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Jessica Lewis

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Viewing 15 posts - 1 through 15 (of 57 total)
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  • in reply to: Brachial Plexus Injury #489685
    Jessica Lewis
    Participant

    Hi Sharon,
    For BPI, the nerve injury can be classified using Seddon Classification or Sunderland Classification. I feel like the most common way we see is with Seddon’s terminology (neuropraxia, axonotmesis, neurotmesis). See classifications below and how they relate to each other (you can see there is some overlap)

    Seddon –> Sunderland
    Neuropraxia –> First degree
    Axonotmesis –> Second and third degree
    Neurotmesis –> Third, forth, and fifth degree

    Sunderland Classification descriptions:
    First degree: demyelinated nerve; a physiological local conduction block; conservative management; recovery expected over weeks to months
    Second degree: some axons disrupted; endoneurial sheaths and surrounding connective tissue layers remain intact; Wallerian degeneration distally; treatment is conservative; complete recovery can be expected over months
    Third degree: axons and endoneurial sheaths disrupted; scarring replaces existing structures; perineurium and connective tissue layers outside of this remains; most of these injuries will recover spontaneously but partially
    Forth degree: axon, endoneurium, and perineurium disrupted; scarring replaces existing structures; epineurium remains; scar blocks all neuronal regeneration; no recovery likely without operative management
    Fifth degree: nerve transection; all structures including epineurium divided; no recovery expected without operative management
    Apparently there is a sixth degree that I wasn’t aware of that describes a nerve injury with features of two or more of the above categories.

    Let me know if this helps clear things up!
    Jessica

    in reply to: ADA Laws & e-stim #489670
    Jessica Lewis
    Participant

    Hi Emily,

    Two challenging topics!

    For ADA, if you’re purely looking for the laws, I would just go straight to the source: https://www.ada.gov/.
    There is an article (kind of old from 1996) that gives some good background info about ADA and how it impacts peds PT. The stats will be old but the general info is still good.
    Lowes L, Effgen S. The Americans with Disabilities Act of 1990: Implications for Pediatric Physical Therapists. Pediatric Physical Therapy 1996;8(3):111-116.

    For estim, I found a few articles that were helpful:
    Bosques G, Martin R, McGee L, Sadowsky C. Does therapeutic electrical stimulation improve function in children with disabilities? A comprehensive literature review. J Pediatr Rehabil Med. 2016;9(2):83-99. doi:10.3233/PRM-160375
    Singleton C, Jones H, Maycock L. Functional electrical stimulation (FES) for children and young people with cerebral palsy. Paediatrics and Child Health. 2019;29(11):498-502.
    https://www.sciencedirect.com/science/article/pii/S1751722219301763
    Chiu HC, Ada L. Effect of functional electrical stimulation on activity in children with cerebral palsy: a systematic review. Pediatr Phys Ther. 2014;26(3):283-288. doi:10.1097/PEP.0000000000000045

    I hope this helps!
    Jessica

    in reply to: SMA #489646
    Jessica Lewis
    Participant

    Rafael,
    Thank you for providing this update!
    Jessica

    in reply to: GM Function curves in CP #489595
    Jessica Lewis
    Participant

    Hi Marie!

    All great questions.
    1. You could look at it either way. As long as you identify that there was an increase in score, that’s the important thing.
    2. Correct, the score is reliable, but still does not exceed the threshold for test error. The CI and SEM need to both be taken into account when you are looking at everything and making decisions about change scores.
    3. Correct!
    4. For this one, the 2008 article was the one we intended to reference. The 2009 article can be a helpful resource, too. If you do consider the 2009 article, you see that a decline in skills for children in GMFCS level III occurs around 7 years, 11 months. The child in this case is 9 years old and is still making improvements in score and percentile. It is trending in the right direction even though we can’t say it is real change. The next score, if he returns to clinic, will be the most telling to determine if he continues to trend in a positive direction or if his scores start to plateau. For this one you are picking the best answer and identifying the positive trajectory in score.

    in reply to: Muscular Dystrophy- prognostic indicators #489523
    Jessica Lewis
    Participant

    UPDATE from my expert friend who is a PI for DMD research:

    She stated that a 6MWT less than 350 meters is an indication that the child will be losing ambulatory status within a year or so (assuming the child is old enough to be on the downturn…this is usually around 10 years old). If the child’s walk distance is below 275-250 meters, that would signal imminent loss. She also added that a walk >500 meters is really stellar for DMD 🙂

    So, for the most part, similar to what McDonald et al. found.

    in reply to: Muscular Dystrophy- prognostic indicators #489522
    Jessica Lewis
    Participant

    Hi Marie!

    Here is what I found for you…For the 6MWT, from what I understand, it’s not necessarily about the specific number of meters lost, it’s about the percentage the patient is below the predicted distance they should be able to walk. This threshold is 55% below the predicted distance (approximately 325 meters). Once children reach this threshold, a high percentage decline >10% over the subsequent year, quickly on their way to losing ambulation. Reaching this threshold value doesn’t necessarily help predict when a child will lose ambulation, but it is an indicator that they are on their way, likely within the next year or two.

    The 30 meter MCID is helpful for drug research studies to help determine what change scores are important.

    I also have a message out to an expert. If she says anything different, I’ll let you know!

    McDonald CM, Henricson EK, Abresch RT, et al. The 6-minute walk test and other endpoints in Duchenne muscular dystrophy: longitudinal natural history observations over 48 weeks from a multicenter study. Muscle Nerve. 2013;48(3):343-356. doi:10.1002/mus.23902

    in reply to: State CEU’s #489056
    Jessica Lewis
    Participant

    Hi Erica,

    You can contact Chrissy at pcsadvantage@rehabknowledge.com and she can get you all of the information you will need.

    Jessica

    in reply to: Sensitivity vs Specificity #489032
    Jessica Lewis
    Participant

    Great resource! Thank you for sharing this Pamela!

    in reply to: Sensitivity vs Specificity #489017
    Jessica Lewis
    Participant

    Hi Alex!

    A confusing topic for sure! Using SPIN and SNOUT when talking about sensitivity and specificity can cause some confusion at times. Often people use the mnemonics SPIN and SNOUT as definitions of specificity and sensitivity, but they and not the definitions. They are mnemonics to remember the RELATIONSHIP of sensitivity and specificity for ruling in and ruling out a diagnosis based on a TEST result.

    Sensitivity (true positive rate) is the likelihood that someone with the condition will be positive on the diagnostic test and refers to the percentage of children who are correctly identified as meeting criteria for a condition. This is valuable for confirming a diagnosis and 80% sensitivity is preferable.

    Specificity (true negative rate) is the likelihood that someone who does not have the condition will be negative on the diagnostic test and refers to the percentage of children without problems who are correctly identified as such. This is valuable to rule out the presence of a condition and 90% is preferable.

    Does this help clear up the confusion?

    in reply to: Spinal Cord Injury Grading #489012
    Jessica Lewis
    Participant

    I think the confusion for this question is that we should have clarified if we were looking for the sensory, motor, or neurological level of injury. The correct answer for this one is referring to the motor level of injury – defined by the lowest key muscle function that has a grade of at least 3 (on supine testing).

    If we were looking for the neurological level your definition would be correct.

    Sorry for the confusion! We will be sure to make a change to clarify that we are looking for the motor level for this one.

    in reply to: Scoliosis Question #489011
    Jessica Lewis
    Participant

    For this question its important to choose the best answer available to you. For this one, based on the patient history and the very mild curve, a strengthening program would work best for her.

    I’m not as familiar with the quality or quantity of research comparing yoga and Schroth. There would be clinical utility in using the Schroth method/principles, but since this is not a choice, the next best thing is general strengthening.

    in reply to: Infant Development #488977
    Jessica Lewis
    Participant

    There are varying thoughts in different references about which roll comes first, prone to supine or supine to prone. It relies so much on tummy time tolerance and the baby. Our chart is based off of the information gathered from our references. I think the important thing to focus on when taking the test is when it would definitely be abnormal for a child not to be rolling. The test writers likely will know that there is a gray area around this and their goal is to ultimately write a good test questions. Ones that have too much gray will not perform well and they don’t want this to be the case. I think understanding that rolling in general should be completed independently in both directions by 6(ish) months is a good place to start. Understanding the general time frames of each is also helpful, but bigger picture is more important.

    Same thing for reflexes integration. Some have huge spans of time when it could be integrated and different references say different things. Think bigger picture and know that the question writers for the tests want to write solid questions that are challenging but have a definitive answer. Things like reflexes and some of those early developmental milestones have wide ranges and they will make sure you have enough information to make an evidence-based choice that doesn’t fall into a gray area.

    in reply to: hip surveillance guidelines #486188
    Jessica Lewis
    Participant

    Hi Juliana!

    Great question! I think the best thing to do in the case of hip surveillance is to recognize that both sets of guidelines have similar trends…the level of surveillance increases as the GMFCS level increases and WGH patterns have their own unique set of rules. If you are expected to choose something that is very specific, my guess would be to rely on the AACPDM guidelines rather than the specifics of the AusACPDM guidelines.

    Jessica

    in reply to: LLD and shoe lifts #486186
    Jessica Lewis
    Participant

    Hi Kellie!

    The Campbell text was not the primary source used when writing for this question. Texts can vary in recommendations regarding shoe lifts – when one is needed and internal vs external. We tried to make the options outside of the most common insert values to help you narrow it down to the best answer. I agree with Campbell that intervention is typically not utilized for a LLD <2.5 cm (which excludes the 1.5 cm option). 6 and 8 cm LLD would be far too large to consider an internal shoe lift. This leaves 3 cm as the best answer. I can see the dilemma here because right around an inch is when you consider internal vs external. However, given the information in the question, 3 cm would be the best answer.

    Jessica

    in reply to: DCD Clinical Practice Guidelines #485377
    Jessica Lewis
    Participant

    Thank you Juliana!

Viewing 15 posts - 1 through 15 (of 57 total)