Cerebral Palsy Interventions Flashcards
muscle relaxants used for CP
Diazepam, dantrolene, baclofen
Neuromuscular blocks used for CP
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
selective dorsal rhizotomy
Patient selection is critical
Team approach is mandatory
STEM cell therapy/regenerative therapy
Emerging treatment
Stem cells develop into specific types of brain cells (replacing those that are damaged)
Clinical trials are underway using cord blood
intrathecal baclofen pump
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
orthopedic surgery
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
spine fusion indications
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
subluxation signs and symptoms
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
hip dislocation signs and symptoms
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
reasons for hip dislocation
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)
conservative treatment for the hip
Passive muscle stretching Splinting Positioning Electrical stimulation Muscle activation
types of surgeries for the hip
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
surgery for adductor tightness indications
Indications
Prevention of hip subluxation (migratory percentage 25-60% age 2-8)
Improvement of scissor gait
Improved care of the perineum
surgery for hip internal rotator deformity
Femoral anteversion is the frequent cause of internal rotation during gait
Procedure: derotation osteotomy usually with medial HS release
GMFCS Recs for Standing level 2
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
GMFCS 3 recs for standing
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
GMFCS 4 and 5 recs for standing
When:
9-12 throughout adulthood
Dosage:
5x per week for 60-90 min per day
Type:
Prone
Supine
standing recs general
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
hamstring contracture
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
surgical indications for a hamstring contracture
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
pes valgus causes and treatment
Pes valgus: eversion, plantarflexion, forefoot abduction Causes Spastic peroneals PF contracture Neonatal talar position Treatment Conservative management Surgical management Grice Triple arthrodesis
varus deformity
more common in hemiplegia
Weak peroneals, spastic posterior tibialis or anterior tibialis
goals for infancy
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
considerations and goals for pre-school
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
considerations and goals for school age/adolescence
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
