PT 744
Final Exam Review
2023
• Orthoses
• Developmental
• Prostheses Coordination
• Equipment Disorder
Priority • Muscular • Autism Spectrum
Information Dystrophy Disorder
• Spinal Muscular • Cerebral Palsy
Atrophy • Acute Care
• Juvenile • ICU
Idiopathic • Rehab
Arthritis
• Burns
• Myelomeningoce • Oncology
le
• Transition to
• Spinal Cord Adulthood
Injury
• Scoliosis
Be able to:
• the most effective interventions, equipment
and orthotics for children with varying
conditions and ages
• assessment tools and methods
Describe: • medications used for specific conditions
• surgeries for specific conditions
• other professionals you may work with on a
team
Orthoses & • Gait lab: solid AFOs, • Single axis knee
shoe wedges for joint for a young
Prostheses children with CP* child*
• Drop foot: posterior • Prosthesis post-op
leaf spring* rotationplasty for
• Crouched gait: proximal focal
ground reaction femoral deficiency:
AFOs* dorsiflexion to flex
knee and
plantarflexion to
extend knee*
Equipment: be able to recommend the most
appropriate equipment for a specific child’s
needs based on age, diagnosis, head & trunk
control, scoliosis, hip dislocation, ability to
activate a power switch, vision
Types of wheelchairs
-Manual: GMFCS III or V
-Power: IV* or III for
Wheelchairs longer distances (and Parts
ability to steer) Review list of frames,
-Standard: no significant seating systems,
deformities at trunk and trunk supports,
hips lateral supports for
legs or trunk, head
-Custom molded seat rest, abductor
and/or back: scoliosis, pommel, arm rests,
kyphosis, hip dislocation foot rest, shoe
-Tilt in space for poor holder, chest harness,
head and trunk control seat belt, trays
or need for pressure
relief*
• Sidelyers
• Prone wedges
Adaptive • Rolls
• Tumbleform seats
Equipment: • Therapy balls
• Standers: prone &
be able to supine • Tilt Boards
select based • Hoyer lift • Scooter boards
on child’s • Robotics • Adaptive bikes and
need for • Supported gait trikes
positioning, • Eye-hand • Powered toys and
coordination cars
therapy, &
• Vestibular
fun
Muscular Dystrophy
Recognize early signs leading to a DMD diagnosis*
• Diagnosed between 1 and 5 years of age
• Gross motor delay: Not walking until 18 months and with a Gower’s sign
• Initially seen by a neurologist for diagnosis
• Progressive regardless of interventions-PT can lessen disability
Cause
• Genetic mutation preventing dystrophin production destroys muscle fibers, recurrent muscle
ischemia*
Classification Scale:
• Vignos*
• 10 levels of functional ratings
Muscular Dystrophy
• Medication: Eteplirsen*
• PT’s role and treatment philosophy
• Splinting & serial casting
• *Equipment for mobility/standing/community participation, transfers, toileting,
bed mobility, dressing & feeding:
• Power chair: may need molded if scoliosis
• Aquatic therapy
• Hoyer lift
• Plan of care across lifespan: participation in adaptive sports, aquatics, horseback
riding*
• Mutation of survival motor neuron gene 1
(SMN1)
• Weakness of voluntary muscles, particularly
shoulders, hips, thighs, back (may lead to
Spinal scoliosis)
• Muscle for breathing & swallowing may be
Muscular affected
• 4 levels:
Atrophy* • -Werdnig-Hoffman most severe*
-SMA2 moderate
-Kugelberg-Welander or Juvenile SMA: mild
-Type 4: rare, very mild, emerges in second
or third decade of life, can walk during
adulthood
Spinal Muscular Atrophy
• Medication: spinraza*
• PT role & management
-therapeutic exercise -strengthening
-developmental skills -aquatic therapy
-standing devices -managing contractures, scoliosis
-selecting assistive devices, wheelchairs, standers, gait trainers
*MD camp
• Idiopathic, autoimmune inflammatory
Juvenile disorder causing joint swelling pain,
stiffness, systemic problems*
Idiopathic • Medications: NSAIDs, Metheltrexate,
Arthritis Anti-IL drugs*
• Types: oligoarthritis*, polyarthritis,
systemic, undifferentiated
(be able to select which for a case)
• Most appropriate assessments tools*:
• GROMS
• Oucher Pain Scale
• Quality of Life
• JAMAR
Myelomeningocele
Procedures performed during pregnancy for a child diagnosed with
myelomeningocele: Diagnosis at 18 weeks*, Ultrasound for cranial
malformations, in utero surgery for repair of myelomeningocele sac)
Be able to select the most appropriate equipment and orthoses for a
child at
-L-4 level (good hip control, walks with crouched gait): KAFO, Lofstrand
crutches or walker*
L1-2 level: KAFO or RGO, forward walker, parapodium*
• Difference in adults & children with
SCI: children recover neurologic more
Spinal Cord frequently & recovery occurs over a
longer period of time*
Injury • Be able to recognize the expected
motor function for a child with
complete L-4 SCI and the appropriate
equipment and orthoses*:
• forearm crutches or cane for
longer distances
• may use a manual wheelchair
for longer distances or adaptive
sports and recreation
• independent walking indoors
with AFOs
Scoliosis Be able to recognize the level of
scoliosis: thoracic, lumber,
thoracolumbar
Be able to recognize the terms used to
describe the side of the scoliosis*
• Dextro= curve with convexity to the right so
leaning left, usually thoracic
• Levo= curve with the convexity to the left so leans
right, lumbar or thoracic level
Surgery typically recommended when
the Cobb angle is 45 degrees or greater*
Be able to describe the motor, social and learning
difficulties for children with DCD.
Developmental
Coordination *Diagnosis: poor motor skills, poor social skills, difficulty in
Disorder school
-clumsiness, slowness, inaccuracy with fine motor skills
(handwriting, scissors) & gross motor skills (riding a bike,
not good at sports)
-interferes with ADLs, vocational activities, leisure and play
*Gait patterns: wider base of support, greater variability in
gait pattern, clumsy and awkward movements, tripping
over feet and bumping into others, weight shifting
problems, toe walking, high stepping, shuffling, stomping
Autism Spectrum Disorder
*Describe the characteristics of children
with ASD
• Neuromotor disorder
• Disturbances in social relationships
• Difficulty communicating
• Repetitive behaviors
• Narrow interests and activities
• Gross Motor Function Classification System: classifies
gross motor abilities
• Describe the ideal candidate for Selective Dorsal
Rhizotomy (GMFCS I, II, III)*
Cases
Cerebral -Select an intervention that will improve the ability to
wear AFOs for a 4 year old child with CP. At this time his
Palsy ankle ROM is -10 degrees with knees extended and -5
degrees with knees flexed. (Botox injections and serial
casting with cast changed weekly up to 6 weeks)
-What is the most effective frequency/dose of PT over
the summer for a 14 year old boy with spastic diplegia
who has had a growth spurt through the school year so
that he is now crouching in standing and has decreased
ROM at hips, knees and ankles? (think intensive: 5 days
per week, 3 hours per day, 3 weeks)*
For all areas and patient types
in the acute care setting, be
able to describe the
Acute importance of collaboration
and teamwork with multiple
Care other professionals and with
families. Be specific about the
roles of PT for the various
diagnoses and ages of patients.
Recognize common diagnoses
of children in the ICU.
Pediatric • Traumatic brain injury, stoke,
tumor resections,
Intensiv encephalopathy, AVM
rupture
e Care • Acute respiratory distress
Unit* • Spinal cord injury
• Post-transplant
• Multi-trauma
Pediatric Intensive Care Unit
Early Mobility decreases*
Benefits of Early Mobility in the PICU* • Length of stay in ICU & hospital
• Improved CV function • Cost of care
• Decreases inflammation • Caregiver burden
• Improves musculoskeletal integrity • Multisystem complications
• Improves cognition • Depression
• Prevents post-ICU psychosis • Failure of weaning O2 support
Increases
• Overall quality of life
• Functional outcomes (functional
independence)
Goals of PT services*
Pediatric Rehab Diagnoses • Functional mobility
• bed
Services • SCI
• transfer
• TBI
• ambulation
• Stroke
• wheelchair mobility
• Multi-trauma • Strength/ROM
• Guillain Barre • Identify/provide orthoses,
• Transverse myelitis bracing, equipment
(walkers, canes,
wheelchairs)
• Patient & family education
Pediatric Rehab Services*
Rehab Team
• MDs
• Rehab
• Neuro
• Ortho PT: Typical Care and
• Neurosurg
Frequency/duration
• Nursing
• Therapist
• 5-6 days per week for 60+
• PT minutes
• OT • 2-4 weeks
• SLP
• Child Life Specialist
• Counselor
• Chaplain
• Teacher
• Nutritionist
Patient & Family Usual equipment
PT Role for Education • Ambulation: walker,
Discharge • Able to assist pt with platform walker,
Planning* (referrals daily HEP crutches, cane
for outpatient • Able to assist pt in • Orthoses
therapy near home, ADLs
equipment, • Wheelchair
• Able to transfer pt • Chair lifts in car
orthoses, follow-up safely &
clinic, family/pt appropriately • Sliding board
teaching, other • Able to transport pt • Appropriate
recommendations to/from outpatient mattresses or
as needed services, other cushions
appointments
Burns: injury caused by heat, chemicals,
electricity, sun or friction
Identify the classification of burns by appearance and level of
pain*
• 1st degree: superficial
• 2nd degree: superficial partial
• 2nd degree: deep partial
• 3rd degree: full thickness
PTs: provide interventions based
on body part and degree of burn
including positioning, play,
dressings, debridement*, and
managing skin grafts
• *Scar management:
Case: 4 year old massage, stretching, • Splinting: multipodus
with full pressure garments, boots, knees
silicone gel sheets immobilizers, custom
thickness burns • *Positioning: made splints, FRC
at shoulders and “positioning of comfort casts
neck with is the position of • Exercise: ROM AROM
debridement contracture” or PROM,
• Position patient in strengthening
and grafting so that healing • Functional mobility &
followed by tissue is elongated gait
immobilization (not on pillows with
• Play: reaching,
neck and
for 3 days: PT extremities flexed) kicking, etc
role • Propping limbs for
edema control
Precautions:
Lower • Greatest hypostatic pressure in ankles and
feet
Extremity • Often in dependent position: poor venous
Burns: Exercise return, edema, bleeding, pain (use ace
wraps or tubigrip)
and Gait • No gait until 5 days post graft
• Beware of donor site pain
• Discourage use of assistive devices
Pre-gait routine:
• Quad/glut sets
• Ankle pumps
• SLRs
• Dangling regimen
Oncology Chemotherapy drug that causes neuropathy to the
sensory and motor nerves: Vincristine*
Priority PT recommendations following tumor
resections followed by chemotherapy
• -ROM -promoting developmental motor skills*
• -Safety/stability -providing toys & equipment (treadmill)*
• -Splinting/assistive devices
• -teaching child, family, & hospital staff
• -Referral to OP PT services as appropriate
• appropriate ways to play*
Precautions/Considerations
• Blood counts
• Chemo schedule
• Concurrent steroid induced myopathy
*Health issues
commonly seen
Pain Unmet healthcare
Transitioning needs
Fatigue
to Adulthood: Pain management
Loss of strength
Adults with Osteoporosis Lack of adult care
CP Dislocated hips
providers
Mental health
concerns
*Physical activity ? Driving ability for
helps prevent pain those who have been
and fatigue driving previously
PA more effective for Women’s healthcare
improving pain & needs
fatigue in ambulatory
adults with CP
Additional *COPM best tool for identifying goals
Review and services to address family & child
priorities
Priorities Family-centered care: asking about
routines, preferences and concerns
from 1 Half
st
-Ask about expectations for therapy,
hope
of Semester
Documents guiding therapy services
Early Intervention Services: Individual Family Service Plan (IFSP)*
-children birth to three
Schools: Individual Education Plan (IEP)*
-children preschool through high school
Best Tests and Outcome Measures in Schools
-Peabody Developmental Motor Scales (PDMS)
-Bruininks Oseretsky (BOT-2)
-School Function Assessment*
Most Effective
Models of *Integrated Model
- PT interacts with child, teacher, aide, family
Therapy in
- Services provided in environment (classroom)
Schools - Focus on practice of skills in the daily routine
- Entire team to implement all therapy services
Collaborative Model
- Select and blend services across disciplinary
boundaries
Other *Section 504 of Americans with
Disabilities Act
Services in Children who are not eligible for
IDEA
Schools Ex: concussion, medical dx not
eligible for Special Ed but needs
extra supports for a period of time
• Concussion*
• Accommodations for ADHD
Congenital Cause: tightness of sternocleidmastoid muscle
on one side*
Muscular Posture: head tilted to one side and rotated to
other side*
Torticollis
Labelled for side to which tilted
Treatment: stretch neck in posture opposite the
torticollis*
Ex: tilted to left and rotated right….stretch in
position of tilting right and rotating left
Hold child upright and tilt to the side of lateral
flexion so child actively rights head to other side
Early Detection*:
• Hammersmith Infant Neurological Exam
(HINE)
• Developmental Assessment of Young Children
(DAYC-2)
Cerebral • Neuroimaging
Palsy Most common factors associated with CP*
• Premature birth
• Low birthweight
• Intraventricular hemorrhage
• Encephalopathy
Correlating areas of brain*
Types*
Spastic: diplegia,
hemiplegia, quadriplegia Pyramidal or extrapyramidal
tracts
Cerebral Dyskinetic
Basal ganglia or thalamus
Palsy: • Athetoid: slow,
continuous writhing
Types movements
• Dystonia: repetitive
movements, distorted
posture
Ataxia
Cerebellum
• Inability to generate
smooth or expected
voluntary movement
• Unstable,
uncoordinated
Cerebral Palsy Assessments*
Spasticity: Modified Ashworth, Tardieu
Gross Motor Function Measure: gold standard for evaluating motor
skills for children with CP
COPM: best tool for identifying meaningful goals and interventions
- Interview parent
- Rates satisfaction and performance
Medications
- Oral: Baclofen
- Injection: Botulinum toxin: Botox
Surgery
- Selective Dorsal Rhizotomy (ideal candidate spastic
CP: Medical diplegia GMFCS I,II,III)
Management* - Intrathecal Baclofen: catheter attached to a pump
usually inserted in abdomen
Orthopedic Procedures
- Lengthening tendons
- Muscle releases or re-attachment
- Osteotomies
Child Abuse*
What is child abuse under Alabama law?
“Harm or threatened harm to a child’s health or welfare which
can occur through nonaccidental physical or mental injury;
sexual abuse or attempted sexual abuse; sexual exploitation or
attempted sexual exploitation.”
Child Neglect*
“negligent treatment or maltreatment of a child, including the
failure to provide adequate food, medical treatment, clothing,
or shelter: provided, however, that a parent or guardian
legitimately practicing his religious beliefs who thereby does
not provide specified medical treatment for a child, for that
reason alone shall not be considered a negligent parent of
guardian; however, such an exception shall not preclude a
court from ordering that medical services be provided to the
child, where his health requires it.”
Red Flags for Child Abuse
Infants and toddlers: Symptoms of trauma
Separation anxiety, excessive clinginess, crying and/or whining, increased fear and anxiety, regression in
developmental progress or failure to achieve developmental milestones.
Elementary School Age 6-12:
Increased anxiety, fear, and distress, withdrawal, avoidance, decreased ability to focus, over-reaction to
auditory stimuli [slamming door or fire alarm], change in academic performance, poor impulse control,
challenges with authority figures or constructive criticism, increase physical complaint [stomach aches,
headaches]
PTs are not mandated reporters but should report any concerns to a mandated reporter or to the Department
of Human Resources
Final Written Exam
39 multiple 4 short
choice answer
Final Video Exam
• 2 videos of children with impairments
For each child:
• List 5 motor skill deficiencies with hypotheses for potential reason for each deficiency
(10 points: 1 point per observation and 1 point per hypothesis)
• List 2 test and measure that you would want to do, based on your observation and the
rationale as to why you chose it (4 points: 2 points for the tests and 2 points for the
rationale)
• List 2 recommendations for seating, adaptive equipment and/or orthoses. Please state
the most important equipment recommendations for the child right now. (2 points)
• List 2 goals for this child appropriate for the clinic based setting (what, how, criterion,
time frame) (4 points: 2 points for each goal)
• List 5 appropriate intervention techniques with rationale (5 points)
