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Advanced Hab/Rehab

Exam 1 Study Guide

QuestionAnswer
What are the parts of a neuron? -Dendrites -Cell Body (Soma) -Axon
Where does myelin come from? -Formed by Schwann cells in PNS -Formed by Oligodendroglia in CNS -Nodes of Raniver
What is synapse? -Formed by an axon terminal from one neuron communicating via neurotransmitter with any region of membrane in another neuron, muscle cell, or gland -Excitatory or Inhibitory -Lots formed when young -Dormant ones can be used later
What are the 4 principle parts of the brain & what makes each of these parts? -Cerebrum -Diencephalon -Cerebellum -Brainstem
Cerebrum -Cortex is gray while underlying tissue is white matter -Divided into hemispheres: connected by corpus callosum and cerebral peduncles + floor of 3rd ventricle -Gyri, Sulci, Fissures
Diencephalon -Below cerebrum and above brainstem -Important structures: Thalamus and Hypothalamus
Thalmus "Receptionist" for incoming information
Hypothalamus -Connection between nervous and endocrine systems -Regulates homeostasis via ANS
Cerebellum -Butterfly shape -Functions: Muscle tone, coordination, balance
Brainstem -3 parts: Midbrain, Pons, Medulla oblongata
Midbrain -"Dutch pants" shape -Red nuclei -Functions: visual, auditory, tactile reflex centers
Pons -Connects cerebellum to brainstem -Cranial nerve origins
Medulla Oblongata -Connects brain with spinal cord -Functions: HR & RR; swallowing, vomiting, sneezing; relays into to thalamus
Difference between UMN and LMN? -Upper Motor Neuron= Pre-central gyrus to anterior horn -Spasticity -More overall effect -Little to no regeneration -Lower motor neuron= Cord to periphery -Flaccidity -More localized -Regeneration
What do "motor" words mean? -Motor behavior= individual way actual movement occurs -Motor control= ability to maintain and change posture and perform coordinated movements -Motor learning= acquistion of skill through practice & experience
Motor words cont... -Motor planning/ programming= step-by-step procedure involved in learning an activity -Motor development= age- related process of changes in motor behavior
What is needed for "normal" movements to occur? -Muscle and neuromuscular coordination -ROM -Balance/ proprioception (body awareness) -Pay attention/ repetitions
What physical problems can affect normal movement? -Decreased mm coordination, ROM, and endurance -Shorten muscles -Deformities -Pain -Sensation issues (diabetic neuropathy) -Cardiovascular and Respiratory issues
What affect does the speed of the movement have on motor control? -Faster movements= less motor control -Slower movements= more balance (body awareness), more range, but harder to do
How does the degree of effort involved affect a movement? -Compensate/ Substitute -Make exer. easier/ decrease weight or reps -Emotional stress= less motivated -Brivery with patients to encourage them to perform their exer.
What is sensory integration? -Sensory Integration: developed by Jean Ayres, OT -Done by OT & PT -Focuses on vestibular system along with tactile and proprioceptive senses
What are primitive and automatic reflexes? -Primitive= Infant, neonatal; integrated within months -Automatic= Developmental; response or reaction -Stretch= used to assess PNS function in adults -Superficial Cutaneous= assesses motor pathways from CNS in adults
What negative effects may a persistent Asymmetrical Tonic Neck Reflex have on a developing child? -ATNR interferes with: feeding/ visual tracking/ midline use of hand/ bilateral hand use/ rolling/ development of crawling -Can lead to skeletal deformities (i.e. scoliosis, hip subluxation or dislocation
Cont...Tonic Labyrinthine Reflex on developing child -TLR interferes with ability to initiate rolling, propping on elbows with extended hips when prone, flexing trunk and hips to come to sitting position from supine -Often causes full body extension, which interferes with balance in sitting/ standing
Cont...Plantar grasp reflex on developing child -Interferes with: ability to stand with feet flat on surface and balance reactions and weight shifting in standing
Cont...Symmetrical Tonic Neck Reflex on developing child -Interferes with: ability to prop arms in prone position, attaining and maintaining hands and knees position, crawling reciprocally, sitting balance when looking around, use of hands when looking at object in hands in sitting position
In what sequence do protective reactions develop when sitting in the UE? UE: Seated positioning: -Downward= 4 months -Forward= 5-6 months -Sideways (lateral)= 7-8 months -Backwards= 9-11 months
In what sequence do protective reactions develop when sitting in the LE? LE: follows the same as for UE, but most emerge later when standing, walking on uneven surfaces begins -Downward= 4 months -Forward, Lateral, Backwards= 15-18 months -Part of motor strategies used to maintain postural control/balance
What is muscle tone? -The force with which a muscle resists being passively lengthened -The "stiffness" of a muscle -Neural and non-neural mechanisms at work -Influenced by...genetic structure of muscle, emotional level, medicines
Muscle tone cont... -When muscle tone is fully mature its high enough to support the body against gravity & low enough to allow for free movement to occur -Never “Force” a muscle w/ elevated tone to lengthen -“Break Up” tone through rotational motions starting proximally
Different types of abnormal muscle tone? -Flaccidity: NO mm tone -Hypotonic: LOW mm tone; decreased DTRs -Hypertonia = INCREASED mm tone throughout SLOW PROM -Spasticity = VELOCITY-DEPENDENT INCREASED mm tone; increased DTRs -Rigidity = Most extreme level of hypertonia
T/F? Someone can be hypertonic without being spastic, but not the other way around -True
Abnormal muscle tone cont... -Clonus: "bouncing" movement caused by muscle contractions stimulated by abrupt stretch -Common with spasticity -Can last seconds to minutes
Apgar Scale: what it assesses, scoring system, time periods given? -1st assessment of a newborn's physical condition -Done 1, 5, and possibly 10 minutes after birth -Scoring: Normal= 7-10
Gross and Fine motor skills: Newborn -Gross: flexion dominate, Infant reflexes cause movements -Fine: hands fisted, reflex palmar grasp
1 month old skills -Gross: lift and turn head in prone, all 4's wave around in supine -Fine: hands fisted, reflex palmar grasp
2 month old skills -Gross: decreasing flexion, lifting head more -Fine: hands fisted, reflex palmar grasp
3 month old skills -Gross: prone on elbows, holds head up in supported sitting, rolls prone to supine via log roll; pronated reaching -Fine: grasps and shakes rattle
4 month old skiills -Gross: head control, trunk symmetry, hands to midline, belly crawling -Fine: objects to mouth
5 month old skiills -Gross: pivot prone, prone on extended elbows, feet to mouth in supine, no head lag in pull to sit, prop sitting -Fine; transfer objects hand to hand, raking
6 month old skills -Gross; sitting with intermittent hand use vs handsfree; w-sitting, rolls supine to prone, pivoting in prone, pull self to stand -Fine: voluntary palmar grasp (fingers only)
7 month old skills -Gross: assume quadruped, assume sitting, unilateral reaching in sitting, variety of sitting positions -Fine: radial palmar grasp (thumb added)
8 month old skills -Gross: creeping, hands-free sitter, cruising, walk with hands held, supinated reaching -Fine: true voluntary release
9 month old skills -Gross: pull to stand at crib, variety of positions, very mobile -Fine: radial digital grasp
10- 11 months old skills -Gross: kneeling, cruising -Fine: inferior pincer grasp, builds tower with 2 cubes, marks paper with crayon
12- 15 months old skills -Gross: independent ambulation on level surfaces, independent up/down steps via creep/scoot -Fine: superior pincer grasp, three-jaw chuck grasp, mature release
16-24 moths old skills -Gross: ambulates pulling toy, stair ambulation w/ 1 hand held, supine to sit via prone roll to squat, jumping down step -Fine; putting small objects in bottle, folding paper, stringing beads, stacks 6 cubes
2-3 y.o. -Gross: independent stair ambulation on individ. steps, unilateral stance < 3 secs, kick large ball & throw small, run on toes -Fine: turn knob, open/closes- disc & cylindrical grasps, buttons large buttons, uses child's scissors with help, folds clothes
3-4 y.o. -Gross: pedal tricycle, climb ladder, up steps reciprocally & down individ., jumps over obstacles- 1 to 2 footed, galloping, overhead ball throw, ball catch w/ arms extended
3-4 y.o Fine: static tripod grasp, matched colors, draws basic shapes/ objects, cuts independently with scissors- lateral precision grip
5-8 y.o. Gross: ambulate on balance beam, skipping, kick a rolling ball, bounce a large ball, bike riding, roller skating Fine: hand preference, prints well, starts cursive- pencil grip handout, button small buttons
9-12 y.o. Gross: mature forms of running, throwing, and catching Fine; "artistic drawing", improved handwriting- dynamic & lateral tripod most commonly used pencil grips
13+ y.o. Gross: increased skills in all areas with some fluctuations due to puberty Fine: develop greater finger dexterity
Grasps in development Newborn: reflex palmar grasp 1-2 mo. old: hands fisted, reflex palmar grasp 3 mo. old: grasps & shakes rattle 4 mo. old: objects to mouth 5 mo. old: transfer objects hand to hand, raking 6 mo. old: voluntary palmar grasp (fingers only)
Grasps in development cont... 7 mo. old: radial palmar grasps (thumb added) 8 mo. old: true voluntary release 9 mo. old: radial digital grasp 10-11 mo. old: inferior pincer grasp 12-15 mo. old: superior pincer grasp, three-jaw chuck grasp, mature release
Grasps in development cont... 2-3 y.o.: disc and cylindrical grasps 3-4 y.o: static tripod grasps, lateral precision grip 9-12 y.o.: dynamic and lateral tripod grips
Premature babies Less than 37 weeks
Nerve levels for associated with DTRs: Plantar S1, S2
Abdominal reflexes above umbilicus- T8-T10 below umbilicus- T10-T12
Biceps muscluocutaneous nerve C5, C6
Brachioradialis (supinator) radial nerve C5, C6
Triceps radial nerve C6, C7
Finger flexors median nerve C6-T1
Hamstrings tibial branch, sciatic nerve L5, S1, S2
Quads (patellar, knee jerk) femoral nerve L2, L3, L4
Achilles (ankle jerk) tibial S1-S2
Input anything done to get a response
Handling tactile input
Inhibition stimuli that decreases unwanted movement, muscle tone, etc.
Facilitation stimuli that increases movement, muscle tone, etc
Vestibular inputs -Especially affects extensor muscles -Equipment: scooter boards, swings, ball activities
How to break up increased muscle tone Through rotational motions starting proximally
Quick vs Slow stimuli responses Quick: facilitates Slow: inhibits
Goals of positioning -Maintain/improve postural alignment -Comfort -Provide mobility and/or stability, which improves function -Gain or reinforce normal movement patterns. -Prevent contracture, deformity, skin breakdown -Allow for weight-bearing
Ideal positioning for sitting -Side sitting promotes trunk elongation and rotation -Sitting promotes active head & trunk control -Provide WBing for extremities -Normalize visual/ vestibular input -Cross-sitting and W sitting to promote muscle tightness
Purposes of the muscle preparation phase of treatment -Provide inputs (especially proprioceptive, tactile, and vestibular) that will increase body awareness -Elongation of shortened muscles -Normalization of muscle tone -Development of stability
What is done in the activation phase -Doesn’t necessarily mean all activities should be active -Work more specifically toward goals for daily treatment -Therapist & child should work hard, but still should be fun
What causes CP: prenatal Rubella, herpes simplex, toxoplamosis, cytomegalovirus, placenta abnormalities, Rh incompatibility,maternal diabetes, toxemia, brain maldevelopment
Causes CP: perinatal Asphyxia, prolonged labor, breech birth, prolapsed cord, rupture of blood vessels or compression of brain, premature separation of placenta, placenta previa, prematurity, low birth weight
Causes CP: postnatal factors Cerebrovascular accident, intraventricular hemorrhage, brain infections: meningitis, encephalitis, seizures, head trauma, near-drowning
Impairments associated with CP: neuromuscular -Abnormal muscle tone -Insufficient force generation -Poor selective control of individual muscle activity -Poor anticipation of postural changes and body movements -Decreased motor memory -Altered reflexes
Orthopedic problems with CP -Excessive or maintained femoral anteversion -Abnormal femoral or tibial torsion -Hip subluxation -Scoliosis
Other impairments with CP ~30% have speech disorders -25-45% have Intellectual Disability -40% have seizure disorders -40-50% have vision abnormalities ~30% have auditory disorders
Patterns of motor involvement in CP: Spastic Hemiplegia -Low tone in trunk -High tone in UE>LE -Scoliosis, kyphosis, hip sublux./disloc., LLD, visual field cuts, perceptual deficits -Intelligent  compensations -Development delays -Decreased endurance & balance -Gait deficits
Spastic Diplegia -Spastic Diplegia -Weak trunk -Spastic extremities LE>UE -Wide range of functional abilities -Commando crawl -Bunny hop on all 4’s -Crouched gait with full body rotation
Spastic Quadriplegia -Includes trunk -Affects UE>LE & 1 side more than other -Hypotonic as infant -Respiratory problems -Scoliosis, hip sub./dis. -Decreased variety of movement, poor endurance
Athetoid -Positioning in WC is hard as tend to sit in a rotated position and propel backwards -Abnormal standing posture
Ataxic -Usually hypotonic -Truncal vs. general -Walks with wide BOS and high guard position -Tremors -Overshoots when reaching, etc
What does a child with DS look like -Mid-face hypoplasia: Flat facial profile Slanted eyes -Tongue protrusion -Simian crease in pa-lms -Decreased leg & hand length
Pathology of SMA -Progressive neuroms. disease inherited in an autosomal recessive pattern -Associated with 2 different genes on #5 -Involves degeneration of ant, horn cells resulting in mm atrophy, proximally & moves distally -May progress & plateau for years
Types of SMA -Acute form: Type I- Acute Infantile (most severe) -Chronic form: Type II/ Type III- Kugelberg-Welander
Genetic basis of DMD (Duchenne's Muscular Dystrophy) -Etiology: X-linked; 2/3 have family history, 1/3 fresh mutations -1 in 3500 live male births -Longevity: late teens to early 20s
Pathophysiology of DMD (Duchenne's Muscular Dystrophy) -Defect in gene coding resulting in decreased amounts of dystrophin  Increased muscle permeability to Calcium  Activates enzymes that breakdown the cell  Pseudohypertrophy and weakness of muscle tissue
Children with what condition will exhibit a Gower's maneuver -Duchenne's Muscular Dystrophy
Treatment precautions for DMD -Pt. will present: Toe walking -Gower’s -Lordosis/scoliosis -Trouble with stair ambulation -Loss of ambulation skills -Declining respiratory status
Worst form of OI -Type II is the worst
Rett's Syndrome -Classified as a neurodevelopmental disorder that is thought to be X-linked dominant -Incidence; 1 in 12000 females -Can live into 50s, although most die young
S&S of Rett's Syndrome -Normal development for ~ 6 mo. then regresses to point of no talking or walking -Intellectual Disability -Ataxia -Growth retardation -Stereotypical hand movements & tremors -Mouthing -Seizures -Scoliosis -Respiratory problems
Ambulation status of each level of spina bifida -Thoracic: THKAFO or HKAFO for supported standing when young/ long term: W/C -L1-L2: KAFO, RGO with walker/crutches 4 short distance in house when young/ W/C -L3: KAFOwith walker/ crutches for short distance in house & community; W/C
Ambulation status of each level of spina bifida cont... -L4: AFO and crutches in community; long term: community and W/C for long distances -L5: may or may not use AFO, FO in community, crutches for long distances; long term: community, W/C for sports -Sacral: may/ may not use FO in community; community
Associated problems with spina bifida -Ortho: Scoliosis, Kyphosis, Lordosis, Club feet, Hip dislocation, Contractures, Cleft palate -Incontinence: bowel/bladder, fused/ absent kidneys -Obesity -Osteoporosis -Skin breakdown -Cognition -Communication -Seizures -Cranial Nerve dysfunction
Allergy common in spina bifida -Latex
S&S of shunt malfunction -Enlarged head -Swelling/ reddness along shunt tract -Prominent scalp veins -Downward deviation of eyes -Sleepy/ irritable -Less interest in feeding -Vomiting
DDH clinical presentation -Asymmetrical hip abduction in flexion -Pistoning with traction -Apparent femoral shortening -Doesn’t show on X-ray until after 6-8 months old -Screening tests
Developmental Dysplasia of the hip (DDH) -Abnormal alignment between acetabulum and femoral head -May involve small or shallow acetabulum, slanted acetabulr roof, subluxed or dislocated femoral head -May develop in the last trimester due to positioning, breach, hormones
Developmental Dysplasia of the hip (DDH) cont... -May develop later due to mm imbalances, obligatory ATNR, or cultural practices -Family history -1 in 1000 births in US -6:1 more common in girls -Left>right
Treatment for DDH -Conservative: -Keep legs flexed & abducted (brace/cast/diaper) -Caregiver education -Gait training -ROM/ Strengthening -Balance -Aggressive: -Soft tissue releases -Osteotomies -Acetabular reshaping -THR
Legg-Calve-Perthes Disease (LCPD) -Degeneration of femoral head due to loss of blood supply -AVN of epiphysis -Unknown etiology/ unilateral -Prevalent in boys 2-12 y.o.
Clinical presentation of LCPD -Trendelenburg gait pattern -Decreased hip ROM, especially ABD and IR -Thigh, calf, or buttock muscular atrophy -LLD
Treatment for LCPD -Conservative: -Swimming for ROM & strengthening -ABD splints or Spica cast -Decreased weight-bearing -Aggressive: -Varus osteotomy of femur and/or pelvis -THR
Osgood-Schlatter's Disease -Inflammation of quad tendon insertion @ tibial tubercle -Called patellar tendonitis in adults -Caused by rapid growth of long bones coupled with stress from sports activities -Occurs in Girls ages 8-13 y.o., Boys 10-15 y.o.
Osgood-Schlatter's Disease clinical presentation -Localized P! and swelling -Prominence of tibial tubercle
Treatment for Osgood-Schlatter's Disease -RICE -Pain medication & anti-inflammatory drugs -Knee immobilization -Ionto/Phonophoresis -Isometric quad exercises in extension only until MD approves more. -Decreased weight-bearing
Different types of Juvenile Rheumatoid Arthritis (JRA) -Oliogoarticular= most common <4 joints: knees>ankles>elbows>wrists -Polyarticular= 30-40% >4 jts: symmetrical in knee>ankle>elbows>wrist>hands>TMJ>C/S>hips>shoulders -Systemic: least common: acute onset in children < 16 y.o. duration of @ least 6 wks
Modalities contraindicated in JRA -Ultrasound
What is impaired in autistic and Learning Disability (LD) children -Impaired communication: echolalia, emotionless -Socialization: poor eye contact, vacant gaze, don't touched -Imagination: repet playing, no abstract thinking, tantrums if routine changed -Abn sensory responses: sound, texture, stereotypical movement
Pathology of pediatric asthma -Chronic, reversible airway obstruction with trapping of air, gas exchange impairment -Bronchospasms, inflamed mucous membranes, increased mucous production -75-80% of children -Genetic predisposition with environmental stimulus
Pathology of cystic fibrosis (CF) -Autosomal recessive gene defect involving chromosome #7 -Defect in production/working of CF transmembrane regulator (CFTR) protein resulting in excess exocrine production + abnormal salt movement
Most common pediatric cancer -Leukemia
What do you do if a child has a seizure during treatment -Protect, but don't restrain -Dos: move to floor, clear area, lie on side -Don't: Don't put anything in mouth, don't hold them down
Created by: alovedaytn