(7) Paediatric Neurology Flashcards
When is the CNS most vulnerable to damage?
during periods of rapid changes such as when the areas of neural network are being formed
What does congenital mean?
present from birth
What are teratogens?
- substances that cause congenital disorders in developing embryo
- anything female exposed to or ingests during pregnancy that known cause foetal abnormalities
What is a cytomegalovirus?
- infectious agent
- if passed onto unborn may cause hearing loss, developmental & learning problems
What are some factors influencing development?
- genetics & metabolic
- chromosomal
- CNS malformations
- dietary
- drugs & toxins
- environment and social factors
- utero infections
- neonatal seizures or hypoxia
What causes genetic abnormalities?
- caused by mutation in a single gene (monogenic), multiple genes (polygenic) or by chromosomal abnormality
When are symptoms of genetic abnormalities usually seen?
- may give rise to neurological disorders from birth but others may not show symptoms for months or years
- normal development followed by regression
What are examples of chromosomal disorders?
- Down’s syndrome (additional chromosome 21)
- Edward’s syndrome (additional chromosome 18)
What is involved in the maturation of the CNS?
- myelination & regional brain maturation
- changes in synaptic density
- changes that occur postnatally including development learning & proprioception
What is the main cause of neurological disorders in childhood?
maldevelopment of the nervous system or as a result of adverse factors during pregnancy & birth
What are the 3 categories of neurological disorders most common in children?
- CP
- Epilepsy
- Complex learning disability
What are commonly encountered neurological conditions?
- CP
- epilepsy
- traumatic brain injury
- spinal injuries
- genetic conditions
- hydrocephalus
What are developmental coordination disorders?
- children w/o TBI or CP who lack motor coordination to perform tasks that most children can
- dyspraxia
- difficulty attending more than “one thing” at a time
- no genetic defect found
- associated with premature birth
What are some neurological disorders of children?
- CNS infection
- Brain tumours
- Serious head injury
- TBI
- ABI (acquired brain injuries)
What are common CNS malformations?
- neural tube defect
- microcephaly (smaller than normal head)
- Chiari malformation
- Dandy Walker Syndrome
What is Dandy Walker Syndrome?
congenital brain malformation involving the cerebellum with enlargement of the 4th ventricle and partial or complete absence of the vermis of cerebellum
What is microcephaly?
- Abnormally small brain
- motor deficits
What is hydrocephalus?
- enlargement of cerebral ventricles due to impaired CSF drainage
- learning & language disorders
What is Lissencephaly?
- smooth brain without normal central gyri
- learning difficulties, hypotonia, epilepsy
What is Porencephaly?
- destructive changes in one cerebral hemisphere
- hemiplegia, epilepsy, learning difficulties
What is cerebellar hypoplasia?
- maldevelopment of cerebellar hemispheres or vermis
- ataxia, hypotonia, disordered eye mvmts
What is chiari malformation?
- cerebellar tonsils protrude through the foramen magnum
- Type 1 asymptomatic, Type 2 occurs with spina bifida
What is spina bifida occulta?
- maldevelopment of lower spinal cord & vertebrae covered by skin
- progressive unilateral foot deformity & weakness, neuropathic bladder
What is Schizencephaly?
- characterized by abnormal slits or clefts in the cerebral hemispheres of the brain
What is motor control?
the systematic transmission
of impulses from the motor cortex to motor units, resulting in coordinated muscular contractions
What is motor development dependent on?
- maturation of nervous system
- individual coding
- handling
- environmental experiences
What is motor development?
- process of change in motor behaviour that is related to the age of the individual
- includes age-related changes in both posture and movement, the two basic ingredients of motor
behaviour
What are the developmental milestones?
- gross motor (sitting crawling)
- fine motor (zips, buttons)
- language (sounds to words)
- play
- cognition
What is motor learning?
is a set of processes associated with a practice or experience leading to relatively permanent changes in capability for responding
What are the aspects of physiotherapy management?
- Ax child’s abilities & disabilities
- aim Tx enhance function and improve QOL
- measurement of change of function over time
- link knowledge
What is involved in the physiotherapy developmental Ax?
- age appropriateness of fine & motor skills
- neurological status
- msk status
- postural & balance reactions
- sensorimotor / perceptual Ax
- motor skill ability & coordination
What are risk factors for neurological impairment?
- neurological
- respiratory
- cardiac
- metabolic
- genetic
- neonatal orthopaedic problems
- childhood acquired brain injury
- haematology / oncology
What are standardized Ax for paediatric neurological conditions?
- Alberta Infant Motor Scale (AIMS)
- Bayley Scale for Infant and Toddler Development
- GMFCS (mobility)
- Movement ABC (delays or impairment motor development)
- Paediatric balance scale
What are some treatments that can be used for this population?
- normal movement based
- tone normalisation
- recruitment of activity
- attainment of function
- minimization of orthopaedic complications
What are some tools that may be used?
- mirrors
- balls
- wedges
- standers
- assistive devices
- hydrotherapy
- adaptive equipment
- orthotics
