CP Interventions

Question 1

Single system impairments for CP

Answer 1

1. Primary
   
   • insufficient force generation
   • spasticity
   • abnormal extensibility
   • hyperactive reflexes
2. Secondary
   
   • malalignments such as torsion or hip deformity

Question 2

Multisystem impairments for CP

Answer 2

1. poor selective control of muscle activity
2. poor regulation of activity in muscle groups in anticipation of postural control changes and body movement
3. decreased ability to learn unique movements

Question 3

what are the key predictors of reduced life expectancy in CP

Answer 3

lack of mobility and feeding difficult

Question 4

GMFCS levels and prognosis

Answer 4

1. Level V → 90% of motor potential reached by age 3
2. Level 1 → 90% of motor potential reached by age 5

Question 5

predictors of ambulation potential in CP

Answer 5

hemiplegic

sit by 24 months

Question 6

factors that indicate poor prognosis for ambulation in CP

Answer 6

1. rigidity
2. persistent tonic neck reflexes

Question 7

T/F: nearly all who eventually walk do so by age 8

Answer 7

TRUE

Question 8

prognosis for CP

Answer 8

• 31% of adults live independently
• 12% married
• 28% employed

Question 9

Neuromedical interventions for CP

Answer 9

1. Muscle relaxants
   
   • diazepam
   • dantrolene
   • baclofen
2. Problems with these drugs:
   
   • lethargy
   • sleepiness

Question 10

when are neuromuscular blocks used in CP?

Answer 10

used when a problem is balancing the agonist/antagonist activity

• phenol → low cost, long lasting
• botox → lasts 3-6 months, higher costs
  
  • tends to be reserved for kids 3 years or older
  • must be in combo w/therapy

Question 11

What neurosurgical interventions can be used in CP?

Answer 11

selective dorsal rhizotomy

• patient selection is critical
  
  • if dystonia or weakness being masked by spasticity this intervention may not be indicated
• team approach mandatory

Question 12

list an emerging treatment for CP

Answer 12

stem cell therapy/regenerative therapy

Question 13

what are the criteria for an Intrathecal Baclofen Pump?

Answer 13

1. moderate severe spasticity
2. sufficient body mass
3. appropriate goals
   
   • decrease pain
   • improve ease of caregiver
   • prevent worsening of deformity
4. family committed to follow up
5. patient free of infection and medically stable
6. successful baclofen trial

Question 14

what are the general goals of orthopedic surgery pertaining to CP?

Answer 14

1. improve function
2. decrease discomfort
3. prevent structural changes that may become disabling

Question 15

T/F: you want to avoid repeat surgeries on same muscle group

Answer 15

TRUE

Question 16

what are indications for a posterior spinal fusion?

Answer 16

curve approaching 90 degrees when the child is sitting with difficulty sidebending back toward the middle

any time the curve has the potential to restrict the lungs

Question 17

T/F: it is preferable to delay a posterior spinal fusion until the child reaches puberty

Answer 17

TRUE

Question 18

3 main reasons for hip subluxation?

Answer 18

1. lack of changes in the neonatal hip
   
   • too great an angle of inclination
   • shallow acetabulum
2. lack of LE weight bearing in multiple positions
3. muscle imbalance
   
   • hip adductors more active than abductors
   • contracture of hip flexors

Question 19

describe a subluxation of the hip

Answer 19

the head of the femur moves out of its normal, centered position in the acetabulum but not over the edge completely

Question 20

Signs of a subluxed hip

Answer 20

1. limited ROM
2. pain w/motion
3. leg shortening on subluxed side
4. limping
5. refused to bear weight or walk

Question 21

T/F: with a bilateral subluxation of the hip one side appears shorter

Answer 21

FALSE

typically symmetry is maintained in the pelvis

Question 22

Signs of a dislocated hip

Answer 22

1. severed pain in hip or knee
2. hip swelling
3. obvious deformity
4. muscle spasms
5. weakness
6. numbness
7. lack of weight bearing

Question 23

unilateral hip dislocation presents as ________

Answer 23

pelvic obliquity

Question 24

conservative management of hip issues in CP

Answer 24

1. passive muscle stretching
2. splinting
3. positioning
4. electrical stimulation
5. muscle activation

Question 25

how should children with hip dysplasia need to stand?

Answer 25

in abduction (15-30º) and neutral hip flexion

Question 26

Types of surgeries that can be done at the hip

Answer 26

1. soft tissue transfer and/or releases involving the adductors, iliopsoas, and/or proximal hamstrings
2. femoral osteotomy
3. pelvic osteotomy
4. combined femoral osteotomy and pelvic osteotomy
   
   • with and without soft tissue release
5. resection of the femoral head and neck
6. arthrodesis and arthroplasty

Question 27

what are reasons for surgery pertaining to adductor tightness

Answer 27

1. prevention of hip subluxation
   
   • migratory percentage 25-60
   • age 2-8
2. improvement of scissor gait
3. improved care of perineum

Question 28

what is the most common cause of a hip IR deformity?

Answer 28

femoral anteversion

derotation osteotomy usually w/medial ham release

Question 29

conservative management for hamstring contractures

Answer 29

in addition to Botox, soft immobilizers, casting, standing regime

Question 30

Indications for hamstring contracture surgery

Answer 30

1. kyphotic seating due to tight hams
2. fixed knee flexion contractures
3. popliteal angle of greater than 40-45º
4. knee flexion of 20-30 at foot contact
5. knee flexion of 20-30 at midstance

Question 31

how may PF contractures present?

Answer 31

1. Toe walking
2. hyperextension of the knee → back-knee

Question 32

what is Pes Valgus and what are the causes?

Answer 32

eversion, PF and FF Abd

causes → spastic peroneals, PF contracture, neonatal talar position

Question 33

surgical management of pes valgus

Answer 33

1. grice
2. triple arthrodesis

Question 34

varus deformities are more common __________

Answer 34

in hemiplegia

weak peroneals, spastic posterior or anterior tibialis

Question 35

PT Intervention in Infancy

Answer 35

1. focus on edu family, facilitating caregiving and caregiver interaction
2. promote optimal sensorimotor experiences and skills
3. address current as well as potential problems
4. promote caregivers’ skill, ease and confidence in handling and caring for their infant
5. positioning, carrying, feeding, dressing
6. incorporate therapeutic activities into daily routines
7. use a variety of movements and postures to promote sensory variety
8. frequently include positions that promote the full lengthening of spastic or hypo-extensible muscles
9. use positions that promote functional voluntary movement of limbs with as little assistance as possible

Question 36

PT Intervention in Preschool age

Answer 36

1. children begin to interact with outside world
2. impairments may limit socialization and participation
3. parents more aware of differences
4. goals → prevent secondary impairments
5. optimize gross motor skills, fitness, play, communication, self care, problem solving

Question 37

PT Intervention School Aged and Adolescent Period

Answer 37

1. For most → optimal level of functioning has been achieved
2. participation
3. maintenance, prevention
4. potential changes
   
   • weight gain, pain, loss of muscle extensibility, puberty, cumulative physical overuse, more demanding lifestyle
5. progressive resistance training