Peds Exam #2

intertrial variability

whether regulatory conditions are the same or different on successive repetitions of performing the trials:

E: what to do, or declarative

I: how to do, or procedural

what is the difference between implicit and explicit knowledge?

1. Initial Stage: development of skill, works on movement characteristics with successful and unsuccessful attempts, lacks efficiency

2. Later stages: able to adapt movement, perform movement consistently, high efficiency

describe the Gentile Stages of learning

closed, fixation

closed/open skills require ___, in which the learner must refine the pattern with little conscious effort and minimum physical energy

open, diversification

closed/open skills require ___, in which the movement pattern needs to be adaptable to ever changing charactieristics

explicit, implicit

explicit/implicit knowledge dominates the initial stages of learning while explicit/implicit knowledge dominates the later stages of learning

1. cognitive: high cognitive activity, learner is concerned with understanding the task and developing strategies

2. associative: learner has selected best strategy and begins to refine the skill

3. autonomous: skill is automatic and requires a low degree of attention for performance

describe the Fitts and Posner Three Stages Model of Learning

cognitive

what stage of the Fitts and Posner Model requires the highest cognitive activity?

A

which of the following is not true about motor learning?

a. multiple aspects of the child's performance should be given feedback at once
b. frequency of feedback should occur less than 100% of the time
c. mental practice is best performed with physical practice combined

blocked

what type of practice schedule involves practicing the skill for a period of time?

random

what type of practice involves the practice skill with all variations in random order throughout the session?

blocked, random

performance may be better with blocked/random practice while transfer may be better with blocked/random practice

distributed

what type of practice occurs when rest between trials is equal to or greater than time in the trial?

massed

what type of practice occurs when the amount of practice time in a trial is greater than the amount of rest?

distributed, massed

distributed/massed practice is better for continuous skills while distributed/massed practice is better for discrete skills like reaching, grasping, and limb positioning

low, high

whole practice involves skills that are high/low in complexity and high/low in organization

high, low

part practice involves skills that are high/low in complexity and high/low in organization

changes in speech

fever/malaise

recurring headache

decreased activity level

decreased school performance

onset or increased strabismus

change in appetite and weight

incontinence begins or worsens

scoliosis

spasticity

personality change

decreased grip strength

difficult to arouse

decreased visual acuity, coordination

seizures

what are the signs of VP shunt malfunction?

true

true or false: down syndrome is the most common chromosomal disorder

norm-referenced

many outcome measures for children with down syndrome are norm-referenced/criterion-referenced

false (increases)

true or false: the threat of down syndrome decreases with maternal age

false (hypotonia and joint hypermobility)

true or false: those w/ DS may have hypertonia and joint hypomobility

weakness

what is often the primary impairment w/ DMD?

Gower Sign: posterior calf enlargement

enlargement of what muscle is a common examination finding w/ DMD?

males

DMD primarily effects males/females

5

diagnosis usually occurs around __ years old

dystrophin

muscle cell destruction of DMD occurs as a result of abnormal or missing:

steroids

what is the only treatment for DMD that has been found to change the natural history of the disease?

neck flexors, abdominals, hip extensors, interscapular muscles

what muscles tend to be particularly weak with DMD?

false

true or false: DMD exercise should be performed at maximum intensity due to the extensive lack of strength

false (adolescent period)

true or false: with DMD, walking is typically lost in late adulthood, early before death

***After 7 yo, 6 min walk test of less than 325 m time to stand more than 30 sec time to climb 4 stairs more than 8sec 10 m walk or run time more than 10-12 sec and mean linearized NSAA 34 or less (raw score of 9)

**Prognosis for DMD based on T&M

true

true or false: eccentric exercise should be avoided in children with DMD

true

true or false: resting AFOs are more appropriate for nocturnal stretching throughout the lifespan than functional use in a child w/ DMD

false (opposite)

true or false: KAFOs are more consistently used for functional rather than therapeutic use

respiratory issues

what is the most common cause of morbidity/mortality in someone w/ DMD?

cardiomyopathy

dystrophin deficiency in the heart secondary to DMD often causes what condition?

0-4 months

mortality in about 1-10 yeras

when is typical onset for SMA Type I (Werdnig-Hoffman)? what is the prognosis?

6-12 months, slow progression with moderate to severe weakness

when is typical onset for SMA Type II? what is the prognosis?

juvenile onset, slow progression, mild impairment

when is the typical onset for SMA Type III Kugelberg-Welander?

adult onset

when is typical onset for SMA Type IV?

SMA

what disorder is characterized by the loss of anterior horn cells in the spinal cord?

Type I

what SMA type will never sit independently, with limited antigravity movement of the UE/LE and weak neck, trunk, pelvis, and shoulder?

Type II

what type of SMA will be able to sit independently, with fasciculations of the tongue and tremors with significant fatigue?

Type III

what type of SMA will walk without assistance or bracing at some point, with occasional fasciculation and tremors in the hand with proximal LE weakness and fatigue?

I

most SMA cases are Type _

hip dislocation, foot/chest deformities, scoliosis and pelvic obliquities

what should be particularly monitored in children w/ SMA?

SMA

GERD may be associated with what developmental disorder?

calcaneus

any orthotic that captures the foot must start by first aligning the ____

false (most)

true or false: Any foot orthosis that extends over the ankle must be set at the angle of least ankle restriction

pronation/supination

SMOs are generally used to corect severe:

drop foot w/ minimal/no medial/lateral instability

what are the general indications for a posterior leaf spring AFO?

assist joints w/ DF

what is the indication for a hinged AFO w/ DF assist?

toe walking, mild-moderate genu recurvatum, medial/lateral instabilities, encourages knee flexion in early phases of gait

what is the indication for a hinged AFO w/ PF stop?

severe hypertonia

what is the indication for a solid ankle foot orhtosis?

weak quadriceps w/o medial/lateral knee instability

what are the general indications for a ground reaction AFO?

low thoracic/high lumbar level paralysis

severe knee hyperextension

what are the general indications for a KAFO?

prevents

knee hyperextension orthosis prevent/encourages hyperextension

mid thoracic to high lumbar paraplegia

what is the general indication for an RGO?

**

*different types of spina bifida*

lowest intact, functional neuromuscular segment

how is the motor level of paralysis defined in spina bifida?

1. complete cord transaction

2. incomplete lesions (mixed spasticity/volitional control issues)

3. skip lesions: more caudal segments are functioning despite nonfunctional segments in between

how may neuromuscular involvement present itself in spina bifida?

forward head, rounded shoulders

kyphosis, scoliosis

excessive lordosis/anterior pelvic tilt

rotational deformities

flexed hip, knees

pronated feet

what is the typical posture of someone with spina bifida?

crouch standing

what standing posture is common in patients with spina bifida?

thoracic

scoliosis is most common in those with spina bifida whose lesions are in what area of the spine?

arnold chiari malformation type II

what malformation is usually associated with hydrocephalus?

false (80-90%)

true or false: VP shunt implantation is a rare procedure for those with hydrocephalus and spina bifida

cocktail personality (articulate and verbose, appear to have high verbal skills but close examination shoulds inappropriate use of words)

what cognitive complication is common in those with hydrocephalus?

latex allergies

what allergy is common in people with spina bifida?

VI, IX, X

what cranial nerves may be effected in spina bifida patients?

***

indications for orthotics in SB patients***

***

prognosis for different SB levels**

iliopsoas, quads

those w/ spina bifida with grade 4-5 in ___ and ___ are almost all community ambulators

gluteal, anterior tibialis

those w/ spina bifida with grade 4-5 in ___ and ___ are community ambulators and did not require use of AD or orthoses

traction injury during difficult delivery

C5-6

what is the common cause of OBPI? what nerve roots are effected?

neurotmesis

what phrase describes a complete rupture of a nerve?

axonotmesis

what phrase describes a disrupture of axons while the endoneurium remains intact?

neurapraxia

what phrase describes a temporary nerve conduction block w/ intact axons?

Erb's palsy

what is an injury to the upper plexus at C5-6?

waiter's tip position (extension, IR, adduction, pronation, wrist/fingers flexed)

what common position occurs w/ Erb's plays?

extended includes C7

what is the difference b/w Erb's palsy and extended Erb's palsy?

false (opposite)

true or false: sensation is usually intact while grasp is typically diminished or lost in Erb's palsy

Global palsy

what is an injury to the upper and lower plexus (C5-T1)?

C5-6

C5-T1

C8-T1

what nerve roots are effected w/ Erb's Palsy and Global Palsy and Klumpke's palsy?

Horner's syndrome

what occur's with a T1 root avlusion of the sympathetic ganglion?

Klumpke's palsy

what occurs with damage to the lower roots or spinal nerves?

C8-T1

what nerves are effected with Klumpke's palsy

S0: no reaction to painful or other stimuli

S1: reaction to painful stimuli, none to touch

S2: reaction to touch, not to light touch

S3: normal sensation

**sensory grading system for children w/ OBPI**

true

true or false: as neural regeneration proceeds w/ OBPI, sensory loss may change to hyperesthesia

9 months-2 years

what time frame does spontaneous rehabilitation of the UE occur with an OBPI?

ADHD, communication disorders, epilepsy, GI disorders, sleep disorders, toe walking...

what conditions are commonly associated with ASD?

clumsiness/slowness and inaccuracy of motor skills

developmental coordination disorder is manifested how?

low

DMD and ASD both have possibly high/low tone presentations

true

true or false: visual perception may be effected w/ DMD

closed

those with ID typically perform exercises better in open/closed environments

oral baclofen, botox

those with global spasticity more likely are taking oral baclfen/botox treatments while those with focal spasticity more likely are taking oral baclofen/botox treatments

nerve root cutting that may lead to low tone if too much is cut

how may those with irreversible spasticity treat the condition?

S: velocity-dependent resistance to passive movement, varying with direction of joint movement

H: abnormal increase in resistance to passive movement about a joint

what is the difference between spasticity and hypertonia?

"dynamic component"

a large difference b/w R1 and R2 in the Modified Tardieu Scale suggests a:

contracture

a small difference b/w R1 and R2 in the Modified Tardieu Scale suggests a: