744 final

absence occurs within the long axis of the limb, occur more frequently than transverse, name bone affected in a proximal to distal sequence, then whether each affected bone is totally or partially absent

Longitudinal deficiencies

why are bones damaged in JIA?

Low nutrition = low weight = low PA = fracture risk (long term steroid use)

What are 2 ways of determining TBSA for children?

Lund-Browder Chart: estimates relative percentage of TBSA affected by growth, Most accurate method for estimating burn extent and MUST be used in evaluation of all pediatric patients Rule of Palm: Size of PATIENT's hand not caregiver equals 1% of TBSA of patient's body, Useful tool when burns are irregularly shaped

Who composes the Individualized Family Service Plan for early intervention services?

family and service coordinator

what are the core values of early intervention

family- centered developmentally appropriate individualized in natural environments train/ equip the parent/ caregiver collaborative

to have a joystick on a wheelchair you only need -- control

finger

orthotic for a kid with severe crouch and no active DF or PF(knees would collapse into flexion without the braces) typically kids with MM. Sink into excessive dorsiflexion through weakness. Lack plantarflexion strength. Can extend at the knee and hip when manually repositioned during weight bearing. Are not crouching due to tight hip flexors, hamstrings.

floor reaction AFO

For patients who exhibit very mild pronation and have a fully correctable foot position. The patient's medial arch is reduced yet visible. Forefoot abduction and heel eversion is minimal. For patients who may benefit from the sensory feedback that a -- can provide.

foot orthosis

skin is red/pink and blanches with pressure, no blisters/raw areas, can be painful Ex: sunburn, healing time < 7 days No intervention typically warranted

1st degree/superficial

normally the neural tube starts closing on day -- and completes closing on day --

21 28

At what age does the transition plan (from EI to preschool) begin?

27 months

blisters present/ruptured with raw areas, color varies from red/pink to areas of white mottling or dark red, wet to waxy dry appearance, painful with pressure healing time: > 20 days intervention: debridement, likely grafting

2nd degree/deep partial thickness

What are the criteria for referral to "newborn follow up clinic?"

- <1000 grams, <30 weeks, HIE: head cooling, specific studies - Specialty clinics for BPD, neurology, GI, pulmonary - Outpatient PT and/or OT: for monitoring, addressing specific needs - Early intervention: diagnosis or delay >25%

What are the criteria for referral to Early Intervention in Alabama?

- 25% delay or medical diagnosis (this program emphasizes parent support rather than "frequent/direct therapy" so may also refer to outpatient therapy (feeding problems, toe walking, parent concerns))

What ages of children are appropriate to receive early intervention services?

- Child birth to three years of age who have a: o Qualifying diagnosis Medical, documented by physician 1 five-part developmental eval o Qualifying delay Based on 2 evaluations • 2 five-part developmental evals or 1 fivepart developmental eval AND 1 discipline-specific eval Conducted by 2 qualified professionals from different disciplines 25% or greater delay in at least one area on both instruments

In what setting does Early Intervention occur?

- EI is provided where children & families typically are: home, daycare, etc. - EI services must include the daily activities & routines of the family.

basic components of the NICU evaluation

- Early focus on risk assessment - Assess development based on adjusted age - Muscle tone - Reflexes: developmental, righting, tendon - Joint range and integrity - Bone alignment - Impact of diagnoses and surgeries - Movement - Endurance - Strength - Alertness - Tolerance to handling (vital signs/stress signals) - Sensory processes

What is the purpose of IDEA, Part C?

- Enhance the development of infants and toddlers with disabilities - Reduce educational costs by minimizing the need for special education through EI - Minimize the likelihood of institutionalization and maximize independent living - Enhance the capacity of families to meet their child's needs - Utilize practices from scientifically-based research

members of the EI team

- Family members - Caregivers - Service coordinators - Service providers - Support staff - Manager/administrator - Other agency staff - Medical/clinical partners

describe the core values of EI

- Family-centered o Services and supports should be aimed at helping the family support and care for their child (more than child directed treatment) o Services should be aimed at supporting families in their role as parents and helping them by providing formal and informal services to make a developmental difference o Families' needs and concerns should be continually revisited - Developmentally appropriate o It is EI philosophy that training is offered to families with consideration for the projected developmental track of the child based on any number of factors - Individualized o Family defined outcomes and the interventions address these outcomes, should be as individualized as the families we serve o No two IFSPs should look alike because the functional needs of the children and families we serve are different o EI services should be individualized to meet the needs of the child/family outcomes o EI services could change in terms of frequency and length based on the progress towards meeting outcomes - In natural environments o EI is provided where children and families typically are: home, daycare o Natural environment, however, is more than just a place, EI services must include the daily activities and routines of the family o Providing services in an artificial environment is not considered an appropriate natural environment - Train/equip the parent/caregiver o EI is a family/caregiver training program o The child's development is the primary responsibility of the family o It is the EI's responsibility to aid and support families in this process by: Teaching the families the skills they need and emphasizing that frequent practice is needed to assure skill development and retention Making practical suggestions and modeling strategies that git in their everyday routines Addressing the family defined outcomes identified during the family assessment that will address the individualized challenges of the family/caregiver - Collaborative o All family needs cannot be met by EI alone o Establishing community partnerships (informal supports) to assist with family concerns is a must o Collaborating with agencies such as CRS (i.e clinics) to assist families in meeting their needs is part of a service coordinator's role, if needed, and a big part of how EI assists families

What is an IFSP and when must it occur following referral to EI?

- Individualized Family Service Plan: Family defined outcomes & the interventions to address these outcomes, should be as individualized as the families we serve - 45 days

basic components of treatment for neonates to include the importance of developmental teaming with the family and nursing to promote developmental care

- Movement, positional changes - Stretches - Splinting - Address state control - Positioning to calm, allow freedom of movement and minimize torticollis, plagiocephaly, hip dysplasia, asymmetry - Caregiver teaching - The importance of developmental teaming with the family and nursing to provide developmental care is to guide nurses and families on positioning, play, and interactions that affect how the baby will grow and learn

What is the focus of PT/OT assessment in the newborn follow up clinic?

- Muscle tone - Range-of-motion/alignment - Quality of movement - Reflexes: developmental and tendon - Development of head/trunk control, sitting, standing/walking, hand skills, eating

What professionals are included in newborn follow up clinic?

- Pediatrician - Nutrition - PT and OT - Audiology - Research coordinator - Clinic coordinator/NP

What are some of the musculoskeletal issues that can occur due to poor positioning, and how does the PT help to prevent these?

- Plagiocephaly - Tightness in neck muscles - Tightness in scapular retractors - Tightness in hip external rotators - Tightness in foot/ankle everters - Pt can help prevent these issues by using wedges, rolls, stretches, creating a position plan,

What is the purpose of the IFSP? Who writes the IFSP goals?

- Resources - Current level of development - Concerns - Outcomes - Plan for services o What services? o What providers? o Where? o How often? - Plan for transition - Who writes the IFSP goals? - family and therapist associated with each department, goals are written as a team

What is the FOCUS of early intervention as presented by Dr. York?

- To train and equip and support parents and caregivers in being the first and best teacher for their child - So that they can help their child develop according to his/her individual needs - Be able to continue to help their child develop when he/she transitions from EI

collaborative model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

- entire team, student - learning environment and other natural settings - educationally related activities - ongoing intervention, discipline referenced, knowledge shared among team members, so relevant activities occur thought the day -team - organized around life domains in ecologic curriculum

relational goal oriented model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

- entire team, student, -learning environment or other natural settings - emphasis on overachieving goals and desired outcomes that require relationship skills -customized -team - short term to have positive child experience, midterm to reduce impairment, optimize function, and enhance participation, long term to optimize adaptation and adjustment

monitoring model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

- student - learning environment, therapy are if necessary for specific child - emphasis on ensuring that child maintains status to benefit form special education -intermittent depending on needs of pupil, may be as infrequent as once in 6 mos. - PT - specific to being able to maintain educational program

consultative model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

- teacher, parent, aide, student, - learning environment and other natural settings -educationally related activities, positioning, adaptive materials, emphasis on adapting to learning environment and generalization of acquired skills -intermittent or as needed, depending on needs of staff or pupil -teacher, parent, aide -specific to educational program

Direct model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

-student -distraction free environment, specialized equipment needed - educationally related functional activities, specific therapeutic techniques that cannot safely be delegated, emphasis on acquisition of new motor skills - regularly scheduled sessions, generally at least weekly -Pt/PTA -specific to therapy programs as related to educational needs

integrated model: therapist primary contact- environment for service delivery- methods of intervention- amount of actual service times- implementer of activities- IEP objectives-

-student, teacher, parent, aide -learning environment and other natural settings, therapy area if necessary for specific child -educationally related functional activities, positioning, emphasis on practice of newly acquired motor skills in daily routine -routinely scheduled, flexible amount of time depending on needs of staff or pupil - Pt,PTA, teacher, parent, aide, OT, OTA -specific to educational program

Classification System (7 categories) "Methods of Describing Limb Deficiencies Present at Birth"

1) Failure of formation of parts 2) Failure of differentiation 3) Duplication 4) Overgrowth 5) Undergrowth 6) Congenital constriction band syndrome 7) Generalized skeletal deformity

why are muscles damaged in JIA?

1. Alterations in anabolic hormones 2. Production of inflammatory cytokines 3. High resting energy metabolism 4. Abnormal protein metabolism 5. Motor unit inhibition from pain and swelling 6. Disuse

DCD participation/ environmental factors

1. Doors too heavy to open 2. PE is competitive and skill oriented 3. Time to dress and undress reduces participation in recess and readiness for home and community activities 4. Slow and messy written communication in class limits academic performance

JIA-expected impairments at the body structure/function level of the ICF: physical fitness- health and performance related

1. HEALTH RELATED FITNESS a. VO2 peak i. 21.8% lower in children with JIA compared to healthy controls 2. PERFORMANCE RELATED FITNESS a. Muscle strength & anaerobic capacity b. Peak Work Rate (cycling watts), Peak HR and Exercise Time was lower for JIA compared to healthy controls. c. Kids with JIA work at a higher percentage of aerobic capacity than controls, even during routine daily activities

Describe the recommended frequency of PT services after SDR

1. Inpatient acute phase on Neurosurgery service for 4 days with PT 1 time/day and OT 1 time 2. Inpatient rehab stay Day 5-Day 18: 2 times/day for 6 days/week 3. Hospital discharge to 6 months post-op: 4-5 times per week 4. 6 to 12 months post-op: 3-4 times per week 5. 12 to 36 months post-op: 2-4 times per week, based on individual needs. The frequency will vary during this period and includes intensive bursts of therapy and transitioning into community-based activities 6. 36 or more months post-op: Physical therapy needs will be assessed by the rhizotomy team and recommendation given at the time of follow-up visits.

JIA-expected impairments at the body structure/function level of the ICF: growth disturbances and postural abnormalities

1. Linear growth - slow with extended periods of disease (steroids). 2. Premature closure of growth plates 3. Small hands and feet or 1 small digit 4. Growth - rapid during remission if epiphyses are open. 5. Puberty may be delayed. 6. Osteopenia - increase risk of fracture 7. Leg length discrepancy or radial ulnar growth discrepancies due to bony overgrowth

who is the ideal candidate for SDR

1. Spastic Diplegia with GMFCS of Level 1, 2, or 3 2. Age 3-6 3. Lower extremity spasticity is limiting functional progress 4. No lower extremity contractures; no previous orthopedic surgeries 5. No significant dystonia 6. Child is able to cooperate with therapy follow-up and parental compliance with therapy is good

Why are joints damaged in JIA?

1. Synovial fluid increase stretches and weakens joints, ligamentous laxity and joint instability 2. contractures from intra-articular adhesions and tendon fibrosis • pannus (synovium overgrowth) invades articular cartilage ( eventually degrades), releases inflammatory enzymes, irregular joint space, osteopenia +periosteal new bone

how do you diagnose DCD(4)

1.Substantial motor impairment (Clumsiness, Slowness, Inaccuracy of motor skills (catching, scissors, handwriting, riding a bike, sports)) 2.Significantly and persistently interferes with ADL's and impacts academic productivity, prevocational and vocational activities, leisure and play. 3. Onset of symptoms is in the early developmental period 4. Motor skill deficits are NOT better explained by: intellectual disability (e.g. intellectual developmental disorders) or visual impairment. Neurologic condition affecting movement (CP, Muscular dystrophy, degenerative disorder

MM is diagnosed at -- weeks by --

18 Maternal serum alpha-fetoprotein (> 2.5 MoM) Will not detect skin covered lesions Ultrasound to determine cranial malformations (Chiari II) Amniotic fluid analysis

blisters present/ruptured with raw areas, clear drainage/wet appearance, painful with air exposure/touch healing time 7-20 days Intervention: loose wound dressing with antimicrobial ointment to prevent infection Feet, lower back, and palms more likely to heal than others

2nd degree/superficial partial thickness

According to the 2015 report, what was the employment rate for non-institutionalized adults with disabilities?

34.6% of non-institutionalized, male or female, with a disability, ages 21-64, all races, regardless of ethnicity, with all education levels were employed

skin may be white, grey, black, leathery or charred, may or not hurt after burning process ends(nerve damage, circulation tissues) Healing time: never if > 2% and not grafted Intervention: debridement and skin grafting

3rd degree/full thickness

treatment duration for AML

4-6 months, typically in four 1 month cycles

Concerns typically noted by parents of children with developmental coordination disorder at different ages: self- care

4ish-9ish difficulty using utensils; needs help dressing and grooming, can't tie shoes or do zippers and buttons, messy eater, can't cut meat

STANDING PROGRAMS TO IMPROVE BONE MINERAL DENSITY

5 DAYS PER WEEK FOR 60-90 MIN/DAY May positively affect bone mineral density and ROM (Paleg, 2013) 10-11 months put in parapodium for weight shifting and standing

explain DCD questionnairre

5-15 years of age 15 items (max score is 75) Parent report (ICF: activity) Measures the functional impact of the motor coordination difficulties It is a SCREENING tool not meant to diagnose DCD but is a tool to recommend further testing Download the DCDQ'07 good sensitivity and specificity

Concerns typically noted by parents of children with developmental coordination disorder at different ages: academic

6ish to 11ish awkward pencil grip, difficulty completing written work, gap between verbal ability and performance eon evaluations, frustration with writing and homework

the copm is best for kids with DCD ages

8 and older

treatment duration for osteosarcoma

8-10 weeks of chemo (2 cycles), restaging, surgery, 2-3 weeks rest, 16 weeks chemo (4 cycles)

What is the 5 year survival rate for children with cancer?

> 80% 2nd leading cause of death ages 5-14

there are 4 types of PFFD and -- is least affected and -- is most affected

A(femoral head present) D(femoral head absent)

polyarthritis JIA: a. Clinical signs and symptoms b. Distinguishing characteristics of each c. Common joints affected for each d. Expected outcomes for each (prognosis)

A. Clinical signs and symptoms a. symmetrical, affects both large and small joints b. 5+ joints c. Joints are swollen and warm but not red d. Mild systemic problems: low grade fever, mild/mod hepatosplenomegaly, lymphadenopathy e. Juxta- articular osteopenia, muscle atrophy, weakness, contractures, growth disturbance B. Distinguishing characteristics a. joints are swollen & warm but not red b. systemic issues C. Common joints affected a. might have nodules on elbows, tibia, fingers, erosive synovitis with RF+ b. jaw, c-spine, toes D. Expected outcomes- hip involvement and polyJIA in the 1st year of disease = poor functional outcomes

Oligoarthritis JIA: a. Clinical signs and symptoms b. Distinguishing characteristics of each c. Common joints affected for each d. Expected outcomes for each (prognosis)

A. Clinical signs and symptoms: Low grade inflammation in <4 joints, joint is warm and swollen but not always painful, systemic sings are unusual b.Onset early childhood; peak 2-4 years B. Distinguishing characteristics a. 30% develop iridocyclitis which may lead to functional blindness C. Common joints affected a. knee most common, then ankles/elbow b. spared in hip and hand D. Expected outcomes- good functional outcomes!

L5 lesions

Able to ambulate without orthoses yet require them to correct foot alignment and substitute for lack of push-off. Gluteal lurch is evident unless upper limb support is used. Upper limb support recommended for community ambulation to decrease energy expenditure, protect legs and for safety. Wheelchair (or bike) is useful for long distances 80% achieve independent living status as adults

JIA-expected impairments at the body structure/function level of the ICF: muscle

Acute- spasms and hypertonus (contraction deformities) Subacute/ chronic- muscle atrophy and weakness near affected joints

Describe the clinical method for assessing scoliosis.

Adam's forward Bend Test i. Shoulders asymmetrical ii. Prominent shoulder blade iii. Visible curve iv. Hips asymmetrical v. Waist asymmetrical vi. Upper back hump vii. Lower back hump

What are the current recommendations for aerobic and anaerobic exercise for kids with JIA?

Aerobic: 2x/week @ mod/vig intensity(60-85%Hrpeak), 45-60 min per session 6-12 weeks Anaerobic: • Hypothesis: training of the anaerobic system might be equally as valuable as training the aerobic system. • Suggested dose is 3 sets of 15 high-intensity cycling sprints (15-30 sec HARD) @ 1-2 min active rest and 5 min recovery between sets. • 2-3 times per week

potential causes / risk factors for MM

Alcohol intake (also will have Fetal Alcohol Syndrome) Anticonvulsants (valproic acid or carbamazepine) Maternal pre-gestational IDDM Maternal BMI of > 29

WHAT SUPPORTS CAN DO

Align body parts Help neutralize abnormal muscle tone Present deformity Enhance movement and function Provide minimal cueing to maximal support Enhance autonomic system function (i.e. respiratory, digestion) Promote communication

What is the difference between allograft and autograft?

Allograft (not self): xenograft (pig skin), cadaver, skin substitutes, Surgically debrided then graft applied and held with staples, Allows for good wound bed before "real graft" done, No movement restrictions Autograft (self): most common split thickness skin graft (STSG) Priorities: 1) survival 2) function 3) cosmesis

What is meant by "state control" in a neonate?

Arousal o State 1 deep sleep o State 2 light sleep o State 3 drowsy o State 4 quiet alert o State 5 active awake o State 6 crying

IDEA part D

Authorizes national activities and federal funding to improve education of children with disabilities (e.g. grants to improve the education and transitional services and support programs)

Who is eligible for IDEA?

Autism Deaf-blindness Deafness Emotional disturbance Hearing impairment Intellectual disability Multiple disabilities Severe orthopedic impairment Other health impairment Specific learning disabilities Speech or language impairments Traumatic brain injury Visual impairment including blindness

DCD activity impairments

Awkward, slow gait Delayed and poor quality of fine and gross motor skills, such as hopping, jumping, ball skills, and writing Delayed oral-motor skills

PT assessment MM

Baseline biomechanical assessment Baseline strength assessment Assess functional activities in the developmental sequence. Head & trunk control Mobility (rolling, prone, sitting, quadruped, standing) Based on motor level, prepare family for equipment needs Educate! Refer to OT and ST (if needed) Set goals using the COPM

evidence based assessment tools that PT's will use to assess children in schools: school outcomes measure

Being developed and researched at the University of Oklahoma Minimal data set designed to measure outcomes of students (3-21 yrs) who receive school based PT/OT. Takes 10-15 minutes and is completed by entire team More responsive for students with mild/moderate functional limitations.

What is the greatest obstacle to rehabilitation of children with burns and how do hospitals/PT's overcome this obstacle?

Burns involve the worst pain a human can experience which is the greatest obstacle in rehab i. overcome by acknowledging the child is in pain, allow child to express pain/emotions provide rest breaks, distraction ii. prepare patient, timing of meds before therapy, use reward systems, be firm but flexible iii. breathing techniques/guided imagery iv. analgesics: morphine is most common, versed for anxiety, IV is preferred route (faster)

with MM it is best to have -- birth

C-Section birth: less risk for infection and damage to neural sac.

is determined by the position of the rear wheels and will affect a person's ability to propel a w/c. Moving the -- as far forward as possible without compromising stability will improve function but a -- that is too far forward will cause tipping and falls.

CENTER OF GRAVITY

S1 lesions S2 S2-3 no loss

Can walk without orthoses or upper limb support Weak push-off when running or climbing stairs Mild to moderate gluteal lurch May use FO or AFO to improve foot alignment S2: Decreased push off and stride length S2-S3: no obvious deficits No loss: no bowel or bladder dysfunction

MM Upper limb dyscoordination secondary to:

Cerebellar ataxia due to Chiari II syndrome Motor cortex or pyramidal tract damage secondary to the hydrocephalus Motor learning deficits resulting from the use of the upper limbs for balance and support rather than manipulation and exploration

What are some side effects of chemotherapy and radiation?

Chemotherapy I. Myelosuppression: decreased energy/activity tolerance, infection risk Radiation I. Fatigue: decreased energy/activity tolerance II. Try not to radiate brains in children under age of 3

MM Cranial nerve palsies due to -- causes --

Chiari II malformation Lateral rectus eye muscle wx (CN VI) and esotropia CN IX and X Hoarseness, swallowing difficulty

purpose of IEP

Child's present level of academic achievement Measurable annual goals How goals will be measured & when progress reports will be provided Special ed & related services to meet goals Explanation of extent child will not participate in regular education Accommodations necessary Start date, frequency, intensity, duration, location of services Transition goals and services (16 and up)

what organization publishes the most current recommendations (i.e. consensus treatment plans) of drug therapy for children with JIA?

Childhood Arthritis and Rheumatology Research Alliance

Which children with burns will require IV fluids?

Children with > 10% TBSA burns needs formal fluid resuscitation and iv pain meds

What is the relationship between Down Syndrome and AML?

Children with down syndrome face a heightened risk of developing AML as well as ALL

Describe the posture of a child with CMT

Clinical presentation consists of persistent head tilt towards the involved side with the chin rotated toward the contralateral shoulder

typical DCD presentation

Clumsy & awkward movements Trip over feet and bump into others Unusual gait pattern Unique way of "fixing" or stabilizing joints Reach motor milestones on time Difficulty generalizing learned motor skills across settings

is related to the severity of hydrocephalus, CNS infections, Chiari malformations

Cognitive dysfunction

cognitive approaches for DCD

Cognitive orientation to daily occupational performance (CO-OP) (Cameron, 2017; Scammell 2016) Verbally based strategies that help the child to problem solve movement strategies

increase in participation in PE DCD

Consult with physical educators Strategies to increase participation MATCH strategy: Modify the task Alter expectations Teach strategies Change the environment Help by understanding Find & download a flyer that will help the PE teacher for a child with DCD (CanChild website Resources)

IDEA part A

Defines disability and recognizes that education is more than just academics. Schools must include Assistive Technology as needed. Evaluation, purchasing, coordination with education plans and programs.

What other cranial deformation typically occurs with torticollis and how is it treated?

Craniofacial asymmetry, deformational plagiocephaly Plagiocephaly is a flattened spot of the baby's head and it can be caused by the baby's tendency to sleep with a rotated head Typically treated with a plagiocephaly helmet

why are the 4 evidence based outcome tools to assess kids with DCD

DCD quetionnaire MABC-2 COPM PEGS

DCD participation/ personal factors

Depressed Quits trying to participate/ unmotivated Low self-esteem Poor fitness Activities performed without concern for time restrictions Vocational anxiety

what areas of the brain are affected with DCD

Diffuse areas of the CNS are affected:Thalamus, BG & cerebellum, motor/attention/perceptual processes

task specific approaches to interventions for DCD

Direct teaching of functional skills in appropriate environments. Optimize the way in which skills are performed Allow the child to solve the movement problems: Verbal cueing Physical prompts or assistance Guide and direct so the child can "feel" the efficient movement. Part-whole task Tons of practice

Review the classification of Scoliosis (based on location and direction)

Direction is named by the convexity of the spine Terms that describes the location of the curve: Thoracic scoliosis (90% of curvatures are to the right)- Curvature in the middle (thoracic) part of the spine, Most common location for spinal curvature Lumbar scoliosis- Curvature in the lower (lumbar) portion of the spine Thoracolumbar scoliosis- Curvature in both the lower thoracic portion and the upper lumbar portion of the spine Terms that describe the direction of the curve: Dextroscoliosis- Describes a spinal curve to the right ("dextro" = right), Usually occurring in the thoracic spine, Most common type of cure Levoscoliosis- Describes a spinal curve to the left ("levo" = left)., While common in the lumbar spine, the rare occurrence of levoscoliosis in the thoracic spine indicates a higher probability that the scoliosis may be secondary to a spinal cord tumor. A physician will order an MRI for a thorough diagnosis.

MM and folic acid supplement

Dose depends on family history of MM(.4-4mg/day) Begin 3 months before conception

What is the focus of the PT evaluation for children with burns?

Evaluate within 24 hours of admission (burn scar contracture occurs within 1-4 days of injury Location of burn, TBSA, depth, size, eschar ROM (stiffens 2-4 days up to stiffen up Strength (usually no strength issues unless electrical, common to guard active movement) Sensation (no sensation indicates full thickness burn) Edema (main limitation of ROM at evaluation) Pain Joint involvement/circumferential Functional mobility (bed mobility, transfers, gait, posture, coordination) Potential positioning, splinting needs Social/family situation Frequent re-evaluation

According to the research presented by Dr. Vogtle, how have physical activity interventions helped improve pain and fatigue in adults with CP? What was the difference between results in adults who were ambulatory vs non-ambulatory?

Exercise interventions Improved strength and gross motor function No increase in spasticity Decreased pain and fatigue, increased energy, concentration, improved ADL Significant beneficial changes were found in the pain and fatigue scales among the ambulatory participants during the intervention phase. However the beneficial changes diminished during the follow-up phase. Secondary outcomes examined included, pain interference, daily physical activity and health-related quality of life.

evidence based assessment tools that PT's will use to assess children in schools: PEDI-CAT

Expanded to include children up to 20 years of age. Measures abilities in 3 functional domains: Daily Activities Mobility Social/Cognitive Can be used with all clinical diagnoses and across all settings

How does a child become eligible for ESY?

Extended school years based on: Individual need Nature and severity of disability Educational benefit Regression and recoupment Self-sufficiency and independence Failing to meet short term goals and objectives PT evaluations before and after long breaks could demonstrate need for ESY

describe FMA for amputees

FMA: functional mobility assessment LOOKS AT 6 CATEGORIES: 1. PAIN 2. FUNCTION (TUDS AND TUG) 3. USE OF SUPPORTS OR ASSISTIVE DEVICES 4. SATISFACTION WITH QUALITY OF WALKING 5. PARTICIPATION IN WORK, SCHOOL, SPORTS 6. ENDURANCE (9 MINUTE WALK-RUN TEST

prone lying

Facilitates head control and weight bearing on upper extremities. Would not leave a child in this position if the child has extremely poor head control. If a strong Tonic Labyrinthine Prone reflex is present, the child will have increased flexor tone in this position.

supine lying

Following feeding to control reflux. During sleep to control respiration Able to use vision without having to control head. Eye-hand control is easier Comfortable If a strong Tonic Labyrinthine Supine reflex is present, the child will have increased extensor tone in this position

What are goals of PT interventions for an infant with CA induced developmental delay?

Formal assessment of current developmental level Educating caregivers and staff on age appropriate activities to facilitate gross motor skills Prevention of further delays Referral to OP PT/early intervention as appropriate Special considerations-Infection risk, Treatment schedule, Co-morbidities (Trisomy 21)

L4 lesion

Functional ambulation with AFO's and forearm crutches. Wheelchairs for long distances When first learning to walk, may need KAFO's and walker 20% continue to ambulate as adults

typical musculoskeletal deformities with MM

Forward head Rounded shoulders Kyphosis Scoliosis Excessive Lordosis Anterior pelvic tilt Rotational deformities of the hip or tibia Flexed hips/knees Pronated feet Incidence of fracture - 11-30% - reduce bone mineral density Biomechanical Evaluation is Necessary! hip dysplasia, subluxation, dislocation ok to ambulate if good ROM and level pelvis

Where will the wheels be related to the COG in a manual chair?

Forward: improves mobility and function but too far forward causes tipping and fall

relational goal oriented model of school system PT

Framework: life-needs model of pediatric service delivery Based on the values of the intrinsic worth, dignity, and strengths of individuals Addresses the "why, what, and how?" of service delivery Focus: on the relationship of the client and the entire team Considers attitudes, beliefs, and behaviors Creates culture of empowerment, trust, and respect

treatment of spinal deformities:

Goal: Maintain a balanced trunk and pelvis Orthotic intervention: bivalve Silastic TLSO Surgical fusion after the age of 10 to avoid truncal shortening 10-11 yo in girls 12-13 yo in boys Now have growing systems so can do the surgery at younger ages

explain the perceived efficacy and goal setting (PEGS)

Good for kids too young for COPM (for goal setting) Children indicate their competence in doing 24 daily tasks They can identify other activities that are difficult for them by looking at pictures of activities. Children's goals often differ from that of their parents so it is good to involve the child.

What are special considerations for LE burns?

Greatest hydrostatic pressure in feet/ankles Dependent position: poor venous return, tissue engorgement, edema, bleeding pain Watch for orthostatic hypotension No gait until 5 days post graft Quad/glut sets, ankle pumps, SLR's, dangling regimen prior to gait Fast start: keeps muscle engaged Beware of donor site but do not be limited by it Discourage use of assistive devices

components of a wheelchair from head to toe

Headrest - straps don't work well Occipital supports, need for school bus Trunk laterals Chest Harness- if they can't stay up Armrests: Swing away? Tray Pelvis: 4 point seatbelt- to help keep pelvis tucked back Wedged seat-higher in front than back to keep them from pushing out Hips: Hip guides and/or abductor pommel Swing away laterals? Legs: Extending leg rests Troughs; calf rests Feet: Footplate vs shoe holders Swing away

high level lesions (thoracic to L2) typical presentation

Hip flexion, abduction, external rotation contracture Measure hip extension in prone to protect spine Knee flexion contracture Ankle plantar flexor contracture Lordosis of the lumbar spine Scoliosis (90% have it)

mid to low lumbar lesions (L3-L5) typical MS presentations

Hip/Knee flexion contractures Increased lumbar lordosis Scoliosis (40% mid lumbar and 10% of lower lumbar have it) Genu and calcaneal valgum Pronated feet when bearing weight Walk with pronounced crouch gait Bear weight primarily on their calcaneus

treatment duration for ALL

I. 2-3 years depending on risk stratification II. induction, consolidation/intensification, maintenance

What are the 4 most common CA diagnoses seen by PT's for children 0-14 years

I. Acute lympocytic leukemia II. Brain and CNS III. Acute myeloid leukemia IV. Bone tumors

What are the 4 most common CA diagnoses seen by PT's for children 15-19

I. Brain and CNS II. Acute lympocytic leukemia III. Bone tumors IV. Acute myeloid leukemia

Describe goals of PT intervention in regards to late effects of chemotherapy on the body.

I. Postural correction (core strengthening) II. Flexibility III. Gentle strengthening (slow progression) IV. CV endurance

Describe late effects of chemotherapy on the body.

I. Scoliosis II. Osteopenia/osteoporosis III. Osteonecrosis (AVN) IV. Obesity V. Myopathy VI. Impaired CV function VII. Impaired pulmonary function

process of IEP

IEP Meeting: Purpose a. To determine whether the child has a disability b. To determine the educational needs of the child Performed at least every 3 years, unless parent and Local Education Agency (LEA) agree that re-eval is unnecessary No more often than 1 time a year, unless parent and LEA agree more frequent is necessary PT evaluations may be done more frequently depending on state regulations PT eval before IEP: Focus on limitations across the ICF that impact academic demands and functional performance at school How much assistance? What accommodations? What modifications need to be made to the environment? All of these to be able to participate in the educational process IEP form filled out with the following sections: educational areas of concern addressed, activities/ component addressed in therapy as related to service to assist student to benefit from special education, supplementary aids and services/ environmental/ equipment adaptations necessary to assist student to meet curriculum standards/IEP, types of services, present level of academic achievement or functional performance OT/PT progress summary

What are the differences in interpretation of the Least Restrictive Environment in 1975 vs. today?

In 1975: children with disabilities must be educated in the same classroom as children without disabilities. Special classes, separate schooling or removal of children with disabilities from the regular educational environment: Only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved. Today: Children should be educated in the local school to the maximum extent appropriate The degree of inclusion in the general classroom will vary based on what is appropriate for each child. The child must be enabled to fully participate Assistive Technology must be provided

What is the overall goal of pharmacological treatment for children with JIA

Induce remission and control arthritis, prevent joint erosion, manage extra- articular manifestations

high level lesions (thoracic) Innervation: Goals: Motor function at or above T10:

Innervation of neck, upper limb, shoulder girdle and trunk, but no volitional lower limb movements. Goals: maintain a straight spine, level pelvis and symmetric lower limbs Motor function at or above T10: lower trunk is weak (may need sliding boards for transfer) Motor function at T12: strong trunk, good sitting balance. Ambulation for exercise with a parapodium Will require wheelchair for mobility Most do not achieve independent living status

Describe PT interventions & considerations for children with burns.

Interventions Positioning:"position of comfort is the position of contracture", healing tissue in elongated state, edema control splinting: prevent contracture Exercise/ROM-AROM most desirable but PROM is usually needed, muscle strength cannot overcome tensile strength of collagen (scar tissue), PROM under anesthesia - helps PT identify actual soft tissue restrictions , PROM for heavily sedated/intubated/critical pt Precautions: New grafts, Escarotomies, Tendon exposure, Combative pt Strengthening:Make it FUNctional!! Play is function for kids!, Have inventory of activities, involve parent, Strengthening muscles opposite scar contractures, Maintain strength of un-involved areas, Improve endurance (s/p bedrest, intubation), Work on posture, Beware of substitutions Functional mobility/gait Scar management Massage: tissue mobilization, desensitization, increase circulation, helps with itching, combine with end-range stretch (begin POD #5 if grafted), Pressure garments: keeps collagen formation under control, collagen realigned Begin garments prior to d/c (interims 10-20 mm Hg) New set every 3-4 months (customs 25 mm Hg) Worn 23/24 hours per day Garments worn up to 2 years post injury Silicone gel sheets (no research to prove why they work but they do! Increases collagenases?)

Describe the common clinical findings in children with JIA

Joint swelling, pain, limited mobility-stiffness (and morning stiffness), iridocyclitis, systemic issues (eyes, etc)

Do joint replacements help adults with CP?

Joint replacements can be successful in this population when patient selection is carefully done

What must be a characteristic of a prosthetic knee joint for a toddler?

Knee joints of prostheses for toddlers must be stable

For patients who exhibit moderate pronation with a fully correctable foot position, where medial arch is reduced but visible and there is moderate heel eversion and forefoot abduction. For patients who may benefit from the sensory feedback that a contoured shoe insert can provide.

LABORATORY BRACE (UCBL BRACE)

DCD and cerebellum issues

Lack of automization when attentional demands are increased Dual task paradigms where the performance of 1 task is negatively affected by the 2nd task if both tasks require the same pool of visual/cognitive resources. Difficulty adapting performance to gradual changes in environmental stimuli

7. Describe treatment for babies with CMT (e.g. knowing what exercises to perform and which way to turn or side bend the head).

Lateral flexion opposite the involved side as well as rotation towards the involved sides, massage Usually see them once a week and have parents do it three times a day min. have baby lay supine and stretch neck sideways and rotation, hold baby in a way that stretches neck

--allergy in 73% of kids with MM (no balloons or gloves, need latex free theraband)

Latex

In-Utero repair of the MM Sac under ideal conditions

Less need for shunting Reversal of hindbrain herniation Greater likelihood to walk without devices Motor function 2 or more levels better than expected by anatomic level Increased risks of spontaneous rupture of membrane, premature delivery, oligohydramnios (deficiency of amniotic fluid)

Describe the 4 levels of care in the NICU

Level 1- "regular" newborn nursery Level 2- medical conditions requiring intensive care Level 3- lifesaving services (mechanical ventilation, surgery) Level 4- ECMO, multidisciplinary team dedicated to unit

Once skin grafts are placed, how long should the child stay on bedrest with no movement?

Mesh grafts: Surgical site left undisturbed for 3 days first dressing change on day 3 Patient on bedrest for 5 days Can use splits/positioning aids to maintain functional position Can still do ROM/ther-ex on non-grafted areas, isometrics Prevent shearing forces ex: scooting to edge of bed with posterior thigh graft—need to bridge to move self over Can usually begin AROM on day 4 PROM with end range stretch on day 5 (staples out) Sheet grafts: First dressing change on day 1 for rolling graft to express fluid

sacral lesions

Mild hip/knee flexion contractures Increased lumbar lordosis Ankle/foot either in varus or valgus + pronated or supinated forefoot Mild crouch gait Bear weight on calcaneus unless plantar flexor muscles are at least 3/5

DCD and problems with mirror neurons

Mirror neurons (studied mostly in monkeys): Fire when we observe someone performing an action Allows us to imitate movements & understand movements of others. Allows us to learn movement through observation The mirror neuron system (MNS): Pars opercularis of the inferior frontal gyrus; adjacent ventral premotor cortex; rostral inferior parietal lobule. Superior temporal sulcus. May work in concert with the cerebellum to code and update movement.

direct model of school system PT

Most common Focus on acquisition of motor skills and therapy cannot be delegated Occurs regularly (weekly) Could occur in the classroom or in an isolated pullout setting

DCD and cerebellum + posterior parietal cortex problem

Motor imagery deficits Hypothesis: Kids with DCD have difficulty generating efference copies of motor commands through feedforward models (posterior parietal cortex) Inadequate forward (predictive) modeling of movements Cannot form, access or update their internal models resulting in poor online error correction, ultimately affecting motor learning

What outcome measure enables objective scoring of the severity of CMT?

Muscle Function scale

In general, the following diseases are commonly seen in the NICU

Myotonic muscular dystrophy, Pompeii disease, Trisomy 18, Trisomy 21, Pierre Robin Syndrome, Intraventricular Hemorrhage, hydrocephalus, myelomeningocele, hypoxic ischemic event, gastrochisis, necrotizing enterocolitis, ompholocele (note: if you don't generally know what these are, you should look them up).

The entry-level physical therapist is -- to work independently in the NICU. The new graduate will --

NOT ready train with experienced NICU PT's to become proficient in the care of these very fragile infants

Currently, what drugs are most commonly used for JIA?

NSAIDs, Methotrexate(MTX) non- responders are treated with drugs that target TNF(tumor necrosis factor) or anti-IL6 drugs

body structure function impairments DCD

Neurologic "soft" signs Poor strength Poor coordination Jerky movements Poor visual perception Joint laxity Poor spatial organization Inadequate information processing Poor sequencing Poor feedback and feedforward motor control Poor memory

What are some precautions that must be followed following SDR?

No passive hip flexion past 90 degrees for 6 weeks after surgery. The patient can perform this actively to his/her tolerance. No passive trunk rotation/lateral flexion into extremes of range for 6 weeks after surgery. The patient can perform this actively to his/her tolerance. No vigorous hamstring stretching for 6 weeks after surgery. Hamstring stretching should be limited by back pain and not discomfort caused by the stretching of the hamstring muscles themselves. Because of increased weakness in the feet and ankles, splints should be worn during standing and ambulation activities. Expect some sensory changes in the lower extremities, especially some hypersensitivity on the bottom of the feet. This may be alleviated by handling feet firmly and wearing socks and shoes. This hypersensitivity usually resolves in the first few weeks. As the edema resolves around the site of the surgery, a bump may appear just above the scar. This is the spinous process of T-12 or L-1 and should not be a cause for concern. If drainage from wound is purulent or increases, contact neurosurgery. It is common for the child to tire more easily than normal. Changes in behavior such as irritability and frustration for no apparent reason are common as the child learns that movement feels different. They may not have the motor control and/or strength to produce the desired movement. Do not begin Aquatic therapy or swimming until two weeks after surgery. Incision site must be closed or covered with impermeable dressing. Do not begin or resume electrical stimulation of any kind until 4 weeks after surgery. Focused primarily on lower extremities. Do not begin Hippo-therapy or horseback riding until 6 weeks after surgery

explain the movement assessment batter for children (MABC-2)

Norm-referenced multi-item test for 3-16 y/o kids 3 sections (manual dexterity, aiming and catching, balance) Examples of items: threading beads, putting pegs into pegboard, catching and throwing a beanbag, balancing on 1 leg, jumping, hopping, tandem walking 8 items for: 3-6 years; 7-10 years; 11-16 years Total score determines if motor performance is within normal ranges, borderline, at risk or significantly impaired. Validated for DCD - better than BOT-2 at identifying kids with DCD (does not include handwriting) Takes less time than BOT-2 Good reliability for kids with DCD

Be familiar with the CMT classification of severity.

Note: you do not have to memorize these grades. Just know that there are 7 grades and they increase in severity and age. For example, know that grade 3 is early severe, grade 6 is late severe. Grade 1: early mild: posture/muscle tightness < 15 degrees Grade 2: early moderate: muscle tightness 15-30 degrees Grade 3: early severe: muscle tightness > 30 degrees/SCM mass Grade 4: late mild 7-9 mos: postural/muscle tightness < 15 degrees Grade 5: late moderate 10-12 mos: postural/muscle tightness < 15 degrees Grade 6: late severe: muscle tightness > 15 degrees of cervical rotation Grade 7: late extreme: muscle tightness > 30 degrees/SCM mass

what are the different types of myelodysplasia

OCCULTA (10% IN L5 OR S1) - NO PARALYSIS MENINGOCELE - SKIN COVERED - NO PARALYSIS MENINGOMYELOCELE (MM - MAY OR MAY NOT BE SKIN COVERED WILL CAUSE PARALYSIS) MYELOSCHISIS (NOT SKIN COVERED - SPINAL CORD EXPOSED)

1. What sensory deficits are expected for children with MM and how can PT's test for these deficits?

Often do not correlate with motor level May skip levels - important to test all dermatomes and multiple sites within a dermatome Light touch or pinprick, vibration Also test proprioception Educate on importance of protecting their skin and body Pressure relief Can test sensation in kids but putting Sticker on their foot and see if they will take it off Definitely need to do pinprick as well How do you test proprioception in kids? Or someone with higher lesion they wont feel that but you will have to perform on older kid

standers

PRONE: use for a child who has good head control SUPINE: use for a child with poor head control STANDING BOX: doesn't support the head or shoulders MOBILE vs STATIONARY: Some standers have wheels Enables mobility Good basic information on choosing a stander

collaborative model of school system PT

PT focus is on team operations and management and ways to seamlessly interact with team members to select and blend services The degree of role release and crossing of disciplinary boundaries is greater than other models Intervention should be occurring all the time, even at home (life situation)

Compare and contrast the three surgical intervention for scoliosis discussed in class.

Posterior Spinal Fusion (PSF) with instrumentation i. Harrington Rods- only frontal plane correction but not sagittal plane correction ii. The Cotrel-Dubousset- minimum of two rods are used with selective compression or distraction forces. Rotational correction is questionable iii. Direct Vertebral Rotation- improve curve correction along with apical vertebral rotation

What improves following joint replacement?

QOL, Pain

It is probably NOT DCD if the following are reported:

Recent head injury or trauma Deterioration in previously learned or acquired skills Headaches, eye pain, blurred vision Global developmental delays Fluctuating tone, significant hypotonia Asymmetrical strength Musculoskeletal abnormality Tumor or other neuro lesions Avoidance of eye contact, unwillingness to engage socially Gowers' sign Ataxia or dysarthria Absence of DTR Dysmorphic features Visual impairment (untreated)

L3 lesion

Require KAFO's and crutches for household and some community ambulation Wheelchair for longer distances 60% achieve independent living status as adults

IDEA part B

Requires that all children with disabilities (3-21 yrs) are provided a free, appropriate education. Related services to meet their unique needs and prepare them for further education, employment and independent living. Children 3-5 years will be served in Early Intervention OR Preschool, depending on the laws of each state. Children 19-21 may or may not be served, depending on state laws

IDEA part C

Requires that infants and toddlers with disabilities receive early intervention services IFSP rather than an IEP Assist the family in meeting their child's developmental needs in order to increase functional abilities, gain independence and mobility and be an active participant in his/her family and community. Prepare the child for preschool and kindergarten to avoid the need for extensive special education services.

Why is a rolling walker and jumper not recommended for children with spasticity?

Rolling walkers- safety, they will lean and not develop normal mechanics Jumper- also developing abnormally and not weight shifting appropriately

For patients who have excessive pronation and/or supination. For patients who have delayed development with very low tone pronation and sensory issues. For patients who need high levels of specific foot correction but have adequate ankle control for functional level. For patients who engage in frequent floor activities requiring free ankle movement.

SMO

Be familiar with the political history of special education. You do not have to memorize the numbers of all of the laws, but I would like for you to be familiar with the YEARS that each major law was passed, and the major features of the law.

Section 504 of the rehabilitation act of 1973 Comprehensive antidiscrimination statute designed to ensure that federal funding recipients (i.e. schools) provide equal opportunity to people with disabilities 1975: Education for All Handicapped Children Act All children ages 5 or 6 (depending on state) - 21 get a public education in a least restrictive environment 1986: Education of the Handicapped Act Amendments of 1986 Extended services to infants, toddlers and preschoolers with disability 1990: Americans with Disabilities Act Comprehensive civil rights protection similar to those provided to persons on the basis of race, sex, national origin, and religion under the Civil Rights Act of 1964. e.g. employment, transportation, public accommodations, telecommunications, access to and within public buildings (ADA compliant) 1991: The Individuals with Disabilities Education Act Amendments of 1991 (IDEA) Reauthorized and amended in 1997 Transition planning: must be included in the IFSP and IEP 2001: No Child Left Behind Act of 2001 Purpose was to ensure that all children, including those with disabilities receive a high quality education. Includes a yearly standardized test to demonstrate adequate yearly progress 2004: Individuals with Disabilities Education Improvement Act of 2004 Improved on the Individuals with Disabilities Education Act Amendments of 1991 Explained further in later section 2008: Americans with Disabilities Amendments Act of 2008 (expanded version of section 504) A person not qualified for IDEA could be qualified to receive services under section 504 e.g. Accommodations for ADHD or post-concussion syndrome Interpretation of the law varies among states and even among individual school districts. 2015: Every Student Succeeds Act Replaced the No Child Left Behind Act of 2001 Gave education agencies and states more flexibility

Why are individuals with CP at increased risk for cardiovascular issues?

Sedentary behavior and inactivity have raised concerns regarding cardiovascular risks

monitoring model of school system PT

Similar to consultative, but the PT is directly responsible for the outcome of the intervention PT "checks in" with the child May only see the child 2x/year to be sure nothing has changed Goal: maintain what is going on in the educational program

DCD encourage success on the playground and leisure

Show them how to use playground equipment in a relaxed environment Life sports: Swimming, skating, skiing, cycling, rollerblading: challenging and will require lots of teaching but worth the extra effort Find a flyer to help a parent know which sports are best for kids with DCD & how to encourage success (CanChild Website Resources)

consultative model of school system PT

Similar to integrative model but the PT acts only as a consultant, not as a direct provider of the intervention Most of the work of the PT happens at the beginning of the school year, or when major changes occur

10. Describe the different types of orthoses prescribed for children with CMT

Soft collar Tubular orthosis for Torticollis Contralateral torticollis postural positioning device Pinless halo

If an adult with CP has an orthopedic condition that affects soft tissue (e.g. muscle strain or tendonitis) why might an MD ignore the problem?

Soft tissue injuries in the lower limbs are by and large ignored because physicians see the cerebral palsy and fail to consider other causes of pain

MM issues: -- (9%) & -- (10-30%) Neurogenic bowel Only 5% of kids with MM develop voluntary -- bc S2 to S4 is not functioning. Incontinence, constipation, impaction Need to go on a --, successful if there is presence of a -- Neurogenic bladder requires -- -- breakdown and --

Spasticity Seizures bladder/bowel control bowel program cutaneous reflex Clean intermittent catheterization on a regular schedule skin obesity

evidence based assessment tools that PT's will use to assess children in schools: school function assessment

Standardized measure of participation in all aspects of the educational program for students K-6th grade. Completed by all interactive members of the team and helps to develop IEP goals and frequency of services Judgement-based, criterion-referenced, discriminative (identifies functional limitations) and evaluative (measures change over time) Assesses student levels of activity, required support and performance in daily school routines Participation in 6 major school activity settings Classroom, playground, transportation, bathroom, transitions to and from class, lunchroom Two types of task support Adult assistance Adaptations to environment Activity performance 21 DOMAINS 12 Physical tasks 9 cognitive/behavioral tasks Required level of assistance Cut-off scores High internal consistency (α=0.92 to 0.98) & test-retest reliability (ICC=0.80-0.99)

principles of treatment for children with burns

Start early Frequent treatment Frequency of movement is key Goal is to achieve full ROM daily Low load, long duration stretching Intensity: tailor to patients metabolic status (a child may burn 4,000 to 5,000 calories a day just to heal)

What does SPoRT stand for and what is the goal of this brace?

Symmetric, patient-oriented, rigid, three-dimensional aims to restore spinal rotation from the pelvis cranially

What is the difference between IDEA and Section 504?

The definition of qualified "handicapped person" is broader than IDEA to include any individual with a physical or mental condition with substantially limits at least one major life activity

MM motor level

The lowest intact, functional neuromuscular segment For example: L4 level indicates that the 4th lumbar nerve and myotome it innervates are functioning, whereas segments below L4 are not intact. International Myelodysplasia Study Group Criteria for Assigning Motor Levels

What is the prognosis for most children with CMT when treatment is initiated prior to 3 months of age? What is the prognosis for babies treated after 3 months of age?

The prognosis for full resolution of CMT that is treated conservatively prior to 3 months of age is 100% and lower (75%) when treated after 3 months of age. The later the onset of treatment after identification of the condition, the lower the chance of full resolution and the greater the need for surgery.

integrated model of school system PT

Therapist interacts with the child, teacher, aide, and family Services are provided in the learning environment Focus is on practice of skills in the daily routine Entire team should implement the therapy (including the PT)

Briefly describe the evidence based conservative interventions for individuals with AIS (see Fusco et al. 2011 - posted on canvas).

There is increasing evidence suggesting that SSE(side shift therapy) and brace treatment can significantly limit the progression of spinal curvatures

what is the treatment for children with burns? What is the #1 treatment priority?

Treatment Objectives Preserve ROM and function Restore lost motion and function Return to pre-burn functional status Prevent and treat burn scar contracture deformity and hypertrophic scarring #1 Treatment Priority Breathing: if the patient's airway is patent, are they breathing? Prevent respiratory distress-RR, breath sounds, O2 sats, work of breathing, ABG, may require intubation due to increasing airway edema Infection Contracture/scar management

ROLLS.BOLSTERS.STABILITY BALLS

Use during therapy for moveable surfaces Promote core strengthening, righting and equilibrium reactions Use during prone positioning to promote UE weight bearing and head control Can make your own out of towels and noodles! Can purchase stability balls at Academy or Wal Mart.

Why would a child need an orthosis for CMT?

Used for infants or children: Who are 4 months of age or older Have constant head tilt of 5deg. or greater for more than 80% of awake time Perform all movement transitions and motor skills with a constant head tilt Used to obtain, maintain, and restrain certain motion

2 types of shunt for hydrocephalus

Ventriculoperitoneal: to stomach Ventriculoatrial: through jugular vein into right atrium

high lumbar (L1L2 lesions)

Weak hip movements Can do short distance household ambulation using KAFO's or RGO's (reciprocal gait orthosis) & upper limb support Wheelchair for community distances 50% achieve independent living status but difficult to maintain competitive employment as adults.

Describe how the gait pattern of children with DCD differs from that of typically developing kids

Wider steps Elevated variability in the time spent in double support and stride time Greater ML velocity and acceleration Young: Elevated variability in ML acceleration Greater variability in velocity and acceleration in all 3 directions

to impart stress on healing tissue in a controlled manner to cause scar tissue to remodel

Wolff's Law

Why should an open burn wound be closed within 2 weeks?

Wound closure within 2 weeks decreases likelihood of worsened hypertrophic scars

Describe the Timed Up and Down Stairs Test (TUDS). Does this test have good reliability for children with amputation?

a. "Quickly but safely go up the stairs, turn around on the top step and come all the way down until both feet land on the bottom step. Ready. Go" b. The participant can choose any method. c. Start timing on GO and stop timing when the 2nd foot returns. d. ICC>0.93 (good) e. Age 8-14 yo norms = 8.1 sec (range 6.3-12.6) or 0.58 sec/step

What is Cobb's method? How it is conducted?

a. Antero-posterior view of the radiograph b. Determines the degree of scoliosis c. Decide which vertebrae are the end-vertebrae of the curvature d. These end-vertebrae at the upper and lower limits of the curve which tilt most severely toward the concavity of the curve e. Draws a line along the upper endplate of the upper body and along the lower endplate of the lower body

Describe some of the red flags for child abuse

a. Burn pattern (sock or glove like pattern) b. History given by caregiver inconsistent with pattern of burn c. Family history of child protective services (CPS) or department of human resources (DHR) d. Other signs/symptoms of abuse (bruises, scars, old fractures)

How is JIA diagnosed?

a. By exclusion, no lab tests. ILAR(international league of associations for Rheumatology) criteria, named by clinical features b. begin before the age of 16 and persists for longer than 6 weeks and of unknown cause

Briefly describe the CAPP-FSI

a. CHILD AMPUTEE PROSTHETICS PROJECT - FUNCTIONAL STATUS INVENTORY i. Specific to amputation, looks at participation and activity and how much they use the prosthesis ii. 3 VERSIONS: CHILD (8-17 YRS), PRESCHOOLER (4-7 YRS), TODDLER (1-4 YRS)

What are some reasons why adults with CP stop walking?

a. Choice, degeneration of motor function b. Potentially pain

Systemic JIA: a. Clinical signs and symptoms b. Distinguishing characteristics c. Common joints affected d. Expected outcomes

a. Clinical signs and symptoms i. Spiking fever 1-2x/day in afternoon or evening for 2 weeks w/ rapid normalization ii. fever causes rash on trunk, limbs, face, palms, soles of feet iii. onset throughout childhood b. Distinguishing characteristics i. Pleuritis, pericarditis, myocarditis, hepatosplenomegaly, lymphadenopathy ii. Systemic precedes arthritis iii. Fever, rash, and pericarditis subside but may reoccur c. Common joints affected d. Expected outcomes

What are some of the causes of CMT?

a. Direct injury to the muscle b. Ischemic injury c. Rupture of the muscle d. Infective myositis e. Neurogenic injury f. Intrauterine compartment syndrome g. Heredity factors

What are the 2 most common surgical treatments for LE osteosarcoma?

a. Distal femur limb salvage b. Proximal tibia limb salvage c. rotationplasty

the anatomy of the skin

a. Epidermis: outer most layer, very thin (only a few cells) b. Dermis: middle layer, thicker than epidermis c. Subcutaneous: bottom layer, adipose tissue d. Functions of skin Protection from trauma, dehydration, microbial invasion Thermoregulation sensation

Describe rotationplasty to include how the child activates knee extension and flexion.

a. Excision of the distal femur and proximal tibia b. 180 degree rotation c. Re-attach to the proximal femur d. Fibula must be present e. The ankle is now a knee: PF extends the knee/ DF flexes the knee

9. What is the GROMS and how is it scored?

a. Global Range of Motion Score b. Each joint was weighted from 0=least important to 5=most important (MODE). c. Take child's ROM (A). d. Divide by Normative (B) to get C e. Multiply C by Mode (D) to get E. f. GROMS = Sum of E X 100/ Sum of D

2. Describe the three primary etiologies of scoliosis in children?

a. Idiopathic (infantile 0-3 years, juvenile 3-10 years, adolescent 10-18 years, adult over 18) Pathogenesis remains poorly understood. Genetic and hereditary causes remain widely accepted b. Paralytic (neuropathic, myopathic) Occurs as a result of poliomyelitis, CP or spina bifida. Greater degree of muscle imbalance and growing age complicate and rapidly deteriorate the scoliosis in children making surgery inevitable c. Congenital (osteopathic, neuropathic) If severe can be detected at birth; in milder forms it may appear at the time of the adolescent growth spurt. Its complications render the brace ineffective and surgery may be required

Be generally familiar with the JIA-specific outcome measures as discussed in class.

a. JADAS(juvenile arthritis disease activity score) • This is one that is typically done by the physician and you may get this score in his records • 10 only looks at 10 joints, 27, and 71 look at that number of joints • Score based on the physician global assessment, what do they say about how bad they are • Patient and parent say how bad they think they are 0-10 • Active joint count tells you how many joints affected out of how many they look at • ESR acute phase reactant stage • Use all this to get total score b. JAMAR (juvenile arthiritis multidimensional assessment report) • Measures 12 constructs in kids 7-18 yrs: • Well-Being. Pain. Functional Status. HRQOL. Morning Stiffness. Disease Activity. Disease Status and Course. Joint Disease. Extra articular symptoms. Side effects of medications. Therapeutic compliance. Satisfaction with illness outcome. • One score is obtained c. Quality of My Life Scale, VAS version of the childhood health questionnaire

define scoliosis

a. Lateral curvature of spine b. Deviate/shift vertebral body axial rotate to same side c. Thoracic vertebrae occur common d. Series of vertebrae segment in extension or lordosis

When do limbs begin to grow in utero

a. Limb buds first develop at the end of the 4th week of embryonic development b. Grow & differentiate over the next 3 weeks c. Proximo-distal sequence d. End of week 7 - skeleton developed

Why do adults with CP have difficulty with primary health care and wellness (e.g. women's health, dental)?

a. Limited physicians willing to take Medicaid reimbursement b. Problems with communication c. Length of time visits take- greater than reimbursement covers d. Physicians tend to see the CP and overlook other problems e. Dental needs not covered by Medicaid f. Equipment (tables, mammogram devices) are not accessible for persons with disabilities g. Many adult women with CP do not get routine gynecological follow-up

Review Case #1 (right frontal brain tumor). What did the MD originally diagnose? What were the impairments?

a. MD originally diagnoses Erb's palsy b. Impairments were new onset seizure activity, and one month history of decreased left upper extremity use

What are the goals of PT intervention for a child with chemotherapy induced neuropathy? (also, see case #2, remembering the videos that Maegan showed)

a. Maintain ROM b. Assess safety/stability c. Address splinting/assistive device needs d. Referral to OP PT services as appropriate

Is there evidence that muscle strengthening works for kids with JIA? What does it help?

a. Muscle strength in hip & knee extensors (and BMD) improved after a 12 week program (3X/week) b. Jumping rope (100 times), muscle strengthening, core exercises and exercises with free weights (0.5-2Kg), 10X3 repetitions. c. Evidence says yes for strength.

Describe the components of the PT assessment of a child with CMT

a. Posture and shape of the head b. Neuro-motor development and MSK impairments c. Condition of the SCM by bilateral palpation d. Spontaneous motility e. Rotation and lateral flexion of the cervical spine by means of goniometric measurement

What are the indications for surgical intervention for children with scoliosis?

a. Progressive idiopathic curvature b. Cobb's angle of 45 degrees and greater

What are unmet needs for adults with cerebral palsy

a. Research and intervention for aging and early loss of function b. Support and aid with sexual function/needs c. Pain management d. Lack of adult health care providers to manage their needs- orthopedics, primary care, OB-gyn, preventative care e. Public portrayal of person with CP in the media f. Legal interference with adults who are parents g. Mental health hospitalization concerns h. System questions regarding driving ability of those with licenses

Describe PFFD (proximal femoral focal deficiency) to include the clinical signs and symptoms.

a. Shortened thigh held in flexion, abduction and ER b. Hip/knee flexion contracture c. Severe leg length discrepancy with the foot often at the level of the other knee d. Absent or deficient cruciate ligaments e. 70-80% have total longitudinal deficiency of the fibula f. 15% bilateral

What are the different types of braces that are used for children and adolescent with scoliosis?

a. The Milwaukee brace- is a removable CTLSO b. Total-contact Boston brace- this brace uses active and passive corrective forces and differs from the Wilmington brace, which employs a passive mode of correction by applying longitudinal forces combined with lateral pressure when the brace is custom made using a traction table c. The Lyon Brace- it requires prior reduction of the curve in a cast for up to four months before the brace is manufactured, and works on the principle of active axial auto-correction as the child is stimulated to pull away in order to reduce skin pressure d. The Cheneau brace- has been reported to prevent progression of the curve in 80% of patients e. The Sforzesco brace- subsequently the SPoRT (Symmetric, Patient-orientated, Rigid, Three-dimensional) bracing concept was developed which combnes features of the Risser cast, Milwaukee, Lyon and Cheneau braces, and aims to restore spinal rotation from the pelvis cranially

Discuss considerations for PFFD surgery

a. Type A limb lengthening, types B,C,D amputation or surgical revision/ prosthesis b. 60% of predicted femoral length must be present for a lengthening procedure c. Femoral osteotomy d. Knee arthrodesis e. Foot amputation f. Syme or Boyd g. Rotationplasty

How does osteosarcoma present clinically and what common athletic orthopedic condition also presents with similar signs/symptoms?

a. Typically develops in areas of bone that grow quickly b. Begins as pain that progresses to swelling c. Osgood Schlatter/arthritis

Can women with CP who are taking anti-spasticity meds continue to take them while pregnant?

a. Use of AEDs has been associated with primary gonadal dysfunction and increase risk of polycystic ovarian syndrome b. Limited reports on pregnancy indicate concerns with use of anti-spasticity drugs and difficulties with pregnancies

Describe examples of activity limitations and participation restrictions in children with JIA.

a. Wrist involvement in a toddler (unable to crawl) b. Change in walking pattern or bottom shuffling c. Kids with severe polyJIA may need help with ADL's d. Parents may discourage them from learning life skills (bike, climbing, active play) e. School: • Tardiness (morning stiffness) • Frequent absence

4 aspects that explain the pathogenesis of JIA

a. immune system: altered immunity & immunoregulation, cytokine production b. cell-mediated pathogenesis: abnormal T cells and inflamed synovium c. humoral abnormalities: multiple autoantibodies and immune complexes d. genetic predisposition: chromosome 6, multiple genes, correlations between HLA- risks and protective effects that are age related for each onset type

examples of specific interventions for kids with JIA

aerobic conditioning aquatic exercise low impact weight bearing exercise gait training body mechanics training postural training strengthening, power and endurance training active- assistive and restive exercise task specific performance training flexibility muscle lengthening ROM balance, coordination and agility training

scoring for DCDQ

ages 5years - 7 years 11 months: 15-46 indication of DCD or suspect 47-75 probably not DCD age 8-9 years 11 months: 15-55 indication of CD or suspect 56-75 probably not dcd age 10-15: 15-57 indication or suspect DCD 58-75 probably not DCD

criteria for assigning motor levelsS2-S3

all of the lower limb muscle groups are of normal strength ( may be grade 4 in one or two groups) also includes normal appearing infants who are too young to be bowel and badder trained

Concerns typically noted by parents of children with developmental coordination disorder at different ages: motor

around 2.5-7ish delays in fine and gross motor skills; late riding tricycle, can't catch or throw ball with accuracy, can't ride bicycle, difficulty jumping and skipping, decreased fitness

Concerns typically noted by parents of children with developmental coordination disorder at different ages: social

around 8ish on limited participation in sports and extracurricular activities; tends to watch instead of participating, victimization/ bullying, social isolation

Concerns typically noted by parents of children with developmental coordination disorder at different ages: behavioral/ emotional

behavioral: avoids active play and fine motor activity, dislikes sports and active recreation, is frustrated and avoids tasks emotional: self deprecating comments, decreased self esteem, poor perceived competence, anxious, depressed withdrawn

DCD motor learning: Less -- dependent signals as compared to TD in: cerebellar-parietal and cerebellar-prefrontal networks as well as brain regions associated with --. Poorer --accuracy at retention than TD

blood-oxygen-level visual-spatial learning tracing

early signs of shunt dysfunction

changes in speeh fever and malaise recurring headache dec. activity level dec. school performance onset of inc. strabismus(at rest one eye is looking different from the other ) changes in appetite or weight incontinence begins or worsens onset or worsening of scoliosis onset of inc. spasticity personality change (irritability) dec. or static grip strength difficult to arouse in morning dec. visuomotor coordination dec. visual acuity or diplopia(double vision) dec. visuoperceptual coordination onset or inc. freq of seizures

Considering the various orthoses for scoliosis: Which one is reported to prevent scoliosis in 80% of patients?

cheneau brace

facts about DCD(developmental coordination disorder)

chronic (lifelong ) condition affects movement and posture affects ADLs, academics and play, not related to specific neurological DX, 5C: impaired motor function and sensory integrity associated with non progressive disorders of the NS, 4 distinct criteria must be met for diagnosis, strong association between DCD and ADHD, affects 5-6% of school aged kids, children do not "grow out of" the disorder

As a new PT working with infants with CMT, what document would you obtain in order to have the best evidence for treating this condition?

cincinnati children guideline

-- is common with MM verbose but with excessive & inappropriate use of jargon and clichés (common with hydrocephalus)

cocktail party personality

Musculoskeletal deformity observed in infancy characterized by unilateral contracture of the SCM. May be present at birth or may not appear until 2-4 weeks post-delivery

congenital muscular toticollis (CMT)

DCD brain areas: Axial diffusivity of the --&-- was lower in DCD than TD Axons were going the right direction, but had different --.

corticospinal tract & posterior thalamic radiation intrinsic characteristics

when does outpatient therapy begin for SDR

day 6

criteria for assigning motor levels T11 or above

determined by sensory level or palpation of abdominal muscles

power training imcreases speed muscular contraction via several neural mechanisms

earlier motor unit activation enhanced maximal motor unit firing rate in initial stages of activation increased efferent neural drive to antagonists improved inter muscular and intramuscular coordination improved force control

As a PT, what can you do to help adults with CP to be more active? What can you do as pediatric therapists to prepare them for adulthood?

encourage participation in health and wellness programs address falls prevention with adults who have CP be aware that commercial gymnasiums are concerned with liability and may limit participation of adults with CP there are online programs to train personal trainers for training PWD

criteria for assigning motor levels S1-S2

exceeds S1 criteria but does not meet S2 criteria

criteria for assigning motor levels L1-L2

exceeds criteria for L1 but does not meet L2 criteria

criteria for assigning motor levels L3-4

exceeds criteria for L3 but does not meet criteria for L4

criteria for assigning motor levels L4-5

exceeds criteria for L4 but does not meet criteria for L5

criteria for assigning motor levels L5-S1

exceeds criteria for L5 but does not meet S1

to ride a school bus a wheelchair must have

head rest

orthotic for someone who needs PF blocked but can control DF and knee flexion and extension. Need medial/lateral stability to help control strong excess pronation or supination, but need free motion in the sagittal plane

hinged AFO

DCD uses -- strategy and slowed muscle force production in --

hip (rather than ankle) knee flexors

-- Occurs in 25% or more of kids born with MM, then 60% develop it after closure of the back lesion. it can affect cognition

hydrocephalus

describe muscle function scale

i. Categorical scoring of six levels from 0-5 ii. Infant is held vertical and lowered to horizontal in front of a mirror iii. Head position is observed and both sides are tested iv. Scores are given according to position in relation to the horizontal line and the infant must hold their head in the same position for 5 seconds to obtain that score v. Describes an infant's muscle function in the lateral flexors of the neck through ordered categorical scores of six levels from 0 to 5 vi. The infant is held in a vertical position and then lowered to the horizontal position in front of a mirror vii. The head position is observed and both sides are tested. Scores are given according to the head position in relation to the horizontal line. The infant has to be observed with the head held in the same position for 5 seconds to obtain the score at that level.

What is the relationship between cerebral palsy and fatigue

i. Chronic severe fatigue more common in adults who stop walking ii. In lab studies, adults with CP demonstrate individual muscle fatigue more quickly than controls; in clinical studies, levels of fatigue are related to performance of functional tasks

What is the relationship between cerebral palsy and other health conditions

i. Increased incidence of disc degeneration, radiculopathy in adults with athetoid CP ii. Obesity, osteoporosis, cardiovascular concerns iii. UTIs, chronic constipation iv. Significantly elevated mortality from all cancers v. Elevated rates of and death from respiratory concerns- asthma, COPD vi. Increased death rates from accidents and drowning vii. Sexual assault viii. Sedentary behavior

Risk factors for CMT

i. Large birth weight ii. Male iii. Breech position iv. Multiple births v. Primiparous mother- Being young in age and giving birth for the first time vi. Difficult labor/delivery vii. Use of vacuum or forceps assist viii. Nuchal cord ix. Maternal uterine abnormalities

red flags for CMT

i. Late-onset torticollis at 6 months or older, which can be associated with neurological conditions, tissue mass, inflammation, or acquired asymmetry ii. Visual abnormalities including nystagmus, strabismus, limited or inconsistent visual tracking, and gaze aversion iii. History of acute onset, which is usually associated with trauma or acute illness. iv. Suspected hip dysplasia-Hip dysplasia Screening is done using two tests (Ortolani and Barlow tests) v. Skull and/or facial asymmetry, including plagiocephaly and brachycephaly vi. Atypical presentations, such as tilt and turn to the same side, or plagiocephaly and tilt to the same side. vii. Abnormal tone

6 features of the Education for All Handicapped Children Act, which are also the features of IDEA today

i. Least restrictive environment ii. Right to due process iii. Nondiscriminatory evaluations iv. IEP (individualized education plan) v. Parent participation vi. Free appropriate public education

Are all licensed PT's competent to begin working as School PT's just because they have a license? How many areas of competencies were identified in the study by Effgen et al?

i. NO ii. PT's who work in the school system require specific skills and knowledge to effectively serve children with disabilities. iii. There were 9 competency areas with associated competencies identified

Who is included in "related services?"

i. PT/OT/ST ii. psychologist iii. transportation iv. audiology v. recreation therapists vi. medical vii. counseling services

What is the relationship between cerebral palsy and pain

i. Pain increases with age in persons with CP at significantly higher rates than in the population without CP ii. Studies to date have looked at incidence rather than pain management

criteria for assigning motor levels L2

iliopsoas, sartorius, and hip adductors all grade 3 or better

10 most important predictors DCD deficits in

imitation of gestures digital praxis digital perception manual dexterity arithmetic* coordination upper and lower limbs* reading/ spelling* visual spatial attention* orofacial praxia vertical pursuit* (all are present in mixed and * is present in visual spatial constructive)

taekwondo training in DCD results

improved vestibule ratio to like typically developing, improved sway on SLS, improved visual ratio and composite scores

what has the child been doing for 6 days following SDR

inpatient therapy and lying flat

What is the purpose of post-rhizotomy therapy?

is facilitating new motor patterns utilizing isolated strength, blending muscle actions, and facilitating good alignment during movement in order to improve daily functional skills

bone disorder characterized by abnormal joining of two or more spinal bones in the neck

klippel- feil syndrome

DCD timed handwriting tasks showed

less text than peers not due to slow movement but due to pauses for processing

What are some of the barriers to adults with CP living in their own apartment or house?

many adults with CP live with their parents who themselves are aging Finding trained caregivers who are not family is expensive and challenging those who are able to find work can pay for housing many low-income facilities include adapted apartments for adults with disabilities group homes exist, quality of care is not always optimal

DCD systematic review: Children and adults with DCD: Deficits imitating -- &-- gestures Different response patterns to controls when attempting -- Reduced activation and connectivity of --

meaningful and novel complex motor imagery tasks frontal, parietal and temporal MNS regions

criteria for assigning motor levels L4

meet or exceeds criteria for L3 and the medial hamstrings or the TA is grade 3 or better. a weak peroneus tertius may be seen

criteria for assigning motor levels no loss

meets all criteria for S2S3 and has no bowel or bladder dysfunction

criteria for assigning motor levels S1

meets or exceeds L5 criteria plus at least 2 of the following: gastric/ soleus grade 2 or better, glut med grade 3 or better, or glut max grade 2 or better ( can bucket buttocks)

criteria for assigning motor levels S2

meets or exceeds S1 criteria, the gastroc soleus must be grade 3 or better and glut med and max are grade 4 or better

criteria for assigning motor levels L3

meets or exceeds criteria for L2, plus quads are grade 3 or better

criteria for assigning motor levels L5

meets or exceeds criteria for L4 and has lateral hamstring strength grade 3 or better plus one of the following: glut. med grade 2 or better, peroneus tertius grade 4 or better, or tibialis posterior grade 3 or better

differential diagnosis associated with CMT

more specialized diagnostic tests such as X-ray, MRI, or CT scan can rule out presence of other pathologies i. Klippel-Feil syndrome ii. Posterior fossa syndrome iii. Sandifer syndrome: iv. Spasmodic torticollis v. Atlas malformation vi. Respiratory tract infection vii. Cervical adentitis: infection of a lymph node in the neck

--&-- are extremely prone to thick bands causing decrease shoulder and neck ROM.

neck and axilla

DCD: unkown, possibly heterogeneous -- insult of --,--, or -- origin

nervous system prenatal, perinatal or post natal

what is the focus of PT in the NICU?

o Developmental intervention All areas of development Specific to movement, posture, musculoskeletal condition Family at the center

What is the purpose of physical therapy in the NICU?

o Provide direct patient care and/or consultative services for the premature and/or medically complex infants in the NICU o Strive to maximize developmental outcomes, support infant mental health o Support and facilitate infant-parent relationships o Contribute to the optimization of each infants development at the earliest point in the lifespan

Who is at the center of care in the NICU?

patient

orthotic for a kid who has mild to mod PF tone and needs dome DF assist. For patients who have excessive pronation or supination. For patients who have excessive plantarflexion or dorsiflexion. For patients who have knee hyperextension. For patients who have some voluntary control that is very useful and can use that control to increase overall function.. For patients who need more medial/lateral stability than possible in the DAFO 3 or DAFO 4. For patients who need assistance in managing knee position in flexion and/or extension. For patients who need a resting splint.

posterior leaf spring

involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia

sandifer syndrome

A position to facilitate eye-hand control, play and rest Will not increase or decrease tone

sideling

orthotic for a kid who has mod to strong PF tone and has little control at the knees. For patients who are younger/smaller. For patients who have strong patterns of pronation or supination. For patients who have excessive plantarflexion; very little voluntary control of the ankle, consistent toe walking. For patients who have strong hyperextension of the knee.

solid ankle AFO

criteria for assigning motor levels T12

some pelvic control is present in sitting or supine (this may come from the abdominals or paraspinal muscles ) hip hiking from quadratus lumborum may be present

JIA-expected impairments at the body structure/function level of the ICF: joint

swelling, end-range stress, stiffness, ROM loss, enlarged bony landmarks, muscle spasm (contraction deformity rather than contracture)

Considering the various orthoses for scoliosis:Which one requires that the child be in a cast for 4 months prior to fabrication?

the lyon brace

overall goals for interventions for JIA

to restore and optimize the child's activity, participation and physical health by maintaining or improving function and providing education and support to the child and family.

Which surgical technique leads to the best prognosis for CNS tumor? Note that in children, the most common site for CNS tumor is in the posterior fossa which may affect cranial nerve function and eye movements.

total surgical resection of tumor

Considering the various orthoses for scoliosis: Which one uses active and passive corrective forces?

total- contact Boston brace

describe the level within the segment beyond which no skeletal elements exist

transverse deficiencies

MM may be associated with genetic abnormalities such as

trisomy 13,18 and 21

How can a PT determine the # of joints affected and which joints are painful in children?

use faces scale (OUCHER), they draw/point to joints that hurt, questionnaire..

hydrocephalus: Ventriculoperitoneal catheter shunts fluid from the -- to -- where CSF is reabsorbed. can become infected or obstructed and shunt dysfunction symptoms are gradual

ventricles to the peritoneal space

Which type of chemotherapy drug causes severe neuropathy to the sensory and motor nerves? Note that cisplatin chemotherapy ALSO causes hearing loss due to damaging the cilia in the cochlea. Vestibular may also be affected.

vincristine

criteria for assigning motor levels L1

weak iliopsoas muscle (grade 2)

What 4 factors are strongly correlated with the need for surgery in children with CMT? (note: refer to the CPG to find this information).

when asymmetries of the head, neck, and trunk are not resolving after 4 to 6 weeks of initial intense treatment; after 6 months of treatment with only moderate resolution; or if the infant is older than 12 months on initial examination and either facial asymmetry and/or 10 to 15◦ of difference persist between the left and right sides for any motion; or the infant is older than 7 months on initial examination and a tight band or SCM mass is present; or if the side of torticollis changes. Children with a SCM tumor, those with an initial deficit in cervical rotation of >30o, and those who initiate therapy after 12 months are more likely to require surgical intervention to attain a functional and cosmetically acceptable outcome

When should EI interventions begin?

within 30 days of referral