____________ of systems with impairments -Observe the child, ask the child what they _______ to do, and ask the parents about any observed ___________ -_________ with other colleagues

-space -intentional -toes -feedback -increasing -Increase // resistance // Shoes

Sensory Integration: --Proprioception Under-Registration: -Child does not know where they are in _________ -They may be on their chair one minute, and then suddenly end up on the floor; this can become a behavioral issue, but is initially not ____________ -They may walk on their ________ to increase their awareness of where their legs are and to receive more input through their feet -May bump into things, fall, push, grab; using the environment and other people to get ____________ -Hyperactive and sensory seeking - trying to find out where they are by ___________ speed and force. -Treatment Goal: ___________ the response to a stimulus within a session // Provide increased ___________ to activities to improve input (Ideas include: wall push-ups, mat sandwich, roll on mat, tug of war, appropriate "crashing" onto a mat, body sock, firm squeezes/hugs) // ________ that fit well are important to give appropriate feedback (NO CROCS)

-painful -bonding -hyperactive // ground -Decrease // pressure

Sensory Integration: --Tactile Over-Registration: -Tactile system responds to touch as ___________ or uncomfortable -Child withdraws from touch, can impact ___________ with caregivers -Tend to be __________, run away. Some children who are walking on their toes are pulling away from the sensation of _________ on their feet -Treatment Goal: ____________ the response to input within a session // Provide firm ___________, swaddling, added weight, compression garments

-sensitive -touch -tone // lazy -Increase // fill

Sensory Integration: --Tactile Under-Registration: -Not as __________ to typical touch -Nervous system is under-responsive to feedback from _________ sensors -Often present with low muscle ________ and joint hyperextensibility. The perception can be that these kids are slow or _______, but this is NOT true! -Treatment Goal: __________ the response to input within a session. // We need to "______ their cup" with tactile input such as tickling, squeezing, warmth, fans, bubbles, sensory tables, add texture under the feet when walking (bubble wrap)

-sensitive -dislikes -cautious // new -clingy // raised -decrease // gravity // lower

Sensory Integration: --Vestibular Over-Registration: -Vestibular system is too __________ to movement -Child _________ playground equipment -Very __________ and slow-moving, prefers to be sedentary, doesn't like to try _______ things. May not like elevators and escalators -May be ________, afraid of heights and _________ surfaces, "gravitational insecurity" -Treatment Goal: __________ the response to a stimulus within a session // Address small changes in __________, such as gentle movements on a swing // Start __________ to the ground and work up.

-increased -tone // wider -falling // extension -movement // down -still -Increase // structure // cognitive

Sensory Integration: --Vestibular Under-Registration: -Child appears to need ___________ input -Tend to have decreased _______ and a _________ base of support -May not notice when they are __________, have decreased protective ___________ -Seeks constant ____________ such as bouncing on furniture, running, or rocking. May climb onto things but be unable to get _________ -Has difficulty remaining seated or standing _______ -Treatment Goal: ___________ the response to a stimulus within a session // Provide increased __________ to activities, such as lily pads, balance beams, slides, swings, wheelbarrow walk, scooter, bikes, dancing // Combining a physical and ___________ task will help focus the child

-Combine balance tasks with simple addition -Vivie is demonstrating signs of Vestibular dysregulation, and appears to be under-registered, or trying to "fill her cup" with lots of movement. Combing a physical task with a cognitive activity is one strategy in the category.

Vivie is a 7yo girl in second grade recently referred for a PT evaluation at school by her teacher who said, "Vivie is all over the classroom, I can't keep her in her seat". Prior to seeing her for the evaluation, you quietly observe Vivie from the back of the room. When the class is seated and working on a craft activity, Vivie is standing and moving from table to table, sitting down and standing up several times, and climbs onto the table. You suspect that Vivie has some difficulties with sensory integration. Which of the following is the best goal for your upcoming treatment sessions based on your observations? -Work on gentle movements on the swing in the PT gym -Work at a sensory table at the beginning of a session -Combine balance tasks with simple addition -Add a weighted vest to activities during PT

-Not using 2-word phrases -At 1 year of age, we would expect Maddie to be saying some words, babbling, making gestures, making eye contact, and responding when her name is called. Putting two words together comes a bit later, so would not be a concern yet. -Tactile Over-Registration -Benny is showing signs of Tactile Over-Registration, or a hypersensitivity to touch.

You are seeing Maddie for an evaluation in early intervention. She just had her first birthday, and her Mom is concerned that she is not walking. While you are doing your evaluation and observing Maddie playing with her 3yo brother, you notice that she mostly plays on her own and doesn't really interact with her brother, who keeps trying to get her attention. All of the following are early signs of Autism except: -No babbling or using words -Not using 2-word phrases -Not responding when her brother calls her name -Not making eye contact with you Benny is a 4yo recently diagnosed with Autism. He demonstrates some aversion to certain clothes and foods, and does not like others to touch him. What sensory system impairment is described here? -Tactile Under-Registration -Proprioceptive Over-Registration -Tactile Over-Registration -Vestibular Under-Registration

-Walking on a treadmill at 85% HRR -Research has shown that high-intensity aerobic activity can improve ASD-specific behaviors. 85% of HRR is high-intensity. -Tell her how cute Chip is and ask to see more videos -Chip is showing signs of Autism (flapping, not responding to his name, decreased eye contact), so we can rule out DCD. We would not be giving a diagnosis of Autism, and the MCHAT identifies risk facts and does not give a diagnosis. The best thing to do would be to ask to see more videos to guide your next step. If you continue to suspect Autism, you may choose to tell Mrs. Pott's what you're seeing, and recommend that she see Chip's MD for more testing.

You are seeing Rob, a 10yo with ASD, in your outpatient clinic. Which of the following interventions is likely to have the most impact on his tendency to rock and raise his voice when he's upset? -Walking on a treadmill at 40% HRR -Walking on a treadmill at 85% HRR -Working on Tennis skills -Balance activities on a bosu The receptionist at your outpatient clinic, Mrs. Potts, has a 4-year-old son named Chip. She is excited to show you a video of her son on the playground. As you watch, you notice that he frequently flaps his hands, and does not look toward the camera when his mother calls his name. He appears to have difficulty sequencing his extremities as he climbs the equipment and does not stop himself at the bottom of the slide, landing on his bottom. Which of the following is the most appropriate next step? -Tell her how cute Chip is and ask to see more videos -Let Mrs. Potts know that Chip might have Developmental Coordination Disorder -Recommend that Mrs. Potts fill out the MCHAT to see if Chip has a diagnosis of Autism -Gently let Mrs. Potts know that Chip has Autism