Case 4: Hemipolymicrogyria: Bracing for Gait Flashcards
What kind of movement at the ankle does a dynamic ankle foot orthosis allow
Anterior - posterior movement
What is EQUINUS DEFORMITY
Limited ankle DF
What is Type of brace that keeps the foot in a neutral position, and does not allow movement at the ankle
Soldi ankle foot orthosis
What is Type of low-profile brace that limits ankle inversion and eversion, but generally allows dorsiflexion and plantar flexion
Supramalleolar orthosis
What is the general PT POC/goals for a child with hemiparesis
- maintain ROM and activity in hemiparesis side
- address movement patterns to ensure that the child is using the most energy efficient methods
- prevent MSK complications
What is the PT interventions for a child with hemiparesis
- WB and acitviation of antagonist mm to reduce tone
- movement Thu typical progression and activation of hemiparesis side with acitvities that encourage participation in typical childhood things
- constraint induced therapy
- e stim
- functional movement
- dynamic bracing
What is the precautions during PT for a child with hemiparesis
- significantly increased tone often requires meds
- adverse drug reactions of meds - decreased alterness and excessive weakness
- forcing movements against increased tone can cause structural problems
What is the complications interfering with PT for a child with hemiparesis
- increased speed or activity can increase tone in hemiparetic side
- long term use of constraint induced therapt could interfere with bilateral limb use
- significant tone reduction could negatively affect movement
What is polymicrogyria
Condition related to the formation of gyri or folds in the brain before birth
When is polymicrogyria more mild or more severe
More mild if it unilateral
More severe if it is bilateral
What are the 2 methods used for measuring tone
- ashworth scale
- tardieu scale
What is the difference between the ashworth scale and the modified one
The scoring so for ashworth it is 0,1,2,3,4,5, or th modified it is 0,1,1+,2,3,4
If there is a slight increased in mm tone , manifested by a catch , followed by minimal resistance throughout the remaining (LESS THEN HALF) of the ROM what grade is it on the modified ashworth scale
1+ bc more then half if it was more toward the end then it would be a 1
What does botulinum toxin injections do
Temporarily reduce spasticity so that antagonist mm can be strengthened and new motor plans can be learned
T/F: In children with cerebral palsy (GMFCS Levels I-III), botulinum toxin injections followed by physical therapy temporarily reduce spasticity so that antagonist muscles can be strengthened and new motor plans can be learned
True
___ to reduce tone and normalize gait parameters is an effective intervention in children with lower extremity spasticity, but the specific bracing type needs to be individualized to the child
Bracing
All of the following are true regarding children with hemiplegia, except:
A. They have an asymmetrical gait pattern.
B. They sometimes present with equinus deformity.
C. They always need bracing to normalize gait.
D. They have involvement of the arm and leg on the same side.
C
Children who present with increased tone may benefit from all of the following, except:
A. Medical management of tone
B. Strengthening programs
C. Bracing during movement
D. Increasing tone for stability
D
A valid and reliable tool for measuring tone is:
A. GMFM
B. Modified Ashworth scale
C. Manual muscle testing
D. Palpation of the muscle
B
