Neuro 3 Final

speech and swallowing changes in Huntington's Disease

dysarthria dysphagia

what ar ethe 6 EBP treatment for Autism

modeling naturalistic teachign strategies (practicing the skill in context) exercise peer training package schedules scripting

Enteral nutrition (EN)

provides nutrients into the GI tract •Enteral nutrition -Poor gut motility -Immature enzymes -Poor absorption -High caloric needs -Start slowly and advance gradually -Breastmilk is preferred nourishment provided via IV therapy •Parenteral nutrition -Inferior to enteral nutrition -Complications •Hepatic injury: cholestasis •Hyperlipidemia •Risk of infection with central venous line

· Question 30 Which of the following best describes the response of a person with multiple sclerosis who experiences a worsening of spasticity and blurring of vision after 60 minutes of vigorous exercise, that subsides within 12 hours? exacerbation pseudoexacerbation appropriate response to exercise myocardial infarction

pseudoexacerbation

Review: do people with MS have spasticity or flaccidity

spasticity (normally doe not reduce in remissions)

Review: Acoustic Neuroma (Vestibular Schwannoma)

unstable benign tumor on vestibularchoclear nerve hearing loss, vestibular problems, when it gets really big it can be life thretanign as it will push on brain stem

Review: Superior Canal Dehiscence (SCD)

unstable vertigo dizzines developmental abnormality of bone over anterior canal

Review: what hertz is used for vibration vs hearing tests

vibration = 128 Hz Hearing = 512 Hz

Review: Meniere's Disease -etiology -s/sx

we do not know much about this unstable

clinical classifications of positional plagiocephaly

}Head flattened on 1side }Associated with torticollis Type 1 -only back of head deformity Type 2 -ear asymmetry Type 3 -forehead deformity Type 4 -cheek deformity Type 5 -temporal or vertical bulging

Brachycephaly classification

}Head width > length }Back of head flattened

Signs of muscle weakness from peripheral cause (5)

§Tongue fasciculation- sma §Abdominal breathing or accessory muscle use - sma §Head lag when pulled to sit - Duchenne Dystrophy §"Slipping through the hands" when held suspended - SMA CP §Difficulty rising from floor (such as gouwer sign using hands on knees to get up)

do spastic ms have longer or shorter sarcomeres in CP

´Longer sarcomeres: atypical regulation of sarcomere growth (does not maintain relative length)

what does passive motion do to stiffness in CP

´Passive mechanical property studies show increased stiffness of CP muscle fibers compared to controls

Dix-hallpike

+ side is the down side posterior canal BPPV - most common 90% Diagnosis: Dix-Hallpike (upbeat nystagmus) + to the side that is down Treatment: Epleys manuver or semont (start turne dtwords the bad side finished sidelying with turned twords the good side down) horizontal canal BPPV - second most common 10-20% Diagnosis: roll test aka BBQ test (+ is the side that is down) Treatment: Gufoni's manuver of BBQ treatment (AKA lampert manuver)

Brain Changes in Huntington's Disease (4)

- basal ganglia atrophy - ventricular enlarged - decreased brain volume - white matter changes

· Question 5 Medical Dx of ALS usually includes all of the following EXCEPT: a. EMG b. NCV c. Muscle biopsy d. Lumbar puncture

. Lumbar puncture

Review: Gaze evoked nystagmus peripheral vs central

1) "follow my finger with your eyes" - hold gaze up then down 20-30 degrees from center - hold gaze left and right 20-30 degrees from center

Review: what are the 9 movement system diagnoses

1.Movement Pattern co-ordination Deficit - timing/seqencing -example: stroke, down syndrome 2.Force Production Deficit - weakness - example: TBI, CP 3. Fractionated Movement Deficit -inability to fractionate movement - example: stroke, CP 4.Postural Vertical Deficit - inaccurate perception of vertical - example: stroke, TBI 5.Sensory Selection and Weighting Deficit - sensory seeking/avoidance - example: stroke, ASD 6.Sensory Detection Deficit -lack of joint position sense - example: TBI, incomplete SCI 7.Hypokinesia -slow to initiate/execute movement -example: PD, Seizure disorder 8.Dysmetria -overshoot/undershoo -cerebellar dysfunction -example: MS, CP 9.Cognitive Deficit - attention / processing speed -example: dementia, TBI

Least Dangerous Assumption

Assume competence and provide opportunities consistent with high expectations because to assume incompetence and not provide such opportunities could be more harmful.

· Question 22 A 49 year-old person who has relapsing remitting multiple sclerosis (MS) is being evaluated by a physical therapist in an outpatient setting. The therapist suspects significant disuse atrophy in the trunk and lower extremities that is adversely affecting functional skills, with patient report of a recent decline in transfer and walking skills. The therapist is designing a home exercise program with therapeutic goals of improving strength, endurance and function, but is concerned about not over fatiguing this patient. Which of the following home exercise program (HEP) options would be most appropriate to address these goals for this patient? A. Treadmill training at moderate intensity for 45 minutes, 4× week. B. Aquatic exercise program with functional strengthening activities, for 30 minutes, 3× week in a cool pool. C. Lower extremity PRE program using cuff weights performed on floor or bed level, repetitions to fatigue, 1 set, 4× week. D. Lower extremity bicycle ergometer training program for 30 minutes with 1 minute high-intensity (speed) intervals every 5 minutes, 3× week.

B. Aquatic exercise program with functional strengthening activities, for 30 minutes, 3× week in a cool pool.

Interventions for contractures in CP

Botulinum toxin A (Botox) - for equinus -lasts 12-16 weeks Intrathecal Baclofen -´Effective to decrease spasticity in lower extremities no evidence for increased function Selective Dorsal Rhizotomy (SDR) -´invasive pump -ages 2-5 - requires 9 months of therapy -Many possible complications: - post op: no trunk rotation 2-3 weeks - trunk weakness regained at 3 months Multi-level surgery -the standard of care to improve gait and function in children with CP -´Surgeries included: soft tissue lengthening, tendon transfer, femoral derotation osteotomy, growth plate surgeries Serial casting -Serial casting is an evidence-based - intervention for lower extremity contractures - Can be used for hamstring, gastroc/soleus and even hip adductors contractures -Also some evidence for management of contractures of the upper extremity -Low cost, well tolerated Orthotics/AFOs -´Low cost, well tolerated, improves function (balance, gait efficiency) -´Moderate effectiveness to maintain or improve ankle dorsiflexion ROM ´-Increase walking speed and reduce energy expenditure in children with CP -´More often used for children at lower level of function (IV and V) -´May lead to weakness of gastroc/soleus muscles and may contribute to crouched gait later in life ´-May limit floor mobility in infants and toddlers Standing programs -´For children who ambulate less than 2 hours daily -´Decreases knee flexion contracture in NON-AMBULATORY children: moderate evidence: 1 hour daily, 5 d/week -´May promote development of hip: 30-60 degrees of hip abduction; 60 min/day -´ Decreases spasticity temporarily for 30 minutes after standing for 30-45 minutes -´In general, for ROM, recommendation is 45-60 minutes daily -To promote mineral bone density: 60-90 minutes daily (weak evidence

memory changes in Huntington's Disease

Cognitive changes -Cognitive losses are cumulative can lead to global impairments later on - Lack of awareness of cognitive deficit later, but they notice it early on leading to situation depression -Reduction in memory speed and cognitive processing (can occure before motor symptoms) - Hard time cognitively putting tasks in correct order- safety -Difficult multi tasking -Cognitive decline is progressive and inevitable- some medications can help -Hypo frontal lobe function leads to personality changes such as apathy, ocd, irritable, agitated, hypersexual, mania - Major depression is very common- up to 25% of ppl will try to commit suicide - Want to do dual tasking things in therapy

Conductive vs sentorineural hearing loss

Conductive - sound not reaching inner eat -due to obstruction or trama - Conductive aka mechanical hearing loss occurs in outer ear such as ear wax Sensorineural -means there is a problem occurring in either the inner ear or the auditory nerve, which delivers sound to the brain

developmental coordination disorder (DCD) - DSM 5 criteria -symptoms - concerns by age - the 5 C's -etioology - treatment

DSM 5 Criteria A.Coordination, speed and accuracy of movement below what is expected for age and opportunities to develop skills. B.Interferes with academic achievement or ADLs C.Onset is in the early developmental period D.No identifiable medical or neurological condition that explains their coordination problems. Symptoms - planning a motor task -organizing movements - performing a coordinated action - adjusting movements -motor learning deficits -impaired balance concerns by age progression: First motor than, self-care, academic impact followed by lasting behavioural/emotional secondary consequences The 5 C's of DCD common - 5-10% clumsy - physically awkward and uncoordinated - bump into ppl and things chronic health condition - life long co-occurring conditions -ADHD 50% - specific language impairment 35% consequences - without intervention secondary complications: social isolation, health issues, low self-esteem Etiology - largly unknown - possibley realated to cerebellum and action observatoin network Treatment Task-oriented approach (Neuromotor Task Training) -use concrete activity - practice in real life environments -grade the intensity of the activity Motor learning approach - procide instructions -provide opportunities to practice - provide feedback Congnitive approach "they need to learn to learn" - goal, plan do check - use specific strategies - use mental or self verbalizaion -transfer and generalize strategies - the M.A.T.C.H

6 outcome measures for developmental coordination disorder (DCD)

Developmental Coordination Disorder Questionnaire (DCDQ'07) -for parents of children ages 5 - 15 yrs 15 items Bruininks Oseretsky Test of Motor Proficiency - Revised Edition (BOT-2) Movement Assessment Battery for Children -2nd edition Canadian Occupation Performance Measure (COPM) Goal Attainment Scaling (GAS) Perceived Efficacy and Goal Setting (PEGS) For children 5-9 years old.

levels of severity of CMT congenital ms torticollis

Grade 1 - early mild -0-6 months -postural preferences or passive cervical rotation difference between sides < 15 Grade 2 -early moderate 0-6 months -passive cervical rotation diff between sides 15-30 Grade 3 - early severe 0-6 months - SCM mass OR - Passive cervical rotation diff between sides >30 Grade 4 - Later Mild 7-9 months - postural preference OR - passive cervical rotation diff between sides <15 Grade 5 - later moderate 10-12 months - postural preference OR - passive cervical rotation diff between sides <15 Grade 6 - later severe 7-12 months -\7-9 - passive cervical rotation diff between sides <15 10-12- passive cervical rotation diff between sides 15-30 Grade 7 - Later extreme 10-12 months -passive cervical rotation difference between sides >30 7-12 months - STM mass Grade 8 - very late >12 months -any asymmetry -SCM mass - any limitation in cervical rotation

Perinatal asphyxia

Perinatal asphyxia or neonatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain.

vertigo peripheral problem vs central problem

Peripheral nystagumus horisontal and torsional - increase nystagmus with no fixation - acute or subacute - unidirectional nystagmus ( not changin directiosn with diff gazes) Central nystagmus vertical and/or horizontal and/or torsional - remove fixation may increase or decrese nystagmus - chronic - direction changing (nystagumus changes directions with gaze)

Tone: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

Tongue fascicualtoins: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

chest size: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

facial movement: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

gait: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

Review: how to tell between a peripherally caused nystagmus or a centrally caused nystagmus?

Peripheral problem Direction of nystagmus is horizontal and torsional - no vertical motion ever! - increase in nystagmus when fixation removed - direction of nystagmus does not change, unidirectional nystagmus Central problem Direction of nystagmus is vertical and/or horizontal and/or torsional - increase or decrease in nystagmus when fixation removed - direction of nystagmus may change with different gaze

Periventricular Leukomalacia

Periventricular leukomalacia (PVL) is a type of brain injury that affects premature infants. The condition involves the death of small areas of brain tissue around fluid-filled areas called ventricles. The damage creates "holes" in the brain. "Leuko" refers to the brain's white matter. - Decreased cerebral perfusion and/or hypoxia to - Periventricular ischemia to - Periventricular Leukomalacia

movement system symtpms in autsim

Praxis- touble following verbal comapnds, immiting others, symbolic gestures such as waving hard time balancing with eyes closed Also: Limited feedforward or anticipatory reactions Increased sway with dual tasking inpaired immitation decreased gestures and verbal commands difficulty with motor learngin and planning

· Question 3 A physical therapist treats a person with multiple sclerosis for impaired balance and coordination. The patient reports that since being diagnosed four years ago, symptoms have gradually gotten worse, without any plateau or lessening in severity. Which terminology would most accurately describe the patient's disease course? a. RRMS b. Primary progressive c. Secondary progressive d. Progressive relapsing

Primary progressive

CIMT (constraint induced movement therapy) for CP

Principles of CIMT - challenging -short periods -intesive -peers -goal directed

GPG for BPPV

Strong recommendations that clinicians should: -Diagnose posterior SCC BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver -Treat, or refer to a clinician who can treat, pt. with posterior canal BPPV with canalith repositioning maneuver Perform roll tests to assess lateral SCC BPPV of the pt's Hx is compatible with BPPV and the Dix-Hallpike tests exhibits horizontal or no nystagmus Differentiate BPPV with other causes of imbalance, dizziness, vertigo Assess pts. with BPPV for factors that modify management Reassess pts. within 1 month after an initial period of observation or Tx Evaluate pts. with persistent symptoms for unresolved BPPV Educate pts. Regarding impact of BPPV on their safety, recurrence, importance of follow-up Strong recommendations against: -Post-procedural postural restriction after canalith repositioning maneuvers for post canal BPPV. Radiographic testing and vestibular testing for a pt. who meets diagnostic criteria for BPPV in the absence of additional S/Sx inconsistent with BPPV that warrant further imaging Routinely treating BPPV with vestibular suppressant medications

CAPE/PAC

The CAPE gives you information on the activities that the child currently performs- in the past 4 months (with whom, how often, how much they like it etc.) The PAC tells you what they would like to do (maybe something they have never been able to do or did not even know it existed) The activities can be regrouped by categories for reporting such as physical activities, skill-based activities, recreational activities etc. The PACE is a great tool to learn about a child/family current activities so you can guide them in embedding your recommendations into their routines. The PAC helps identify potential for exploration especially if they currently have a very sedentary life style. For example, they might tell you that they would really like to swim even if they are not currently doing it!

School Function Assessment

The SFA is a standardized criterion-reference test. It assesses participation across environments. It also looks at tasks supports/accommodations and performance at the activity level. It is administered as a team. You can also administer only the sections that relate to your area of practice.The sections most relevant to PT practice are: Travel Maintaining and changing positions Recreational movement Manipulation with movement Up/down stairs The raw scores for each sections are transformed into a criterion score for the child's age. The results are then plotted in a visual manner so the greater areas of challenge are easy to see. The cut-off scores are provided for 2 groups: grades k-3 and 4-6. The cut-off score represents the performance level where 95% of the normative sample performed. Therefore, when a student is below the cut-off score they meet eligibility for services since they perform below 2 standard deviation from the norm.

Review: UMN vs LMN symptoms - reflexes -atrophy -fasciculations -tone

UMN •Reflexes: hyperactive •Atrophy: mild from disuse •Fasciculations: absent •Tone: hypertonic Gait: jerky because of high tone LMN •Reflexes: diminished or absent •Atrophy: present •Fasciculations: Present •Tone: hypotonic to flaccid Gait: floppy due to low tone

Review: ALS Amyotrophic lateral sclerosis AKA lou Gehrigs disease - UMN/CNS or LMN/PNS - what is it (6) s/sx (7) - what causes it (5) -reflexes (1) - motor (3) -sensory (1) -fasciculations (2) -tone (2) -PT treatment (3)

UMN/CNS or LMN/PNS - UMN and LMN what is it -progessive -degenerative - asymmetrical weakness distal progressing to proximal - die of respritory failure - no cognitve symptoms S/Sx: - Fasiculatins in arm, leg, shoulder, tongue - Ms cramps - Spasticity - Tight stiff ms - Ms weakness UE, LE neck (later on), diaphragm - Slurred, nasal speech - Dysarthtic speech Difficulty chering and swallowing what causes it - degeneration of cortiocospinal tract - anterior horn damage -motor cranial nuclei -real cause unknown - UMN and LMN damage to motor tracts reflexes decreased DTRs motor -weakness (distal to proximal) -UE, LE, neck, Diaphragm -disuse atrophy sensory intact fasciculations - yes -UE,LE, shoulder, tongue tone - hypotonia -spasticity PT treatment -Stop when fatigue sets in -Soreness is breaking down ms a bad thing in ALS -Exercise to tolerance

Review: Spinal root nerves aka herniated nucleous propolsus - UMN/CNS or LMN/PNS -reflexes - motor -sensory -fasciculations

UMN/CNS or LMN/PNS ? reflexes Decresed DTRs motor Weakness in innervated pattern sensory Dermatomes impared fasciculations possible

Review: Critical illness polyneuropathy CIP and critical illness myopathy CIM - UMN/CNS or LMN/PNS - what is it - what causes it

UMN/CNS or LMN/PNS ? what is it - Major complicaiotns or critical illness - Difficult to distinguish between the two Example: hos chemo caused nerve damage what causes it - Etiology: sepsis, acute respiratory failure, multiple organ failure

Review: Spinal muscular atrophy - UMN/CNS or LMN/PNS - what is it - motor

UMN/CNS or LMN/PNS ? what is it - Progressive - Asymmetrical neuromuscular disorder motor weakness

Review: Post-polio syndrome -UMN/CNS or LMN/PNS - what is it (2) s/sx (5) - motor (1) -PT treatment (1)

UMN/CNS or LMN/PNS ? what is it -Asymmetrical neuromuscular disorder -Strikes 30-40 years after initial attack of polio s/sx: - Weakness - Atrophy - Bulbar presentation = dysarthria and dysphagia - Fatigue - Pain motor atrophy due to weakness PT treatment Controversy on exercise and activity with PPS

Review: MS - UMN/CNS or LMN/PNS - what is it (4) s/sx (8) - what causes it (4) -reflexes (3) - motor (2) -tone (2)

UMN/CNS or LMN/PNS CNS myelin what is it - chronic autoimmune disoder attacking CNS myelin - clincal presentation varied - small area = force production deficit -large area = presents as SCI s/sx: - Motot - Pain - Fatigue - Dysarthria, dysphonia, dysphagia - Cognitive - Postural/intention Tremors - Ataxia Automonic symptoms what causes it -Immune system attacks CNS myelin -Makes multiple sclerotic plaques -Nerve transmission slowed or blocked -Genetic factor but not genetic reflexes UMN - clonus -DTRs -babinski motor -weakness -decrease endurance tone hypotonia spasticity

Review: Diabetic peripheral neuropathy aka polyneuropathy - UMN/CNS or LMN/PNS -reflexes - motor -sensory -fasciculations

UMN/CNS or LMN/PNS PNS reflexes Decreased DTRs motor Weakness and atrophy Distally greater than proximally sensory impaired fasciculations may have em

Review: Guillain Barre - UMN/CNS or LMN/PNS - what is it - what causes it -reflexes - motor -sensory -tone -PT treatment

UMN/CNS or LMN/PNS PNS what is it - acute -ascending -diffuse Symmetrical neuromuscular disorder Symmetrical weakness Symmetrical sensory loss Distal progressis to central syptoms Pain Adult onset Recovery occurs what causes it acute inflammatory demyelinating polyneuropathy or acute motor axonal neuropathy or acute and sensory axonal neuropathy cause is unknown reflexes arreflexia motor Symmetrical Distal weakness progressing to proximal sensory Symmetrical sensory loss Paresthesia Cutaneous and proprioceptive loss tone Hypotonicity Flaccidity PT treatment Avoid ms fatigue Once stabilized - Short non-fatiguing exercise - Increase exercise if no st back in 1 week - Promote activitiey not strength Progression in s/sx = too much

Review: Charcot Marie Tooth - UMN/CNS or LMN/PNS - what is it - what causes it - motor -sensory

UMN/CNS or LMN/PNS PNS what is it Symmetrical neuromuscular disorder - Initial worsening with limited recovery Elevated arch, clawing toes (loss of intrinsic ms innervation) Most common inherited neurological disorder Motor and sensory distal and symmetrical Onset in childhood rapid and progressive what causes it inherited Polyneuropathy impacting myelin or axons motor symmetrical distal weakness sensory Paresthesia Nubmbess Symmetrical Cutaneous and proprioceptive loss

Review: Muscular Dystrophy - UMN/CNS or LMN/PNS - what is it (3) -reflexes (1) - motor 1 -sensory 1 -fasciculations 1

UMN/CNS or LMN/PNS PNS LMN what is it -Progressive -Symmetrical proximal weakness -Neuromuscular disorder reflexes normal to decreased DTRs motor weakness sensory intact fasciculations rare

Review: Mononeuropathy - UMN/CNS or LMN/PNS - what is it - what causes it -reflexes - motor -sensory -fasciculations

UMN/CNS or LMN/PNS PNS LMN what is it damage to nerve outside of brain and spinal cord what causes it trauma reflexes motor Weakness and atrophy in distribution sensory Loss in distribution fasciculations May have em

Review: Myasthenia Gravis - UMN/CNS or LMN/PNS - what is it (5) s/sx (7) - what causes it (4) -reflexes 1 - motor 4 -sensory 1 -PT treatment (5)

UMN/CNS or LMN/PNS PNS LMN what is it -Neuromosculat junction depletion of neurotransmitters -Chronic autoimmune neuromuscular disorder -Thymus may be associated -motor end plate disorder -exacerbations result in weakness in face/neck/hands s/sx: - Ms weakness htat worsen after activity and improves with rest - Ptosis - Diplopia (ms weakness) - Dysphagia (swallowing) - Dysphonia - SOB - Dysarthria what causes it -Damage to motor endplate -ACH receptors destroyed -Prevents ms from contracting -Most common in young adult women reflexes normal DTRs motor Fatigue > ms weakness Loss of power Worsens after activity Improves with rest Arms, hands, fingers, legs, neck sensory intact PT treatment -Energy conservation -Mobiity -Fall prevention -Strengthening -Moderate intensity

Review: Poliomyelitis - UMN/CNS or LMN/PNS - what is it (2) s/sx (5) - what causes it (3) -reflexes (1) - motor (2) -sensory (1) -fasciculations (1) -tone (1)

UMN/CNS or LMN/PNS PNS/LMN what is it -enterovirous invades thorough intestigne affects LMN -recovery = collateral sprouting of axon to ms S/SX - Fatigue - Pain - Asymmetrical ms weakness - Hypotonicity Paralysis what causes it -Person to person Fecal to oral -Attacks cell bodies of motor neurons -Anteiro horn reflexes decreased DTRs motor -asymmetrical weakness - atrophy due to weakness sensory intact fasciculations yes tone hypotonicity

· Question 24 Mr. Smith presents with fasiculations and fibrillations on his EMG is this indicative of an UMN or LMN lesion? a. LMN b. UMN

a. LMN

· Question 48 A person with lower extremity lower motor neuron injury to the left posterior tibial nerve s/p TKA is working on improving independence with functional activities in the kitchen. Which of the following tests would provide the therapist with the MOST useful information on the person's ability to safely perform meal preparation? a. Multidirectional reach test b. Timed up and go c. Rhomberg d. TInnetti performance oriented mobility assessment

a. Multidirectional reach test

· Question 40 Which of the following impairments is relatively rare in people with ALS? a. Sensory deficits b. Dysphagia c. Weakness/paralysis of spinal muscles d. Fatigue

a. Sensory deficits

· Question 42 Which of the following are components of the peripheral vestibular system? a. The otoliths, the vestibular nerve, sensory hair cells b. The vestibular nerve, semicircular canals, vestibular nuclei c. The semicircular canals, cerebellum, the otoliths d. The sensory hair cells, vestibulospinal tract, the vestibular nerve

a. The otoliths, the vestibular nerve, sensory hair cells

· Question 25 Vertigo is defined as: a. false sense of rotation or linear movement b. imbalance c. distortion of spatial awareness d. gaze instability

a. false sense of rotation or linear movement

· Question 9 What is the pathological mechanism that leads to neurological dysfunction in multiple sclerosis? Selected Answer: a. Proliferation of oligodendrocytes b. Inflammatory processes c. Axonal disruption d. Interruption of cerebral blood flow

b. Inflammatory processes

· Question 13 A common sign presenting in patients with multiple sclerosis, where the patient feels an electrical sensation that runs down the back and limbs with cervical flexion: a. Deafferination b. Lhermittes sign c. Trigeminal neuralgia d. Uthoff's phenomina

b. Lhermittes sign

· Question 35 The classic imaging test that confirms MS is: a. CT scan b. MRI c. PET scan d. Fluoroscopy

b. MRI

· Question 21 Which medication is MOST appropriate for the medical management of acute relapses in multiple sclerosis? a. Interferon beta-1a b. Methylprednisolone c. Mitoxantrone hydrochloride d. Baclofen

b. Methylprednisolone

· Question 32 Negative signs of Upper Motor Neuron ssyndrome iinclude all of the following EXCEPT: b. Spasticity c. Fatigue d. Impaired balance a. weakness

b. Spasticity

· Question 39 Postpolio syndrome is diagnosed based on which of the following criteria? a. There is a new onset of problems within 10 years of original infection b. There is onset of weakness in previously unaffected muscles years after the original infection c. Blood tests show low levels of creatine kinase d. Muscle biopsy indicates long-term denervation with no signs of re-innervation

b. There is onset of weakness in previously unaffected muscles years after the original infection

· Question 23 A physical therapist is working in an inpatient rehabilitation facility. They are working on community re-integration prior to discharging the 72 year-old person to their home. Which aspect of gait should be the focus during training to ensure the patient's ability to safely cross the street? a. Step length b. Velocity c. Cadence d. Heel strike

b. Velocity

· Question 41 Asking an individual to look at a stationary target while moving their head horizontally and then vertically at various speeds is PRIMARILY a test for: a. differentiating between central and peripheral vestibular problems b. the vestibular ocular reflex (VOR) and gaze stability c. diagnosing positional vertigo d. detecting the presence of nystagmus

b. the vestibular ocular reflex (VOR) and gaze stability

activities that are good vs bad for children with DCD

bad: -High degree of unpredictability -Environment is variable and changing -Requiring fine precision, eye-hand coordination -Requiring changes in direction, speed, force, distance and timing -Relying heavily on integrating feedback during skill performance Hockey Baseball Football Basketball Racquet sports good: High degree of predictability: environment is not continuously changing (eg. t-ball vs baseball) Repetitive movement sequences: once learned, fewer adaptations by participant Swimming Karate Skating Skiing Cycling Dance

· Question 45 A 45 y/o male presents to an OP physical therapy clinic as a direct access patient with complaints of progressive difficulty with speed of keyboarding and unusual challenges with skiing this season. He is an atmospheric scientist who spends much of his time at a computer. He is an avid skier who is well known to the clinic due to variety of sprains/strains in LE over the last 5 years. He also shared in his interview that he noticed an unusual decrease in his ski quality, more frequent falls and is not able to handle black moguls as he did in past years. You plan to use the HOAC II framework of decision making as you proceed through the PT management model of care for your initial evaluation. His patient identified problems include: a. A combination of Body function and structure and participation challenges b. A combination of Body function and structure, activity and participation challenges c. A combination of activity and participation challenges d. A combination of Body function and structure and activity challenges

c. A combination of activity and participation challenges

· Question 10 In relation to the various subtypes of GBS, the most frequent subtype occurring in North America and Europe, which accounts for 85% of all GBS cases in these regions is: a. Acute motor and sensory axonal neuropathy (AMSAN) b. Acute motor axonal neuropathy (AMAN) c. Acute inflammatory demyelinating polyradiculoneuropathy/polyneuropathy (AIDP) d. Miller Fisher syndrome

c. Acute inflammatory demyelinating polyradiculoneuropathy/polyneuropathy (AIDP)

· Question 4 A 35 y/o person with a Dx of MS has been participating in PT monthly to support their efforts to continue with competitive cycling. The POC has focused on home exercise progression to promote safe cross-training, neuroplasticity, muscle recruitment and high-level dynamic balance activities. They come in today for routine follow up and the physical therapist notices that the person has heightened fatigue with physical performance, mild clonus on R leg and "unusual" tingling in R hand that are not the typical presentation. The physical therapist should recommend: a. Reduced exercise levels to better control core body temperature b. Methodically progressed treadmill walking to improve endurance in activities other than cycling c. Contact the neurologist to share the findings as it is suspected they are beginning an exacerbation of their MS d. Encourage them to monitor symptoms, continue with current exercise plan without progression and request a 2-week (vs. typical one month) follow-up.

c. Contact the neurologist to share the findings as it is suspected they are beginning an exacerbation of their MS

· Question 17 A person recovering from Guillian-Barre syndrome is receiving home physical therapy services. The person is currently walking independently in the house with a single point cane, and a right solid AFO for foot drop. They are able to walk to the mailbox every day to get the mail, but would like to resume their 1-mile walk with their dog every day. The MOST appropriate plan to accomplish the person's goal is: a. Continue home physical therapy services until the goal is attained b. Refer the person to an outpatient clinic c. Design a home exercise program that emphasizes progressive ambulation d. Admit the person to a rehab hospital

c. Design a home exercise program that emphasizes progressive ambulation

· Question 19 Which approach needs to be considered when determining the appropriate amount and type of exercise in a patient with amyotrophic lateral sclerosis whose functional status has declined? a. Encouraging the patient to rest and exercise less so energy can be conserved b. Providing a program that includes exercises with heavy eccentric loading c. Developing a program that focuses more on functional strengthening d. Providing the patient with an exercise program at moderate to low intensities

c. Developing a program that focuses more on functional strengthening

· Question 1 A physical therapist is working with a person who is having an acute relapse of their MS symptoms. The patient reports extreme fatigue is limiting their ability to care for their 3-year-old child. Which of the following interventions would be MOST appropriate? a. Instruction in pursed lip breathing b. Progressive resistive exercises c. Education in energy conservation d. High intensity aerobic training

c. Education in energy conservation

· Question 28 What precaution in regards to exercise is specific to MS? a. Exercise can cause muscle atrophy in individuals with MS b. Exercise is problematic due to breathing problems in individuals with MS c. Exercise-induced increases in body temperature can cause temporary worsening or return of previously existing neurological symptoms d. Exercise can induce emotional stress in individuals with MS

c. Exercise-induced increases in body temperature can cause temporary worsening or return of previously existing neurological symptoms

· Question 26 A person with MS went into a hot tub, and afterward had acute onset of difficulty walking due to extreme weakness in their left leg. It resolved when they were out of the tub for an hour. This is most likely due to: a. Bacterial infection b. Cold-induced pseudoexacerbation c. Heat-induced pseudoexacerbation d. Viral infection

c. Heat-induced pseudoexacerbation

· Question 15 A client with post polio syndrome comes to therapy with foot drop. They wish to regain walking without the use of an AFO or with the least intrusive AFO possible. On testing, the tibialis anterior is graded 1/5 or trace strength. A recommended therapy would be to: a. Prescribe resistance strengthening for the tibialis anterior b. Prescribe a rigid AFO and discourage active dorsiflexion c. Implement strengthening of the extensor hallicus longus and extensor digitorum longus muscles to perform dorsiflexion d. Use a maximal exercise protocol working muscles to failure

c. Implement strengthening of the extensor hallicus longus and extensor digitorum longus muscles to perform dorsiflexion

· Question 18 A 56-year-old patient with amyotrophic lateral sclerosis reports mild to moderate right shoulder pain that has been getting worse over the past 3 weeks. The strength of the shoulder musculature is 4/5. Which of the following is the MOST appropriate intervention at this point in time? a. Performing heavy eccentric exercises to maintain stabilization b. Providing the patient with a sling to allow his shoulder to rest c. Managing pain and advancing to mild resistance exercises d. Using modalities for pain relief

c. Managing pain and advancing to mild resistance exercises

· Question 27 Which of the following statements is accurate? a. ALS only involves the LMN b. Charcot Marie tooth involves only UMN and is unilateral c. Myasthenia gravis is a disorder of the neuromuscular junction/acetylcholine receptors d. GBS is a LMN disorder and is described as an acute ascending asymmetrical mononeuropathy

c. Myasthenia gravis is a disorder of the neuromuscular junction/acetylcholine receptors

· Question 37 Diabetic sensory neuropathy is characterized by: a. Hypersensitivity to painful stimuli b. Primarily proximal involvement c. Primarily distal involvement d. Sudden onset

c. Primarily distal involvement

· Question 7 Which of the following would be characteristics of a central vestibular pathology? a. Sudden onset of vertigo with vertical nystagmus and nausea b. Gradual onset of dizziness with torsional nystagmus and hearing loss c. Sudden onset of vertigo with torsional/horizontal nystagmus and hearing loss d. Gradual onset of dizziness with vertical nystagmus and upper limb weakness

d. Gradual onset of dizziness with vertical nystagmus and upper limb weakness

· Question 12 Which of the following statements regarding pain in multiple sclerosis is true? a. It is usually musculoskeletal in nature. b. It is always acute, never chronic. c. It frequently presents in the face. d. It is usually dull and throbbing in nature.

d. It is usually dull and throbbing in nature.

· Question 11 The most prominent symptom of bilateral vestibular loss is: a. Nystagmus b. Vertigo c. Nausea d. Postural imbalance

d. Postural imbalance

· Question 34 In ALS there is loss of anterior horn cells and motor cranial nerve nuclei, this causes: a. Hyperreflexia b. Hypertonia c. Positive Babinski d. Rapid muscle atrophy

d. Rapid muscle atrophy

· Question 50 A therapist in an acute care setting reviews the medication list for his patient before performing attempting an initial evaluation to address the patient's complaint of dizziness and vertigo. The chart indicates that the physician has prescribed Meclizine (Antivert). What is this medication primarily used for to help manage patient symptoms during the acute phase? a. Reduce inflammation secondary to bacterial infection b. Reduce symptoms related to headache c. Reduce symptoms related to insomnia d. Reduce symptoms related to motion sickness

d. Reduce symptoms related to motion sickness

· Question 16 A person with an acute right unilateral vestibular nerve function loss will likely experience: a. Spontaneous right-beating nystagmus and loss of balance to the left side with head rotations to the right b. Spontaneous right-beating nystagmus and loss of balance to the right side with head rotations to the right c. Spontaneous left-beating nystagmus and loss of balance to the left side with head rotations to the left d. Spontaneous left-beating nystagmus and loss of balance to the right side with head rotations to the right

d. Spontaneous left-beating nystagmus and loss of balance to the right side with head rotations to the right

roll test

diagnosis for horizontal canal BPPV + is the side that is down that causes symptoms

what does dystrophin do

muscle csll membrane stability §Acts as a shock absorber for the muscle to contract and relax without being damaged cell damage leads to ms cell membrane instability cell death, fatty inflitrates, fibrosis

epleys maneuver

normal used to treat posterior cannal BPPV reversed used to treat anterior cannal BPPV intial turn towrds the affected side

when does huntigtons start ?

normally 30-50 juvenile form <20

what are some early warngin signs or muscular dystrophy

not walking by 18 months Gowers sign at any age <6 years §Goal: Facilitate early identification of muscle weakness in children 6 months to 5 years

what % of the population has autism

up tp 10%

Review: what direction of acceleration does the utricle detect what direction of acceleration does the saccule detect

utricle horizontal hairs pushed backward duirng forward acceleration Saccule vertical hairs pushed upward when person descends

Diagnosis criteria for autism severity levels

vSocial Communication: vsocial-emotional reciprocity: joint attention, eye contact, imitation v vnon-verbal communication: gestures, facial expressions v vRelationships: play, turn taking, perspective taking Restricted repetitive behaviors: vRepetitive movements or speech: ex. spinning, hand flinging, rocking, echolalia, etc. v vDependence on routines, rituals: ex. upset with changes, rigidity, carrying preferred object, etc. v vHighly focused special interests: ex. dinosaurs, trees, solar system, numbers, balls, etc. v vSensory processing difference: ex. Hypo-responsive to pain, clothing intolerance, hyper-sensitive to certain sounds (vacuum cleaner, trucks...), etc.

symptoms of autism

vSocial Communication: vsocial-emotional reciprocity: joint attention, eye contact, imitation v vnon-verbal communication: gestures, facial expressions v vRelationships: play, turn taking, perspective taking Restricted repetitive behaviors: vRepetitive movements or speech: ex. spinning, hand flinging, rocking, echolalia, etc. v vDependence on routines, rituals: ex. upset with changes, rigidity, carrying preferred object, etc. v vHighly focused special interests: ex. dinosaurs, trees, solar system, numbers, balls, etc. v vSensory processing difference: ex. Hypo-responsive to pain, clothing intolerance, hyper-sensitive to certain sounds (vacuum cleaner, trucks...), etc. •Intellectual disability •Language impairments (30% non-verbal) •Comorbid medical or genetic condition •Catatonia Praxis- touble following verbal comapnds, immiting others, symbolic gestures such as waving hard time balancing with eyes closed Also: Limited feedforward or anticipatory reactions Increased sway with dual tasking inpaired immitation decreased gestures and verbal commands difficulty with motor learngin and planning

Necrotizing enterocolitis (NEC) - causes 3 - signs 8 - diagnosis 5 - treatment 5

•Causes: -Ischemia, infection, hyperosmolar feeds •Signs: -Abdominal distension -Lethargy -Apnea -Bloody stools -Vomiting, feeding intolerance -Shock -Thrombocytopenia -Sepsis •Diagnosis -Abdominal Xray •Gas in the bowel wall (pneumatosis intestinalis) •Obstructive pattern •Fixed loops of bowel •Free air •Treatment -Bowel rest - NPO -Nasogastric suction -Treat shock -Antibiotics •If perforation: -Laparotomy with resection

Review: Multiple Sclerosis -what is it -what are the symptoms

•Chronic autoimmune inflammatory disorder affecting CNS myelin •Sclerotic plaques (multiple) ( created by breakdown of myelin) •Nerve transmission slowed or blocked •Clinical presentation varied (Because the myelin breaksdown randomly some ppl just have fore production deficit vs if large segments are missing it may present as a SCI) •Characteristic periods of exacerbation and remission - a diagnosis of exclusion demyelination becomes plaques that can be seen by MRI common areas of involvment •optic nerves (Optic Neuritis) •periventicular white matter •spinal cord •cerebellar peduncles Symptoms: - parastheisa - numbness -heat and cold intolerance -hyperpathia: hypersensitivity to minor sensory stimulus - disturbances of proprioception - acute paroxysmal pain common - Lhermitte's sign - chronic neuropathic pain (demyelination spinothalamic tract or sensory root) - musculoskeletal pain -optic neuritis -scotoma -nystagmus -gaze palsy -diplopia -clonus -DTRs -Babinski -slow, stiff, weak movements - reduce strength, endurance -spasticity - fatigue -dysarthria (slurred, trouble with muscles) - dysphonia (vocal quality) -dysphagia (swallowing) - cognitive - impaired attention and concentration -slowed processing -impaired recent memory -impaired executive functions - depression -emotional changes -cardiovascular dysautonomia -urinary bladder dysfunction - bowel dysfunction -sexual dysfunction -ataxia -postural tremors -intention tremors -hypotonia -loss of balance -scissoring

Hypoxic-ischemic encephalopathy - clinical features mild to sever - treatment 4

•Clinical features -Mild - hyperalert -Moderate - lethargy, hypotonia, seizures -Severe - coma, flaccid, seizures, decreased brainstem function •Treatment -Fluid restriction -Assure adequate glucose -Phenobarbital -Therapeutic hypothermia - whole body cooling better

conditions associated with prematurity vs conditions associated wtih postmaturity

•Conditions associated with prematurity -Respiratory distress syndrome (RDS) -Chronic lung disease (CLD) -Patent ductus arteriosus (PDA) -Necrotizing enterocolitis (NEC) -Intraventricular hemorrhage (IVH) -Periventricular leukomalacia (PVL) -Retinopathy of prematurity (ROP) •Conditions associated with postmaturity -Hypoxic-ischemic encephalopathy (HIE) -Meconium aspiration syndrome (MAS) -Persistent pulmonary hypertension (PPHN)

Review: Dizziness vs vertigo vs light headedness

•Dizziness: distortion of spatial awareness the room is turning •Vertigo: false sense of rotation or linear movement i am turning •Lightheadedness/Presyncope: feeling of faintness

Intraventricular hemorrhage (IVH) - what is it 2 - signs 6 - grades 4

•Fragile germinal matrix •Changes in blood pressure leading to changes in cerebral perfusion pressure (lack of autoregulation) •Signs of significant hemorrhage -Shock -Anemia -Metabolic acidosis -Change in consciousness -Seizures -Bulging fontanel Grades •Grade I: within germinal matrix •Grade II: blood in ventricle Grade III: I or II with ventricular dilatation Grade IV: blood in the brain parenchyma

what causes autism

•No cause identified •Genetic component (increased rate of ASD in siblings)4 •Erratic process of neuron genesis/death, migration, differentiation and maturation4 •Increases white and grey matter volumes: enlarged caudate nucleus and basal ganglia; hippocampus (dentate gyrus)2 •Cerebellum: Purkinje cells anomaly and differences in cerebellar activation of zones responsible for social communication and movement integration3 irreregular synaptic prunig of purkinje cells

Bronchopulmonary Dysplasia(also know as chronic lung disease) -what is it 1 - symptoms 3 - treatment 4

•Oxygen + pressure + time in a surfactant deficient lung •Symptoms and signs -Persistent oxygen requirement -Tachypnea, increased work of breathing -Hypercarbia •Treatment -Nutrition -Diuretics -Oxygen -Steroids

Patent ductus arteriosus (PDA) - what is it 1 - clinical features 5 - treatment 4

•Persistent left to right flow through the ductus arteriosus •Clinical features -Tachypnea -Cyanosis -Increased pulse pressure - bounding pulses -Hyperdynamic precordium -Metabolic acidosis •Treatment -Fluid restriction -Positive pressure -Medical ligation of duct with indomethacin -Surgical ligation of duct

premature baby post mature low birth weight very low birth weight extreamly low birth weight

•Premature: < 37+0 weeks • •Postmature: > 42+0 weeks • •Low birth weight: < 2500 grams • •Very low birth weight: < 1500 grams • •Extremely low birth weight: < 1000 grams

conditions associated with prematurity

•Respiratory distress syndrome (RDS) •Chronic lung disease of prematurity (CLD) •Patent ductus arteriosus (PDA) •Abnormalities of fluids, growth and nutrition •Necrotizing enterocolitis (NEC) •Intraventricular hemorrhage (IVH) •Periventricular leukomalacia (PVL) •Retinopathy of prematurity (ROP)

respiratory distress syndrome - what is it - signs 3 - 1 diagnosis 4 treatment 3 prevention

•Surfactant deficiency •Alveolar collapse •Signs -Grunting, flaring, retracting -Tachypnea -Cyanosis •Diagnosis -Chest Xray •Treatment -Oxygen -Positive pressure -Surfactant replacement -Supportive measures •Prevention -Prevention of prematurity -Antenatal corticosteroids -Prophylactic surfactant

PEDI- CAT

●Birth to 20 ●Judgement based ●Completed by the school team ●Measures Daily Activities, Mobility, and Social/Cognitive & Caregiver Responsibility

school functional assessement SFA

●K-6 ●Judgement based ●Completed by the school team ●Measures functional (non-academic tasks) and assistance ●Maintain and Change Positions ●Travel ●Up/Down Stairs ●Manipulation with Movement

what are the 2 main focus areas in peds to use to report results on the participation level of the ICF

*There are many ways to report results on participation, FOCUS ON STRENGTH and AREAS of CHALLENGES

what is the average delay in diagnosis of MD from first noticed signs

2.5 years

Review: how to do the head impulse test what is it looking for

AKA head thrust test looks at the vestibular occular reflex to determine if vestinular system is hypo or hyper functioning apply rapid rotation of head 20 degress in the plane of tested canal while patient looks at my nose hypofunction or hyperfunctoin is eyes have to snap back to the nose after movement undershoot = hypoactive - corrective saccade in a direction opposite to the head motion overshoot= hyperactive - corrective saccade in same directoin of head motion

Retinopathy of Prematurity (ROP) - what is it 1 - pathogenesis 3 - risk factors 9

Alteration in retinal vascular development in premature infants Pathogenesis -reaches maturity 42-43 weeks -vessels may respond to hypoxia or hyperoxia by constricting -neovascularization Risk Factors •hyperoxia, hypoxia •hypercarbia, hypocarbia •acidosis, alkalosis •severe apnea •blood transfusions •sepsis •IVH •multiple birth •bright-light exposure

Americans with Disabilities Act (ADA Section 504 IDEA

Americans with Disabilities Act (ADA Section 504 - life time - No otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. to be eligible for 504 plan must meet all 3 1. A physical or mental impairment (has a history of having a physical or mental impairment) 2. That substantially limits 3. One or more major life activities (breathing, walking, learning, eating, etc.) IDEA individuals with disabilities education act part C IDEA - birth - 3rd Part B IDEA - 3rd- 22nd 4 parts - Part "A" general provisions - Part "B" required services to learners without disabilities, age 3-22 -Part "C" required services to children with disabilites birth-3 - Part "D" federal funding 6 Pillars of IDEA - individualized education plan - FAPE free and appropriate public education - LRE least restrictive environment - appropriate evaluation and assessments - participation:parent and teachers -procedural safeguards/ due process

Arthogryposis Multiplex Congenita (AMC)

Arthrogryposis multiplex congenita (AMC) refers to the development of multiple joint contractures affecting two or more areas of the body prior to birth. A contracture occurs when a joint becomes permanently fixed in a bent or straightened position, which can impact the function and range of motion of the joint.

what does BPPV stand for ? what causes it?

Benign (not life threatening, not progressive) Paroxysmal (sudden vertigo, spinning) Positional (triggered by head position) Vertigo Cause: pieces of otoconia break off and move to SCC (especially posterior canal)

how does this treatment work for spastiticty in CP: Botox

Botox

how to test AROM in peds

Cervical rotation: •in supine for infants < 3 months old •Sitting on parent's lap, enticing to look for a toy, using a rotating stool Cervical Lateral flexion: •Muscle Function Scale •Combined lateral flexion and rotation •Roll supine to prone to R/L Active neck extension and rotation (infants, for safety): •Prone Active neck and trunk extension (older children) : •Superman, snake Active neck and trunk flexion: •Pull to sit •Supine tucked position (older children) Trunk lateral flexion/righting: •Sitting on therapy ball •Banana, tree in the wind (older children) UEs and LEs: symmetric, reciprocal use, neglect Muscle fuctional scale for strength and endurance

gait changes in Huntington's Disease

Chorea -Wide-based -Staggering gait Bradykinesia/hypertonicity -Slow, stiff unsteady

eye changes in Huntington's Disease (5)

Diminished saccade Decreased velocity of eye movement Delay initiating movement Over or undershooting Smooth pursuit impaired Severity of eye movement based on stage of disorder

are boys or girls more likly to have autism

boys are 4x more likly

DSM 5 criteria for developmental coordination disorder (DCD)

DSM 5 Criteria A.Coordination, speed and accuracy of movement below what is expected for age and opportunities to develop skills. B.Interferes with academic achievement or ADLs C.Onset is in the early developmental period D.No identifiable medical or neurological condition that explains their coordination problems.

what is SIDS

Death of a seemingly health infant during sleep prone sleeping tripled risk •Still most common cause of death between 1-12 months of age (highest risk between 2-4 months)

movement changes in Huntington's Disease

Early choreic movments (dance) - masked as voluntary - increased by cognitive effort, emotions, motor tasks - ms strength normal - may have bradykinesia - normal ms tone -reflexes normal later - rigidity - increased chorea - increased bredykinesia

etiology of developmental coordination disorder (DCD)

Etiology - largly unknown - possibley realated to cerebellum and action observatoin network

facio-scapulohumeral muscular dystrophy

Facioscapulohumeral muscular dystrophy (FSHD) is a disorder characterized by muscle weakness and wasting (atrophy). The disorder gets its name from muscles that are affected in the face (facio), around the shoulder blades (scapulo), and in the upper arms (humeral).

true or false spastic limbs have bigger ms in CP

False ´Smaller volume compared to non spastic limb (by 28%) and compared to controls (by 50%)

genetics vs genomics

Genetics: scrutinizes the functioning and composition of the single gene Genomics: addresses all genes and their inter relationships in order to identify their combined influence on the growth and development of the organism

why is there a greater risk of SIDS while prone

Greater risk of aspiration when prone because trachea is below esophagus Reflux and deglutition both risk for aspiration when infant is in prone

what is IDEA Individuals with Disabilities Education Act

IDEA individuals with disabilities education act part C IDEA - birth - 3rd Part B IDEA - 3rd- 22nd 4 parts - Part "A" general provisions - Part "B" required services to learners without disabilities, age 3-22 -Part "C" required services to children with disabilites birth-3 - Part "D" federal funding 6 Pillars of IDEA - individualized education plan - FAPE free and appropriate public education - LRE least restrictive environment - appropriate evaluation and assessments - participation:parent and teachers -procedural safeguards/ due process

guiding priciples of IEP

IEP = individualised education program under IDEA

when to refer CMT congenital ms torticollis to PCP

If treatment does not progress 4-6 weeks or plateau: refer to PCP (medical intervention is surgical release)

internal model abnormailty in autism

Internal model abnormality: hart to learn things in different settings, when you teach them something we need to advocate trial and erroer rather than just repition because it will promote them to learn something as general knowledge that they can apply in other settings

do ppl with Autism rely more on proprioception or vision

Learn new task by depending more on proprioception than visoi Uses proprioceptive errosr more in feedback Looks like PT has to move their limb so they can feel the movment in space

how to diagnose Huntington's Disease

MRI genetic testing

22Q 11.2 Deletion syndrome

Medical problems commonly associated with 22q11.2 deletion syndrome include heart defects, poor immune system function, a cleft palate, complications related to low levels of calcium in the blood, and delayed development with behavioral and emotional problems. The number and severity of symptoms associated with 22q11.2 deletion syndrome vary. However, almost everyone with this syndrome needs treatment from specialists in a variety of fields Heart murmur and bluish skin due to poor circulation of oxygen-rich blood (cyanosis) as a result of a heart defect Frequent infections Certain facial features, such as an underdeveloped chin, low-set ears, wide-set eyes or a narrow groove in the upper lip A gap in the roof of the mouth (cleft palate) or other problems with the palate Delayed growth Difficulty feeding, failure to gain weight or gastrointestinal problems Breathing problems Poor muscle tone Delayed development, such as delays in rolling over, sitting up or other infant milestones Delayed speech development or nasal-sounding speech Learning delays or disabilities Behavior problems

what ms loose strength the most rapidly in muscular distrophies

Muscles performing the most eccentric activity loose strength more rapidly -hip extensors, knee extensors, and ankle dorsiflexors

how many ppl have hearing loss

Nearly 1 in 8 Americans 12 and older (both ears) = 3rd most common chronic condition3

interventions for CMT congenital ms torticollis

Neck PROM repeat 10X 10X a day - stretching should not be painfull to baby and stopped if infant resists or parent perceives changes in breathing or ciruculatoin - low intsisty, sustained avoid micro traum neck and trunk AROM - standard or care - affected side down toys on affected side for infant to turn head towards the tighter side development of symmetrical movement environmental adaptations parent/caregiver education alternating feeding side to side tummy time = supervised prone 3x or more/daily (60 min total) Full ROM Prevent preferences Soft tissue mobilization if level 1 uCranial orthosis is standard of care for plagiocephaly IF accompanied by CMT or developmental delay micro-currents level 1 Tapping not supported!!!

Review: 3 classifications of Peripheral nerve injuries PNI

Neuropraxia -mild compression injury -sheath is "dented" -no damage to axon - examples: hitting funny bone, foot falling asleep Axonotmesis - more severe -axon not cut through compleatly -longer recovery Neurotmesis - axon cut through - spouting needed to heal - may not have full sensory or motor post healing

What pediatric assessment tools are within the participation level of the ICF

PEDS-QOL -Pediatric Quality of Life SFA - School Function Assessment CAPE/PAC -Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children -CAPE=what they currently do -PAC= if you had no limitaitons what would you like to do MABC2-Checklist -Movement Assessment Battery for Children COPM - Canadian occupational performance measure -parental goals -good for interview to set up participation goals

DTR: peripheral causes vs central causes

Peripheral is SMA and muscular dystrophies Central is CP

cranial orthosis what does it treat? worn how long? what age?

Plagiocephaly mgmt Worn 23 hours / day for 4 to 12 months Start between 4-6 months after 6 months is too late

What pediatric assessment tools are within the body structures and cunctions level of the ICF

ROM Tone Pediatric Balance Scale - Alignment strength Pain

Review: What are the subtypes of MS

Relapsing-Remitting MS (RRMS)-85%* - unpredictable attacks which may or may not leave permanent deficits followed by periods of remission -most common - no progression between attacks - acute attacks with full or residual deficits Secondary-Progressive MS (SPMS) - initial relapsing remitting multiple sclerosis that suddenly begins to have decline without periods of remission - may have plateaus - no recovery between episodes Primary-Progressive MS (PPMS)-10% - steady increase in disability without attacks -possible minor plateaus or remissions Progressive-Relapsing MS (PRMS)-5% - steady decline since onset with episodes on top - progression of disability with clear acute relapses -may not see full recovery after a relapse

Review: Vestibular Neuritis or Labyrinthitis -differencec -s/sx -Dx

S/Sx: -Acute (severe dizziness during ADLs, + when waking up in morning) -Chronic (some asymptomatic while others have chronic dizziness, uncomfortable walking around store, using computer, turning head to speak, closing eyes etc.) Dx: no specific tests exist (process of elimination) •Neuritis (inflammation of the nerve) affects the vestibular branch (associated with balance), resulting in dizziness or vertigo but no change in hearing. The term neuronitis (damage to the sensory neurons of the vestibular ganglion) is also used •Labyrinthitis (inflammation of the labyrinth) occurs when an infection affects both branches of the vestibulo-cochlear nerve, resulting in hearing changes as well as dizziness or vertigo •Primarily viral infections

COPM

Score the important 1-10 Score the performance level 1-10 Score the satisfaction level 1-10 pediatric assesment of the participation level

what is the 504 act

Section 504 - life time - No otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. to be eligible for 504 plan must meet all 3 1. A physical or mental impairment (has a history of having a physical or mental impairment) 2. That substantially limits 3. One or more major life activities (breathing, walking, learning, eating, etc.) The student's present level of performance A goal that a PT might support How much service a PT would be expected to provide The type of service expected by the PT What accommodations that PT might help support

What pediatric assessment tools are within the activity level of the ICF

Shuttle Run - 6 min walk test 30 sec Walk test TUDS - timed up and down stairs TFTS -Timed Floor to Stand TUG GMFM - AIMS - PEDI-CAT -Pediatric Evaluation of Disability Inventory Computer Adaptive Test -on I pad, gives normative age value comparisons PDMS-2 - BOT2 - Movement ABC2 -

spinal muscular atrophy

Spinal muscular atrophy (SMA) is a disease that robs people of physical strength by affecting the motor nerve cells in the spinal cord, taking away the ability to walk, eat, or breathe. It is the number one genetic cause of death for infants. SMA is caused by a mutation in the survival motor neuron gene 1 (SMN1) Without enough SMN protein, motor neuron cells become weaker and weaker and eventually stop working, lose all function, and die. As a result, things many of us take for granted, like breathing, eating, speaking, and lifting the head, become difficult. Once motor neuron cells die, they cannot be brought back.

symtpoms of developmental coordination disorder (DCD)

Symptoms - planning a motor task -organizing movements - performing a coordinated action - adjusting movements -motor learning deficits -impaired balance concerns by age progression: First motor than, self-care, academic impact followed by lasting behavioural/emotional secondary consequences

treatment for developmental coordination disorder (DCD)

Task-oriented approach (Neuromotor Task Training) -use concrete activity - practice in real life environments -grade the intensity of the activity Motor learning approach - procide instructions -provide opportunities to practice - provide feedback Congnitive approach "they need to learn to learn" - goal, plan do check - use specific strategies - use mental or self verbalizaion -transfer and generalize strategies - the M.A.T.C.H approach - help everyone to know about the childs DCD - they take longer at taks - enhance childs motivation - assitst children to monitor their performance good activities: Swimming Karate Skating Skiing Cycling Dance

Review: Caloric Testing

Test for horizontal canal and superior vestibular nerve only •Unilateral vestibular hypofunction à if >20% responses asymmetric -<20 deg/s can suggest b/l vestibular loss ->200 deg/s can suggest cerebellar dysfunction -PTs do not do this warm water = increase firing of vestibular nerve cold water = decrease firing of vestibular nerve COWS: Cold Opposite, Warm Same. Cold water = FAST phase of nystagmus to the side Opposite from the cold water filled ear Warm water = FAST phase of nystagmus to the Same side as the warm water filled ear - not used with BPPv - falling towirds side of deficit - measure the differance

the 5 Cs of developmental coordination disorder (DCD)

The 5 C's of DCD common - 5-10% clumsy - physically awkward and uncoordinated - bump into ppl and things chronic health condition - life long co-occurring conditions -ADHD 50% - specific language impairment 35% consequences - without intervention secondary complications: social isolation, health issues, low self-esteem

PEDI-CAT

The Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) measures abilities in three functional domains: Daily Activities, Mobility and Social/Cognitive. The items are written in plain language. It is a survey that parents complete on a computer or mobile device. It provides a normative standard score (percentile score and T score). The detailed report allows you to identify goals for program planning.

The triple-risk model for SIDS.

The triple-risk model for SIDS.

M-ABC2 Checklist

This M ABC2 "checklist" is NOT a participation tool per say although it includes some participation items. It is more at the activity level of the ICF. The M ABC2 "test" is really not functional and more focused on identifying balance and visual motor coordination difficulties. The checklist however cover a variety of functional activities. It also includes NON-MOTOR factors that may impact a child's ability to learn motor skills or perform them. It is scored on a scale of 0 to 3. If the child can do the task, they get a 0 or a 1 (if they do it "very well" or "just ok") if the child cannot do the task, they get a 2 or a 3 (if they can "almost" do it or "not close") The higher the score, the greater the risk for having a significant motor disability. The scores are organized by ages (5 to 12 years old) and provide a level of risk to help with decision making: red (definite, needs more assessment), amber (at risk, monitore or assess further) or green (no risk)

· Question 46 Which of the following assessment tools would best assess a patient's functional problems related to vestibular dysfunction? a. Balance Evaluation Systems Test (BESTest) b. Bithermal caloric testing c. Manual muscle testing d. Auditory brainstem response

a. Balance Evaluation Systems Test (BESTest)

· Question 29 A person with MS is referred to physical therapy after having been diagnosed with MS 3 years ago. The person's speech sounds very rough and hoarse. This type of abnormal sound would BEST be described as: a. Dysphonia b. Dysarthria c. Dysphagia d. Diplopia

a. Dysphonia

semont maneuver

another way to treat posterior canal BPPV not as good as Epley

diagnosis and treatment of: anterior canal BPPV posterior canal BPPV horizontal canal BPPV

anterior canal BPPV Diagnosis: Dix-Hallpike (downbeat nystagmus)+ to the side that is down Treatment: reverse epley posterior canal BPPV - most common 90% Diagnosis: Dix-Hallpike (upbeat nystagmus) + to the side that is down Treatment: Epleys manuver or semont (start turne dtwords the bad side finished sidelying with turned twords the good side down) horizontal canal BPPV - second most common 10-20% Diagnosis: roll test aka BBQ test (+ is the side that is down) Treatment: Gufoni's manuver of BBQ treatment (AKA lampert manuver)

· Question 31 An appropriate intervention for diabetic clients to prevent or slow the progression of neuropathy is: a. Brisk walking for at least 8 hours a week for 8 weeks b. Brisk walking for at least 4 hours a week as a lifelong activity c. Resistance training of major muscle groups at least 3 times a week d. Daily electrical stimulation to involved muscles

b. Brisk walking for at least 4 hours a week as a lifelong activity

· Question 43 Standardized Outcome Measures should ALWAYS be used in adult and pediatric neurological practice to: a. Develop a movement diagnosis and guide POC b. Develop a home exercise program to support re-testing success c. Justify reimbursement d. Substantiate need for discharge to non-skilled services

b. Develop a home exercise program to support re-testing success a. Develop a movement diagnosis and guide POC

· Question 33 When the polio virus selectively attacks the anterior horn cell, this causes what of the following symtoms? a. Clasp knife phenomena b. Flaccid paralysis c. Hyperreflexia d. Spasticity

b. Flaccid paralysis

· Question 36 Which one of the following symptoms is atypical for patients with multiple sclerosis? a. Neurogenic fatigue b. Flaccid paralysis c. Visual loss d. Sensory paresthesia

b. Flaccid paralysis

· Question 6 An initial evaluation is conducted for a 35 year-old male patient who has been diagnosed with recent left ear labyrinthitis associated with severe vestibular signs and symptoms. Which mechanism of recovery might best be used to guide the plan of care? a. Adaptation b. Habituation c. Substitution d. Compensation

b. Habituation

· uestion 14 A person had unilateral eye pain with transient loss of vision, then presented 6 months later with weakness in the left lower extremity that resolved, now is presenting with the same left lower extremity weakness. The diagnosis is multiple sclerosis. This presentation would most likely describe: a. Primary progressive b. Progressive relapsing c. Relapsing-remitting d. Secondary progressive

c. Relapsing-remitting

· Question 2 Which of the following would be characteristics of a peripheral vestibular pathology? a. Sudden onset of vertigo with vertical nystagmus and nausea b. Gradual onset of dizziness with torsional nystagmus and hearing loss c. Sudden onset of vertigo with torsional/horizontal nystagmus and hearing loss d. Gradual onset of dizziness with vertical nystagmus and upper limb weakness

c. Sudden onset of vertigo with torsional/horizontal nystagmus and hearing loss

· Question 47 Gaze stabilization exercises are the PRIMARY exercise focus if someone is diagnosed with: a. Benign Paroxysmal Positional Vertigo (BPPV) b. Parkinsons Disease c. Unilateral Peripheral Vestibular Disorder d. Diffuse Axonal Injury

c. Unilateral Peripheral Vestibular Disorder

· Question 44 Exercise guidelines for individuals with Post-polio syndrome are: a. not recommended because it leads to known progression of the syndrome b. recommended at high levels of intensity c. recommended at moderate levels of intensity d. recommended only if focus is on strengthening of uninvolved muscles

c. recommended at moderate levels of intensity

· Question 20 The most appropriate initial exercise progression for a patient recovering from GBS with limb muscle strength ranging between P+ (2+) to F− (3−/5) strength is: a. Functional based exercise → light progressive resistive exercise → active range of motion b. Passive range of motion→ active range of motion gravity-eliminated → active range of motion against gravity c. Active range of motion against gravity → light progressive resistive exercise → functional-based exercise d. Active range of motion gravity-eliminated → active range of motion against gravity → light progressive resistive exercise

d. Active range of motion gravity-eliminated → active range of motion against gravity → light progressive resistive exercise

· Question 8 A patient reports difficulty with holding eating utensils and writing but denies difficulty when using the left hand. Upon physical examination, fasciculations are noted in the right upper extremity, as well as a positive neuropathy. Which of the following is the MOST likely diagnosis? a. Acute poliomyelitis b. Charcot-Marie-Tooth disease c. Guillain-Barré syndrome d. Amyotrophic lateral sclerosis

d. Amyotrophic lateral sclerosis

· Question 38 A patient who presents with spontaneous down-beating nystagmus that does not change with visual fixation most likely has: a. Ménière's disease b. Bilateral vestibular nerve function loss c. Unilateral vestibular nerve hypofunction d. Central vestibular dysfunction

d. Central vestibular dysfunction

· Question 49 What is the most common, and often the most disabling symptom associated with MS? a. Spasticity b. Pain c. Depression d. Fatigue

d. Fatigue

Huntington's disease

fatal progressive hereditary (autosomal dominant) - if you have the gene you will develop dz symptoms start in middle age normally 30-50 there is a juvenile form <20 years old prognosis: uFatal uGenerally 15-20 years after onset Presentation: - movement abnormalities (chorea, rigiidity, bradykinesia) - bradykinesia -hypertonicity -dysarthira -dysphagia -cochexia (ms waisting) - sleep disorders - urinary incontinence - personality changes lack of awarness of cognitive deficits - difficult multi tasking - diffiuclt putting tasks inorder -Dementia - brain tissue changes ( basal ganglia atrophy, ventricals enlarged, brain volume decreases, white matter changes) - eye movement ( diminshed saccade, decreased velocity of movements, delayed movements, over or undershooting, smooth pursuits impaired) severity of eye movement based on stage of disorder

what to ask when looking at participation status in babys

feeding sleeping tummy time time in equipment/position devices

Review: what are the F-words in childhood disability

fitness function friends family fun future

Review: unilateral vestibular hypofunction disorders

fixed -vestibular neuritis unstable - meniere's disease - acoustic neuroma -superior canal dehiscence SCD

Review: how to test saccades if abnormal is is a central or peripheral dysfunction

have the patient look back and forth between two points in a horizontal, vertical, and diagnol directions normal is hittign the target abnormal = central dysfunction

management guidlines for BPPV

horizontal = gufonis manuver or bbq treatment (lempert manuver) posterior = epleys manuver anterir= reverse epleys •BPPV can occur b/l. Can tx both side if tolerated by the pt. Advisable to wait ~10 mins between Tx. •Treat BPPV prior to balance/VOR exercises •Recurrence rateà in 1 year: 25%, in 2 years:44% •Daily performance of maneuvers does not appear to reduce the recurrence rate

Review: how to test smooth pursuits if abnormal is is a central or peripheral dysfunction

how to test: have the eyes track an object moving in a + sign and a X sign normal is smooth tracking abnormal = central dysfunction

Gufoni's Maneuver

how to treat horizontal canal BPPV also BBQ ( lempert manuver) used

BBQ treatment (lempert maneuver)

how to treat horizontal canal BPPV also Gufoni's manuver can be used turn towrds bad side

Persistent Pulmonary Hypertension of the Newborn (PPHN) - pathophysiology 4 - underlying conditins 7 - management 6

pathophysiology circular flow of - hypoxemia - increased pulmonary vascular resistance - decreased pulmonary flow - shunting across PDA and PFO back to hypoxemia Underlying conditions •meconium aspiration syndrome (MAS) •perinatal asphyxia •sepsis/pneumonia •respiratory distress syndrome (RDS) •congenital diaphragmatic hernia (CDH) •pulmonary hypoplasia •primary pulmonary hypertension Management •oxygen •alkalosis •gentle hyperventilation •sedation •increase systemic vascular resistance •"pulmonary vasodilators": non-selective

what is mean rotation and lateral flexion for babys

rotation = 110 lateral flexion = 70

action of the sternocleidomastoid ms

same side SB opp rotation opp side of ms is where head flattening occures

what is plagiocephaly? what is brachycephaly? what is scaphocephaly?

scaphecephaly is due to early closing of crainal sutures

Review: how to look for spontaneous nystagmus peripheral spontaneous nystagmus vs Central

steps to look for spontaneous nystagmus 1)Look straight ahead (I look for nystagmus) 2)Look at my nose- have them fixate on target ( look for nystagmus) (If its peripheral nystagmus will decrease with fixation), step 2 if central PT does not treat

Plagiocephaly mgmt

supervised prone 3x or more/daily (60 min total) Full ROM Prevent preferences

recommended tummy time

supervised prone 3x or more/daily (60 min total) Full ROM Prevent preferences start within 2 days of birth

how does this treatment work for spastiticty in CP : Intrathecal baclofen

the internal pump

Duchenne/ Becker Muscular Dystrophy (DBMD)

they are two different types of muscular dystrophies more common in boys, x-linked recessive signs/symtpsoms - ms weakness - delayed walking - waddling gait - calf pseudohypertropohy (due to fat a fibrosis) - gowers sign -respiratory failure caused by bad dysrophin

what are the 2 unintended consequences of having babys only sleep on there backs

torticollis plagiocephaly (head flattened on 1 side, associated with torticollis) prevent these by having tummy time- want at least an hour a day of supervised tummy time

part C vs part B of IDEA

transitioning: part c terminates immediatly on 3rd b day - part b starts 90 days before 3rd b day

true or false Genetic factors have been found to be associated with cardiorespiratory, cardiovascular, and skeletal muscle fitness performance and training responses.

true Genetic factors have been found to be associated with cardiorespiratory, cardiovascular, and skeletal muscle fitness performance and training responses.

prognosis of Hunitgtons dz

uFatal uGenerally 15-20 years after onset

What is Congenital Muscular Torticollis (CMT)? what are the types

uPostural deformity of neck seen at birth or soon after birth uIpsilateral neck flexion and contralateral rotation due to unilateral shortening or fibrosis of SCM muscle uNamed for the side of the involved SCM u90% of children with CMT have plagiocephaly uPlagiocephaly most likely is a result of CMT uCraniofacial asymmetries also co-occur with CMT

Conditions associated with postmaturity 4

•Perinatal asphyxia •Hypoxic ischemic encephalopathy (HIE) •Meconium aspiration syndrome (MAS) •Persistent pulmonary hypertension of the newborn (PPHN)