Pediatric conditions

torticollis

SCM affected: flexion, ipsilateral SB, contralateral rotation

plagiocephaly

prolonged positioning creating P on skull → ipsilateral occipital flattening and contralateral bulging

• tendency to lie on one side flattens skull and shifts it forward

• helmet: worn 20 - 23 hours per day for 2 - 7 months (no longer useful at 18 months)

cerebral palsy

nonprogressive encephalopathy

CP birth

preterm

CP primary causes

hemorrhage under ventricles, hypoxic encephalopathy, malformation, or trauma of CNS

spasticity

• velocity dependent

• increased tone

• lesion of motor cortex

• LE muscles affected: hip flexors, adductors, IRs, knee flexors, ankle PFs

• UE muscles affected: scapular retractors, shoudler extensors and adductors, elbow flexors, forearm pronators

spastic CP gait

crouched gait or toe walkers

dystonia

involuntary movements with sustained contracitons

• hypertonic: PROM stiffness

ataxia

coordination or timing disorder

• lesion of cerebellum; instability of movement

low tone

wide BOS

intention tremors

nystagmus

athetoid

slow writhing movements (wormlike; involuntary

fluctuating muscle tone

• normally decreased muscle tone (floppy baby syndrome)

distal UE commonly involved

level 1 GMFCS for CP

walk without restriction, limitations in advanced gross motor skills

level 2 GMFCS for CP

walk without AD, limitations walking outdoors and in the community

level 3 GMFCS for CP

walk with AD, limitations walking outdoors and in the community

level 4 GMFCS for CP

self-mobility limited, power mobility outdoors and in the community

level 5 GMFCS for CP

self-mobility severely limited even with assistance, may use standing frame for WB, WC bound

spina bifida

neural tube defect resulting in vertebral and/or SC malformation

hydrocephalus signficantly related to closure of neural tube defect

SB myelomeningocele

CSF, SC tissue, and nerve fibers

SB meningocele

cyst includes CSF but SC is intact

spina bifida occulta

closed lesion; no SC involvement

• atypical skin pigmentation, large dimple, or tuft of hair

common impairments with SB

• kyphoscoliosis, shortened hip flexors and adductors, flexed knees, pronated feet

• tethered cord syndrome: spasticity, increased tone, buttocks pain, increased scoliosis, weakened leg muscles

• sensory loss

• L4 - 5 lesions

• cognitive impairments

• club foot

• bowel and bladder dysfunction

• latex allergy

arthrogryposis

nonprogressive condition

multiple joint contractures and muscle weakness throughout body at birth

autism

developmental disorder that appears within first 3 years of life

impairments

• social communication skills

• sensory processing issues

• repetitive behaviors

• dyspraxia: inability to imitate movement; disconnect between idea of movement and motor execution

• decreased coordination

• balance impairments

• hypotonia

down syndrome

extra copy of 21st chromosome

impairments

• hypotonia, ligament laxity

• delayed motor milestones

• deficits in memory and expressive language

• congenital heart defects

• impairments of postural control and coordinaiton

• decreased strength of quads and hip abductors

red flag with down syndrome

atlantoaxial instability

s/s atlantoaxial instability

decreased strength and ROM, hyporeflexive, decreased sensation in extremities, persistent head tilt

duchenne muscular dystrophy

X-linked recessive, inherited disorder

• dystrophin gene missing

impairments

• pseudohypertrophic calves

• progressive weakness

• delayed walking

• frequent falls

• difficulty rising from supine or sitting

• gowers sign

• cardiac tissue affected

• decreased respiratory function

• contractures and deformities

what is important to avoid in patients with DMD

maximal exercise - damages muscles

brachial plexus injury

traction or compression injury to unilateral brachial plexus during birth process or cervical rib abnormality

erb palsy

C5 - 6

• shoulder adducted and IR, elbow ext, forearm pronated, wrist flexed (waiter’s tip)

klumpke palsy

C8 - T1

• intrinsic muscles of hand and wrist, wrist ext, fingers flexed (claw hand)