Cerebral Palsy Interventions

Question 1

muscle relaxants used for CP

Answer 1

Diazepam, dantrolene, baclofen

Question 2

Neuromuscular blocks used for CP

Answer 2

Used when the problem is balancing the agonist/antagonist activity
Phenol: low cost, long lasting
Botox: lasts 3-6 months, higher costs
Must be used in combination with therapy

Question 3

selective dorsal rhizotomy

Answer 3

Patient selection is critical

Team approach is mandatory

Question 4

STEM cell therapy/regenerative therapy

Answer 4

Emerging treatment
Stem cells develop into specific types of brain cells (replacing those that are damaged)
Clinical trials are underway using cord blood

Question 5

intrathecal baclofen pump

Answer 5

Potential problems with oral baclofen
IBP: pump implanted into the abdomen
Must be large enough
Criteria for selection
Moderately severe spasticity
Sufficient body mass
Appropriate goals
Decrease pain
Improve ease of caregiving
Prevent worsening of deformity
Family committed to follow up
Patient free of infection and medically stable
Successful baclofen trial

Question 6

orthopedic surgery

Answer 6

PT goal: delay surgery but assist in determining the optimum timing
Want to avoid repeat surgeries on the same muscle group
General goals of surgery
Improve function
Decrease discomfort
Prevent structural changes that may become disabling

Question 7

spine fusion indications

Answer 7

Indications: curve approaching 90 degrees when the child is sitting with difficulty sidebending back toward the middle
Prefer to delay until the child reaches puberty

Question 8

subluxation signs and symptoms

Answer 8

Subluxation: the head of the femur moves out of its normal, centered position in the acetabulum but not over the edge completely
S&S
Limited ROM
Pain with motion
Leg shortening on the subluxed side
Limping
Refusing to bear weight/walk

Question 9

hip dislocation signs and symptoms

Answer 9

Subluxation: the head of the femur moves out of its normal, centered position in the acetabulum but not over the edge completely
S&S
Limited ROM
Pain with motion
Leg shortening on the subluxed side
Limping
Refusing to bear weight/walk

Question 10

reasons for hip dislocation

Answer 10

Lack of changes in the neonatal hip (too great an angle of inclination, shallow acetabulum)
Lack of LE weightbearing in multiple positions
Muscle imbalance (hip adductors more active than abductors, contracture of the hip flexors)

Question 11

conservative treatment for the hip

Answer 11

Passive muscle stretching
Splinting
Positioning
Electrical stimulation
Muscle activation

Question 12

types of surgeries for the hip

Answer 12

Soft tissue transfer and/or releases involving the adductors, iliopsoas, and/or proximal HS
Small incision in the skin, then in the muscle sheath, making it easier for the muscle to relax
Femoral osteotomy
Pelvic osteotomy
Combined femoral osteotomy and pelvic osteotomy
With and without soft tissue release
Resection of the femoral head and neck
Arthrodesis and arthroplasty

Question 13

surgery for adductor tightness indications

Answer 13

Indications
Prevention of hip subluxation (migratory percentage 25-60% age 2-8)
Improvement of scissor gait
Improved care of the perineum

Question 14

surgery for hip internal rotator deformity

Answer 14

Femoral anteversion is the frequent cause of internal rotation during gait
Procedure: derotation osteotomy usually with medial HS release

Question 15

GMFCS Recs for Standing level 2

Answer 15

When:
9-12 months until onset of indep ambulation
7-8 or when ROM decreases

Dosage:
3x per week for 45 min

Type:
Upright
Sit to stand
Self propelled

Question 16

GMFCS 3 recs for standing

Answer 16

When:
9-12 months through age 5
7-8 if ROM decreases
15 if crouch gait appears

Dosage:
5x per week for 60-90 min per day

Type:
Prone
Sit to Stand
Self Propelled

Question 17

GMFCS 4 and 5 recs for standing

Answer 17

When:
9-12 throughout adulthood

Dosage:
5x per week for 60-90 min per day

Type:
Prone
Supine

Question 18

standing recs general

Answer 18

All children with risk for hip dysplasia need to stand in abduction (15-30 degrees) and neutral hip flexion
Maintain excellent biomechanical alignment (especially of the head/spine)
Devices
Swash Brace
Standing, walking, and sitting hip orthosis

Question 19

hamstring contracture

Answer 19

May be secondary to hip flexor contracture
May lead to:
Contracted muscle
Contracted capsule
Shortening of the sciatic nerve
Conservative
Botox 
Soft immobilizers
Casting
Standing regime

Question 20

surgical indications for a hamstring contracture

Answer 20

Surgical indications
Kyphotic seating due to tight hamstrings
Fixed knee flexion contracture
Popliteal angle of greater than 40-45 degrees
Knee flexion of 20-30 degrees at foot contact
Knee flexion of 20-30 degrees at midstance

Question 21

pes valgus causes and treatment

Answer 21

Pes valgus: eversion, plantarflexion, forefoot abduction
Causes
Spastic peroneals
PF contracture
Neonatal talar position
Treatment
Conservative management
Surgical management
Grice
Triple arthrodesis

Question 22

varus deformity

Answer 22

more common in hemiplegia

Weak peroneals, spastic posterior tibialis or anterior tibialis

Question 23

goals for infancy

Answer 23

Focus on family education, facilitation of caregiving, caregiver interaction
Promote optimal sensorimotor experiences and skills
Address current as well as potential problems
Promote caregivers’ skill, ease, and confidence in handling and caring for their infant
Positioning
Carrying
Feeding
Dressing
Incorporate therapeutic activities into daily routines
Use a variety of movements and postures to promote sensory variety
Frequently include positions that promote the full lengthening of spastic or hyopextensible muscle
Use positions that promote functional voluntary movement of limbs with as little assistance as possible

Question 24

considerations and goals for pre-school

Answer 24

Considerations
Children begin to interact with the outside world
Impairments may limit socialization and participation
Parents are more aware of differences
Goals
Prevent secondary impairments
Optimize gross motor skills, fitness, play, communication, self care, and problem solving
Muscles need to be stretched to their limits on a daily basis and loaded adequately
Bones need compressive forces
CV system needs to be used at moderately intense levels
Spasticity management may be introduced
Integrity of the hip joints is a major concern
Prevent dislocation

Question 25

considerations and goals for school age/adolescence

Answer 25

Considerations
For most, the optimal level of functioning has been achieved
Potential changes
Weight gain
Pain
Loss of muscle extensibility
Puberty 
Cumulative physical overuse
More demanding lifestyle 
Goals
Participation 
Maintenance
Prevention
Progressive resistance training