Neuro_Peds_ALL

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  1. Down Syndrome - S/S - 6 + contraindication; test
    • Hypotonia; DEC mm tone
    • Congenital heart defects
    • Visual & hearing losses
    • Laxity of ligaments
    • Cognitive deficits
    • Contraindication - Hyperextension of elbows & knees during WB; Forceful neck flexion & rotation
    • LATEX ALLERGY??????
    • Test - Gross Motor Function Measure (GMFM-88)
  2. Down Syndrome - best intervention
    WB in antigravity mms bc of low tone
  3. Down syndrome - walking when?
    24 months
  4. Down syndrome - why do they like to W sit? - 2
    • Low mm tone
    • Difficulty achieving sitting
  5. Retts syndrome - 5
    • Normal dev until 6-18 months
    • Head growth slows at 2-4 months
    • Gait abnormalities
    • Stereotypic hand movements (wringing, washing, clapping, bumping...)
    • Test - (+) blood test for mutation
  6. 2 ways Retts presents opposite from Autism
    • Retts: prefers people to objects
    • Retts: enjoys affection
  7. Spina bifida - types - 3
    • Occult - No neural involvement. Identified by tut of hair, dimple
    • Meningocele - external cyst w/CFS but spinal cord intact
    • Myelomeningocele - external cyst w/CFS & herniation of spinal cord
  8. What complication w/myelomeningocele? + 2 facts about it
    • Arnold Chiari II
    • Latex allergy
    • Can lead to hydrocephalus
    • Foot deformities - talipes equinovarus (L4-L5)
  9. Spina bifida - S/S - 6
    • Foot deformities, especially club foot or talipes equinovarus
    • Bowel & bladder problems (L4-L5 lesion)
    • Low tone with poor head control
    • Hip flexor & ADD tightness
    • Developmental delays
  10. Duchenne's Muscular Dystrophy - definition; onset; early sign; progression; test
    • MM cells replaced w/fat & connective tissues
    • PROXIMAL to distal
    • Onset - males (3-7); soon after child begins to walk
    • 1st mm affected - glutes; HS, gastrocnemius
    • 2nd mm affected - sh girdle mm - pecs (sternal); deltoid; abs
    • Extensors affected more than flexors
    • Early sign - Gower’s maneuver - uses hands to walks up legs to get off floor
    • Progression - Kyphoscoliosis (after 11)
    • Test - CPK blood test
  11. Duchenne's Muscular Dystrophy - S/S - 7
    • Proximal to distal
    • Pseudo hypertrophy of calves
    • Gait - waddling; toe walking
    • Scoliosis - INC lordosis
    • Difficulty w/climbing stairs
    • Clumsiness
    • Frequent falls
  12. Duchenne's Muscular Dystrophy - Tx - 4
    • Surgery - lengthening of gastrio; scoliosis
    • PT - ONLY submax exercise - heavy lifting can damage more mm
    • WC bound by 10-12
    • KAFO
  13. APGAR - 5
    • @ birth, 1, 5, 10, 15 & Continues every 5 min if infant is having difficulties
    • Scored 0-2
    • Normal - 7 or better
    • Needs some care - 5-7
    • Needs immediate care - <4
  14. APGAR - what is tested
    • A - appearance (skin color)
    • P - pulse (HR)
    • G - grimace (reflex irritability)
    • A - activity (muscle tone)
    • R - Respiration
  15. ROM & newborns - 2
    • DEC ROM into extension due to physiological flexion
    • INC DF of ankles & flexion at wrists
  16. Dislocated hip can be identified how?
    By asymmetrical gluteal folds, hip click
  17. Meconium Aspiration syndrome - 3
    • Meconium) that mixes w/amniotic fluid
    • Infants are hypersensitive to environmental stimuli: treat in quiet environment
    • 20% present w/developmental delays, some up until 3 years of age
  18. Gestational age - normal & premature
    • Normal: 38-42 weeks
    • Premature: <37 weeks GA
  19. Positional principles for babies - 2
    • Neonates – fetal or physiological flexion, hand by mouth
    • At home – not in prone due to SIDS
  20. Premie - Postural profile - 8
    • WB on toes when placed in upright position
    • Arm movement - DEC in midline
    • Pelvis - Elevated
    • Hips - ABD & extended
    • Scapular - Retracted
    • Shoulders - Elevated & extended
    • Neck & trunk - Hyperextended
    • UE & LE - Symmetrical flexed & ADD
  21. Premies - Tx positions - 2
    • Sidelying & prone - chin tucked, trunk flexed, shoulders protracted, posterior pelvic tilt, flexed legs
    • Gentle flexion of hips & knees in supine & supported semisitting
  22. Premies - Parental education for play & feeding - 7
    • Position head in midline
    • Position prone or sidelying
    • Tilt child to encourage head balance & head righting
    • Suspend toys in front of infant to encourage reaching
    • Play activities that bring shoulders forward
    • Minimize use of infant jumpers or walkers which INC extensor tone
    • Use black/white/red objects 9 inches away
  23. Premies - What increases extensor tone?
    Infant jumpers or walkers
  24. CP - characterized by - 2 + test
    • Involuntary movements
    • Visual, auditory, oral-motor, speech & cognitive deficits
    • Test - Gross Motor Function Measure (GMFM-88)
  25. CP - Ataxic - 6
    • Damage to cerebellum
    • Poor balance & coordination
    • Stance & gait - wide-based
    • Poor ability of fine & rapid movement
    • Low postural tone
    • Intention tremor in hands
  26. CP - Athetoid - 5
    • Damage to basal ganglia
    • Hypotonia - “Floppy baby” syndrome; DEC mm tone; DEC DTR
    • Dystonia - slow, writhing movements
    • Poor postural control of trunk mms (proximal)
    • Tonic reflexes - ATNR; STNR; TLR
  27. CP - Spastic - 5
    • Damage to UMN
    • INC DTR, mm tone
    • Abnormal postures w/movement in mass flex/ext
    • Gait - “crouched” (hip flex/IR; knee flex); scissoring; toe-walking
    • Weakness/Contractures
  28. CP - Tx - 7
    • Selective dorsal rhizotomy - not for dystonia; intensive strengthening
    • Botox injections - last 4-6 months
    • Phenol nn block - lasts 3-6 months
    • Intrathecal baclofen pump - 1-4 months; reversible
    • MM lengthening - achilles tendon; gastrocnemius; illiopsoas; hip ADD
    • MM reverse - hip ADD into hip ABD
    • Osteotomies - hip; pelvis
    • Devices - posterior walker;
  29. How much tummy time does a baby need?
    81 minutes per day - doesn't have to be consecutive
  30. Functional sitting - proper position; how to help child get there
    • Pelvis neutral; hip/knees 90 flexion
    • Tilt seat posteriorly & add wedge under thighs
  31. What can standers help with? - 3
    • Promote WB
    • Reduce primitive reflexes
    • Aid in bladder & bowel functions
  32. Posterior walker - what it encourages (5); for what population
    • Trunk extension
    • Shoulder depression
    • Elbow extension
    • Neutral wrist
    • May DEC scissoring in LE
    • Pathology - CP
  33. Side-lyers - used for what?
    • DEC TLR
    • Also puts hands in visual field
  34. What can help a child be in prone position?
    Foam wedge
  35. What offers maximum support to UE & trunk?
    Gait trainers
  36. Power wheelchairs can be used when?
    As early as 18 months of age depending on the specific child
  37. HKAFO - for what population?
    • Spina bifida
    • SCI
  38. KAFO - for what population - 2
    • Spina bifida
    • Muscular dystrophy
  39. Automatic reactions - use what to help; Ex how to practice forward righting rx
    • Swiss ball
    • Displace ball backward - abdominals activated for forward reaction
  40. RGO - of what population - 2
    • T-spine spina bifida
    • SCI
    • WHEN THERE IS NO HIP FLEXION
  41. To promote sensory integration use what equipment? - 1
    Swings
  42. Pavlov harness - for what population? Does what?
    • Infants w/congenital hip dysplasia
    • Places hips into flex/ABD
  43. If child has INC extensor tone, what can be used to help maintain hip flexion in 90 deg?
    Tilt-in-space WC seat
  44. Scooter/three wheelers require what for use?
    • Fair (3/5) sitting balance
    • UE control
  45. School Functional Assessment (SFA) - what age
    For children in grades K-6 (5-12years of age)
  46. Whole Arm Paralysis (Erb-Klumpke palsy) - nn roots involved; Appearance; Weakness; Tx
    • C5-T1 nn roots stretched during birth
    • Appearance - Claw hand
    • Most affected - Hand function
    • Tx - Partial immobilization of limb across upper abdomen for 1-2 wks
  47. Erb’s palsy - nn roots involved; Appearance; Weakness; Tx
    • Upper arm paralysis - C5-C6
    • Appearance - “waiter’s tip” - Sh ADD/IR
    • Weakness - Shoulder ABD/ER; elbow flexion & supination; DEC sh girdle function
    • Tx - Early - Neutral positioning of arm; Gentle ROM exercises
    • Severe - child cannot hug a doll; drink from cup; zipper coat
  48. Klumpke’s palsy - nn roots involved; Appearance; Weakness; Tx
    • Lower arm paralysis - C8-T1
    • Appearance - claw hand
    • Weakness - Hand & wrist flexors
  49. Rolling - 3
    • Prone/supine to side - 4 months
    • Prone to supine - 5 months
    • Supine to prone - 6 months
  50. Stairs - 3
    • Up & down w/assistance - 18-20 months
    • Up reciprocally (1 at a time) - 2yr
    • Down reciprocally - 3 yr
  51. Grasp - 5
    • Ulnar palmar grasp - 4 mon (can't transfer btwn hands)
    • Radial palmar grasp (using thumb & 1st 2 fingers) - 5 months (can first hold bottle)
    • Pincer grasp w/thumb & forefinger - 8-9 months
    • Pincer grasp w/release - 10-15 months
    • Can transfer hand to hand (FINE MOTOR) - 6 months or in THERAPY ED 8-9
  52. Fine pincer grasp
    11 months
  53. Stacking 2 blocks
    12-15 months
  54. Stacking 6 blocks
    16-24 months
  55. Holding cup while drinking
    12 months
  56. Transferring objects from one hand to next
    8-9 months
  57. Sitting - 4
    • Propped (hands on ankles, supporting torso) - 5 months
    • IND - 6 months
    • IND (arms free to reach w/o LOB) - 7-9 months
    • Side-sitting - 8-9 months
  58. Standing - 5
    • Partial WB - 5 months
    • Pull to stand - 10-12 (as early as 7)
    • IND - 8-9 months
    • Cruising sideways - 10-12 months or 8-9????
  59. Head control - 2
    • Head bobs in supported sitting - 2 months
    • Present in supported sitting - 5 months
  60. Frog-legged - describe; when?
    • B/L ABD/ER
    • 3 months
  61. W sitting - bad why?
    Femoral antetorsion & medial knee stress
  62. Crawling - time
    9-11 months
  63. Walking - time
    12-14 months
  64. Pivot prone: on their stomachs (prone) & lift up their arms (pivot) - when
    4-6 months
  65. Forward flexion in propped sitting after how many months is a red flag for poor abdominal, erector spinae, hip control?
    7
  66. Hands to midline happens when
    3-5 months
  67. Supine head lifting happens when
    4-6 months
  68. 7 reflexes present at birth
    • Moro
    • suck
    • root
    • palmar
    • plantar
    • ATNR
    • babinski
  69. ATNR - asymmetrical tonic neck reflex - stimulus; response; strongest in what position
    • Stimulus - turn head to side,
    • Response - flexion of skull limbs, extension of jaw limbs - fencing posture
    • Strongest in Supine or sitting
  70. Prolonged ATNR can result in what?
    • Scoliosis
    • Hip subluxation/dislocation if there is marked hypertonia
  71. Grasp reflex - stimulus; response; integration
    • Stimulus: maintain P to palm of hand (palmar) or to ball of foot under toes (plantar)
    • Response: maintain flexion of fingers or toes
    • Integration - Palmar - 4-6 months; Plantar - 9 months or when child starts walking
  72. Landau reflex - stimulus & response; when is it absent?
    • Stimulus - lift child under thorax in prone position - superman pose
    • Response - first the head and then the head and legs will extend
    • Absent w/strong flexor spasticity
  73. What will happen if head is pushed down after landau reflex is seen?
    Extensor tone will disappear
  74. Moro/Startle reflex - stimulus & response; integration
    • Stimulus - sudden change in position of head in relation to trunk
    • Response - Extension/ABD of UE with hand opening and crying
    • Followed by flexion/ADD, arms across chest
    • Integration - 5-6 months
  75. Rooting reflex - stimulus & response; integration
    • Stimulus - side of face is stimulated with light touch
    • Response - infant turns head toward side of stimulation & opens mouth
    • Integration - 3 months
  76. Symmetrical tonic neck reflex (STNR) - stimulus & response
    • Stimulus - flexion or extension of head
    • Response - With head flexion: flexion of UE & extension of LE
    • With head extension: extension of UE & flexion of LE
  77. What can the symmetrical tonic neck reflex (STNR) strongly influence in a bad way?
    Ability to assume quadruped position as well as ability to crawl
  78. What can TLR interrupt?
    If reflex persists and is strong, may block rolling from supine position, due to increased extensor tone
  79. Tonic labyrinthine reflex (TLR) - stimulus & response
    • Stimulus - prone or supine position
    • Response - Prone - INC flexor tone / Supine - INC extensor tone
  80. Babinski reflex - stimulus & response; integration
    • Stimulus - Stroke lateral aspect of the plantar surface of foot
    • Response - extension & fanning of toes
    • Integration - normal up to 2 years, may disappear by 1 year
  81. Galant reflex - stimulus; response; integration
    • Stimulus - hold bay face down; stroke 1 side of spine
    • Response - Side-bending to stimulated side
    • Integration - 12 months
  82. Crossed extension reflex - stimulus & response
    • Stimulus - Sharp, quick pressure stimulus to sole of foot of extremity in extension. Tested in supine
    • Response - opposite LE flexes, then ADD & extends
  83. Crossed extension reflex, when coupled with the (+) supporting reaction, can result in what?
    Hyperextension of the knee
  84. How can crossed extension reflex be used with hemiplegic pts?
    Lifting uninvolved leg off the ground during ambulation results in increased extensor tone in involved leg
  85. When will the equilibrium reactions be absent?
    With marked spasticity
  86. Equilibrium/tilting reactions onset? Different positions
    • Prone (6 months)
    • Supine (7-8 months)
    • Sitting (7-8 months)
    • Kneeling (9-12 months)
    • Standing (12-21 months)
  87. (+) Supporting Reaction - stimulus & response
    • Stimulus: contact to ball of foot in an upright standing position
    • Response: rigid extension (cocontraction) of LE with ankle PF/inversion, toes "clawing," & hip IR
  88. (+) Supporting Reaction & CP
    ADD spasm may occur
  89. (+) Supporting reaction & hemiplegia
    • May produce hip ABD
    • Ambulation will be disrupted by inability to DF foot or to properly move leg jts
  90. Order of protective extensions
    • Downward (parachute) - 4 months
    • Forward - 7 months
    • Sideways - 6 months
    • Backwards - 9 months
  91. Protective extensions onset
    • Arms - 4-6 months
    • Legs 6-9 months
  92. Peds - color of objects - 6 months; 3yr;
    • 6 months - Black & white????
    • 3 yr - Multicolored

Card Set Information

Author:
Tanuisha
ID:
323966
Filename:
Neuro_Peds_ALL
Updated:
2016-11-29 18:14:35
Tags:
Neuro Peds ALL
Folders:
Neuro
Description:
Neuro_Peds_ALL
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