CMT Exam/Eval Questions With Correct Answers

What 9 specific health history factors should be obtained prior to an initial screening of a child w/CMT? - Answer 1) age at initial onset 2) age at onset of symptoms 3) pregnancy hx including mom's sense of baby being "stuck" last 6 weeks 4) delivery hx including birth presentation or multiple births 5) use of assistance during delivery 6) head posture/preference and changes in head/face 7) family hx of torticullis or other congenital/developmental conditions 8) other known/suspected med conditions 9) developmental milestones appropriate for age What are MSK conditions that mimic CMT? - Answer Klippel-Feil syndrome clavicle fx congenital scoliosis C1-2 rotary subluxation What are neurological causes of asymmetrical posturing related to CMT? - Answer brachial plexus injury, CNS lesions, astrocytoma, brain stem or cerebellar gliomas, agenesis of CNS structures, hearing impairments What are visual causes of asymmetrical posturing related to CMT? - Answer ocular apraxia, strabismus, ocular muscle imbalances, nystagmus, visual field deficits What is Sandifer syndrome? - Answer trunk arching and neck flexion to the right after eating (type of GERD where infants arch and become tonic to protect airway from refluxing gastric contents) What GI history is important with CMT? - Answer reflux or constipation, preferential feeding from one side What is Grisel Syndrome? - Answer subluxation of A-A joint from inflammatory/ligamentous laxity following an infectious process in head/neck, usually retropharyngeal abscesses (deep neck space infection leading to inflammatory torticollis and vertebral subluxation) Why is it important to determine age at initial onset and age at onset of symptoms with CMT? - Answer determines prognosis What is Klippel-Feil syndrome? - Answer Congenital fusion of any 2 of the 7 cervical vertebrae. Triad of short neck, low posterior hair line, limited range of motion. What red flags that should be examined for CMT? - Answer - atypical positions, such as right cervical rotation with a right lateral flexion - asymmetrical cervical vertebrae on palpation - acute pain responses on cervical movement - tissue masses outside of the SCM or in other areas of the body - children with Down syndrome - C1-C2 cervical spine instability - late onset of a head tilt with known symmetry for the first few months of life - stridor, wheezing, SOB, cyanotic lips What needs to be done as part of the MSK systems review with CMT? - Answer symmetrical shape of face/skull/spine symmetrical alignment of shoulder and hip girdles c-spine vertebrae anomalies rib cage symmetry DDH (developmental hip displasia) symmetrical PROM of neck palpation for SCM masses or restricted movement What needs to be done as part of the neuro systems review with CMT? - Answer - abnormal or asymmetrical tone - retention of primitive reflexes - resistance to movement - cranial nerve integrity - brachial plexus injury - temperament (irritability, alertness) - achievement of age-appropriate developmental milestones inclusive of cognitive and social integration w/in family setting - visual screen comprising symmetrical eye tracking in all directions, noting visual field defects and nystagmus as potential ocular causes of asymmetrical postures What needs to be done as part of the integ systems review with CMT? - Answer - skinfold symmetry of the hips and cervical regions - color and condition of skin w/special attention to signs of pressure and trauma that might cause asymmetrical posturing What needs to be done as part of the cardiorespiratory systems review with CMT? - Answer - symmetrical coloration - rib cage expansion - clavicle movement to r/o conditions that might cause asymmetrical posturing - acute upper respiratory tract distress What are causes of acquired torticullis? - Answer ocular lesions benign paroxysmal torticollis dystonic syndromes infections Arnold-Chiari malformation syringomyelia posterior fossa tumors trauma *acquired occurs later than congenital* What is craniosynostosis? - Answer premature closure of cranial sutures What are secondary impairments of craniosynostosis? - Answer restricted brain growth increased intracranial pressure *requires surgery and PT interventions* What premature suture closure is associated with CMT? - Answer lamboid