Peds Final Exam

Red flags for newborn

lots of previous medical problems, feeding issues, super stiff or floppy

Newborn normal characteristics

Physiological flexion, WB on cheek, can lift head to clear nose, stepping response, vision is 8-12 inches

one month old characteristics

more extended and mobile head/neck, decreased reflexes, smile, random extremity movement

two month old characteristics

ATNR prominent, asymmetric, less physiological flexion, astasia abasia, more alert, increased asymmetrical extensor activity

two month old red flags

New issues, excess hyper or hypotonia

Three month old characteristics

Symmetry/midline begins, brings hands to midline, uses hands to explore, increased bilateral symmetrical activity and antigravity flexor control, alert and aware, can forearm prop with elbows

Three month old red flags

Maintains strong asymmetry, cannot maintain head in midline, cannot symmetrically use UE, lack shoulder girdle control and has difficulty with convergence.

Four month old characteristics

symmetry midline orientation, head/trunk symmetry, bilateral symmetry extremity movements, plays with hand-hand, hand-mouth, mouth to explore, begin controlled purposeful movement, start to see weight shift in prone, may roll prone to side lying, no head lag pull to sit

Four month old red flags

lack of symmetry (lacks flex/ext balance), overuse ATNR, inability to extend head/neck prone, low mm tone may maintain frog legg position (no add or hip flexion), high tone- push into extension in supine, inability to sit for short period without support

Five month old characteristics

• voluntary asymmetrical dissociated reciprocal movement, visually direct reaching, foot-mouth, actively roll supine to sidelying with head righting, roll prone-supine, in prone begin to weight shift and functionally reach for a toy, prop sits, pivot prone swimming

• Roll begins- prone-to supine

Five month old red flags

Supine: Inability to bring hands to feet in supine; lack of antigravity flexion; poor pelvic control; or poor rib cage stability, Over-reliance on extension pattern for rolling from supine to sidelying, Lack of prone with extended arms, Lack of forearm weight bearing with weight shift to skull side for reaching, Lack of development of LE dissociation

6 month old characteristics

•  roll supine to prone and prone to supine and maintain side lying, equilibrium reactions possible, weight shifting, extend arm weight bear in prone, sit independently without external support, antigravity flexor control in supine, antigravity extensor control in prone, can reach with one or both arms in supine, pushups in prone

• babbling

6 month red flags

no variety in movement, unable to roll supine-prone, roll with hyperextension neck, cant sit independent, no/lack hand -foot play, unable sidelying

7 month old characteristics

• earn to achieve quadruped, bear standing, working on transitions,(quadruped-sit, sit-quad, rising to stand), LE stable in siting, different LE postures, cruising sideways, rarely in supine long

• Self feed bottle hold

7 month old red flags

• prefers supine-prone, difficulty weight shift prone, can't achieve quadruped, lack of independent sit, lack of bearing through UE

8 month old characteristics

smooth with transitions, moves alot, variety of LE positions when sitting, trunk rotation in sitting, variety of reaching patterns in variety of directs in sitting, crawling most efficient mobility, strong interest in moving and exploring, rise to stand (legs involved)

8 month old red flags

delays in sitting, quadruped, standing, cruising, lack of variety movement, difficulty transitioning

9 month old characteristics

• combine fine/gross motor skills and increase active sensory-spatial exploration, sitting functionals and transitional position, takes full weight on legs in standing, squat to floor to pick up toy, practice rotation in standing, voluntary release of objects

• Self feeding

9 month old red flags

cannot sit correctly (not W posture) long sitting inhibited by tight HS, inability to crawl, uses a bunny hop, inability to stand, or difficult maintain balance w head/trunk

10 month old characteristics

play with perceptual concepts, container play, 2 hands coordination for manipulation and exploration, developing find motor hands, mimic gestures, crawl over obstacles, crawl primary means of motion, squat w support symmetrically and asymmetrically, variable pattern in cruising and supported walking

11 month old characteristics

independent standing wide BOS, climbing, attempt to rise to stand without UE, mimic activities, use both hands in games, unsupported walking, WBOS, abducted arms, upper trunk fixing

12 month old characteristics

primary locomotion walking, occasionally crawling, plays in squatting, rise to stand no external support, basic motor skills present, active, independent, plays in kneel, half kneel no support

Wolve’s Law

Loading bone longitudinally can result in compression or tension forces, both applied intermittently with appropriate for can simulate bone growth.

What are torsions

Caused by shear forces running parallel to the epiphyseal plate in bone, some are normal

Tibial torsion at birth

0-5d medial torsion

Tibial torsion adults

Migrates 15d lateral from birth

Femoral torsion birth

40d

Femoral torsion adult

15d

at birth, we have genu varum or valgum

varum

at ages 1-2 we have genu varum/valgum

neither; neutral

at ages 2-4 we have genu varum or valgum

peak genu valgum

adults have ___d of genu ___

5d, valgum

If there is ___ at ages_ through _ it requires referral

Varus, 2-6

Infants have a __pes planus and a increased/decreased fat pad on medial arch

flexibile, increased

When does the medial longitudinal arch develop?

ages 2-6

When does the medial longitudinal aarch finsih developing?

age 10

Average walking age

12 months

what are the 5 attributes to normal gait

stability in stance, foot clearance, prepositioning of foot in swing, adequate step length, energy conservation

Neuromaturational theory

Functional behaviors appear as the nervous system matures; hierarchal model that is milestone based and linear with progression.

Dynamic systems theory

Multiple systems engage to produce skill change and the primary driver role fluidly transfers between systems to allow emergence of a new behavior; nonlinear and driving influence changes with time

Ecological theory

Complex systems of relationships affected by multiple levels of the surrounding environment; encompasses developmental processes individuals experience over time.

Top down approach

Outcome drives treatment

cognitive motor learning model

learner is concerned with understanding the task

Associative motor learning mdoel

Learner selected the best strategy and begins to refine skillA

Autonomous motor learning model

Skill is automatic and low degree of attention is required

Blocked practice schedule

Practice skill for certain period of time

Random practice schedule

Practice skill with all variations in random order throughout session

Distributed practice

Rest between trials is equal to or greater than time in the trial

Distributed practice is better for learning ___ skills

Continuous

Massed practice is better for learning ___ skills

Discrete

What is massed practice

Amount of practice time in a trial is greater than the amount of rest

Whole practice is best for what kind of skills

Low in complexity and high in organization

Part practice is best for what kind of skills

High in complexity low in organization

What is norm referenced

Compares against group same age peers, sensitive to change over time

Norm referenced is used for

Determining eligibility

Criterion referenced is used for

determining if a child is improving, maintaining, or regressing

What is criterion referenced

Compares performance against described criteria such as knowledge, skills, abilities, shows change over time

What is the AIMS test

Maturation of gross motor skills

Sub scales of the AIMS

Supine, prone, sitting, standing

Age range for AIMS

Birth to 18 months

Purpose of AIMS

Identify motor delays, evaluate motor development over time

PDMS-3 age range

Children aged 0-5 years 11 months

PDMS-3 purpose

Estimate a child’s gross and fine motor functioning comapred to peers and the scores can be compared to determine discrepancies between fine and gross motor skills

PDMS-3 ceiling

three 0’s in a row

DAYC-2 age

birth- 5 years 11 monthsD

DAY-C2 use

Assess cognition, communication, social/emotional development, physical development, and adaptive behavior

DAY-C2 helps determine

early intervention under IDEA model

The GMFM is ___ referenced

Criterion

Purpose of GMFM

Shows changes in CP

Age for GMFM

5 months-16 years

Clinically important change for GMFM

5-7%

GMFM level 1 plateau age

max potential around 5 yars

The more ___ the CP, the ___ they reach their plateau

severe, faster

PEDI use

Assess functional skills, level of independence, extent of modifications needed to perform ADL’s

Norm-referenced age for PEDI

6 months- 7.5 years old

Criterion-referenced age for PEDI

older than 7.5 years

BOT-3 purpose

Measures fine and gross motor skills

BOT-3 age

4-25 years

Bot-3 is criterion or norm referenced

Can be both

ASD pathology

Neurodevelopment disorder with deficits in social communication and interactions with restricter/repetitive behavior

ASD motor characteristics

Low tone, clumsy, unusual gait, toe walking, motor planning deficits, postural instability, motor limitations.

ASD sensory features

Hyper/hypo reactive to sensory input

Common standardized tests for ASD

PEDI, TGMD-3, MABC-2

Interventions ASD

Task analysis and repetition, group play, core strengthening, static and dynamic balance, sequencing and planning practice

Adaptive equipment and orthotics for ASD

Weighted items, visual schedules and communication boards, orthotics only if true biomechanics deficit

DCD pathology

Disorder of motor coordination not explained by ID, CP, or vision impairment

DCD standardized tests

MABC-2, BOT-2

Intervention DCD

task orientated with cognitive approach (CO-OP)

SMA Pathology

Autosomal recessive SMN1 deletion causing muscle atrophy b/c LMN issue

Tests used for tracking SMA

Hammersmith, CHOP, INTEND, MFM, PEDI

Body function SMA presentation

Hypotonia, weakness, scoliosis, respiratory issues

Activity SMA presentation

Delayed motor milestones

Participation SMA presentation

Limited mobility and endurance

SMA interventions

ROM, stretching, posture, endurance, respiratory care

assistive devices for type one and two SMA

Standing frames, TLSO

Assistive device for type three SMA

Maintain ambulation and strengthen gently

DMD pathology

X-linked recessive mutation in dystrophin gene causing muscle replaced by fat

DMD progression

Proximal to distal weakness; gowers sign

DMD exam findings

Elevated creatine kinase

DMD body function presentation

WEakness, contractures, scoliosis, respiratory/cardiac declineAc