Lifespan Midterm

• Pathology
• Impairment
• Functional Limitation
• Disbility

International classification of functioning and disability and health

World Health Organization

ICF

• Body structure & function
• Activities & participation
• Personal participation factors
• environmental factors

• Provides scientific basis to evaluate functional states
• refers to limitation and function instead of disability
• common international language
• uses ICD codes

• Adaptation: basic biological need to permit a person to function in a given environment 
• Assimilation: changing elements of the environment so they  can be incorporated into the organism’s structure
• Accommodation: changing of function in accordance with the environment

• Sensorimotor (birth to 2 years): six separate substages that are characterized by the development of a new skill.
• Preoperational (2-7 years): playing and pretending. Characteristics of this stage include egocentrism and difficulty understanding conservation
• Concrete operational (7-10 years): thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts.
• Formal operations (12+): skills such as logical thought, deductive reasoning, and systematic planning begin to emerge.

• Basic needs
• Psycological needs
• Self-Fulfillment needs

• Unconditioned stimulus - eg: food
• Conditioned neutral stimulus - eg: bell
• Conditioned learned response - eg: dog salivating

• Positive Reinforcement - if you do something good, you get something you like
• Negative reinforcement - if you do something good, you don't have to do something you dislike
• Extinction: removing selective variables that reinforce a behavior (kid is screaming, ignore his ass!)
• Punishment - do something bad, get something bad!

• Continuous
• Partial (intermittent)
• Fixed-interval schedule
• Variable-interval schedule
• Domains of Function

• Cognitive: knowledge and understanding, applying knowledge, interpretation, developing systems, assessing effectiveness
• Affective: motivation; response, values, organize, internalize
• Psychomotor: motor skills; imitation, manipulation, precision, articulation, naturalization

general systems theory

result of variable interaction of a number of complex systems in accordance with Control parameters and Environmental constraints

variables that move the system into a new attractor state; ex. Direction, force, speed

• Emergent: the individual will alter in myriad ways in order to meet the current conditions
• Anticipatory: the motor program is adjusted even before any interaction with the environment

the prevailing environment conditions that help shape the movements

• Personal: personal traits indentified in others and predicts the social interactions between individuals based on expected behaviors
• Self-schema: the characteristics and traits a person assigns to self
• Role schema: a person’s social position within a certain culture and the expected behaviors of a person in that position
• Event schema: manner in which familiar situations are organized, such as the sequence of events on a child’s first day of school

• Absolute poverty: severe conditions of inadequate shelter, poor nutrition, and an increased risk for delays or disabilities
• Relative poverty: those who can afford some basic necessities but are unable to maintain an average standard of living

• Prenatal
• Infancy Birth-18 or 24 mth
• Early childhood
• End of infancy- 5/6yrs
• Middle and late childhood 6-11yrs
• Adolescence 10-18/20yrs (females); 12-20/22yrs (males)
• Early Adulthood Late teens/early 20’s-30’s
• Middle Adulthood 35-45 yrs (extending to 60’s
• Late adulthood 65+

• Conception to birth
• Germinal stage: fertilization -2 weeks
• Embryonic stage: 2-8 weeks
• Fetal stage: 8 weeks -birth

• Young old 65-74 yrs
• Old-old 75+

46; Each parent contributes 23 chromosomes

• 23rd
• XX=Female & XY=Male

• Monozygotic- a cluster of cells in the ovum splits off within the first two weeks after fertilization resulting in 2 genetically identical zygotes.
• Dizygotic- two separate ovum-sperm combinations.

the trait that is expressed

the trait that remains in the organism but, is not displayed

receiving similar genes from parents

receiving different forms of the genes from the parent

underlying combination of genetic material present (but outwardly invisible)

the observable trait

combination of multiple gene pairs

recessive genes located on the X chromosome

drug, chemical, virus, etc can produce birth defects

Morning sickness drug in the 50's that inhibited limb growth

miscarraige medicine in the 70's that caused children to have reprocuctive issues

• Germinal Stage:(0-2 weeks): Cells of the zygote divide quickly and become specialized
• Embryonic Stage (2-8 weeks): Secured to uterine wall
• Fetal Stage (8 weeks to birth) Formally begins when differentiation of major organs has occurred & sex is determined

forms skin, hair, teeth, sense organs, brain, and spinal cord

muscles, bones, blood, circulatory system

digestive system, liver, pancreas, and respiratory system

during the 4th week when the neural tube fails to close

21st

• HYPOTONIA (low muscle tone)
• Mental retardation
• Short stature
• Flattened nasal bridge
• Almond-shaped eyes
• Developmental delay
• ANTLANTOAXIAL INSTABILITY

• Improve postural control and strength (child has low tone and is very flexible)
• Improve gross and fine motor skills
• Teach family need for activity to avoid obesity
• Avoid flexion activities if there is
• laxity of antlantoaxial joint

• PROXIMAL muscle weakness
• WADDLING GAIT
• Toe walking
• Pseudohypertrophy of calf muscles
• Difficulty climbing stairs
• Gowers Sign

• Symptoms emerge between ages 2-5
• Unable to ambulate age 10-12
• Death (late teens, early 20’s) due to cardiac or respiratory failure

• Submaximal exercise to maintain strength
• Improve mobility (equipment, w/c)
• Breathing exercises
• ROM to prevent contractures (especially tight heelcords)
• Family education and emotional support

• Spina Bifida Occulta: no herniation
• Meningocele: meninges and CSF form sac outside spine but no nerve damage
• Myelomeningocele: herniation of spinal cord, nerves, meninges, and CSF

• hydrocephalus
• Arnold-Chiari malformation (displacement of cerebellar tonsils through foramen magnum and blocking flow of CSF)
• Tethered cord syndrome
• Latex allergy
• Motor and sensory loss below the site of the defect

• ROM and stretching
• Strengthening of innervated muscles
• Mobility
• Assessment for assistive devices
• Gait and locomotion training with appropriate assistive equipment
• Balance and coordination activities
• Patient and family education regarding care for areas of body that do not have sensation

brittle bone disease

• Remember: As much exercise as possible without risking fracture
• Maximize mobility
• Increase muscle strength to in turn increase bone mass

• Short stature
• Easy bleeding
• Frequent fractures
• Breahting problems
• Frequently develop scoliosis

• May suffer strokes due to sickle-shaped red blood cells get stuck in small blood vessels, and may break into pieces to interrupt blood flow
• Sickle-shaped red blood cells deliver less oxygen to tissues than normal ones

• If acute stroke: treat it
• Breathing techniques to increase lung function
• Aquatic therapy very helpful
• Exercise as tolerated

• Bone doesn’t form
• There may be distal parts present with total or partial loss of a specific bone
• Radius and fibula: most common

• teratogen (ex thalidomide)
• Infection
• Trauma

hands and/or feet attached directly to proximal bone or to trunk

• Strengthening to prepare for prosthesis
• Prosthetic gait training

• Movement progresses from primitive, mass movement reflex patterns to voluntary, controlled movement
• Cephalocaudal Motor development
• Proximal to distal motor development
• Consistent sequence of development among infants and for each infant

• Joints and muscles work in coordinated patterns which are not totally controlled by the cerebral cortex
• Use of “feedback” rather than hardwiring of CNS
• Organismic and Environmental constraints

• Maturation of CNS (neurological damage is significant limiting factor)
• Strength
• Head size
• Trunk/limb ratio

• Postural control against gravity
• Temperature
• Noise
• Lighting
• clothing

• Baby born before 36 weeks gestation
• Baby born after 38 weeks but weighs < 2500 g (“small for gestational age”  

• LBW < 2500 g (5 lbs)
• VLBW < 1500 g (3.3 lbs)
• ELBW (extremely low birth weight)< 1000 g

• Lower responsiveness to environmental stimuli
• Higher risk of respiratory distress in early weeks
• Slower motor development

38 weeks

• Respiratory distress syndrome
• Bronchopulmonary Dysplasia (BPD)
• Cardiopulmonary Complications
• GER
• Musculoskeletal complications
• Nervous System complications
• Retinopathy of prematurity

brain damage in utero, during delivery, or shortly after delivery

• Spastic CP: Lesion in the cerebral cortex leading to upper motor neuron damage
• Athetoid CP: damage to basal ganglia
• Ataxic Cerebral Palsy: damage in the cerebellum

• Spastic Quadripegia (all 4 extremities)
• Spastic Diplegia (both LE’s)
• Spastic Hemiplegia (ipsilateral UE and LE)
• Spastic Triplegia (diplegia plus hemiplegia)

• ROM and stretching
• Position patient to inhibit primitive reflexes from preventing movement (ex: place child with strong ATNR and TLR on their side to play with toys)
• Facilitate gross motor developmental milestones
• Promote balance/ equilibrium reactions
• Strengthen
• Improve endurance to exercise
• Gait training or mobility with assistive devices
• Family education

• Position in utero
• Breech in utero
• Difficult delivery

Unilateral contracture of SCM resulting in lat flexion to same side, rotation to opposite side, facial assymetries

• Stretching tight SCM in all directions (move infant into lat flexion to the opposite side, chin tuck, and rotation to the same side)
• active ROM by facilitating visual tracking and play in the opposite direction of tightness
• positioning (move crib so that child looks to side opposite tightness, position child in car seat and infant seat so that head is in midline)
• parent education: stretching of SCM needs to be done by parents several times a day; positioning to facilitate ROM need to be done constantly; home program very important for children with torticollis.

• Back of head flattened to one side
• Compensatory bulging of forehead on the same side of head
• Ear will also likely be pushed forward on that side of their head

placiocephaly

• Helmet to shape skull before fontanelles close
• Instruct in positioning to take pressure off the flattened area of the head
• Tummy Time??? FOR THE LOVE OF GOD PATTI, WHAT DOES THAT MEAN?

Due to difficult delivery in which neck is severely flexed to one side so that the brachial plexus is stretched

• Erb’s Palsy: C5 and C6; upper and lower arm; MOST COMMON
• Upper-middle trunk BPP: C5,C6, C7
• Klompke: C8 and T1; hand (this does not occur alone but usually with upper level BPP)

• not moving the upper or lower arm or hand
• Absent Moro reflex on the affected side
• Arm flexed at elbow and held against body
• Decreased grip on the affected side

• ROM
• Strengthening exercises
• Positioning for improved alignment (ex- TheraTogs)

last trimester

• Asymmetrical hip abduction with tightness
• Apparent shortening of femur on involved side

• Ortolani test
• Barlow maneuver
• ultrasound

• Bracing, splinting, or traction
• Open reduction with spica cast after

• baby 12 months or younger dies during sleep with no warning signs or a clear reason
• Treatment: back to sleep program
• No PT intervention

• Signs: adduction of forefoot, equinus of ankle, various positions of hindfoot
• splinting and serial casting after birth; may require surgery followed by casting

• Causes: may be due to virus, infection, or trauma that elicits an autoimmune reaction; genetic predisposition
• PT Therapy
• PROM, AROM, positioning, splinting, strengthening, endurance, weight bearing, postural tx, functional mobility
• Pain management: paraffin, US, warm water, cryotherapy
• Home program to maintain strength and flexibility between exacerbations

• Structural: cannot be corrected with passive movement, with rotation of vertebrae toward convexity of curve; rib hump over convex side of curve
• Nonstructural (also called functional): correction with lateral bending (from leg length descrepancy, hypotonia)

• Curve < 25 degrees: monitor
• Curve 25-40 degrees: PT for posture, flexibility, respiratory, body mechanics; orthotic support
• Curve > 40 degrees: surgery

• Milwaukee brace
• -a cervico-thoracic-lumbo-sacral orthosis. This brace looks like the other brace, but has a neck ring that is attached to the body of the brace to hold it in place.
• -suggested for thoracic spine curvatures
• -worn 23 hours a day; can be removed during the day for physical activity.
• Boston brace
• -also called a thoraco-lumbo-sacral orthosis; underarm brace
• -worn 23 hours a day, but can be removed for gym class, swimming and other sports.
• Charleston brace
• -molded to the child’s body when they are bent toward the convexity of the curve, thus applying more pressure to the curve
• -recommended for curvatures of 25-40 degrees with the apex of the curve below the height of the shoulder blade
• -worn at night, many self-esteem issues are avoided.
• Child who is in a wheelchair and who has scoliosis needs to be treated with a 3-point system:

• Scroth Method (3 D approach to treatment for scoliosis)
• -improve and maintain flexibility and function
• -improve posture so that the body can regain its original vertical axis.
• -To restore muscular balance, those muscles that have grown longer must be shortened and those that have become shorter must be lengthened. 
• -The basis of correction is a properly aligned pelvis;  a scoliotic pelvis is often not only shifted laterally but also tilted and rotated.

• Degeneration of femoral head due to avascular necrosis
• Most common in boys age 2 – 12
• Usually only occurs in one hip

pain, decreased ROM, antalgic gait, + Trendellenberg

relieve pain, maintain femoral head in alignment, improve ROM

stretching, splinting, crutch training, aquatic tx, traction, exercise

• inflammation of the tendon below the kneecap (patellar tendon) where it attaches to the shinbone (tibia).
• OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly.
• occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet.
• most symptoms will completely disappear with completion of the adolescent growth spurt, around age
• 14 for girls and age 16 for boys.

• Rest
• Applying moist heat for 15 minutes before or icing for 20 minutes after activity can minimize swelling.
• Stretching of quads and HS before and after exercise

• Symptoms:
• Rapid respirations
• Lengthened expiration phase
• Cause:
• genetic disorder resulting in thickend mucus in lungs and other organs
• PT treatment:
• postural drainage,
• breathing exercises
• adaptation of environment  for energy conservation

• Autism: most common
• Asperger’s: milder form of autism with social isolation, eccentric behavior, differences in speech inflection and patterns
• PDD-NOS (not otherwise specified): on the spectrum of autism

• communication impairments
• Social impairments
• abnormal relationships with objects and events
• tend to have low muscle tone, decreased strength, poor balance and delayed gross motor skills
• Behavioral issues

• Use familiar objects and routines
• Prepare child for changes in routine
• Speak clearly and with simple instructions
• Structure environment to teach social skills
• Use daily activities to increase strength and function

• children will walk by 2-3 years old
• bouncing children on something causes increase in muscle tone if hypotonic

• AFO’s for stability
• Strength throughout LE but intrinsic may be weak
• Decreased sensation in feet
• Bowel and bladder control may be impaired

• Ambulates with AFO’s and crutches
• Decreased sensation lower legs and feet
• Tires easily
• No bowel or bladder function

• Crutches or walker with KAFO’s or AFO’s
• Wheelchair for community mobility

• Ambulatory short distances with crutches or walker and KAFO’s or HKAFO’s
• Not a community ambulatory

• no nerve innervation distal to T5 so will not be ambulatory: will depend on power or standard wheelchair for mobility
• In PT: child can use parapodium or standing frame; reciprocating gait orthosis in therapy