Common Neurological Conditions in infants Flashcards
cerebral palsy definition
a group of permanent disorders of the development of
movement and posture, causing activity limitation, that are
attributed to non-progressive disturbances that occurred in
the developing fetal or infant brain”
name the rate of incidence of cerebral palsy in children
100-150 children born with CP in Ireland each year
17 million worldwide yearly
how can cerebral palsy be classified
using the classification tree for sub-types
Gross motor function classification system
topographical classification system
functional classification e.g. Manual ability classification system (MACS), communication function classification system (CFCS), Eating and drinking ability classification system (EDACS)
How does the classification tree put cerebral palsy into sub categories
increased(spastic) /decreased (hypotonia) muscle tone
if increased muscle tone is bilateral or unilateral
if the tone is varying (dyskinetic) or consistent
if there is hypotonia is paired with signs of ataxia
https://www.intechopen.com/chapters/63463
how does topographical classify cerebral palsy
unilateral - monoplegia or hemiplegia
bilateral - diplegia, triplegia or quadriplegia
what is the level I of the Gross motor function classification system
can walk and climb stairs independently unaided but will have difficulty running or jumping
describe level II of Gross Motor Function Classification system
can walk independently unaided short distances on level surface but may need upper limb support from a hand rail when climbing stairs. cannot run or jump
describe level III of Gross Motor Function Classification System
can walk independently with a hand held mobility device on level surface but will need assistance from adults climbing stairs, or will need help travelling long distances, outdoors or uneven surfaces
describe level IV of Gross Motor Function Classification System
at best can walk independently with a mobility device and adult supervision but can have difficulty maintaining balance on uneven surfaces.
can use self powered wheelchair
describe level V of Gross Motor Function Classification System
Requires the assistance and mobility device to mobilise regardless of ambulatory distance or surface level
symptoms of cerebral palsy
altered muscle tone e.g. spasticity can cause impaired lengthening of muscle fibres, impaired voluntary muscle control, difficulty isolating movements, impaired recipricol inhibition => altered resting posture of limbs, difficulty balancing agonist/antagonist
muscle weakness, delayed milestones
persistence of primitive reflexes
describe how spasticity may present itself across CP
worse in LL in B/L CP
worse in UL in U/L CP
What causes spasticity
UMN lesion
define spasticity
A velocity dependent increase in stretch
reflex
describe the F words ICF framework
body structure = fitness
activity = functioning
participation = friends
environment = family
personal = fun
https://canchild.ca/system/tenon/assets/attachments/000/004/249/original/ICFFramework_and_Fwords_ENG-ACCESS.pdf
motor types
spastic
ataxic
dyskinetic
dyskinesia
involuntary movement from basal ganglia damage
ataxia
shaky movements - affects balance and sense of positioning
cerebellum damage
what is the importance of regulating muscle tone
maintain posture
for purposeful co-ordinated movement
children with CP are at risk of developing
hip joint condition
joint or muscle contracture
emergent dystonia
increase body mass and possible underlying muscle weakness
describe the integrated pathway of cerebral palsy
established integrated pathway in australia, UK
Pelvic X ray at age 2, 6 and 16
more frequent x rays increased if possible risk of hip dislocation is detected
a clinical exam is conducted every 6 months between the ages 2-6
clinical exam completed annually from 6-16
spina bifida definition
congenital malformation in which the spinal column is split (bifid) as a result of failed closure of the embryonic neural tube, during the fourth week post-fertilization
https://www.cdc.gov/ncbddd/spinabifida/facts.html
list three types of spina bifida
occulta - mildest form with a gap in the spine but not sac and the spinal cord and nerves are normal and intact
meningocele - a gap in spine but a formation in a sac of fluid but no nerve damage
myelomeningocele - most severe sac formation comprised of nerves and spinal, involves nerve damage
how can neural tube defect be detected during pregnancy
scan conducted at 20 wks
ultrasound
AFP - alpha fetoprotein the foetus produces and is sent to mother’s bloodstream. higher AFP levels can indicate spina bifida
purpose of MRI for spina bifida
determines level of lesion in antenatal period
if the child has a spina bifida lesion at thoracic level T1 T2 will they able to walk, will they require a shunt, will the bowels be affected
all children will be wheelchair users
9/10 require shunt
bowels affected
if the child has a spina bifida lesion at lumbar level L1 L2 will they able to walk, will they require a shunt, will the bowels be affected
all children will be wheelchair users
10/10 require shunt
bowels affected
if the child has a spina bifida lesion at lumbar level L3 will they able to walk, will they require a shunt, will the bowels be affected
8/10 children will be wheelchair users
9/10 require shunt
bowels affected
if the child has a spina bifida lesion at lumbar level L4 will they able to walk, will they require a shunt, will the bowels be affected
5/10 can walk
7/10 require shunt
all children bowels affected
if the child has a spina bifida lesion at lumbar level L5 will they able to walk, will they require a shunt, will the bowels be affected
3/4 children walk
7/10 require a shunt
all children bowels affected
if the child has a spina bifida lesion at sacral level will they able to walk, will they require a shunt, will the bowels be affected
9/10 children walk
6/10 require shunt
all children bowels affected
describe motor function of child with meningomyelocele spina bifida at thoracic level and L1-3
cannot stand unsupported
wheelchair bounds
may face spinal curves, hip dislocation, knee contracture, talipes
needs assistance with ADLs
describe motor function of child with meningomyelocele spina bifida at L4-5
assistive device needed for walking, may need wheelchair for longer distances
orthotics - AFO, KAFO
may face hip dislocation, knee contractures, talipes
need help w/ ADL
describe motor function of child with meningomyelocele spina bifida at sacral level
stands unsupported
may need AFO/orthotics
may have orthopaedic needs
surgical intervention of spinal bifida
not all children with spina bifida get surgery
children with hydrocephalus get surgical stunt
signs of spina bifida
Full or bulging fontanelle (soft spot), Seizures, Enlarged
head size, Headache, Swelling or redness along the shunt tract,
Fever, Irritability, Vomiting, Drowsiness, Loss of previous abilities,
Change in appetite, Prominent veins on scalp
what other complications can children with spina bifida face
syringomyelia - collection of CSF in spinal cord
tethered spinal cord - loss of free movement. of spinal cord may require surgery
bladder issues - may require clean intermittent catheterisation
may require bowel management through diet, regular routine and medical support
list rate of incidence in obstetric brachial plexus
1 in 200 births
method of injury in obstetric brachial plexus injury
baby’s shoulder stuck in mother’s pelvis - shoulder’s dystocia
symptoms of upper obstetrics brachial plexus injury
cannot flex elbow
symptoms of lower obstetrics brachial plexus injury
loss of wrist/hand function
flexed claw like position of fingers
scapular control issues
what possible stretch nerve injury could occur in obstetrics in birth
neuropraxia
rupture - can be partial and may require surgery
avulsion injury - nerve pulled from cord mat require surgery or nerve transplant
what is developmental co-ordination disorder / dyspraxia
child has difficulty co-ordinating movement
diagnosis of DCD
Childhood onset - longstanding problems w/ motor function
no alternative explanation
at least 5 years old
subjective axam - DCD-Q-R
objective 5th centile for age on M-ABC2 = unequivocal
what is the physio intervention for children with DCD
flexibility
strength
endurance
transverse myelitis
inflammation of spinal cord
hereditary spastic paraplegia
inherited disorder including weakness, spasticity, and stiffness or paralysis of legs
