Cerebral palsy Flashcards
Modified Ashworth Scale
O = No increase in muscle tone
1 = Slight increase in muscle tone manifested at end ROM
1+ = Slight increase in muscle tone manifested by a catch, followed by minimal resistance throughout the
remainder (less than ½) of the ROM
2 = More marked increase in tone, through most of the ROM, but joint easily moved
3 = Considerable increase in muscle tone, passive movement is difficult
4 = Affected part is rigid in flexion or extension
Baclofen
Up to 80 mg (pr 2mg/kg) in divided doses in 3 to 4 divided doses; higher doses have been used for severe spasticity.
Structural analog of gabaaminobutyric acid (GABA), binds to pre and post synaptic GABA-B receptors.
AE: Sedation, drowsiness, confusion, dizziness, weakness. Risk of withdrawal
Tizanidine - first like for stroke
Up to 36 mg daily in divided doses in 3 to 4
divided doses.
Imidazoline derivative, central or adrenergic receptor agonist to prevent release of presynaptic neurotransmitters .
AE: Sedation, dry mouth, dizziness, hypotension, elevated liver enzymes, and hallucinations.
Drug interaction with ciprofloxacin.
Dantrolene
Up to 400 mg/d in up to 4 divided doses.
Hydantoin derivative, reduces the action potential- induced release of calcium from the sarcoplasmic reticulum of skeletal muscle fibers.
AE: Muscle weakness, sedation, gastrointestinal symptoms. Hepatotoxicity
Diazepam
0.1 mg/kg q6hly - Up to 30 mg/d in 3-4 divided doses
GABA-A agonist, decreases mono and polysynaptic reflexes in the spinal cord by potentiating pre synaptic inhibitor. Can be helpful to control painful muscle spasms at night.
Benzodiazepines may compromise neurologic recovery.
AE: Sedation, confusion, muscle weakness. Risk of overdose (respiratory depression, coma) and withdrawal (anxiety, seizures)
Research into sleep in CP
Likely to have multiple factors contributing. Sleep problems are common in children with CP, often related to positioning in those with more severe physical disability. Behaviour environment and settling routines tend to be more universal
An approach to sleep in children with CP
Listen. Observe. Explore. Describe
B - bedtime, getting to bed and settling
E - excessive daytime activities
A - Awakenings during the night
R - regularity in duration of sleep, routines, circadian rhythms
S - sleep disordered breathing, as well as safety
Culture, season, environments, family context, age and development. Tone, neuromuscular complications. Medications and mood. Comorbid conditions (including epilepsy, pain, hunger, respiratory). Impacts
F words in CP
Function: refers to what people do - how things are done is not what is important; synonyms include ‘role’, ‘job’, ‘task’, etc. (for children, ‘play’ is their ‘work’)
Family: represents the essential ‘environment’ of all children
Fitness: refers to how children stay physically active, including exercise and other recreational opportunities
Fun: includes particular activities children are involved in or enjoy participating in
Friends: refers to the friendships established with peers; social development is an essential aspect of personhood
Future: is what child development is all about; it refers to parents and children’s expectations and dreams for their future
Gabapentin
Although structurally related to GABA like mechanism is that it binds to specific receptors in presynaptic voltage gated calcium channels in the brain, which reduces release of excitatory neurotransmitters that are involved with nociception and epileptogenesis
Clonidine
Binds to both pre and post synaptic Alpha-2 adrenoreceptors to reduce spinal cord reflex arc, also having effects in reducing sympathetic outflow from the brain stem. Inhibits short latency of motor neurons and augments presynaptic inhibition
