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What are the 4 subcategories of the Nagi Model?
- Functional Limitation
What does ICF stand for?
International classification of functioning and disability and health
Who developed ICF?
World Health Organization
Which model does OT use as its frame of reference?
What are the 4 diminsions of ICF?
- Body structure & function
- Activities & participation
- Personal participation factors
- environmental factors
What are the advantages of ICF?
- Provides scientific basis to evaluate functional states
- refers to limitation and function instead of disability
- common international language
- uses ICD codes
3 Components of Piaget's Theory of Cognitive Development
- Adaptation: basic biological need to permit a person to function in a given environment
- Assimilation: changing elements of the environment so they can be incorporated into the organism’s structure
- Accommodation: changing of function in accordance with the environment
What are Piaget's stages of cognitive development?
- Sensorimotor (birth to 2 years): six separate substages that are characterized by the development of a new skill.
- Preoperational (2-7 years): playing and pretending. Characteristics of this stage include egocentrism and difficulty understanding conservation
- Concrete operational (7-10 years): thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts.
- Formal operations (12+): skills such as logical thought, deductive reasoning, and systematic planning begin to emerge.
What are the 3 categories of Maslow's pyramid of Motivation?
- Basic needs
- Psycological needs
- Self-Fulfillment needs
Components of Pavlov's theory of Learning?
- Unconditioned stimulus - eg: food
- Conditioned neutral stimulus - eg: bell
- Conditioned learned response - eg: dog salivating
What are the types of consequences of Skinner's theory?
- Positive Reinforcement - if you do something good, you get something you like
- Negative reinforcement - if you do something good, you don't have to do something you dislike
- Extinction: removing selective variables that reinforce a behavior (kid is screaming, ignore his ass!)
- Punishment - do something bad, get something bad!
What are the types of reinforcements of Skinner's theory?
- Partial (intermittent)
- Fixed-interval schedule
- Variable-interval schedule
- Domains of Function
Domains of the Traditional Model of Learning and performance
- Cognitive: knowledge and understanding, applying knowledge, interpretation, developing systems, assessing effectiveness
- Affective: motivation; response, values, organize, internalize
- Psychomotor: motor skills; imitation, manipulation, precision, articulation, naturalization
Hierarchical theory is the dialect of ...
general systems theory
In Dynamic Systems Theory behavior is....
result of variable interaction of a number of complex systems in accordance with Control parameters and Environmental constraints
variables that move the system into a new attractor state; ex. Direction, force, speed
What are the 2 types of control?
- Emergent: the individual will alter in myriad ways in order to meet the current conditions
- Anticipatory: the motor program is adjusted even before any interaction with the environment
the prevailing environment conditions that help shape the movements
What are the 3 types of schemas?
- Personal: personal traits indentified in others and predicts the social interactions between individuals based on expected behaviors
- Self-schema: the characteristics and traits a person assigns to self
- Role schema: a person’s social position within a certain culture and the expected behaviors of a person in that position
- Event schema: manner in which familiar situations are organized, such as the sequence of events on a child’s first day of school
What are the levels of poverty?
- Absolute poverty: severe conditions of inadequate shelter, poor nutrition, and an increased risk for delays or disabilities
- Relative poverty: those who can afford some basic necessities but are unable to maintain an average standard of living
What are the 8 periods of development?
- Infancy Birth-18 or 24 mth
- Early childhood
- End of infancy- 5/6yrs
- Middle and late childhood 6-11yrs
- Adolescence 10-18/20yrs (females); 12-20/22yrs (males)
- Early Adulthood Late teens/early 20’s-30’s
- Middle Adulthood 35-45 yrs (extending to 60’s
- Late adulthood 65+
What are the 4 prenatal stages?
- Conception to birth
- Germinal stage: fertilization -2 weeks
- Embryonic stage: 2-8 weeks
- Fetal stage: 8 weeks -birth
What are the 2 stages of late adulthood?
- Young old 65-74 yrs
- Old-old 75+
How many chromosomes does a person have?
46; Each parent contributes 23 chromosomes
Which pair of chromosomes determines the sex?
What are the 2 types of twins?
- Monozygotic- a cluster of cells in the ovum splits off within the first two weeks after fertilization resulting in 2 genetically identical zygotes.
- Dizygotic- two separate ovum-sperm combinations.
the trait that is expressed
the trait that remains in the organism but, is not displayed
receiving similar genes from parents
receiving different forms of the genes from the parent
underlying combination of genetic material present (but outwardly invisible)
the observable trait
combination of multiple gene pairs
recessive genes located on the X chromosome
drug, chemical, virus, etc can produce birth defects
Morning sickness drug in the 50's that inhibited limb growth
miscarraige medicine in the 70's that caused children to have reprocuctive issues
Stages of Prenatal Development
- Germinal Stage:(0-2 weeks): Cells of the zygote divide quickly and become specialized
- Embryonic Stage (2-8 weeks): Secured to uterine wall
- Fetal Stage (8 weeks to birth) Formally begins when differentiation of major organs has occurred & sex is determined
Ectoderm (during the embryonic phase)
forms skin, hair, teeth, sense organs, brain, and spinal cord
Mesoderm forms what during the embryonic phase?
muscles, bones, blood, circulatory system
Endoderm forms what during the embryonic phase?
digestive system, liver, pancreas, and respiratory system
When does spina bifida occur?
during the 4th week when the neural tube fails to close
Down syndrome is the mutation of which chromosome?
What are the clinical manifistations of Down Syndrome?
- HYPOTONIA (low muscle tone)
- Mental retardation
- Short stature
- Flattened nasal bridge
- Almond-shaped eyes
- Developmental delay
- ANTLANTOAXIAL INSTABILITY
PT intervention of Down Syndrome
- Improve postural control and strength (child has low tone and is very flexible)
- Improve gross and fine motor skills
- Teach family need for activity to avoid obesity
- Avoid flexion activities if there is
- laxity of antlantoaxial joint
Duchenne Muscular dystrophy signs & symptoms
- PROXIMAL muscle weakness
- WADDLING GAIT
- Toe walking
- Pseudohypertrophy of calf muscles
- Difficulty climbing stairs
- Gowers Sign
Progression of Duchene's Muscular Dystrophy
- Symptoms emerge between ages 2-5
- Unable to ambulate age 10-12
- Death (late teens, early 20’s) due to cardiac or respiratory failure
PT Management of Duchenes Muscular Systrophy
- Submaximal exercise to maintain strength
- Improve mobility (equipment, w/c)
- Breathing exercises
- ROM to prevent contractures (especially tight heelcords)
- Family education and emotional support
Types of Spina Bifida
- Spina Bifida Occulta: no herniation
- Meningocele: meninges and CSF form sac outside spine but no nerve damage
- Myelomeningocele: herniation of spinal cord, nerves, meninges, and CSF
Complications of Spina Bifida
- Arnold-Chiari malformation (displacement of cerebellar tonsils through foramen magnum and blocking flow of CSF)
- Tethered cord syndrome
- Latex allergy
- Motor and sensory loss below the site of the defect
PT tx for Spina Bifida
- ROM and stretching
- Strengthening of innervated muscles
- Assessment for assistive devices
- Gait and locomotion training with appropriate assistive equipment
- Balance and coordination activities
- Patient and family education regarding care for areas of body that do not have sensation
brittle bone disease
PT Tx for Osteogenesis Imperfecta
- Remember: As much exercise as possible without risking fracture
- Maximize mobility
- Increase muscle strength to in turn increase bone mass
Physical Characteristics for Osteogenesis Imperfecta
- Short stature
- Easy bleeding
- Frequent fractures
- Breahting problems
- Frequently develop scoliosis
Symptoms of Sickle Cell
- May suffer strokes due to sickle-shaped red blood cells get stuck in small blood vessels, and may break into pieces to interrupt blood flow
- Sickle-shaped red blood cells deliver less oxygen to tissues than normal ones
PT Tx of Sickle Cell
- If acute stroke: treat it
- Breathing techniques to increase lung function
- Aquatic therapy very helpful
- Exercise as tolerated
Longitudinal Congenital Limb Deficiency
- Bone doesn’t form
- There may be distal parts present with total or partial loss of a specific bone
- Radius and fibula: most common
Transverse Congenital Limb Deficiency
- teratogen (ex thalidomide)
hands and/or feet attached directly to proximal bone or to trunk
PT Tx for Limb Deficiency
- Strengthening to prepare for prosthesis
- Prosthetic gait training
Four assumptions of the Traditional Neuromaturational Model
- Movement progresses from primitive, mass movement reflex patterns to voluntary, controlled movement
- Cephalocaudal Motor development
- Proximal to distal motor development
- Consistent sequence of development among infants and for each infant
Four assumptions of the Dynamic Systems Approach
- Joints and muscles work in coordinated patterns which are not totally controlled by the cerebral cortex
- Use of “feedback” rather than hardwiring of CNS
- Organismic and Environmental constraints
- Maturation of CNS (neurological damage is significant limiting factor)
- Head size
- Trunk/limb ratio
- Postural control against gravity
LBW babies include....
- Baby born before 36 weeks gestation
- Baby born after 38 weeks but weighs < 2500 g (“small for gestational age”
3 Subcategories of LBW
- LBW < 2500 g (5 lbs)
- VLBW < 1500 g (3.3 lbs)
- ELBW (extremely low birth weight)< 1000 g
Characteristics of LBW
- Lower responsiveness to environmental stimuli
- Higher risk of respiratory distress in early weeks
- Slower motor development
A birth is considered premature at less than
Complications of Prematurity
- Respiratory distress syndrome
- Bronchopulmonary Dysplasia (BPD)
- Cardiopulmonary Complications
- Musculoskeletal complications
- Nervous System complications
- Retinopathy of prematurity
What causes Cerebral Palsy
brain damage in utero, during delivery, or shortly after delivery
Types of CP
- Spastic CP: Lesion in the cerebral cortex leading to upper motor neuron damage
- Athetoid CP: damage to basal ganglia
- Ataxic Cerebral Palsy: damage in the cerebellum
Types of Spastic CP
- Spastic Quadripegia (all 4 extremities)
- Spastic Diplegia (both LE’s)
- Spastic Hemiplegia (ipsilateral UE and LE)
- Spastic Triplegia (diplegia plus hemiplegia)
PT Tx for CP
- ROM and stretching
- Position patient to inhibit primitive reflexes from preventing movement (ex: place child with strong ATNR and TLR on their side to play with toys)
- Facilitate gross motor developmental milestones
- Promote balance/ equilibrium reactions
- Improve endurance to exercise
- Gait training or mobility with assistive devices
- Family education
Possible causes of Congenital Torticollis
- Position in utero
- Breech in utero
- Difficult delivery
Unilateral contracture of SCM resulting in lat flexion to same side, rotation to opposite side, facial assymetries
PT Dx for Congenital Torticollis
- Stretching tight SCM in all directions (move infant into lat flexion to the opposite side, chin tuck, and rotation to the same side)
- active ROM by facilitating visual tracking and play in the opposite direction of tightness
- positioning (move crib so that child looks to side opposite tightness, position child in car seat and infant seat so that head is in midline)
- parent education: stretching of SCM needs to be done by parents several times a day; positioning to facilitate ROM need to be done constantly; home program very important for children with torticollis.
Signs of Plagiocephaly
- Back of head flattened to one side
- Compensatory bulging of forehead on the same side of head
- Ear will also likely be pushed forward on that side of their head
Patients with torticollis frequesntly have ....
Tx for placiocephaly
- Helmet to shape skull before fontanelles close
- Instruct in positioning to take pressure off the flattened area of the head
- Tummy Time??? FOR THE LOVE OF GOD PATTI, WHAT DOES THAT MEAN?
What causes a brachial plexus injury?
Due to difficult delivery in which neck is severely flexed to one side so that the brachial plexus is stretched
What are the 3 types of a brachial plexus injury
- Erb’s Palsy: C5 and C6; upper and lower arm; MOST COMMON
- Upper-middle trunk BPP: C5,C6, C7
- Klompke: C8 and T1; hand (this does not occur alone but usually with upper level BPP)
Signs of a brachial plexus injury
- not moving the upper or lower arm or hand
- Absent Moro reflex on the affected side
- Arm flexed at elbow and held against body
- Decreased grip on the affected side
PT Tx for Brachial Plexus injury
- Strengthening exercises
- Positioning for improved alignment (ex- TheraTogs)
When does congenital hip displasia take place?
Signs of congenital hip displasia
- Asymmetrical hip abduction with tightness
- Apparent shortening of femur on involved side
Diagnostic tests for congenital hip displasia
- Ortolani test
- Barlow maneuver
Treatment for congenital hip displasia
- Bracing, splinting, or traction
- Open reduction with spica cast after
info in SIDS
- baby 12 months or younger dies during sleep with no warning signs or a clear reason
- Treatment: back to sleep program
- No PT intervention
Club Foot: Talipes Equinovarus info
- Signs: adduction of forefoot, equinus of ankle, various positions of hindfoot
- splinting and serial casting after birth; may require surgery followed by casting
Juvenile Rhumatoid Arthritis
- Causes: may be due to virus, infection, or trauma that elicits an autoimmune reaction; genetic predisposition
- PT Therapy
- PROM, AROM, positioning, splinting, strengthening, endurance, weight bearing, postural tx, functional mobility
- Pain management: paraffin, US, warm water, cryotherapy
- Home program to maintain strength and flexibility between exacerbations
Types of Scoliosis
- Structural: cannot be corrected with passive movement, with rotation of vertebrae toward convexity of curve; rib hump over convex side of curve
- Nonstructural (also called functional): correction with lateral bending (from leg length descrepancy, hypotonia)
Scoliosis curve info
- Curve < 25 degrees: monitor
- Curve 25-40 degrees: PT for posture, flexibility, respiratory, body mechanics; orthotic support
- Curve > 40 degrees: surgery
Types of braces for treating scoliosis
- Milwaukee brace
- -a cervico-thoracic-lumbo-sacral orthosis. This brace looks like the other brace, but has a neck ring that is attached to the body of the brace to hold it in place.
- -suggested for thoracic spine curvatures
- -worn 23 hours a day; can be removed during the day for physical activity.
- Boston brace
- -also called a thoraco-lumbo-sacral orthosis; underarm brace
- -worn 23 hours a day, but can be removed for gym class, swimming and other sports.
- Charleston brace
- -molded to the child’s body when they are bent toward the convexity of the curve, thus applying more pressure to the curve
- -recommended for curvatures of 25-40 degrees with the apex of the curve below the height of the shoulder blade
- -worn at night, many self-esteem issues are avoided.
- Child who is in a wheelchair and who has scoliosis needs to be treated with a 3-point system:
PT intervention for scoliosis
- Scroth Method (3 D approach to treatment for scoliosis)
- -improve and maintain flexibility and function
- -improve posture so that the body can regain its original vertical axis.
- -To restore muscular balance, those muscles that have grown longer must be shortened and those that have become shorter must be lengthened.
- -The basis of correction is a properly aligned pelvis; a scoliotic pelvis is often not only shifted laterally but also tilted and rotated.
- Degeneration of femoral head due to avascular necrosis
- Most common in boys age 2 – 12
- Usually only occurs in one hip
S/S of Legg Calve Perthes
pain, decreased ROM, antalgic gait, + Trendellenberg
Tx goals of Legg Calve
relieve pain, maintain femoral head in alignment, improve ROM
PT management of Legg Calve
stretching, splinting, crutch training, aquatic tx, traction, exercise
- inflammation of the tendon below the kneecap (patellar tendon) where it attaches to the shinbone (tibia).
- OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly.
- occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet.
- most symptoms will completely disappear with completion of the adolescent growth spurt, around age
- 14 for girls and age 16 for boys.
Tx of Osgood Schlatter
- Applying moist heat for 15 minutes before or icing for 20 minutes after activity can minimize swelling.
- Stretching of quads and HS before and after exercise
- Rapid respirations
- Lengthened expiration phase
- genetic disorder resulting in thickend mucus in lungs and other organs
- PT treatment:
- postural drainage,
- breathing exercises
- adaptation of environment for energy conservation
types of pervasive developmental disorder
- Autism: most common
- Asperger’s: milder form of autism with social isolation, eccentric behavior, differences in speech inflection and patterns
- PDD-NOS (not otherwise specified): on the spectrum of autism
Characteristics of pervasive development disorders
- communication impairments
- Social impairments
- abnormal relationships with objects and events
- tend to have low muscle tone, decreased strength, poor balance and delayed gross motor skills
- Behavioral issues
PT intervention of pervasive development disorders
- Use familiar objects and routines
- Prepare child for changes in routine
- Speak clearly and with simple instructions
- Structure environment to teach social skills
- Use daily activities to increase strength and function
Down syndrome info
- children will walk by 2-3 years old
- bouncing children on something causes increase in muscle tone if hypotonic
Goals for sacral myelomeningocele
- AFO’s for stability
- Strength throughout LE but intrinsic may be weak
- Decreased sensation in feet
- Bowel and bladder control may be impaired
Goals for myelomeningocele at L4-5
- Ambulates with AFO’s and crutches
- Decreased sensation lower legs and feet
- Tires easily
- No bowel or bladder function
Goals for myelomeningocele ay L3-4
- Crutches or walker with KAFO’s or AFO’s
- Wheelchair for community mobility
- Ambulatory short distances with crutches or walker and KAFO’s or HKAFO’s
- Not a community ambulatory
- no nerve innervation distal to T5 so will not be ambulatory: will depend on power or standard wheelchair for mobility
- In PT: child can use parapodium or standing frame; reciprocating gait orthosis in therapy