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Peds Disorders3
DCD, Plagiocephaly, Torticollis, BPI, DDH, Club Foot, Osteogenesis Imperfecta
| Question | Answer |
|---|---|
| Developmental Coordination Disorder (DCD) | 'clumsy child' & developmental apraxia. motor coordination - not due to a general medical condition |
| Developmental Coordination Disorder (DCD) clinical presentation | poor gross & fine motor skills (unable to skip, diff w/crossing midline, poor handwriting, unable to tie shoes) muscle weakness & low tone, requires verbal & visual cues |
| DCD task performance | re-learning a task each time attempted |
| Plagiocephaly | 'a flattened head' incidence (back to sleep campaign), positional; plagio, brachy, scapho. Crainiosynostosis - sutures fused together wrong |
| Plagiocephaly PT intervention | prone positioning!! helmet in severe cases. see by 2 months, 10-12 months too late |
| Torticollis presentation | asymmetrical posturing of head & neck, sidebend to ipsilateral side w/rotation to contralateral side (named for direction of tilt - 75% right) |
| Torticollis types | sternomastoid tumor, muscular, post-postural |
| Torticollis clinical presentation | Right - shortening of R upper trap & L splenius capitus. Significan trunk tightness, decreased symmetrical upper & lower body rotation & lateral flexion |
| Torticollis secondary complications | developmental delay, shoulder elevation, decreased midline control & ROM during growth spurts, fussiness, irritability w/poor self-calming, decreased tolerance to movement, pain. |
| Torticollis PT intervention | cargiver education!! positioning, stretching, developmental motor skills, facilitation of 'opposing' musculature |
| Brachial Plexus Injury (BPI) | Incidence 1/1000 births, Paralysis or weakness of the UE due to trauma to C5-T1 spinal nerve roots |
| Types of Brachial Plexus Injury (BPI) | Erb's Palsy (C5-C6 - waiter's tip), Klumpke's Palsy (C8-T1 - claw hand, don't have elbow ext, int rot & finger ext), Erb/Klumpke - entire UE involved |
| Causes of Brachial Plexus Injury (BPI) | difficult labor, large baby, hypotonic infant, (traction on should during delivery in breech position or head & neck during vertex delivery |
| Symptoms of OPBI | facial involvement, clavicular/humeral fx, subluxation of shld, torticollis, partial paralysis to diaphram (C4) |
| BPI PT intervention | E-stim, Botox, position/active movement promotion, modified constraint-induced protocols |
| BPI surgical intervention | neurosurgery between 6-12m, before 12m ideal, effectiveness is ?. Ortho surgery for contractures/postural problems |
| Developmental Dysplasia of the Hip (DDH)/Congential Hips Dysplasia (CHD) - Treatment | up to 6m - positioning in hip flex & abd. up to 12m - closed reduction, spica cast. over 1yr - surgical osteotomy (pavlik harness/casting) |
| Club Foot | plantarflexion, inversion - varus (rearfoot), midfoot/forefoot add & supination. 1/1,000 births, 2:1 males. bilateral approx 30-50% of cases |
| Clubfoot Classification Category 1 | postural cluvfoot, flexible deformity, medial & plantar deviation of had/neck of talus, foot size equal no atrophy |
| Clubfoot Classification Category 2 | true club feet, fixed deformity, involves talonavicular & midtarsal jts, navicular & entrie forefoot add & supinated, soft tissues of calf & foot are contracted & underdeveloped |
| Clubfoot Classification Category 3 | sever, fixed deformity, usually associated w/myelodysplasia, may have other severe neuromusculoskeletal problems |
| Clubfoot Interventions | correct deformity early (prior to 1yr) and completely. Maintain corrected position until foot stops growing (ponseti serial casting & Dennis Brown Splint). Mild cases mixed in surgical outcome |
| Osteogenesis Imperfecta | Brittle bone disease. Inherited disorder of connective tissue resulting in gfragile bones & recurrent fractures, muscle weakness & ligmentous laxity w/blue sclera |
| Osteogenesis Imperfecta Incidence & severity | 1/200,000 birth. Mild - forms classified differently. Severe - multiple fractures at birth 7 infants do not usually survive. |
| Osteogenesis Imperfecta Management | Bisphosphonate, bone marrow transplant or surgical -intermedullary rods in long bones. |
| Osteogenesis Imperfecta PT Management | Family education & SUPPORT/COUNSELING. ROM & strengthening program-usually aquatic, reduce injury, splinting, casting, assistive devices (prevent deformities) |
| Legg Calve Perthes Disease | Boys 4:1, 4-12yrs. Disease of the hip initiated by avascular necrosis of femoral head |
| Legg Calve Perthes Disease Presentation | limp w/pain referred to groin, thigh & knee. Hip ROM limitation in IR, abd & flex |
| Legg Calve Perthes Disease Medical Intervention | orthotic use to maintain hip approximation, surgery. |
| Legg Calve Perthes Disease PT Intervention | strengthening & ROM pre/post orthotic or surgical management. Maintain pain-free ROM & non-weight bearing during progressive stage |
| Slipped Capital Femoral Epiphysis | Boys, 11-15, obesity factor. Femoral head slips or is displaced from normal alignment w/femoral neck. |
| Slipped Capital Femoral Epiphysis Clinical Presentation | pain-groin, medial thigh or knee, limp, ER of LE, limited hip flex, abd & IR |
| Slipped Capital Femoral Epiphysis Medical Intervention | stabilize growth plate through bedrest, traction or surgical pinning |
| Slipped Capital Femoral Epiphysis PT Intervention | NWB, gain training |
| Autism | behavior conditions existing on continuum involving: socialization, communication, repetitive behavior |
| Autism Clinical signs | evident before 3 yrs old. poor eye contact, koesn't know how to play w/toys, excessively lines up toys or objects, overly attached to one particular toy/object, doesn't smile, appear hearing impaired |
| Autism PT Presentation | 60-80% demonstrate motor signs, poor muscle tone (hypotonia), poor motor planning, toe walking, sensory impairments (hypo/hyper) |
| Autism PT Intervention | sensory integration, coordination activities, motor patterning /planning, low tone, focus on safety, benefit from increased structure or consistent plan, decreased verbal interaction (communication w/pictures/visual aids) |
Created by:
jklincoln
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