Pediatrics Overview for NPTE Final Frontier

Gestational Age

Weeks since mother's last menstruation, most widely used during pregnancy.

Chronological Age

Age in weeks since birth.

Corrected or Adjusted Age

Chronological age - prematurity (from 40 weeks), used for preemies to account for milestone expectations.

APGAR Score

A scoring system to assess the health of newborns at 1 min, 5 mins, and 10 mins (only if needed).

APGAR Appearance

0: Blue, 1: Blue extremities, 2: No blue.

APGAR Pulse

0: Absent, 1:

APGAR Grimace

0: No response, 1: Grimace, 2: Cry or withdrawal.

APGAR Activity

0: Flaccid, 1: Some flexion, 2: Active motion extremities.

APGAR Respiration

0: Absent, 1: Weak cry, hypoventilation, 2: Strong cry.

Gross Motor Development

Development progresses from reflexes before cortex to gross motor before fine motor.

PEDS Milestones Month 3

Prone on elbows, can lift head in prone.

PEDS Milestones Months 3 - 4

Supine to sidelying, prone to supine, pull to sit without head lag, sitting with UE support.

PEDS Milestones Months 5 - 6

Feet to mouth.

PEDS Milestones Months 6 - 7

Supine to prone.

PEDS Milestones Months 9-10

Quadruped creeping.

PEDS Milestones Months 10 - 15

Begins to walk unassisted, quadruped, cruises to sideways.

PEDS Milestones 10 months

Transitions in and out of squatting, plantigrade, pulls to stand.

PEDS Milestones 10 months

Independent ring sitting, controls grasp AND release.

PEDS Milestones 10 months

Transfers objects between hands, improving grasping skills, pincer, three jaw chuck.

PEDS Milestones 10 months

Stacks two cubes, trunk rotation in sitting, crawling on belly.

Practice Question 1

A newborn is examined at birth using the APGAR screening test. The following observations are made at 5 mins: heart rate 120 bpm, strong crying, grimace with irritability testing, kicking and arm movement are present, and the baby demonstrates normal color throughout the body. What is the most appropriate action of the PT?

Integrated

When the reflex disappears to allow for normal development

Persistent

A reflex that has not integrated and indicative of central nervous system (CNS) dysfunction

Flexor Withdrawal

Noxious stimulus (pinprick) to sole of foot leads to toes extending, foot dorsiflexing, and LE flexing uncontrollably. Onset: 28 weeks gestation, Integrated: 1-2 months.

Crossed Extension

Noxious stimulus to ball of foot of LE fixed in extension leads to opposite LE flexing, then adducting and extending. Onset: 28 weeks gestation, Integrated: 1-2 months.

Rooting

Stroking the side of baby's cheek causes head to turn toward stimulus and mouth to open. Onset: 28 weeks gestation, Integrated: 3 months.

Traction

Grasp forearm and pull up from supine into sitting position. Onset: 28 weeks' gestation, Integrated: 2-5 months.

Asymmetrical Tonic Neck (ATNR)

Rotation of the head to one side causes flexion of skull limbs, extension of the jaw limbs, resulting in a 'bow and arrow' posture. Onset: Birth, Integrated: 4-6 months.

Palmar Grasp

Maintained flexion of fingers occurs with maintained pressure to palm of hand. Onset: Birth, Integrated: 4-6 months.

Moro

Drop patient backward from sitting position causes extension, abduction of UEs, hand opening and crying followed by flexion, adduction of arms across chest. Onset: 28 weeks gestation, Integrated: 5-6 months.

Symmetrical Tonic Labyrinthine (TLR / STLR)

In prone position, increased flexor tone of all limbs; in supine position, increased extensor tone of all limbs. Onset: Birth, Integrated: 6 months.

Positive Supporting

Rigid extension (co-contraction) of the LEs occurs with contact to the ball of the foot in upright standing position. Onset: Birth, Integrated: 6 months.

Plantar Grasp

Maintained flexion of toes occurs with maintained pressure to ball of foot under toes. Onset: 28 weeks gestation, Integrated: 9 months.

Symmetrical tonic neck (STNR)

Flexion or extension of the head results in flexion of UEs and extension of LEs or vice versa. Onset: 4-6 months, Integrated: 8-12 months.

Startle

Sudden loud or harsh noise causes sudden extension or abduction of UEs, crying. Onset: Birth, Integrated: Persists.

Plagiocephaly

A condition characterized by an asymmetrical head shape.

Fine motor development screening

An assessment to evaluate the fine motor skills of a child.

Physical Therapy Intervention(s)

Strategies to address muscle imbalances and encourage continued normal motor development.

Practice Question 2.1

Which of the following positions is LEAST expected during gait in this child? A. High guard position of the arms B. Abduction and internal rotation of the hips C. Hips and knees slightly flexed D. Pronated feet.

Practice Question 2.2

Which of the following types of grasp would be LEAST expected in this patient when attempting to pick up a crayon? A. Pincer grasp B. Palmar grasp C. Three jaw chuck grasp.

Persistent ATNR reflex

A reflex that remains active beyond the typical developmental period, affecting the ability to transition positions.

Integrated ATNR reflex

A reflex that has been successfully integrated into normal movement patterns and no longer interferes with development.

Persistent STNR reflex

A reflex that continues to be present and affects the child's ability to move and transition between positions.

Persistent TLR reflex

A reflex that remains active and can impact the child's ability to control head and body movements.

Cerebral Palsy

A group of disorders affecting movement and muscle tone, often caused by damage to the developing brain.

Torticollis

A condition characterized by a twisted neck, resulting in the head being tilted to one side.

Plagiocephaly

A condition resulting from prolonged asymmetrical pressure on the skull, leading to a parallelogram shape.

Down's Syndrome

A genetic disorder caused by the presence of an extra chromosome 21, leading to developmental delays and physical features.

Autism Spectrum Disorder

A developmental disorder characterized by challenges with social skills, repetitive behaviors, and communication.

Muscular Dystrophy

A group of genetic diseases causing progressive weakness and loss of muscle mass.

Scheuermann Disease

A condition that causes abnormal curvature of the spine during adolescence.

Erb's Palsy

A type of paralysis that affects the arm and is caused by injury to the upper group of arm nerves.

Klumpke's Palsy

A type of paralysis affecting the hand and wrist due to injury to the lower group of arm nerves.

Spastic Cerebral Palsy

Characterized by velocity-dependent resistance of a muscle to stretch, often leading to contractures and crouched gait.

Ataxic Cerebral Palsy

A disorder of coordination, force, and timing, associated with cerebellar involvement.

Hypotonic/Dyskinetic Cerebral Palsy

A disorder characterized by involuntary movements that are slow and writhing, often due to basal ganglia dysfunction.

Gross Motor Classification of CP Level 1

Patient will walk without restrictions but will have limitations in more advanced gross motor skills.

Gross Motor Classification of CP Level 2

Patient will walk without assistive device with limitations in walking outdoors and in the community.

Gross Motor Classification of CP Level 3

Patient will walk with assistive device with limitations in walking outdoors and in the community.

Gross Motor Classification of CP Level 4

Patient self mobility will be severely limited; children are transported or use power mobility outdoors and in the community.

Gross Motor Classification of CP Level 5

Patient self mobility will be severely limited, even with the use of assistive technology, requires caregiver.

Plagiocephaly Assessment

Involves assessing cervical spine range of motion and strength, and educating parents on positioning, exercises, and tummy time.

Patient mobility without restrictions

Patient will walk without restrictions but will have limitations in more advanced gross motor skills.

Patient mobility with assistive device

Patient will walk with assistive device with limitations in walking outdoors and in the community.

Severe self mobility limitation

Patient self mobility will be severely limited, even with the use of assistive technology.

Patient mobility without assistive device

Patient will walk without assistive device with limitations in walking outdoors and in the community.

Plagiocephaly

Results from prolonged asymmetrical pressure on the premature skull.

Plagiocephaly shape

Creates a parallelogram shape when viewed from the vertex.

Occipitoparietal flattening

Occurs with contralateral occipital bossing in plagiocephaly.

Ipsilateral frontal bossing

Occurs with anterior displacement of the ear in plagiocephaly.

Plagiocephaly assessment

Assess c/s ROM and strength, educate parents on positioning, exercises, and tummy time.

Down's Syndrome cause

Results from presence of full or partial extra copy of the 21st chromosome; trisomy 21.

Down's Syndrome risk factor

Increased risk with increased age of the mother.

Neck flexion limitation

Forceful neck flexion and rotation activities should be limited due to laxity of odontoid ligament and potential for a subluxation of atlanto-axial joint.

Motor function encouragement

Encourage motor function and avoid hyperextension of the elbows and knees during weight bearing activities.

Symptoms of Down's Syndrome

Hypotonia, ligamentous laxity, delayed motor milestones, deficits in memory and expressive language, impairments in postural control and coordination, decreased quadriceps and hip abductor strength, inefficient movement strategies due to hypotonia.

Autism Spectrum Disorder characteristics

Social/communication skill limitations, especially non-verbal skills, repetitive behaviors, sensory processing issues, difficulty developing relationships, hypo-reactive or hyper-reactive to sensory input, dyspraxia.

Interventions for Autism Spectrum Disorder

Controlled, multi-sensory input, give specific information, behavioral interventions, encouraging motor development, coordination, visual supports, using first, then (or sequencing), consistency.

Practice Question 5 scenario

A 6-year-old child with Down's Syndrome is being treated by a physical therapist. The child has moderate developmental delay, hypotonia, and incoordination, and is able to walk with assistance.

Practice Question 6 scenario

Which of the following signs and symptoms is LEAST likely to be seen in a 7 years old male patient with muscular dystrophy?

Duchenne Muscular Dystrophy

X-linked recessive, inherited by boys; dystrophin gene missing - destruction of muscles' cells; causes pseudohypertrophy (collagen and adipose tissue).

Examination for Duchenne Muscular Dystrophy

Strength, ROM, Functional testing, skeletal alignment, respiratory function, assess need for adaptive equipment.

PT interventions for Duchenne Muscular Dystrophy

Maintain mobility as long as possible; maintain joint ROM with active/passive; DO NOT OVER FATIGUE.

Scheuermann Disease

Characterized by Schmorl's Nodes and angled/wedged thoracic spine; pain with thoracic extension and rotation; aggravation with long periods of standing/sitting or physical activity; increased thoracic kyphosis & lumbar lordotic curve.

PT Interventions for Scheuermann Disease

The Schroth Method, stretch pecs, strengthen thoracic extensors and scapular stabilizers.

Erb's Palsy

Injury to the C5-C6 nerve roots resulting in loss of abduction and lateral rotation of the shoulder; characterized by Waiter's tip deformity.

Klumpke's Palsy

Injury to the C8-T1 nerve roots resulting in paralysis of the intrinsic muscles of the hand; characterized by claw hand.

Mechanism of Injury for Erb's Palsy

Stretching head downward.

Mechanism of Injury for Klumpke's Palsy

Stretching of arm overhead.

Treatment for Erb's and Klumpke's Palsy

Immobilization, then gentle ROM.

Practice Question 7 Diagnosis

A patient reports loss of sensation over the ulnar side of the hand with weakness in the intrinsic hand muscles leading to nonfunctional hand; the MOST LIKELY diagnosis is Klumpke's palsy.

Upcoming Class: SCI (for PTs)

Saturday 3/23 at 8:30am PST (11:30am EST).

Upcoming Class: PTA Mega Review

Saturday 3/23 at 8:30am PST (11:30am EST).

Upcoming Class: Vestibular Rehab

Tuesday 3/26 at 5pm PST (8pm EST).

Upcoming Class: EKG & Exercise Progression

Tuesday 3/26 at 5pm PST (8pm EST).