Peds exam 1 CS

What are criterion-referenced tests?

tests that establish cutoff scores

compare a child to self

What are normative tests?

tests that compare to distribution

established standard point scores

compare child to same age peers

Which category of standardized tests establishes cutoff scores?

criterion

Which category of standardized tests establishes age-appropriate scores?

normative

List the criterion referenced peds tests

GMFM

SFA

AEPS

List the normative peds tests

peabody (PDMS3)

bayley

AIMS

BOT3

PEDI

ASQ3

timed floor to stand

Describe the Peabody test

normative

assesses gross/fine motor, HE coordination

ages 0-5yrs (71mo)

What age range is appropriate to administer the Peabody?

0-5yrs (71mo)

Name the 5 subsets of the Peabody

body control

body transport

object control

hand manipulation

HE coordination

Describe the Bayley scales of infant development

norm referenced test

ages 16d - 42mo

gold star for infant development!

Which standardized test is the gold standard to assess infant development?

Bayley

Name the domains of the Bayley

cognitive

language

motor

social-emotional

adaptive

Describe the Alberta Infant Motor Scale (AIMS)

norm test

ages 0-18mo

evaluates WB, posture, and anti grav movements

In what age range is it appropriate to administer the AIMS?

0 - 18mo

In what age range is it appropriate to administer the Bayley?

16d - 42mo

In what age range is it appropriate to administer the Peabody?

0 - 5yrs (71mo)

Describe the BOT3

norm test

8 subsets totals (PT often does bilateral coordination, balance, strength, and dynamic movement)

age 4-21yrs (25yrs?)

In what age range is it appropriate to administer the BOT3?

4-21 years (but Ling said 25 so IDK)

What subsets of the BOT3 are often administered by physical therapists?

bilateral coordination

balance

strength

dynamic movement

Describe the PEDI

norm referenced test

assesses functional activities based on routines questionnaire

good test to indicate health-related outcomes

ages 6mo - 7yrs

In what age range is it appropriate to administer the PEDI?

6mo - 7yrs

Which peds test is a questionnaire used to assess functional activities based on routines?

PEDI

What three domains are assessed by the PEDI?

self-care

mobility

social function

Describe the ASQ3

norm referenced test

to assess developmental and social-emotional areas

commonly used as a screen for autism

ages 0-6yrs

In what age range is it appropriate to administer the ASQ3

0 - 6yrs

Which test is commonly used as a screen for autism?

ASQ3

Describe the timed floor to stand test

norm referenced test

like the TUG but for kids

norms available for ages 4-15 (m, f, and combined)

Describe the GMFM

criterion test

looks at movement ability, not quality

66 or 88 item test

ages 6mo - 5yrs

List the 5 dimensions assessed by the GMFM

lying/rolling

sitting

crawling/kneeling

standing

walking/running/jumping

The GMFM has specific norms for which populations?

cerebral palsy and down syndrome

Which standardized test assesses movement ability instead of quality?

GMFM

Describe when it would be more appropriate to administer the GM66 instead of the GM88

primarily for children w/ CP

based on barefoot testing

gets progressively harder

Describe when it would be more appropriate to administer the GM88 instead of the GM66

for children w/ CP or DS

recommended for children w/ ambulatory aids / orthoses

Describe the SFA

criterion test

measures performance of functional tasks as it relates to school

grades K-6th grade

Which standardized test assessed performance of functional tasks in the school?

SFA (school function assessment)

In what age range is it appropriate to administer the SFA?

K - 6th grades

Describe the AEPS

criterion test

used in Indiana EIP

ages 0 - 6yrs

In what age range is it appropriate to administer the AEPS

0 - 6yrs

Which standardized test is used in the Indiana EIP?

AEPS

List some timed tests that may be administered to a pediatric patient

2min walk test

6min walk test

10m walk test

timed floor to stand test

Which standardized test would be appropriate to administer in an early intervention program?

AEPS

Which standardized test would be appropriate to administer in a school?

SFA

Which standardized test(s) would be appropriate to administer in an outpatient setting?

PMDS

BOT

Bayley

GMFM

Which standardized test(s) would be appropriate to assess a child's participation section of the ICF model?

SFA

AEPS

ASQ3

What is "efficiency"?

the amount of useful energy that can be derived from a given energy supply

Define step length

measured from heel center of footprint to heel center of the footprint of opposite foot

Define stride length

measurement between the heel points of two footprints of the same foot

2x step length

ex. left foot to left foot

Define cadence

steps per minute

the total number of steps divided by ambulation time

Heel strike typically emerges by ____

2yrs

(18-24mo)

When will a child typically have the max amount of (normal) genu valgum?

3-3.5yrs ish

Around what time will a child's walking velocity begin to normalize with their height?

4-6yrs

List the five major attributes to typical walking

1 - stability in stance

2 - foot clearance in swing

3 - appropriate pre-positioning for initial contact

4 - adequate step length

5 - energy conservation

What types of interventions may be appropriate to address stance phase stability deficits?

SLS

trunk stability exercises

single and double leg balance

hip strengthening (esp ABDs)

What types of interventions may be appropriate to address deficits in foot clearance during the swing phase of gait?

walk w/ flippers

stepping over obstacles

walking on heels

stability exercises

At what age should children have adequate/full knee extension?

around 18-24mo

What kinds of interventions may be appropriate to address deficits in foot placement during initial contact?

stretching hams/PFs (for full knee ext)

strengthen quads/DFs

articulating or solid AFOs if necessary

What are some potential MSK causes of toe walking?

tight heel cords

weak posterior chain

What are some potential neurological causes of toe walking?

tone/spasticity

(common for individuals w/ CP)

What are some potential sensory causes of toe walking?

avoiding/seeking behaviors

What initial intervention would be appropriate for an individual who walks on their toes?

need adequate ROM first

stretching

serial casting

braces

What are some potential MSK causes of in-toeing?

hip restrictions

antetorsion

tibial torsion

forefoot adductus

What are some potential causes of foot drop / toe dragging in children?

weak DFs

sensory - dragging toes for sensory input

something neurologic

Describe the typical knee alignment for newborns

typically born w/ more genu varum, will eventually straighten out by 1-2yrs

normal physiologic (slight) genu valgum at 2+ years (F>M)

In terms of LE development, how might children who are non-ambulatory or become ambulatory later in life be affected?

lack of WB may have delayed/slowed bone growth

typically more genu varum

poor development, higher risk of fracture

Define femoral torsion vs femoral version

torsion - amount of twist in the femur, angle between femoral neck and femoral condyles

version - position of femoral head in the acetabulum

Which term describes the angle of the femoral neck relative to the femoral condyles?

femoral torsion

Which term describes the position of the femoral head relative to the acetabulum?

femoral version

Describe femoral antetorsion

femoral head is rotated forward relative to femoral condyles

Describe femoral retrotorsion

femoral head is rotated posteriorly relative to femoral condyles

Describe femoral anteversion

femoral head is positioned anterior in the acetabulum

(results in thigh ER)

Describe femoral retroversion

femoral head is positioned posterior in the acetabulum

(results in thigh IR)

Describe the degree of femoral torsion and version present at birth

newborns have the max amount of torsion and version

~30d antetorsion

~60d anteversion

~30d external rotation

Normal adult femoral antetorsion is ____

12deg

How can femoral torsion be measured?

indicated and predicted by TPAT or hip IR/ER values

How can femoral version be measured?

ONLY with imaging

MRI best, but can also do CT and US

What is a normal (adult) femoral neck angle? How does this differ for newborns?

adult - 126deg

newborn - 140deg

Describe normal knee alignment development starting at birth

0-18mo - normal genu varum

18-30mo - begin to straighten out

3+ yrs - slight genu valgum

women tend to have more genu valgum (normally)

Infants are typically born with more ___ tibial torsion, but progressively becomes more _____

at birth, more internal (-) tibial torsion

progresses to more external (+) tibial torsion

Describe the normal alignment of the knee and tibia at birth

knee - genu varum

tibial - internal tibial torsion (-)

Describe the normal alignment of the hip, knee, and tibia at birth

hip - coxa valga (~140deg)

knee - genu varum

tibia - internal torsion (-)

Describe normal foot development from birth

born with flexible flat feet (fat pad on plantar surface)

medial longitudinal arch develops ~2-6yrs d/t weight bearing

When does the medial longitudinal arch in the foot typically develop?

born with flat feet

arch develops ~2-6yrs

You are evaluating a 2-year-old with primary concern of flat feet and genu valgum. Is this typical? Explain.

yes! normal

fat pad in foot doesn't start dispersing until 2-6yrs

knee alignment generally normalizes ~10yrs (ish)

Name the components of a torsional profile

foot progression angle (FPA)

hip ER and IR

trochanteric prominence angle test (TPAT)

thigh-foot angle (TFA)

forefoot alignment

Describe how to measure the foot progression angle (FPA)

angular difference between long axis of foot (bisect the 2nd met) and line of walking progression

Describe how to denote in-toeing vs out-toeing according to the FPA

in - minus sign

out - plus sign

What is a normal foot progression angle?

average FPA is +10deg

ranging from -3 to +20deg

What position is generally best to measure hip rotation in children?

prone

Describe the norms for hip rotation in children

similar to adults

40-45deg of ER/IR

at birth ~70deg ER

Describe the relationship between femoral antetorsion and hip rotation ROM

antetorsion is indicated by increased IR > ER

*excessive* FA is predicted if difference between IR/ER is >45deg

(not assumed for

How can hip rotation be used to indicate/predict femoral antetorsion?

IR>ER indicates femoral antetorsion

difference of >45deg (IR>ER) predicts excessive femoral antetorsion

(not assumed for

Describe the relationship between femoral retrotorsion and hip rotation ROM

retrotorsion is indicated by increased ER > IR

(not assumed for

Describe the trochanteric prominence angle test (TPAT)

prone w/ knee bent to 90

internally rotate the hip

palpate the greater trochanter at its most prominent place during hip rotation

look at foot position

Describe how to interpret the TPAT

if the foot is turned out --> suggests antetorsion

if the foot is turned in --> suggests retrotorsion

You complete a torsional profile on your 5yr old patient. They have 70d of hip IR and 25d of hip ER.

Is FA indicated based on these measurements? Is excessive FA predicted?

Explain why.

yes, FA is indicated (IR > ER)

excessive FA is indicated (difference >45d)

Describe some potential implications of excessive hip interval rotation

in-toeing gait pattern

knee valgus

decreased SLS

external tibial rotation

PFJ instability, anterior knee pain

ankle pronation

What are some potential complications of W sitting?

increased risk of hip subluxation or dysplasia

Describe some potential implications of excessive hip external rotation

toe-out gait

likely a soft tissue limitation rather than bony

Describe how to measure the thigh foot angle

measured in prone w/ knee flexed to 90d

angle between the axis of the foot and midline axis of the thigh

What is a normal thigh foot angle?

mean thigh-foot angle in childhood is +10

range +5 to +30