Case 8: CP - Postsecondary Education & Transition to Adulthood Flashcards
Federal civil rights legislation that prohibits discrimination against individuals with disabilities in employment, transportation, public accommodations, communications, and governmental activities
Americans with Disabilities Act of 1990
One of seven neurotoxins (labeled A-G) produced by the bacterium Clostridium botulinum; therapeutic uses for _____ injection include focal dystonia and spasticity; injected muscles are temporarily weakened or paralyzed for several months
Botulinum toxin A
federal legislation that provides protections such that individuals with disability shall not be discriminated against or denied benefits/services from any employer receiving federal financial assistance.
section 504 ensures access and accommodations for students in public primary and secondary schools who do not require special education, for students in colleges and universities, for adults employed by governmental agencies or other employers that receive federal financial assistance, and for individuals seeking the services of governmental agencies or other agencies that receive federal$$$$$
section 504 of rehab act of 1973
PT precautions for this population
Fatigue, pain, postural asymmetries, decreased balance
complications interfering with PT
- Medical insurance plan restrictions
- increased time and energy demands for daily tasks, employment, and exercise
- decline of mobility and increases in secondary impairments from CP
- transition to adult-oriented healthcare providers
- lack of public transportation accessibility
As individuals with CP age, impairments and activity limitations occur at a higher prevalence and progress faster than in individuals without CP.
What impairments and activity limitations increase?
- more pain
- more fatigue
- more postural asymmetries
- decreased balance
- decreased gross motor capacity
- reduced fitness
- decreased ambulation
- decreased function
- lower self concept, more depression than non-CP
For individuals with spastic CP using crouched gait, what is frequently seen MSK pain wise?
patella alta –>
anterior knee pain, decreased functional ambulation, patellar stress fractures, or subluxation and dislocation of the patella
____ is present in up to 30% of adults with CP? esp if they have increased anterior pelvic tilt or dorsal rhizotomy
spondylolysis
adults with CP have higher risk of what MSK neck dysfunction?
early cervical disc degeneration
mid cervical instability with narrowed spinal canal
Although it was develloped for up to 18 years of age, the ___ is a reliable tool for gross motor function in adults with CP
GMFCS
_ _ injected into muscles with severe spasticity can reduce spasticity and pain, increase passive ROM, and improve positioning in young adults with CP. GRADE B
Botulinum toxin type A (BTX-A)
Progressive _ increases strength in youth and young adults with CP.
Progressive resistance exercise increases strength in youth and young adults with CP. GRADE B EVIDENCE
An outpatient physical therapist is working with a 22-year-old young adult diagnosed with diplegic CP, GMFCS level III. She reports that she has been experiencing increased pain with ambulation, anterior knee pain, and decreased endurance, all of which have become more pronounced over the past year.
Which of the following tools would be most appropriate to measure this young woman’s cardiorespiratory fitness?
A. Gross Motor Function Measure (GMFM)
B. Progressive protocol test with a cycle ergometer
C. Short Form 36 Version 2.0 (SF-36v2)
D. Tinetti Performance Oriented Mobility Assessment
B.
A progressive protocol test using a cycle ergometer has been found to be an appropriate means to test cardiorespiratory fitness in adults with CP.
The GMFM (option A) assesses typical developmental milestones.
The SF-36v2 (option C) assesses physical functioning, pain, general health perceptions, vitality, social functioning, performance in emotional roles, and mental health.
The Tinetti Performance Oriented Mobility Assessment (option D) is a balance assessment.
Anterior knee pain in an adult with spastic diplegic CP is most likely to be the result of which of the following?
A. Hip dysplasia
B. Osgood-Schlatter disease
C. Patella alta
D. Spondylolysis
C. Patella Alta
Patella alta in adults with spastic diplegic CP presents as anterior knee pain and occurs most frequently in individuals who use a crouch-type gait pattern. While hip dysplasia (option A) and spondylolysis (option D) are common in adults with CP, these conditions do not present as anterior knee pain. While anterior knee pain can be the result of Osgood-Schlatter disease (option B), it is not the most likely cause of this young woman’s knee pain.
This young woman is interested in starting an exercise program for health promotion and wellness. Which of the following is the most appropriate recommendation for her?
A.Progressive resistance exercise and aerobic exercise using a stationary bike or recumbent cross-trainer
B. Exercise for health promotion is not recommended for this young woman, as secondary impairments will continue to progress with age.
C. Passive stretching 20 minutes per day
D. Walking 20 minutes per day in the community
**A. Progressive resistance exercise and aerobic exercise programs have been found to create significant improvements in strength and cardiorespiratory fitness in young adults with CP. **
Passive stretching (option C) will not improve health and wellness. Walking 20 minutes per day (option D) is not ideal for increasing or maintaining her aerobic fitness, given her ambulation status.
For adults with CP, pain is most frequently reported in the
lower back
hip
legs
feet
Associated musculoskeletal disorders for CP that may progress during adulthood include
osteoarthritis
patella alta
hip dysplasia
spondylolysis
cervical stenosis.
general PT POC and goals for young adult with CP transitioning into work/college
- coordinate transition and support into work environment
- assistance to facilitate workplace acceptance and accommodations for employment
- adaptations to support paricipation in full time work environment
- successful transition into adult healthcare systems
general PT interventions for young adult with CP transitioning into work/college
- coordinate with high school educational team, University Accommodations office, orientation and mobility specialist, public transportation accessibility office, adult-oriented healthcare providers
- Instruction on health promotion, energy conservation
- assistance in transitioning to adult healthcare providers who are familiar with adults with CP/long term sequelae
posture and postural ability in young adults with CP may be assessed via the 7 point ordinal scale assessing mobility:
PPAS: Posture and Postural Ability Scale
Although the _ was designed to assess typical developmental milestones up to age 5, it has also been used to study adults with CP
GMFM
What balance tests were used for the adult in this case?
BEST
Observational Gait Scale
Tinetti Performance Oriented Mobility Assessment
self-report assessment of physical functioning, performance in physical roles, bodily pain, general health perceptions, vitality, social functioning, performance in emotional roles, and mental health over a 4-week or 1-week recall period
SF-36v2
Short Form 36 Version 2.0
(quality of life self report measure)
