Cerebral Palsy - Ferril Flashcards by Matt Stanton

cerebral palsy

abnormal motor activity and posture

non-progressive

perinatal asyphyxia, complication prematurity, perinatal infection, kernicterus

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forms of CP

spatstic - pyrimidal - MC
non-spastic - extra-pyramidal
atonic
cerebellar
ataxic
combined

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athetosis, chorea, dyskinesias

non-spastic CP

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persistent generalized hypotonia

atonic CP

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manifest when posture challenged

cerebellar CP

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CP diagnosis

of exclusion

early sign - resistance to passive motion - especially flexion

slow motor development, abnormal muscle tone, unusual posture

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diagnose CP time

not before age 2

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work up for CP

CT, MRI, US

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OMT with cerebral palsy

address muscle tone
and proprioceptive input affecting motor output

muscle tone - function affects structure
proprioception - structure affects function

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goals of OMT in CP

cannot fix problem
-decrease pain - chronic muscle spasm

affect changes in proprioceptive input - limit/prevent contraction

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wheelchair bound CP

hip dislocation - hip contractures

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hypertonic

stiff limb - spatic CP

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hypotonic

floppy limb - non-spastic CP

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pyramidal

spastic

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exrtrapyramidal

non-spastic

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pyramidal tracts

nerve fibers - voluntary movements - cortex to BS

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extramyramidal areas

basal ganglia, thalamus, cerebellum

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spastic

jerky/awkward movements

often arms and legs

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non-spastic CP

two types ataxic and dyskinetic

ataxia - wide irregular gait, impaired eye movements

dyskinesia - athetoid and dystonia

athetoid

involuntary movements - arm, leg, hand

dystonic

trunk mm - twisted fixed posture

chorea

irregular movements repetitive or rhythmic - jerky/shaky

-with non-spastic CP

choreathetoid

chorea and athetosis

movements irregular, but twisting and curving

dystonia

involuntary movement with abnormal, susained posture

ataxia

impaired balance/coordination

spastic CP postural compensation

tight hamstring - posterior innominate - decreased lumbar lordosis - extended TLG - flat thoracic kyphosis - extended OA

myotactic reflex

sensory input - dorsal ganglion motor output - ventral horn DTR - hammer on tendon normal - descending pathways from cortex - down-regulate the response -abnormal - no down-regulation of response = spastic agonist/antagonist - don't work together

isometric

same length

isotonic concentric

muscle shorten improve firing pattern hypotonic mm

isotonic eccentric

muscle lengthen address short antigravity muscles

isolytic

quick overcome patient contraction

reciprocal inhibition

withdrawal and crossed-extensor reflex MET to one group of muscles - affects antagonist partner

MET not best choice

kids under 8yo

isolytic

good for adhesion, fibrosis, long term contraction

reciprocal inhibition

good for decreasing tone of hypertonic muscles hemiplegias, unilateral contractures

non-spastic CP

hypotonia with increased DTRs dyskinesia by childhood 50% sensorineural hearing loss

postural compensations in CP

anterior pelvic displacement -short adductors, quads decreased cervical lordosis - head forward -extension of OA - short suboccipital mm tibial rotation and torsion, femoral anteversion, pes planus, genu valgus back pain, knee, hip pain, HA

myofascial release

long lever strains - entire system carries proprioceptive info tx fascial tubes of TAP cylinder

BLT in CP

balance tone throughout joints tx tibia-fibula and IO membrane

FPR in CP

short restrictors - subocc and paraspinals

CS in CP

lenthen and relax tone in long restrictor muscles

HVLA in CP

not so much hypotonic - ligament laxity hypertonic - risk injury surrounding tissue

G-tube for nutrition

in reflux with CP

ADHD behavior

compensation for muscle weak and fatigue, or vision and hearing impairment

out of pattern changes

signal something may be happening change in stability may indicate new pathology new inability to walk - hip dislocation or fracture

MFR in spastic CP

MFR with static stretching - greater immediate effect on spasticity then stretching alone

OCF and MFR vs. acupuncture as tx for children with spastic CP

significant improvement in OMT group vs. acupuncture and control groups