PT 713: All About the Kiddos

Talk REDE To Me

100

What are the 3 phases of the REDE model and what are the acronyms associated with each phase?

Establishment (SAVE)

Development (VIEW)

Engagement (ARIA)

200

You are in a session with your patient, you have completed your evaluation and are summarizing your PT diagnosis to your patient and what that means for them. You explore their thoughts/opinions about options for a plan of care to make sure it is best catered to their lifestyle. At the end of the session, you summarize the conversation and check for understanding before concluding. What phase of the REDE model aligns itself with this interaction?

Engagement of Relationship

300

You are in your session with a patient, they are explaining their concerns and thought process to you. You are staying mostly silent during this part of the conversation, only speaking to elicit further patient input/insight to important aspects. It is important to demonstrate active engagement in what the patient is saying. What phase of the REDE model aligns itself with this interaction?

Development of Relationship

400

You meet a patient at the door of your clinic and walk them into the treatment room, the first part of your communication is introducing yourself and building rapport with your patient. Together, you establish the main concern to be addressed at this session and how to approach it. What phase of the REDE model aligns itself with this interaction?

Establishment of Relationship

500

In the Palisano article about the Collaborative Model in Pediatric populations, what are the 3 key principles identified to approaching communication in pediatric settings?

Family Identified Needs

Shared Responsibility

Family Empowerment

600

Family Professional Collaboration in Geriatric Rehab includes all the same components as those used in Pediatric settings (Family Identified Needs, Shared Responsibility, and Family Empowerment) plus one more. What is the additional component to communication with this population?

Patient Autonomy

700

Fun Fact: What is the largest muscle in the body?

A. Heart

B. Gluteus Maximus (booty)

C. Latissimus Dorsi

D. Trapezius

B for Booty!

800

These 4 strategies form a continuum that addresses successful collaboration between family/caregiver, patient, and clinician. There are 2 different approaches for either Pediatric or Geriatric settings, they are generally very similar. What are these 4 strategies (for either Pediatric or Geriatric settings)?

Pediatrics:

1. Mutually Agreed Upon Goals

2. Shared Planning

3. Shared Implementation

4. Shared Evaluation

Geriatrics:

1. Communication Plan

2. Mutually Agreed Upon Goals

3. Shared Planning

4. Shared Implementation and Evaluation

Baby SATs

100

Name one type of Genetic Testing used to screen for birth defects

Newborn Screening: most widespread, almost every newborn in the US is screened for genetic diseases - it allows for early detection of diseases leading to intervention to prevent onset of symptoms/minimize disease severity

Carrier Testing: used to help individuals/couples learn if they might be carriers of genetic diseases - it tests for specific alleles and is generally offered if there is a family history/increased risk of genetic condition due to ethnic background

Prenatal Diagnostic Testing: used to diagnostic changes in a fetus's genes/chromosomes - it is accomplished via tissue sample (amnio or chorionic villus sampling)

200

What are the 3 types of birth defects and the primary method of identification?

Structural: ultrasound (usually btwn 11-14 wks or 18-20 wks)

Genetic Syndromes: carrier screening 

Chromosomal Disorders: amniocentesis (15-20 wks) or CVS/Chronionic Villus Sampling (10.5-14 wks)

300

Newborns are tested for at least how many serious but treatable conditions in every state?

At least 30 (some states test for more than 50)

400

This type of chromosomal testing is done between 15-20 wks, a needle is inserted into the uterus and a small amount of fluid is drawn from the fluid that surrounds the baby. It carries with in a 0.2% risk of miscarriage.

Amniocentesis

500

Name at least one consideration when deciding whether or not to screen

Insurance Coverage (especially for low risk patients under 35 yrs old with no concerning US or screening test)

Is this info good to know prior to delivery?

How do they feel about ending pregnancy?

Feelings about raising a child w a disorder?

Impact on family

Feelings about miscarriage

Who will care for an adult w special needs once the parent is unable?

Constant worry throughout pregnancy

600

This type of chromosomal testing is done between 10.5-14 wks, a placenta sample is taken for this test. It carries with in a 1% chance of miscarriage.

Chorionic Villus Sampling (CVS)

700

True or False: Women’s brains actually shrink during pregnancy

True 

800

Fun Fact: What else is as unique as human finger prints?

A. Cerebral Sulci and Gyri

B. Wrinkles

C. Tongue Prints

D. Teeth

C. Tongue Prints

ACDC

100

What standardized motor exam is most commonly used for DCD screening?

M-ABC

200

What are the 4 diagnostic criteria as defined by the DSM-V for DCD?

Motor Performance Deficits

Participation and ADL Deficits

Early Onset

No Exclusionary Conditions

300

Name at least 1 co-occurring disorder for DCD

ADHD

Learning Difficulties

Speech/Language Disabilities

400

Fun Fact: Which of the following used to be an Olympic Sport?

A. Competitive Cleaning

B. Competitive Clockmaking

C. Competitive Reading

D. Competitive Art

D. Competitive Art

"Between 1912 and 1948, the international sporting events awarded medals for music, painting, sculpture and architecture."

500

What are the risk factors associated with DCD?

Low Birth Weight

Prematurity

600

There are two approaches for interventions pertaining to DCD, what are these?

Task Oriented Approach: motor activities/programs to increase acquisition and execution of a specific functional motor task

Process Oriented Approach: motor activities which emphasize on body structure/function impairments

700

Describe at least 1 aspect of DCD Clinical Presentation

Dyspraxia

Fine Motor Impairments (struggle with handwriting + selfcare)

Gross Motor Impairments (clumsy and awkward movements)

Sensory Integration Impairments (poor balance + unusual gait pattern)

Visual Perception Impairments

800

Fun Fact: Where was German Chocolate Cake invented?

A. Germany (duh????)

B. Texas

C. Belgium

D. Iceland

B. Texas

"The 'German' part of German chocolate cake comes from an American man"

hAD enough yet?

100

Autism has 2 critical components for diagnosis, what are these?

Social Communication Impairments

Restricted/Repetitive Behaviors

200

Is AD more prevalent in males or females?

Males (4:1)

300

Motor impairments are considered to be secondary impairments in AD, name at least 2 motor impairments that are associated with AD.

Gross Motor Impairments

Fine Motor Impairments

Posture/Balance Impairments

Gait Impairments

Coordination Impairments

Imitation Impairments (praxis)

Motor Planning Impairments

Motor Synchrony Impairments

400

What standardized measures are most appropriate for AD?

TGMD

BOT-2

M-ABC

SFA

500

Name at least 2 motor interventions that can be performed for AD

Balance Training

Coordination

Motor Planning

Strengthening

Functional Mobility

Movement Synchrony

(motor interventions via lessons learned -- socially embedded movements, context, multisystem effects, spontaneous exploration, and skill generalization)

600

Behavior strategies are often utilized in AD interventions, name at least one of these

Structure (schedule)

Environmental Set Up

PECS (picture exchange communication system)

Prompts

Choice

Breaks

700

Your patient is 11 years old with DMD, he is experiencing pronounced LE weakness and you are seeing him for re-eval with you CI. Your CI asks you what standardized assessment you think is most appropriate for him at this stage in the disease progression.

Performance Upper Limb

Additional Notes:

- best for late ambulatory and non-ambulatory phases

- used when UE weakness becomes more prominent

- contains 22 items looking at UE function (incl reaching/lifting weight over head/bringing hands or weight to mouth/opening containers/writing/tearing paper/picking up coins)

800

Give one example of social communication and repetitive/restrictive behaviors that a child with AD might display

Social communication:

- eye contact + shared attn/engagement

- peer relationships

- social/emotional reciprocity (flat affect)

- speech development (varying fluency)

- echolia (repetition of heard words/favorite phrases and characters)

Repetitive/Restrictive:

- stereotyped motor mannerisms

- specific routines

- preoccupation w objects

- preoccupation w restricted patterns

Toddler SATs

100

Standardized assessments are classified as two broad types, what are these?

Measurement Based: norm-referenced (child's performance compared to a referenced group) and criterion reference (child's performance compared to predetermined criteria of performance/skill mastery)

Performance Based: process oriented (assessment measuring the process/quality of movement) and product oriented (assessment measuring the movement output)

200

What are the 2 purposes of Standardized Assessments?

Developmental Screening (brief overview exam to evaluate need for further and more in depth testing)

AND/OR

Comprehensive Exam (examine for differential diagnosis or to establish eligibility for services)

Extra Notes:

Standardized testing is used for...

- diagnose developmental delay and extent of delay

- establish eligibility for services

- document functional status/developmental level/progress

- determine intervention targets and monitor progress with treatment

300

This standardized Assessment is used for DMD, it is a 17 item scale that assesses motor function in ambulatory patients. Items incl walking, running, jumping, rise from floor, single leg balance, ascend+descend from step. It can be administered in 10-20 mins by the PT.

North Star Ambulatory Assessment (NSAA)

Additional Notes:

- includes TTF of rise from floor and 10MWT

- some items may not be developmentally appropriate for very young patients

400

What 3 tests are a part of the Timed Tests of Function in DMD?

Timed Rise From Supine

10 MWT

4 Stair Climb

500

Name at least one standardized assessment for children

Test of Gross Motor Development (TGMD)

Bruininks Oseretsky Test of Motor Proficiency (BOT)

Movement Assessment Battery for Children (M-ABC)

Functional Independence Measure for Children (weeFim)

Pediatric Evaluation of Disability Inventory (PEDI)

School Functional Assessment (SFA)

Gross Motor Function Measure (GMFM)

600

Name at least one standardized assessment for infancy and beyond

Alberta Infant Motor Scale (AIMS)

Peabody Developmental Motor Scales (PDMS)

Test of Infant Motor Performance (TIMP)

Bayley Scale of Infant Development (BSID)

Mullen Scale of Early Learning (MSEL)

Ages and Stages Questionnair (ASQ)

Battelle Developmental Inventory (BDI)

700

Name at least 2 developmental screens for infants, just to remind you that a developmental screen is a brief assessment when there is suspicion of a delay; it is for early ID of children with unsuspected deviations from typical development

Harris Infant Neuromotor Test (HINT)

Denver Developmental Screen Test II

New Bayley Screen Test II

TIMP/TIMPSI

800

Your patient is a 6 year old child with suspected developmental delays, name a standardized tests that are appropriate for this child.

TGMD

Additional Tests:

- Battelle Developmental Index (BDI)

- Movement Assessment Battery for Children (M-ABC)

NOT:

- BOT (may be too high function and frustrating)

- weeFim/Pediatric Evaluation of Disability Inventory (PEDI)/School Functional Assessment (SFA)/GMFM = functional assessments that are more ADL focused vs impairments

Designer Genes

100

DS is a chromosomal disorder caused by an error in cell division; on which chromosome pair is there usually this error?

Chromosome 21

200

Fun Fact: In which country is it illegal to own just one guinea pig as a pet?

A. Switzerland

B. Brazil

C. Russia

D. New Zealand

A. Switzerland

"It's considered animal abuse because they're social beings and get lonely"

300

Name one body structure/function impairment that you might see in DS

Neuromuscular:

- hypotonia

- delayed postural development

- slowed postural reactions+ reaction times

- deficits in postural alignment

- decreased balance

- decreased coordination

MSK:

- decreased muscle force production/strength

- joint hypermobility

- atlantoaxial instability

- altered body proportions

- scoliosis

- decreased agility

- arthritis

Cognitive and Language

Sensory

Cardiovascular

400

In early life, what are some characteristics of gait that may be observed in a child with DS? (Name at least 2)

Flat foot stance

Decreased step length

Decreased single leg stance time

Pes planovalgus w pronation

Decreased stability

(Adolescent gait: hip ER, knee flexion, knee valgus, ER tibia -- "Chaplin-esque Gait")

500

What is the typical timeline for children with DS attaining their gross motor milestones?

 Rolling by 6 months

Sitting by 12 months

Crawling by 18 mothers

Independently walking by 24 months

600

What are the warning signs of atlantoaxial instability? (Name at least 2)

Gait Changes

Urinary Retention

Torticollis

Reluctance to Move Neck

Increased DTR

700

Name at least 1 strategy to utilize in PT sessions when working with a DS patient

Declutter environment

Give choices (but don't overwhelm)

Provide assistance as needed

Repeated practice

Positive reinforcement

Use socially embedded activities (group therapy/peer modeling)

Use of play-based intervention activities (that can easily be incorporated into child's routine)

800

Intervention sessions with DS patients should focus on what? (Name at least 1 area of focus)

Promoting development of optimal PC and movement independence 

Promoting strength and coordination

Facilitating movement experiences for which the child is ready but not seeking

Prevention/Correction of development of abnormal/related aberrant patterns of movement 

Family education

Insurance things

100

At what age are children eligible to receive Early Intervention?

Birth - 3 yrs old

(EI supports infants and toddlers w developmental delays/disability)

200

What services kick in after age 3?

IDEA Part B (3-21 yrs old)

300

After an individual's 22nd birthday, IDEA services cease. There is a service that an individual needs to qualify and apply for that provides assistance with supported living, supported work, adult daycare, and day programs. What is this service called?

Department of Developmental Disabilities

400

What factors increase the likelihood of gainful employment after the cessation of services provided by IDEA?

High School Diploma

Exposure via Well Structured Transition Program

Good Social Skills

Good Expressive Language

500

The ADA ensures reasonable accommodations for what processes?

Application Process

Hiring Process

Job Itself

Way the Job is Done

Work Environment

600

Typically, when do transition services begin to take effect?

16 yrs old (specifically beginning no later than the first IEP to be in effect when the child turns 16 OR younger if determined by IEP team)

700

This refers to a document that guides the program of special education and related services for school aged children

IEP (individualized educational program)

800

This refers to a comprehensive anti-discrimination statute to ensure federal funding recipients (incl school) provide equal opportunity to people w disabilities

Section 504 of the Rehab Act

DMD

100

What are the 5 stages of DMD progression?

Diagnosis (2-5 yrs old)

Early Ambulatory (5-9 yrs old)

Late Ambulatory (10-13 yrs old)

Early Non-Ambulatory (13-16 yrs old)

Late Non-Ambulatory (16+ yrs old)

200

While exercise and safety of performing exercise when diagnosed with DMD is not well understood, there are general guidelines. Name 2 of the guidelines.

Submaximal (avoid maximal effort - can damage muscle)

Concentric Exercises (avoid eccentric - can damage muscle)

Stretching 3-5x/wk (major focus)

Watch for signs of over work (soreness, weakness, excessive fatigue)

300

In the transitional stages of DMD, what pattern of muscle weakness is typically seen? (Name at least 3)

Proximal Muscles

Core

Hips

Quads

Ankle PF/DF

Shoulder Flexors/Extensors

Elbow Flexors/Extensors

400

In early stages of DMD, what are the 3 movement patterns typically seen?

Toe Walking, Gowers Sign, Difficulty Running/Jumping

Additional Notes:

- transitional stages: increased lordosis, trunk sway/waddling gait, stance w heels elevated, trunk lean in sitting

- late stages: lateral trunk lean in sitting, use of elbow support for hands to mouth, head momentum for trunk repositioning

500

In the early stages of DMD (diagnosis/early ambulatory), what pattern of contractures is most likely to emerge?

Ankle Plantar Flexors

Hip Flexors

Hip Abductors

Additional Notes:

(Late Ambulatory/Early Non-Ambulatory: the above + knee flexors, pronators, and long finger flexors)

(Non-Ambulatory: the above + elbow flexors/extensors, cervical tightness -- UE function and positioning is generally limited by contractures and scoliosis)

600

Name at least 1 standardized function assessment that may be a part of a PT eval

Timed Tests of Function (TTF)

North Star Ambulatory Assessment (NSAA)

Performance Upper Limb (PUL)

Egen Klassification (EK Scale)

700

Why are AFOs not used during ambulation in DMD?

Boys need the compensation to stand and walk (ankle PF and knee hyperext)

800

Name one intervention that can be implemented for each of the following stages of DMD: diagnosis/early ambulatory, late ambulatory, early non-ambulatory, and late non-ambulatory

(Note: you do have to have a different intervention for each stage; for example, patient and caregiver education is relevant for each stage but it will not be accepted as the answer for all the stages here)

Diagnosis/Early Ambulatory (3-9 yrs old):

- establish stretching program

- night time orthotics 

- establish safe submax exercise

Late Ambulatory (10-13 yrs old):

- refine/update stretching program 

-  continue nighttime orthotics

- continue safe submax exercise

- focus on seating/positioning at home and school

- educate and assist w mobility needs

- prescription of standing frame (if needed)

Early Non-Ambulatory:

- refine/update stretching program

- continue safe submax exercise

- continue nighttime orthotics

- update/refine mobility and seating needs across environments

- continue to evaluate equipment/mobility needs

Late Non-Ambulatory:

- refine/update stretching program

- continue safe submax exercise

- continue to evaluate equipment/mobility needs