Pediatrics Unit 2: Pediatric examination, Perinatal diagnoses, CVP conditions and fitness

what is always included in a pediatric PT examination

task analysis in the systems review of a developmentally appropriate task

what is considered during a task analysis (10)

symmetry

speed

amplitude

alignment

verticality

stability

smoothness

sequencing

timing

accuracy

if a child cannot understand the instructions of an MMT what can be done to assess strength

observation of a functional skill

what is the FLACC scale

an observational scale or children who are pre verbal or nonverbal that looks at facial grimacing and expressions, extremity withdrawal, level of cry, activity, and consolability

what pain scales are used for pts who can verbalize

wong baked FACES rating scale or the visual analog scale

what is completed when determining the POC

a problem list and a one paragraph assessment summary including all ICF components,

what is the focus of SMART goals for the peds population

activity and participation based

what is a childs chronological age

the age of a child from actual birth

what is gestational age

age of pregnancy started at the woman's last menstrual period

the amount of time that a baby has been in the mother

what is the adjusted age

the chronological age reduced by the number of weeks the child was born before 40 weeks gestation

why is adjusted age used

to adjust expectations of developmental progress for babies born prematurely

when is adjusted age used

when the baby is born less than 37 weeks GA until they are 2 years old

what are single task outcome measures

those that assess one domain such as endurance, gair speed, or fall risk

how is the TUG performed for pediatrics

the pt stands and walks either 3 meters or 10 feet, turns around, walks back and sits

what is the time up and down stairs

the child walks up and down 14 stairs instructed to go quickly but safely using either a step to or step through pattern with handrails if needed

what cannot be used in the times up and down

orthotics

what is the 30 second walk test used for

it informs the PT about walking speed when the pts disability restricts the time or distance that they can walk

why is the 10 meter walk test not used as often as the 6 min walk test or 30 sec walk test

it is difficult to get the child to achieve their regular waling pace in a short distance

how is the 5xSTS performed for pediatric pts

same as the adult test just with a chair that allows sitting at 90/90

what is the timed floor to stand

the child stands up from the floor walks 3 meters then comes back to sit again with their legs crossed

what is the pediatric balance scale

a balance scale similar to the berg balance allowing examination of functional balance in the pediatric population

what is a multi item outcome measure

outcome measures that assess numerous items to quantify a child's motor ability, functional performance, and/or their ability to participate in child related activity

what does the segmental assessment of trunk control assess

postural control

what ICF domain does the SATCO assess

body structure and function

what does the BOT test assess

strength and coordination

mobility tasks like running and jumping

what ICF domain does the BOT test assess

body structure and function

activity

what is the school function assessment

assesses how a child experiences and performs in the school setting

what ICF does the SFA assess

participation

what is a criterion referenced test

a test that is meant to evaluate a child's performance on a specific set of skills in which their score is not compared to any one other than the child being evaluated

what is a norm referenced test

a test evaluating a child's performance that is compared to age matched peers or developing children their age

what is beneficial with a criterion referenced test

we can compare performance overtime to assess progress

when are norm referenced tests used

when screening a child to determine if the show developmental delay or to justify the start of therapy

when is a criterion referenced test used

if you are working with a child with a known developmental delay in order to track progress

who is the GMFM outcome used for

pts between 5 months and 16 years old validated for use for children with cerebral palsy and down syndrome

who is the Alberta Infant Motor Scale used for

for children between 0-18 months old

what outcome measure for pediatrics are norm referenced (4)

alberta infant motor scale

peabody developmental motor scale

Bruininks oseretsky test of motor proficiency

pediatric evaluation of disability index

what pediatric outcome measures are norm referenced and criterion referenced

test of infant motor performance

what outcome measure for pediatrics are criterion referenced (3)

school function assessment

segmental assessment of trunk control

gross motor function measure

what age range is appropriate for the test of infant motor performance

34 weeks GA-4 months

what age range is appropriate for the peabody developmental motor scales

0-60 months

what age range is appropriate for the pediatric evaluation of disability index

6 months-7.5 yers

what age range is appropriate for the school function assessment

kindergarten to 6th grade

what outcome measures assess ICF activity limitations (4)

peabody development motor scales

alberta infant motor scale

gross motor function measure

test of infant motor performance

what outcomes assess body structure and function and participation (2)

pediatric evaluation of disability index

school function assessment

what causes a brachial plexus injury (BPI)

due to injury during a difficult vaginal delivery most commonly shoulder dystocia or a unilateral traction injury to the brachial plexus

what is shoulder dystocia

the anterior or posterior shoulder is caught behind the symphysis pubis or sacrum of the mother

what increases the risk for BPI during birth (7)

shoulder dystocia

birth weight greater than 90th percentile

maternal gestational diabetes

prolonged maternal labor

labor induction mechanical assistance

breech delivery

history of BPI birth

where is the most common location of BPI

where the nerve rootlets are attached to the spinal cord at the anterior or posterior rootlets or the spinal nerve itself

what is neurotmesis

avulsion from the spinal cord

what is axontmesis

a disruption of axons while the endoneurium remains intact

what is neuropraxia

temporary nerve conduction block with intact axons

what is the typical prognosis timeline for BPI

4-9 months with 4-6 common in upper arm and 7-9 common in lower arm with recovery continuing to 2 years in the upper arm and 4 years in the lower arm

what is Erbs palsy

BPI to the C5 and C6 nerve roots

what is extended erbs palsy

injury to C5-C7 nerve roots

what posture is seen in erbs palsy

shoulder held in extension, IR, and adduction

elbow extension

pronation

hand and finger flexion

AKA waiters tip position

what muscles are impacted in Erbs palsy (13)

rhomboids

levator scap

serratus anterior

subscap

deltoid

supraspinatus

infraspinatus

teres minor

biceps

brachialis

brachioradialis

supinator

wrist, finger, and thumb long extensors

what is Klumpke's palsy

injury to the lower roots or spinal nerves of C8-T1

what posture is seen in Klumpke's palsy

supination and elbow flexion with paralysis of the wrist flexors and extensors and intrinsic hand muscles

what is preserved in Klumpke's palsy

shoulder and elbow motion

what is horners syndrome

often expected with Klumpke's palsy due to T1 root abortion or injury to sympathetic ganglion which can cause deficient sweating, recession of eyes, abnormal pupil response, miosis ptosis, and the irises of different colors

what is global palsy

BPI to the upper and lower plexus of C5-T1 resulting in total arm paralysis and loss of sensation

how may global palsy present

it may appear as a milder form of Horners syndrome

what may occur with BPI due to the unilateral presentation

torticollis and/or plagiocephaly due to a resting posture of the neck in rotation away from the affected arm

what may be observed with reaching with a pt with BPI

muscle substitution with excessive IR and wrist and finger flexion to reach for an object

what can be seen if sensory is affected in BPI

neglect

what diagnostic tests are done for a BPI (5)

MRI

EMG

CT

CT-myelogram

diagnostic ultrasound

when would neurosurgery be recommended for BPI

between 3-9 months of age generally or

what are the indications for BPI neurosurgery (2)

lack of active shoulder ER

lack of biceps control or supination

what is done post-op for microsurgery neurosurgery for a BPI

immobilization for 3 weeks with PROM and muscle activation after

what has been found to improve active motion after neurosurgery

botox

what should be included in the subjective exam of a BPI (5)

history of birth

birth complications

diagnostic test results

parents understanding of dx

goals

what should be included in the physical exam for a BPI (6)

PROM

strength or motor function of C/S and UE

posture

FLACC pain scale

sensation

tone

what is the active movement scale and modified mallet scale used for

muscle grading systems and active UE motion classification system

what ICF activity and/or participation outcome measures can be used for a pt with a BPI (5)

test of infant motor performance

alberta infant motor scale

brachial plexus outcome measure

brachial plexus outcome measure activity scale

assisted and assessment

what interventions are done for BPI

gentle PROM and stretching

scapula support for scapulohumeral rhythm

emphasis on shoulder flexion with ER and elbow flexion

developmental activities

tactile stimulation of facilitation of weak muscles

what are the goals of intervention for BPI (6)

PROM and AROM

increase strength

increase sensation

decrease pain

prevent contractures

facilitate symmetry

what is developmental delay

when a child does not achieve their milestones compared to their age matched peers

what is significant developmental delay

performance that is 2 or more standard deviations below the mean on an age appropriate standardized norm referenced test

what are prenatal causes of developmental delay

the cause occurs towards the end of pregnancy, through labor and delivery, and up to one month after the baby is born

what are post natal causes of developmental delay

causes after one month of birth

what are examples of prenatal causes of developmental delay (6)

genetic disorders

cerebral dysgenesis

vascular issues in the brain

drugs the baby was exposed to

toxins

infections

what are cerebral dysgenesis

parts of the brain did not form or formed in an atypical way

what are examples of perinatal risks for developmental delay (5)

prematurity (major risk)

growth retardation

periventricular leukomalacia

hypoxic ischemic encephalopathy

metabolic conditions

what is periventricular leukomalacia

a disorder of the white matter in the brain

what is hypoxic ischemic encephalopathy

when the brain does not get enough oxygen typically during labor

what are examples of postnatal risk factors for developmental delay (4)

infections such as meningitis or encephalitis

metabolic issues

anoxia

trauma

what is anoxia

when the brain doesn't get enough oxygen

what about a childs environment lead to development delay

things like severe under stimulation, maltreatment, malnutrition, or maternal mental health disorders

is there always a cause for developmental delay

no there may be an unknown cause

what are the 4 main domains of development

physical

social emotional

language

cognitive

what is the physical domain of development

things such as gross motor and fine motor

what is isolated developmental delay

developmental delay in a single delay

what is global developmental delay

a significant delay in 2 or more developmental domains affecting children under the age of 5 years old

what is the focus of intervention with developmental delays

developmentally appropriate activities following the expected progression of gross motor milestones

what is the most common birth defect

congenital heart defects

when do pts receive PT with CHD

post operatively due to developmental delays

what are acyanotic CHD

CHD that impact the normal flow of blood through the body

what are examples of acyanotic CHD (7)

atrial septal defect

ventricular septal defect

patent ductus arteriosis

coarction of the aorta

aortic stenosis

AV septal defect

pulmonary stenosis

what is the impact of acyanotic CHD

they can lead to left ventricle hypertrophy and increase in pulmonary blood flow requiring the heart to work harder

what should be done with caution for a pediatric pt after a median sternotomy

tummy time or other developmental positions