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ortho test 2
202: pediatric spine
| Question | Answer |
|---|---|
| diagnoses seen in adults may also be seen in children | Overuse, Arthritis (cervical spine, ankylosing spondylitis, sacroiliitis), Disc herniation, Poor core stability |
| pro of immature spine | changes are possible secondary to remaining growth |
| cons of immature spine | impacts may be greater secondary to remaining growth |
| torticollis | Lateral curvature of the cervical spine directly related to abnormal length of SCM (shortened) |
| prenatal factors that can cause torticollis | Ischemic injury based on abnormal vascular patterns or head position in utero leading to compartment syndrome, Intrauterine crowding or persistent malpositioning |
| perinatal factors that can cause torticollis | Birth trauma from breech presentations or assisted deliveries |
| postnatal factors that can cause torticollis | Positional preference, Frequent container use (swing, lounger), Deformational plagiocephaly (flat spot on some part of head that head rests in) |
| what can increase torticollis prevalence | twin births, premature births, associated with GERD (reflux), developmental hip dysplasia |
| torticollis has increased since the ____ campaign | back to sleep- can cause flat spot to develop on back of head |
| how can bottle feeding affect torticollis | if bottle fed same way every time - can develop, make sure to switch sides |
| when is torticollis usually notices | soon after birth |
| how is torticollis named | by the direction the head is tilted in |
| torticollis Causes head to side bend to the side of short SCM and rotate to ____ side | opposite |
| torticollis can be ___ in origin | neuromuscular (conditions with abnormal muscle tone: CP, spinal muscular atrophy) |
| torticollis treatment goals | stretch shortened side, strengthen shortened side in lengthened position, strengthen overstretched side (usually responds well to PT and HEP) |
| scoliosis | any curvature of the spine |
| any curvature less than ___ degrees is spinal asymmetry, not scoliosis | 10 |
| types of scoliosis | Idiopathic, Neuromuscular, Congenital |
| how is scoliosis classified | Origin, Location, Magnitude, Direction |
| two categories of scoliosis | 1.Non-structural 2.Structural |
| Non-structural scoliosis | Lateral curve of the spine without fixed bone deformity, No rotational component, lateral curvature correct with forward/side bending |
| what can cause non structural scoliosis | Compensatory to some other condition: pain, mm spasm, nerve root irritation, disc bulge, Leg length discrepancy, Muscle / joint contracture, Weakness |
| how is non structural scoliosis diagnosed | Forward bend test to rule out spinal asymmetry / rib hump or X-rays to rule out rotatory component |
| treatment for non structural scoliosis | Primary diagnosis causing the scoliosis, Can potentially become a structural scoliosis if untreated |
| structural scoliosis | Lateral curve of the spine with fixed bony deformity, Rotational component, Does not correct with forward flexion and/or supine bending |
| structural scoliosis has ____ curves above and below the primary curve(s) that may or may not correct | Compensatory |
| types of structural scoliosis | Idiopathic , Congenital , Neuromuscular, Mesenchymal (connective tissue) Disorders, Trauma |
| idiopathic scoliosis | Three dimensional curvature of the spine |
| cobb angle for scoliosis | > 10° to be considered a true scoliosis, along with vertebral body rotation < 10° is considered a spinal asymmetry |
| theories for what causes idiopathic scoliosis | Hereditary, Environmental factors, Connective tissue |
| 90 % of curves are to the ____ (R/L) in the thoracic or thoracolumbar area in adolescents(left sided curves more common in infants | right |
| MRI is needed if the curve is to the ____ (L/R) | L. atypical, could be associated with tethered cord |
| does idiopathic scoliosis have back pain | not typically |
| Risser sign | Used to determine skeletal maturity by ossification of pelvic brim when assessing risk for curve progression (0: skeletal immaturity to 5: skeletal maturity scale) |
| early onset scoliosis | Diagnosis prior to 10 years of age |
| late onset scoliosis | Diagnosis at 10 years or older |
| intaftile scoloisis | diagnosis at 0-3 years |
| juveniles scoliosis | diagnosis at 4-9 years |
| adolescents scoliosis | diagnosis at 10 years and older |
| diagnosis for scoliosis | Forward bend test ages 10-16 (grades 5-9) however can be done at any tim |
| what season do we see more scoliosis diagnoses? | summer, kids wearing tank tops etc. that show more of spine |
| Any reading greater than ___ degrees on scoliometer warrants a follow-up with radiographs | 5° |
| 5° scoliometer reading heavily correlated with ____ Cobb angle | 20° |
| diagnosis red flags for scoliosis that may indicate follow up is needed | scoliometer reading over 5 deg, tuft of hair over the lumbar spine, Café au lait spots, Abnormal Neuro Exam |
| what is tuft of hair over lumbar spine indicate | Associated with spina bifida occulta |
| what do Café au lait spots indicate? | Associated with neurofibromatosis |
| what elements are included in PT eval for scoliosis | Posture, Leg Length - CAUTION, ROM, Trunk strength, Activity level, Neurological exam |
| ____ ____ and ____ _____dictate x-ray schedule | Cobb angle, Risser score |
| 0-10 cobb angle tx | watch and see (spinal asymmetry) |
| 10-25 cobb angle tx | close monitoring with follow up every 3-6 months |
| 25-50 cobb angle tx | probably bracing with continued close monitoring |
| greater than 50 cobb angle tx | probable spine surgery |
| treatment goals for idiopathic scoliosis | prevent progression of curve, decreased pain to improve fn, promote, improved sagittal balance to decrease pain and dysfunction, Train patient in appropriate body mechanics |
| effectiveness of electrical stimulation for scoliosis tx | not found to keep curves from progressing |
| effectiveness of positioning tx for scoliosis | not found to keep curves from progressing |
| effectiveness of Chiropractic Treatment/Massage Therapy for scoliosis | no studies have documented effectiveness in keeping curves from progressing |
| exercise treatment for AIS | Many different proposed treatment methods and approaches over the years; Most recent exercise approach known as scoliosis specific exercise (SSE); Schroth and |
| Schroth Method | Scoliosis specific exercise program *curve specific* |
| goal of schroth method | to correct the scoliotic posture using a 3D exercise approach |
| who can practice Schroth Method | PTs and PTAs |
| components of Schroth method | correct pelvic alignment first; auto-elongation; expansion collapsed areas; mm activation at prominences; integration |
| what does muscle activation at prominences help with? | Derotate and deflect curve; Detorsion curve |
| limitations of schroth method | does not cure scoli; prevents progression of curve to surgical range |
| secondary goal of schroth method | minimize any curve progression |
| schroth method is always done is conjunction with ____ | bracing |
| when might a child not be brace candidate? | skeletally mature, no documented progression, pain |
| schroth method is only used in ___ scoli | idiopathic |
| extreme spinal extension contributes to... | dorsal collapse of the spine already seen in scoliosis |
| extreme spinal flexion contributes to... | torsion or twist of the spine, also creates high disc pressure |
| braces are for curves greater than ___ degrees | 25 degrees |
| braces are not effective for curves greater than ___ degrees | 45 |
| how many hours per day should brace be worn? | 16- 23 hrs |
| how long does brace need to worn for | until skeletal maturity is reached |
| Pressure from brace retards growth on the ____side (Wolff's law) | convex |
| Relief from pressure stimulates growth on the ____ side | concave |
| goal of bracing | prevent progression of the curve to surgical range |
| boston brace | Provides pelvic stabilization, Pressure pads apply direct force to the apex of the curves, Asymmetric curve pushed into symmetric mold |
| Wilmington brace | Molded or scanned in corrected position, Brace starts as asymmetric and then provides further correction |
| Cheneau Style Brace/3D Brace | Emphasis is on derotation of the curves with opposing cutouts to allow for offloading of the curve as it corrects |
| Charleston Bending Brace | Worn at night only; Good for high curves, single curves; Can cause compensatory curve to worsen |
| Providence Bending Brace | Worn at night only; Good for double curves |
| 3D bracing technique | primary standard of orthotic management |
| when is surgery indicated for scoliosis | For curves > 50° in skeletally mature and immature children |
| Curve > 50° is likely to increase ___ degree / year | 1° |
| goals of scoliosis surgery | Straighten the spine, Balance the trunk over the pelvis, Stabilize the spine |
| Fusion takes about___year to fully mature | 1 |
| considerations for spinal fusion surgery | Patient activity level limited, Spine growth does stop, Immature spine needs anterior and posterior fusion |
| role of physical therapy in idiopathic scoliosis | Educate regarding bracing and exercise goals, Exercises to maintain trunk strength and flexibility if ordered, Post-op remobilization and education |
| congenital scoliosis (structural) | Vertebral anomaly causing scoliosis; Failure of vertebral segmentation or vertebral formation or mixed defect |
| congenital scoliosis has Aggressive curve at what age age with 50% progression | very early |
| what type of scoliosis is associated with abnormalities of other organ systems | congenital/structural |
| diagnostics for congenital scoliosis | May require studies to rule out cardiac and genitourinary anomalies; X-ray to measure angle and to predict curve progression |
| when is congenital scoliosis usually diagnosed | 0-3 years |
| casting for congenital scoliosis | MEHTA casts |
| bracing can cause ____ deformities | rib |
| Bracing should not be used for children under____ years of age (casting done prior) | 2 |
| Surgery is avoided as long as possible to allow spinal growth and continued _____development | lung |
| physical therapy for congenital scoliosis with brace or cast | support development with their device |
| neuromuscular scoliosis | uScoliosis is the result of their primary neuromuscular diagnosis |
| two types of neuromuscular scoliosis | neuropathic and myopathic |
| types of neuropathic scoliosis | Cerebral Palsy, and Neurofibromatosis |
| types of myopathic neuromuscular scoliosis | Muscular Dystrophy; Amyotonias; Spinal Muscular Atrophy |
| predisposing factors for neuromuscular scoliosis | weakness/ spasticity, children w/CP who ambulate, non ambulatory globally involved children with CP |
| Weakness and / or spasticity lead to _____ and ____ that can cause scoliosis | joint contractures and imbalance |
| Children with cerebral palsy who ambulate are _____ times more likely to develop scoliosis than children without CP | three |
| Non-ambulatory / globally involved children with ____ ____increase of severe scoliotic curves | cerebral palsy |
| ____% of globally involved kids will develop scoliosis | 65% |
| nonsurgical treatment for neuromuscular scoliosis | positioning/stretching/exercise, bracing |
| positioning/stretching/exercise for neuromuscular scoliosis | Attempt to prevent contractures in children who use a wheelchair, Build support into the seating system |
| bracing for neuromuscular scoliosis | Custom molded; More equally distributed pressure for those not able to express discomfort |
| Curves in people with spasticity and imbalance progress even after ____ ____ | skeletal maturity |
| neuromuscular scoliosis surgery for non ambulators | anterior and posterior fusion to the pelvis |
| neuromuscular scoliosis surgery for ambulators | anterior and posterior fusion to L-4/L-5 of possible |
| physical therapy for neuromuscular scoliosis | Exercise / stretching program; Wheelchair seating systems; Alternate positioning equipment; Re-evaluate these after surgery; Educate families in proper handling post-surgery |
| kyphosis | Increased posterior curvature typically in the thoracic spine |
| normal kyphotic curve angle | 20 - 50° is normal; average 35° |
| what degree of kyphotic curve is considered pathological | <9° or >53° |
| two types of kyphosis | 1.Postural 2.Scheuermann's |
| postural kyphosis | Non-structural deformity which is correctable |
| predisposing factors for postural kyphosis | - weakness (abs, inter scapular, trunk extensors) - tightness (hamstrings, pecs) - poor self-esteem - depression |
| diagnosis for postural kyphosis | observation, X-rays (lateral view) |
| treatment for postural kyphosis | exercise, bracing, surgery |
| exercise for postural kyphosis | Strengthening, Stretching and postural correction, Re-education |
| bracing for postural kyphosis | Curve > 65°, Boston Brace with sternal pad for full-time wear |
| surgery for postural kyphosis | Anterior & posterior spine fusion when curve > 70-75° |
| physical therapy for postural kyphosis | Exercise program; Improve body image / self-esteem |
| Scheuermann's kyphosis | Structural deformity causing kyphosis |
| what causes Scheuermann's kyphosis | - Anterior wedging of the vertebrae - Damage to the vertebral growth plates occur due to kids outgrowing their bone strength during the puberty growth spurt - Hereditary component |
| who does Scheuermann's kyphosis affect most? | M/F distribution is 2:1 |
| diagnostics for Scheuermann's kyphosis | X rays |
| what might you see on an X ray that indicates Scheuermann's kyphosis | Ventral vertebral body wedging, Irregular end plates, Virtual narrowness of IVD space, Schmorl's nodes |
| treatment for Scheuermann's kyphosis | Same as postural kyphosis; Typically more motivated in compliance secondary to not having the psychological component;Can also use Schroth principles |
Created by:
bdavis53102
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