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MSK > cerebral palsy and special needs > Flashcards

cerebral palsy and special needs Flashcards

1
Q

complex exceptional needs categories

A 
motor skills 
communication
learning + mental functions 
self care
hearing, vision
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2
Q

CEN if

A
  • severe impairment 4+ categories and enteral/parenteral feeding
  • severe impairments 2+ categories and ventilation/CPAP

impairment >6m and ongoing

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3
Q

ex CEN with ortho involvement

A 
muscular dystrophy 
cerebral palsy 
neurofibromatosis
spina bidifa
downs and turner syndromes
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4
Q

cerebral palsy

A

permanent and non-progressive motor disorder due to brain damage before birth or in first 2yrs life

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5
Q

cerebral palsy: prenatal causes

A 
placental insufficiency 
toxaemia 
smoking 
alcohol 
drugs 
infection: rubella, herpes II
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6
Q

cerebral palsy: perinatal causes

A 
premature
anoxic injury 
infection 
kernicterus
haemolytic disease of newborn
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7
Q

cerebral palsy: postnatal causes

A

head trauma

infection: CMV, rubella

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8
Q

cerebral palsy: physiological classification

A

spastic: pyramidal system, motor cortex
athetoid: extrapyramidal system, basal ganglia
ataxia: cerebellum, brainstem
mixed: combo spastic and athetoid

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9
Q

cerebral palsy: anatomical classification

A

monoplegia
hemiplegia
diplegia
quadraplegia

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10
Q

cerebral palsy: gross motor function classification system level I

A

walk without limitations

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11
Q

cerebral palsy: gross motor function classification system level II

A

walks with limitations

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12
Q

cerebral palsy: gross motor function classification system level III

A

walks using handheld mobility device

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13
Q

cerebral palsy: gross motor function classification system level IV

A

self-mobility with limitations (may use powered mobility)

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14
Q

cerebral palsy: gross motor function classification system level V

A

transported in manual wheelchair

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15
Q

cerebral palsy issues

A 
spasticity 
lack of voluntary limb control 
weakness
poor coordination 
impaired senses: hearing, vision, touch, taste
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16
Q

cerebral palsy complications

A

joint subluxation, dislocation
dynamic contractures
fixed muscle contractures

17
Q

cerebral palsy ortho priorities

A 
spine, hip, feet 
torsional problems 
upper limb function 
maintain sitting balance
optimise gait
improve/maintain standing posture
18
Q

cerebral palsy hip problems

A

born with normal hips, 1/3 have hip displacement by maturity

dislocation

  • painful
  • upset sitting posture
  • higher GMFCS higher the risk
19
Q

cerebral palsy non-op Rx

A

posture management: physio, seating

spasticity management

  • generalised: oral baclofen, diazepam
  • localised: botox, baclofen intra-thecal pump
20
Q

cerebral palsy surgery pros

A

reduce risk dislocation
reduce pain
better seating

21
Q

cerebral palsy surgery cons

A

not all would have went on to dislocate

big surgery

22
Q

cerebral palsy surgical Rx

A

soft tissue realise: hamstrings, adductors

bony realignment: pelvic osteotomy, varus deterioration osteotomy

23
Q

equinovarus foot deformity (clubfoot)

A

hindfood in varus, midfoot adducted, ankle in equinus

24
Q

risk factors for clubfoor

A 
male 
FHx
parental smoking 
pressure theories: oligohydramnios, abnormal fetal position 
placental insufficiency 
constriction bands
25
Q

clubfoot Rx

A

casting and manipulation
5 casts changed weekly

1st cast corrects cavus and adductus deformities
remaining casts correct varus deformity and equinus

26
Q

scoliosis

A

any deviation of spine in coronal plane

27
Q

non-structural scoliosis

A

due to extrinsic cause e.g. leg length discrepancy

resolves when causative factor fixed

28
Q

structural scoliosis

A

abnormal rotation of vertebrae
intrinsic spine problem
potential to progress

29
Q

scoliosis: aetiological classification

A 
congenital 
idiopathic
neuromuscular 
post trauma
infection
degenerative
30
Q

scoliosis: classification by age presentation

A

infantile <3yrs
juvenille 3-10yrs
adolescent >10yrs

31
Q

scoliosis: classification by area of spine

A

thoacic
lumbar
thoracolumbar
double

32
Q

scoliosis: Ix

A

AP erect x-ray whole spine +/- lateral

MRI: cord abnormality, vertebral anomalies, tumour

33
Q

scoliosis: early diagnosis matters becuase

A

outcome less favourable from severe curves: cardioresp compromise, pain from pelvic/rib abutement
neuromuscular causes at high risk progression

34
Q

scoliosis non-op Rx

A

bracing

  • need to wear 23/24hrs
  • delays curve progression
35
Q

scoliosis surgical Rx

A

complex , extensive
approach: ant, pos, both
intra-operative spinal cord monitoring

36
Q

scoliosis surgical complications

A

nerve root damage
cord traction injury
problems with growth: growing roots, changing roots

MSK (33 decks)

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