OTD 306: Quiz 1

CC

chief complaint

c/o

complains of

Dx

diagnosis

FH

family history

HEENT

head, eyes, ears, nose, throat

H&P

history and physical

HPI or PI

history of present illness or present illness

Hx

history

IMP

impression

L&W

living and well

NAD

no acute distress

NKA, NKDA

no known allergies, no known drug allergies

O

objective

OH

occupational history

P

plan

PE, Px

physical examination

PERRLA

pupils equal, round, reactive to light and accomodation

PH, PMH

past history, past medical history

R/O

rule out

ROS, SR

review of systems, systems review

S

subjective

SH

social history

Sx

surgery (symptoms)

UCHD

usual childhood diseases

WNL

within normal limits

WFL

within functional limits

What are the components of a SOAP note?

S: subjective (patient report of symptoms, C/C, emotions, attitude)

O: objective (measurable or observable information - bp reading, what you did, patient's response)

A: assessment (interpretation of patient's strengths, progress, explain data, explain the why)

P: plan (recommendations, strategy, AE or AT, future plans, need for referral for services)

What are the 9 categories of occupations in the OTPF?

1. ADLs

2. IADLs

3. Health management

4. Rest/sleep

5. Education

6. Work

7. Play

8. Leisure

9. Social participation

What are the types of context in the OTPF?

1. Environmental factors (geography, light, food)

2. Personal factors (age, gender identity, upbringing)

What are the 4 types of performance patterns in the OTPF?

1. Habits

2. Routines

3. Roles

4. Rituals

What are the 3 categories of performance skills in the OTPF?

1. Motor skills (stabilizes, positions, reaches)

2. Process skills (paces, handles, terminates)

3. Social interaction skills (approaches, touches, social gestures)

What are the 5 areas of client factors in the OTPF?

1. Values

2. Beliefs

3. Spirituality

4. Body functions (attention, thought, perception, memory)

5. Body structures

What are the 4 areas of activity demands in the OTPF?

1. Objects (tools, supplies, equipment)

2. Space demands (size, arrangement)

3. Social demands (shaking hands, giving hugs)

4. Sequencing (schedule, order of events)

The study of the interaction of chemicals (ex: drugs) with biological systems

Pharmacology

Name for specific compound structure

Chemical name

Name derived from chemical name; shorter

Generic (Official) name

Name assigned by drug manufacturer

Trade (Proprietary) name

What are the 5 routes of administration of drugs?

1. Enteral (passage of drugs through alimentary tract: oral, rectal, buccal, sublingual)

2. Parenteral (bypasses alimentary tract)

3. Transdermal (application of drugs directly to skin)

4. Topical

5. Inhalation

The study of how the body changes the drug

Pharmacokinetics

Rate at which a drug leaves the site of administration and the extent to which this occurs

Absorption

Involves the delivery of drug from systematic circulation to tissues

Distribution

Major mechanism by which a drug action is terminated

Metabolism

Drugs eliminated by body unchanged or as metabolites

Excretion

A drug that binds (affinity) and activates a receptor in order to elicit a response (key that opens a door)

Agonist

A drug which does not evoke a maximal response as compared to strong agonist (partially opens the door)

Partial agonist

A drug to which is attracted to the receptor (affinity), but is devoid of activity of an agonist (key that fits but doesn't open door)

Antagonist

Group of clinical syndromes that affect movement, muscle tone, and coordination, as a result of injury or lesion to the underdeveloped brain

Cerebral Palsy (CP)

Premature or low birth weight babies are how many times more likely to be diagnosed with CP?

10x

What are the perinatal causes of CP?

1. Respiratory distress syndrome (inelastic lungs; altered air pressure)

2. Umbilical cord becomes pinched in birth canal (Hypoxic Ischemic Encephalopathy)

3. Incompatible blood Rh factor of mother and fetus

4. Bleeding in brain releases glutamate

5. Hyperbillirubiema (bilirubium builds up in liver and is toxic to brain)

6. Twinning or multiple births results in low birth weight

What are the postnatal causes of CP?

1. Hydrocephaly

2. Infection (meningitis inflammation0

3. Congenital malformation of the brain

4. Acquired (brain injury, drowning, poisoning, CVA)

What are the types of CP?

Spastic, Athetoid, Ataxic

What is spastic CP anatomically associated with?

Lesion in the motor cortex characterized by hypertonicity

What is the most common type of CP?

Spastic (80% of cases)

Describe Spastic Hemiplegia

- involves one side of body with asymmetrical hand use

- associated reactions: increase effort, increase tone, increase posturing (excitement)

Describe Spastic Diplegia

- involves lower extremities more than upper extremities (reduced hip flexion, LE extension and adduction)

- inability to sit- relies of UE for support (impaired equilibrium reactions)

Describe Spastic Quadriplegia

- entire body is involved

- intellectual disability

- under the influence of TLR (difficulty with transfer)

- oral motor impairment

What is Athetoid CP associated with?

Associated with dystonia - impaired muscle tone, hypermobility

Describe Athetoid CP

- difficulty with achieving midline movement

- slow involuntary uncontrolled proximal movements (oral motor- dysphagia)

- choreiform type movements

- dyskinetic type movements

Describe Ataxic CP

- cerebellar

- decreased balance

- poor timing and gradation

- over contract to gain stability

-altered balance with abulation

- less common

What types of CP are most commonly seen together and what is associated with this?

Spastic and Athetoid

-associated with fluctuating tone (from hypertonicity to hypotonicity)

Elicited with active or passive rotation of the head

(when face is turned to one side, the arm and leg on the side to which the face is turned extend and the leg on the opposite side flexes)

Asymmetrical Tonic Neck (ATNR)

Prone : head extended, arms, flexed, legs extended

Standing:

- head flexed: arms bent, legs extended

- head extended: arms extended, legs bent

-normal in babies

Symmetrical Tonic Neck Reflex (STNR)

Supine: neck hyperextension, legs extended and crossed (results in decreased transitional movement- rolling)

Prone: increased flexor tone, decreased head raising, weight bearing on arms, increased hypertonicity

Tonic Labyrinthine Reflex (TLR)

Ball of foot touches on firm surface, legs extended, hinders standing and walking

Positive Supporting Reflex (PSR)

Frontal, Parietal, Temporal, and Occipital Sequelae to CP

Frontal: loss of m/m limbs, plan and sequence complex m/m, problem solving, attention

Parietal: reduced awareness of body parts (ADLs), tactile processing, difficulty with R/L discrimination

Temporal: persistent talking, memory loss, difficulty identifying and describing objects

Occipital: deficits in vision, difficulty locating objects in environment, difficulty with reading and writing

Spine curves too far inward in the low back (anterior curve)

Lordosis

Posterior curvature of the thoracic spine

Kyphosis

Lateral curvature of the spine

Lateral curvature of the spine

What are 2 visual deficits associated with CP?

1. Strabismus (malalignment of eyes)

- esotropia (turned/cross eyed)

- exotropia (turned out - muscle weakness)

2. Nystagmus (involuntary movement of eyes (ataxia)

Describe Selected Doral Rhizotomy (SDR) and explain the mechanism for reducing spasticity

Nerve roots electrically stimulated

Amount of spasticity is observed

Selective afferent roots contributing to spasticity are cut (touch and position roots are retained)

Spasticity is reduced by increased muscle weakness

What type of drugs are used with CP to treat spasticity?

Spasmolytic drugs

What are the direct acting Spasmolytic drugs?

Dantrolene Sodum (Dantrium) and Botulimium neurotoxin (Botox)

Dantrolene sodium (Dantrium)

- mechanism of action

- side effects

- therapeutic uses

- impairs release of calcium

- generalized muscle weakness; dose-limiting hepatitis and fetal hepatitis (monitor liver function)

- relief of spasticity regardless of underlying pathology

Botulinium Toxin (Botox)

- mechanism of action

- side effects

- therapeutic uses

- inhibits release of acetylcholine from presynaptic vesicles

- Black Box warning - some experience generalized weakness at distant sites

- reduction of localized spasticity

What are the indirect acting Spasmolytic drugs used for CP?

Baclofen (Lioresal) and Diazepam (Valium)

Baclofen (Lioresal)

- mechanism of action

- side effects

- drug interaction

- pump

- GABAb receptors cause hyperpolarization

- drowsiness

- CNS depression is increased when used with other CNS depressants (alcohol)

-Intratehcal baclofen pump (ITB) - CNS effects are minimized while muscle function is improved

Diazepam (Valium)

- mechanism of action

- side effects

- GABAa binds to its receptors in a protein complex leading to inhibitory effects of GABA

- abuse potential, CNS depressants (sedation more severe compared to baclofen)

What are the types of Autism?

Autistic Disorder

Asperger's Disorder (syndrome)

Pervasive developmental disorder not otherwise specified (PDD-NOS)

Childhood degenerative disorder

Rett's disorder

What are the 3 main symptoms of Autism?

1. Social interaction/communication

2. Repetitive behaviors

3. Restricted interests

How is sensation impacted by Autism?

hypo and hyperactivity to sensory information and/or unusual preoccupation with sensory aspects of the environment

- difficulty moderating sensory experiences in order to maintain a calm alert state

- difficulty with motor sklls (dyspraxia- plan and process motor skills)

- difficulty with discrimination of the quality of sensory stimulus

How are gross and fine motor performance impacted by Autism?

Problems in skilled movement, hand-eye coordination, speed, praxis and imitation, posture and balance

ambiguous hand preference

Difficulty with motor planning

dyspraxia

How do the inferior olive, Purkinje cells, and the limbic system contribute to clinical signs and symptoms of autism?

Limbic system: regulates emotions, controls responses, understanding meaning: abnormal in persons with ASD

Cerebellum - motor learning

- fewer neurons connected to Purkinje cells (cells that convey signals from cerebellum)

What drugs are FDA approved for autism?

Atypical Antipsychotics

- Aripirazole (Abilify)

- Risperidone (Risperdal)

What is the cause of Treacher Collins Syndrome

Change in the gene on chromosome 5 which affects facial development

What are several signs and symptoms of Treacher Collins Syndrome

- Very small lower jaw and chin

- Very small upper jaw

- Eyes that are slanted downward

- Notch in lower eyelid

What clinical signs and symptoms contribute to the diagnosis of Angelman Syndrome?

-Developmental delays - no crawling or babbling at 6-12 months

- Intellectual disability

- Trouble going to sleep or staying asleep

- Seizures

- Unusual behaviors, hand flapping and arms uplifted while walking