Case 4: Bracing for Gait (Hemipolymicrogyria) Flashcards
Dynamic Ankle-Foot Orthosis (Definition)
DAFO
Allows for AP movement at the ankle
Includes hinged and PLS
Equinus Deformity (Definition)
Limited ankle DF
Solid Ankle-Foot Orthosis (Definition)
AFO
Keeps foot in a neutral position
Does NOT allow movement at the ankle
Supramalleolar Orthosis (Definition)
SMO
Limits ankle inversion and eversion
Allows DF and PF
What are some adverse drug reactions (ADRs) patients have in response to medications for tone management?
Decreased alertness
Excessive weakness
Forcing movements against significantly ___ tone can cause ___.
increased, structural problems
e.g., forcing DF can cause a midfoot break
Significantly increasing what two factors can increase tone in the patient’s hemiparetic side?
speed and activity
T or F: Long-term use of Constraint-Induced therapy can interfere with bilateral limb use.
T
Can tone reduction negatively affect movement?
Yes!
Especially if the child was relying on tone for stability
Polymicrogyria (Definition)
Formation of gyri (folds) in the brain before birth
Too many gyri and the gyri are smaller than normal
Can be unilateral (mild) or bilateral (more significant)
Winters Classification System
Describes patterns of gait in children with spastic hemiplegia
Group I: Foot drop during swing / flat foot or great toe strike at IC / excessive hip and knee flexion during swing / adequate DF during stance
Group II: Tone more severe / more constant PF throughout gait cycle
Group III: Knee hyperextension / increased lumbar lordosis
Group IV: Most severe / limited hip movement / significantly increased lordosis
Is there such thing as too much support from a brace during gait?
Yes!
Too much support can significantly impair gait pattern, causing compensation further up kinetic chain
Modified Ashworth Scale
0: No increase in muscle tone
1: Slight increase / catch and release OR minimal resistance at end of ROM when affected part is moved into flexion or extension
1+: Slight increase / catch followed by minimal resistance throughout remainder (less than half) of ROM
2: More marked increase in tone throughout most of the ROM / affected parts easily moved
3: Considerable increase in tone / passive movement difficult
4: Affected parts rigid in flexion or extension
Tardieu Scale
Measures resistance to passive movement at 3 velocities (as slow as possible / limb falling against gravity / as fast as possible)
2 range calculations (feel of a catch - R1, full ROM - R2)
Is strengthening appropriate for muscles with increased tone?
Yes!
Research shows that strengthening activities do not increase spasticity
T or F: Muscles with increased tone do NOT have the ability to restrict growth.
F
Muscles with increased tone can restrict growth if they are not stretched and used
Children with hemiplegia have an ___ gait pattern and sometimes present with ___ deformity.
asymmetrical, equinus
Do we encourage increase of tone for stability purposes?
No!
