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pediatric
pediatric neuro objectives
81
Anatomy
Graduate
11/26/2012

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Term
what are some delayed motor milestones that are warning signs in infants
Definition
not rolling by 6 months. Fisting after 5 months. Not sitting with support by 8 months. Not walking by 15-18 months. Discrepancies between intellectual and motor development
Term
what abnormalities of muscle tone are warning signs in infants
Definition
head lag beyond 6 months. Poor trunk control/balance. Extension thrusting. Dystonia. Early rolling or standing. Toe walking or scissoring. Abnormal gait patterns
Term
at what point are you worried if clonus persists
Definition
12 months
Term
when would you be concerned about hand preference
Definition
declaring handedness prior to 18 months. Differences in functional abilities of L vs R
Term
what are behavioral warning signs in children
Definition
irritability. Easily startled with exaggerated Moro. Jittery. Sleeping difficulties.
Term
what physical properties are warning signs in infants
Definition
decreased rate of head growth. Poor suck. Delayed feeding milestones. Poor weight gain/failure to thrive.
Term
define CP
Definition
cerebral palsy is the general term for a variety of non-progressive disorders that affect a child's ability to move and maintain posture and balance
Term
can there be any progression with CP?
Definition
the secondary effects of CP do change over time so status/functional abilities might change but it is still considered a non-progressive disorder
Term
is CP a developmental disability?
Definition
yes
Term
what are causes of CP?
Definition
injury to immature brain in utero or during/shortly after birth. Periventricular leukomalacia
Term
what is periventricular leukomalacia
Definition
death in areas of the ventricles
Term
is birth weight related to CP?
Definition
yes. As birth weight decreases, incidence of CP increases
Term
what are some causes of periventricular leukomalacia
Definition
maternal exposure to toxins; infections, meningitis; interventricular hemorrhage
Term
what are the 5 classifications of CP
Definition
spastic, dyskinetic (athetoid and dystonic), ataxic, mixed, hypotonic
Term
what is the most common type of CP
Definition
spastic
Term
describe spastic CP
Definition
move in a limited ROM around mid-range. Often present with low postural tone.
Term
what part of the brain was affected in spastic CP
Definition
motor cortex
Term
what are the two types of dyskinetic CP
Definition
athetoid and dystonic
Term
what part of the brain was affected in dyskinetic CP
Definition
basal ganglia
Term
describe dyskinetic CP
Definition
atypical patterns of posture. Involuntary, uncontrolled movement patterns in affected body parts
Term
describe athetoid dyskinetic CP
Definition
slow, continuous writhing movements. This makes posture and balance challenging
Term
describe dystonic dyskinetic CP
Definition
involuntary muscle contractions: sustained or intermittent with repetitive movements and abnormal postures.
Term
how common is dyskinetic CP
Definition
about 10% of cases
Term
what part of the brain is affected in ataxic CP
Definition
cerebellum
Term
describe ataxic CP
Definition
underlying hypotonic state. Poor co-contraction around joints. Difficult time sustaining positions. Poor control. Unstable
Term
describe mixed CP
Definition
combines spastic and dyskinetic qualities.
Term
what part of the brain is affected in mixed CP
Definition
motor cortex as well as basal ganglia
Term
describe hypotonic CP
Definition
low muscle tone. Challenges moving against gravity.
Term
what part of the brain is affected in hypotonic CP
Definition
no specific area
Term
what determines the type of movement pattern presented by a child with CP
Definition
the part of the brain that has the insult
Term
what is monoplegia
Definition
one extremity involved. Rare
Term
what is hemipleiga
Definition
arm and leg affected on same side of body. Arm is usually more invovled with more problems distally.
Term
what is diplegia
Definition
legs are primarily involved. Usually spastic. Often shortened/tight Achilles leads to toe walking
Term
what is triplegia
Definition
3 involved extremities (usually both legs and one arm)
Term
what general areas should be examined in a child with neurological dysfunction
Definition
history, systems review, function, musculoskeletal exam, neuro exam, gait
Term
what do you want to know in history for CP kid?
Definition
family situatoin, birth history, birth weight, surgeries, tone management, adaptive equipment, splints/braces, educational/daycare setting, previous therapy
Term
what do you look for in systems review of a child with CP
Definition
GI function, cardiovascular/pulmonary, integumentary, cognition/attention/motivation, communication, musculoskeletal, neuromuscular
Term
what to consider with GI function of kid with CP
Definition
postural alignment impacts coordination of suck, swallow, breathing
Term
what to consider with cardiovascular/pulmonary function of kid with CP
Definition
tone impacting posture impacting respiration
Term
what to consider with integumentary of kid with CP
Definition
skin integrity from braces/adaptive equipment. Surgical scars
Term
why to consider cognition, motivation, attention in kid with CP
Definition
impacts goal setting
Term
what to consider with communcation in kid with cp
Definition
receptive vs expressive abilities
Term
what to consider with musculoskeletal review in kid with CP
Definition
ROM, strength, symmetry.
Term
what to look at in neuromuscular review in kid with CP
Definition
posture, balance
Term
what is dissociation
Definition
ability to move independent parts of your body separate from otehrs
Term
what to look for in functional assessment
Definition
symmetry in weightbearing, weightshifting, ROM, tone, weakness
Term
what is the gold standard test for testing kids with CP
Definition
GMFM
Term
what test can be used in the NICU for a child 34 weeks gestation to 4 months
Definition
Test of Infant Motor Performance
Term
what are 2 tests to use with infants with suspected motor delay?
Definition
test of infant motor performance, AIMS
Term
what are some ways to test ROM in kids
Definition
ask them to sit longsitting (hamstrings), lie prone (hip flexor), descend stairs (limited DF, tight PF)
Term
what to look for in neuromuscular exam
Definition
spasticity. Postural reactions (righting reactions, equilibrium reactions.) persistence of primitive reflexes. Neuromotor development and sensory integration. Side to side asymmetries.
Term
describe gait of someone with spastic diplegia
Definition
crouch gait. Excessive hip and knee flexion. Often hip flexor contractures. Excessive trunk motion.
Term
describe gait of someone with hemiplegia
Definition
flexed, fisted UE. Active DF is hard so they will drag their toes. Lead gait with stronger side.
Term
describe gait of someone with athetosis
Definition
gait not smooth or coordinated. Pattern is very variable. Have voluntary control but often overpowered by writhing.
Term
describe gait of someone with ataxia
Definition
wide BOS, forward trunk, hip and plantarflexion
Term
what is especially important to remember for children with neurological dysfunction
Definition
differences in growth and development. Find what functional activities MOTIVAte them And Practice
Term
what are some common impairments in CP
Definition
insufficient force generation, spasticity, abnormal extensibility, poor selective control of muscle activity, poor anticipatory regulation of muscle activity, exaggerated or hyperactive reflexes, decreased ability to learn unique movements
Term
what are some assistive devices that provide support to kids
Definition
benches, lofstrands, reverse walker, wheechair, braces, orthotics
Term
what are some interventions to use with infants/toddlers
Definition
facilitate caregiving, promote optimal sensorimotor experiences and skills, educate the family
Term
what are some treatment considerations for kids with CP during preschool period
Definition
reduce impairments and prevent secondary sequelae: increase force production, manage spasticity, maintain extensibility, maintain good alignment, improve function and participation (UE use, mobility, recreation)
Term
what are treatment consderations for kids with CP during school age and adolescence
Definition
reduce primary impairment. Prevent secondary impairment. Improve mobility and endurance. Facilitate school and community participation.
Term
what are treatment considerations for a child with CP as she transitions to adulthood
Definition
reduce primary impairment and prevent secondary impairment. Promote life skills and recreation. Help with transitional planning.
Term
what can you do to help a child with hemiplegia who has difficulty crawling
Definition
utilize mobility via rolling. Work on weightbearing, weightshifting. OPEN palm in weightbearing.
Term
what to do for child with diplegia who has forward lean and is up on toes due to tight triceps surae
Definition
stretch!
Term
how to help a kid with quadriplegia
Definition
assstiance or adaptive equipment needed for sitting and mobility
Term
what other conditions are confused with CP?
Definition
torticollis, brachial plexus injury
Term
how to determine CP intervnetion
Definition
determine highest functional skill and work from there. Target intervention on what their next step is and what is holding them back.
Term
what are some ideas for stretching kids with CP
Definition
trunk rotation games. Stretch while watching TV. Have them take ownership and control as many stretches as they can. Prolonged positioning with orthoses, standers.
Term
what is an ex Rx for passive stretching
Definition
3-5 repetitions, hold 20-60 seconds, 1-3x/day
Term
Ex Rx for prolonged positioning
Definition
>6 hrs/day using splinting or equipment
Term
what device can be used to stretch tight hamstrings
Definition
knee immobilizer
Term
what device can be used to stretch tight PF
Definition
DF orthoses to hold ankle at 90
Term
what are some strengthening ideas for kids with CP
Definition
task oriented/functional strength training: step ups, using a ball, playing games.
Term
how to work on strengthening for postural control in kids with CP
Definition
balance play with reaching to shift weight to the limits of stability. repetitions of balance perturbations in various positions. Target the trunk. Trunk elongation and rotational movements. Core/trunk strengthening activities. Babies on therap balls.
Term
what are benefits of aerobic exercises
Definition
improves CV endurance. Reduces cost of movement. Preserves bone mass
Term
what are ways to do aerobic exercise in kids with CP
Definition
walking: using assistive device. Aquatic therapy
Term
what is the best predictor of walking
Definition
independent sitting by 24 months
Term
what is the age by which most kids with CP walk if they will ever walk
Definition
8 years
Term
what is a selective dorsal rhizotomy?
Definition
selectively snip nerve rootlets in cauda equina to reduce levels of spasticity.
Term
what is a baclofen pump?
Definition
medicine used for spasticity management
Term
describe botox injections
Definition
local target for overactive muscles
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