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TAS Development ✅ > Common Medical Issues In Neurodisability ✅ > Flashcards

Common Medical Issues In Neurodisability ✅ Flashcards

1
Q

Give 7 medical issues that are more common in chidlren with neurodisability

A
  • Gastro-oesophageal reflux disease (GORD)
  • Respiratory complications
  • Drooling
  • Constipation
  • Temperature regulation
  • Sleep difficulties
  • Orthopaedic complications
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2
Q

What is gastro-oesophageal reflux?

A

The non-forceful regurgitation of gastric contents into the oesophagus

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3
Q

Why may GORD be more common in children with neurodevelopmental problems?

A
  • Incraesed intra-abdominal pressure
  • Functionally immature lower oesophageal sphincter
  • Difficulties in upright position
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4
Q

Why may intra-abdominal pressure be increased in children with neurodevelopmental problems?

A

Structural reasons, e.g. scoliosis

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5
Q

Why might the lower oesophageal sphincter be functionally immature in children with neurodevelopmental problems?

A

As a reflection of abnormal muscle tone elsewhere in the body

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6
Q

What is the first line management of GORD in children with neurodevelopmental problems?

A
  • Postural management

- Adjustment of feed consistency if required

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7
Q

How can GORD be managed positionally?

A
  • Supportive upright seating

- Sleeping positioners

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8
Q

What can be done if conservative management for GORD is ineffective in children with neurodevelopment problems?

A

Pharmacological management

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9
Q

What might be involved in pharmacological management of GORD in children with neurodevelopmental problems?

A
  • Proton-pump inhibitors
  • H2-receptor antagonists
  • Dopamine receptor antagonists
  • Compound alginate preperations
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10
Q

Give 3 examples of PPIs

A
  • Omeprazole
  • Lansoprazole
  • Esomeprazole
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11
Q

How do PPIs work?

A

They block the hydrogen-potassium adenosine triphosphate enzyme system of the gatsric parietal cell - the ‘proton pump’ - inhibiting acid production

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12
Q

Give an example of a H2-receptor antagonist

A

Ranitidine

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13
Q

How do H2-receptor antagonists work?

A

Reduce gastric acid output by antagonism of histamine H2-receptors

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14
Q

Give an example of a dopamine receptor antagonist

A

Domperidone

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15
Q

How do dopamine receptor antagonists work?

A
  • Stimulate gatric emptying and small intestinal transit

- Enhance tone of oesophageal sphincter

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16
Q

Give 3 examples of compound alginate preparations

A
  • Gaviscon
  • Gaviscon Infant
  • Peptac
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17
Q

How do compound alginate preperations work

A
  • Increase viscosity of stomach contents

- Protect oesophagal mucosa from acid reflux

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18
Q

What additional actions do some preperations of compound alginates have?

A

They form a viscous substance which floats on the surface of stomach contents, thus reducing episodes of reflux

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19
Q

What may be required in children with severe symptom of GORD?

A

Surgical intervention

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20
Q

What surgical intervention is done for GORD?

A

Nissen’s fundoplication

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21
Q

What happens in Nissen’s fundoplication?

A

The gastric fundus is plicated around the lower end of the oesophagus and sutured into place, reinforcing the lower oesophageal sphincter

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22
Q

Why can neurological problems lead to respiratory complications?

A
  • Impaired ability to protect airway
  • Structural impairment to respiratory function
  • Impaired immune function
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23
Q

What can the impaired ability to protect the airway in neurodevelopmental problems lead to?

A

Acute or chronic (‘silent’) aspiration, with chemical pneumonitis or secondary infection with anaerobic organisms

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24
Q

Where are the neural control centres responsible for coordination of breathing and swallowing located?

A
  • In the dorsomedial and ventrolateral medullary regions in the brainstem
  • Element of cortical control
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25
Q

What muscles are controlled by swallowing centres?

A

Muscles of the mouth, pharynx, and larynx

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26
Q

What areas are involved in swallow-related motor output?

A
  • Trigeminal motor nucleus
  • Facial motor nucleus
  • Nucleus ambiguus
  • Hypoglossal motor nucleus
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27
Q

Where is the trigeminal motor nucleus located?

A

Near the level of the mid pons

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28
Q

Where is the facial motor nucleus located?

A

At the level of the caudal pons

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29
Q

Where is the nucleus ambiguus located?

A

Runs rostocaudally in the medulla

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30
Q

What is the underlying mechanism leading to aspiration in neurodevelopmental conditions?

A
  • Abnormal tone of facial and swallowing muscles

- Direct damage to swallowing and respiration control dentres

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31
Q

What might abnormal tone of the facial and swallowing muscles occur as part of?

A

A condition causing abnormal tone throughout the body

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32
Q

Give 2 conditions causing abnormal tone that may cause swallowing difficulties

A
  • Cerebral palsy

- Spinal muscular atrophy

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33
Q

What can cause direct damage to swallow and respiration centres in neurodevelopmental problems?

A
  • Traumatic brain injury
  • Stroke
  • Brain tumour
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34
Q

What structural problems may children with neurodevelopmental problems have that put them at risk of respiratory complications?

A
  • Impairment to chest movement and lung capacity

- Difficulty clearing respiratory secretions

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35
Q

Give an example of a condition causing structural impairment to chest movement and lung capacity

A

Scoliosis

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36
Q

What can cause difficulty in clearing respiratory secretions in neurodevelopmental problems?

A
  • Direct weakness

- Reduced cough reflex

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37
Q

Give an example of a condition causing reduced cough reflex

A

Brain injury

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38
Q

Why are children with Down’s syndrome more at risk of respiratory complications?

A
  • Low tone
  • Structural differences
  • Impaired immunity
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39
Q

What impairment in immunity may be present in children with Down’s syndrome?

A
  • Low levels of blood immunoglobulins
  • Impaired vaccine responses
  • Abnormal lymphocyte subsets
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40
Q

What age is drooling considered normal?

A

Up to 4 years

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41
Q

Why might children with neurodevelopmental conditions continue to drool past 4 years?

A
  • Abnormalities in swallowing
  • Difficulties moving saliva to back of throat
  • Poor mouth closure
  • Tongue thrusting
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42
Q

What are the management options for drooling in neurodevelopmental conditions?

A
  • Conservative
  • Pharmacological
  • Surgical
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43
Q

What are the conservative treatment options for drooling in neurodevelopmental problems?

A
  • Rewarding

- Behavioural methods

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44
Q

What are the pharmacological options for the management of drooling in neurodevelopmental conditions?

A
  • Anti-muscarinic drugs

- Botulinum toxin

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45
Q

Give 2 anti-muscarinic drugs that may be used to treat drooling

A
  • Hyoscine hydrobromide

- Glycopyrronium bromide

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46
Q

How do anti-muscarinic agents reduce drooling?

A

Act as competitive antagonist at muscarinic acetylcholine receptors. This causes blockade of parasympathetic innervation of the salivary glands, producing a reduction in saliva production

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47
Q

Which muscarinic receptor do anti-muscarinic drugs act on to reduce drooling?

A

M1 receptors

48
Q

How does botulinum toxin work in drooling?

A

It inhibits acetylcholine release in nerve terminals, mainly at the neuromuscular junction but also at sympathetic and parasympathetic ganglion cells and in postganglionic parasympathetic nerves

49
Q

How can botulinium toxin be adminstered?

A

Can be injected directly into the parotid gland

50
Q

What is the effect of injecting botulinum toxin directly into the partoid gland?

A

It inhibits parasympathetic innervation and reduces saliva production

51
Q

What are the surgical options in the management of drooling in neurodevelopmental problems?

A
  • Diversion of parotid ducts in tonsillar fossae region

- Salivary gland resection

52
Q

Why may consipation more common in children with neurodevelopmental conditions?

A
  • Abnormalities of muscle tone
  • Restricted diet low in fibre
  • Mobility difficulties
53
Q

Where in particular might abnormalities in muscle tone lead to constipation?

A

Bowel wall

54
Q

Why might children with neurodevelopmental problems have a restricted diet low in fibre?

A

Difficulties in chewing and swallowing

55
Q

How is mobility important in constipation

A

Normal upright mobility will aid transit of waste through the bowel

56
Q

How is constipation treated in children with neurodevelopmental problems?

A
  • Diet and lifestyle modification

- Laxatives

57
Q

What types of laxatives are used in children with neurodevelopmental problems?

A
  • Stimulant laxatives

- Osmotic laxatives

58
Q

Give 5 examples of stimulant laxatives

A
  • Bisacodyl
  • Docusate sodium
  • Glycerol suppositories
  • Senna
  • Sodium picosulphate
59
Q

How do stimulant laxatives work?

A

They increase intestinal motility

60
Q

What may need to be used in combination with stimulant laxatives?

A

Faecal softeners

61
Q

Why might faecal softeners need to be used with stimulant laxatives?

A

To lessen the possibility of abdominal cramps

62
Q

Give 4 exampels of osmotic laxatives

A
  • Lactulose
  • Macrogol
  • Phosphate enema
  • Sodium citrate enema
63
Q

How does lactulose work?

A

It draws fluid from the body into the bowel

64
Q

How does movicol work?

A

It is taken with fluid which is then retained within the bowel lumen

65
Q

Where are the body’s thermoregulation centres?

A

In the anterior hypothalamus (preoptic area)

66
Q

What do the themoregulation centres recieve input from?

A
  • Peripheral thermoreceptors

- Central thermoreceptors, including hypothalamus itself

67
Q

Where are peripheral thermoreceptors located?

A

In the skin and mucous membranes

68
Q

What is the result of sensory signals from the peripheral and central thermorepcetors?

A

They are combined the posterior hypothalamus to control heat producing and conservating actions of the body

69
Q

By what systems does the body produce/conserve heat?

A
  • Autonomic nervous system

- Neuroendocrine system

70
Q

What can the body do to produce/conserve heat?

A
  • Shivering
  • Piloerection
  • Skin vasoconstriction
71
Q

Why might a child with a neurodisability present with temperature dysregulation?

A
  • Hypothalamic dysfunction

- Unable to voluntarily response to temperature change, e.g. seeking warmth

72
Q

What problems with sleep do many disabled children have?

A

Problems with sleep initiation and maintenance

73
Q

Why might children with neurodisabilities have sleep problems?

A
  • Disruption of bsleep

- Circadian rhythm abnormalities

74
Q

Give 3 factors that may disturb sleep in children with neurodevelopmental problems

A
  • Pain
  • Epileptic seizures
  • Sleep disorder,s e.g. sleep disordered breathing
75
Q

In what neurodevelopmental conditions is it particularly common to have circadian rhythm abnormalities?

A
  • ADHD

- Visual impairment

76
Q

What is the link between ADHD and circadian rhythm abnormalities?

A

There is a genetic link, with polymorphisms in genes common to ADHD and circadian rhythm

77
Q

Why are children with visual impairments at a higher risk of circadian rhythm abnormalities?

A

Environmental clues about sleep can be missed

78
Q

How should sleep difficulties in children with neurodevelopmental problems be managed initially?

A
  • Advice about good sleep hygiene

- Explanation of sleep-wake cycle

79
Q

What can it be useful to explain about the sleep-wake cycle?

A

It is normal to have short periods of wakening during the night

80
Q

Why might normal periods of wakening during the night be a problem for children with neurodevelopmental problems?

A

The ability to self-soothe back to sleep during these periods may be delayed or impaired

81
Q

When do children normally acquired the ability to self-soothe back to sleep from periods of wakening during the night?

A

Under 1 year of age

82
Q

What can be used in children where sleep initiation is an ongoing difficulty despite well-established and healthy bedtime routines?

A

Melatonin

83
Q

What is melatonin?

A

A hormone

84
Q

Where is melatonin naturally produced?

A

Pineal gland

85
Q

What is melatonin produced in response to?

A

Stimulation of the suprachiasmatic nucleus

86
Q

What stimulates the suprachiasmatic nucleus?

A

The onset of darkness

87
Q

What do circaridan clock mechanisms involve?

A

Period gene expression

88
Q

What is the periodic gene expression involved in circadian clock mechanisms synchronised by?

A

The hypothalamic suprachiasmatic nuclei

89
Q

What are the genes involved in circadian clock control?

A
  • Per
  • Frq
  • Clock
  • Tau
90
Q

How do the clock genes control circadian rhythm?

A

Unknown

91
Q

How can supplemental melatonin help?

A

Can promote sleep initiation

92
Q

What other medications can be used to help with sleep in children with neurodevelopmental problems?

A
  • Sedating antihistamines

- Hypnotics

93
Q

Give an example of a sedating antihistamine

A

Alimemazine

94
Q

Give an example of a hypnotic

A

Chloral hydrate

95
Q

How long can sedating anti-histamines or hypnotics be used in sleep disorders?

A

Short term only

96
Q

When might sedating anti-histamines or hypnotics be considered to treat sleep disorders in children with neurodevelopmental problems?

A

Last resort when sleep difficulties are severe or disabling

97
Q

What orthopaedic complications may occur in children with neurodevelopmental problems?

A
  • Hip subluxation and dislocation

- Spinal deformity

98
Q

What % of children with cerebral palsy who are not walking at the age of 5 years does hip subluxation or dislocation occur in?

A

60%

99
Q

What problems can hip subluxation or dislocation cause?

A
  • Pain
  • Increasing deformity
  • Inability to sit
  • Functional restrictions
  • Spinal deformity
100
Q

What conditions increase the risk of hip subluxation or dislocation?

A

Any condition causing disorders of muscle tone

101
Q

Are children with hypo- or hypertonia at higher risk of hip subluxation or dislocation?

A

Hypertonia

102
Q

What is theorised to cause hip dislocation/subluxation in neurodevelopmental conditions?

A
  • Change in proximal femoral artery
  • Spasticity and shortening of muscles around hip joint
  • Lack of ambulation
103
Q

What causes a change in proximal femoral artery anatomy in children with neurodevelopmental conditions?

A

Effects of delayed motor development and tonal asymmetry

104
Q

Why can spasticity and shorteneing of muscles and lack of ambulation lead to hip subluxation and dislocation?

A

Impacts bony development and joint position

105
Q

What are the elements of hip subluxation/dislocation?

A
  • Acetabular dysplasia

- Femoral head displacement

106
Q

Is the hip joint normal at birth in hip subluxation and dislocation caused by neurodevelopmental problems?

A

Yes

107
Q

Who should receive surveillance for hip subluxation/dislocation?

A

Children with bilateral cerebral palsy

108
Q

What is looked at in routine surveillance for children with bilateral cerebral palsy to look for hip subluxation/dislocation?

A

Migration indices of hips

109
Q

How is the migration indices of the hips calculated?

A

Measurement of the migration percentage on an AP pelvic x-ray

110
Q

What hip migration index is suggestive of hip subluxation or dysplasia?

A

No agreed figure, but more than 33% is suggestive

111
Q

What is scoliosis?

A

Lateral curvature of the spine

112
Q

Which children are at increased risk of spinal deformities?

A

Those with abnormal tone

113
Q

Why are children with abnormal tone at higher risk of spinal abnormalities?

A

Due to motor imapirment due to absence fo normal weight bearing and movement

114
Q

How can spasticity or low tone lead to spinal deformity?

A

It can lead to abnormal forces on the spine leading to curvature

115
Q

What should be done due to the increased risk of spinal defomrity in child with neurodisability?

A

Regular assessment of clinical evidence of spinal deformity and prompt referral for assesesment by a specialist spinal team when spinal deformity is detected

TAS Development ✅ (21 decks)

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