CP Interventions Flashcards
Single system impairments for CP
- Primary
- insufficient force generation
- spasticity
- abnormal extensibility
- hyperactive reflexes
- Secondary
- malalignments such as torsion or hip deformity
Multisystem impairments for CP
- poor selective control of muscle activity
- poor regulation of activity in muscle groups in anticipation of postural control changes and body movement
- decreased ability to learn unique movements
what are the key predictors of reduced life expectancy in CP
lack of mobility and feeding difficult
GMFCS levels and prognosis
- Level V → 90% of motor potential reached by age 3
- Level 1 → 90% of motor potential reached by age 5
predictors of ambulation potential in CP
hemiplegic
sit by 24 months
factors that indicate poor prognosis for ambulation in CP
- rigidity
- persistent tonic neck reflexes
T/F: nearly all who eventually walk do so by age 8
TRUE
prognosis for CP
- 31% of adults live independently
- 12% married
- 28% employed
Neuromedical interventions for CP
- Muscle relaxants
- diazepam
- dantrolene
- baclofen
- Problems with these drugs:
- lethargy
- sleepiness
when are neuromuscular blocks used in CP?
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
What neurosurgical interventions can be used in CP?
selective dorsal rhizotomy
- patient selection is critical
- if dystonia or weakness being masked by spasticity this intervention may not be indicated
- team approach mandatory
list an emerging treatment for CP
stem cell therapy/regenerative therapy
what are the criteria for an Intrathecal Baclofen Pump?
- moderate severe spasticity
- sufficient body mass
- appropriate goals
- decrease pain
- improve ease of caregiver
- prevent worsening of deformity
- family committed to follow up
- patient free of infection and medically stable
- successful baclofen trial
what are the general goals of orthopedic surgery pertaining to CP?
- improve function
- decrease discomfort
- prevent structural changes that may become disabling
T/F: you want to avoid repeat surgeries on same muscle group
TRUE
what are indications for a posterior spinal fusion?
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
T/F: it is preferable to delay a posterior spinal fusion until the child reaches puberty
TRUE
3 main reasons for hip subluxation?
- lack of changes in the neonatal hip
- too great an angle of inclination
- shallow acetabulum
- lack of LE weight bearing in multiple positions
- muscle imbalance
- hip adductors more active than abductors
- contracture of hip flexors
describe a subluxation of the hip
the head of the femur moves out of its normal, centered position in the acetabulum but not over the edge completely
Signs of a subluxed hip
- limited ROM
- pain w/motion
- leg shortening on subluxed side
- limping
- refused to bear weight or walk
T/F: with a bilateral subluxation of the hip one side appears shorter
FALSE
typically symmetry is maintained in the pelvis
Signs of a dislocated hip
- severed pain in hip or knee
- hip swelling
- obvious deformity
- muscle spasms
- weakness
- numbness
- lack of weight bearing
unilateral hip dislocation presents as ________
pelvic obliquity
conservative management of hip issues in CP
- passive muscle stretching
- splinting
- positioning
- electrical stimulation
- muscle activation
how should children with hip dysplasia need to stand?
in abduction (15-30º) and neutral hip flexion
Types of surgeries that can be done at the hip
- soft tissue transfer and/or releases involving the adductors, iliopsoas, and/or proximal hamstrings
- 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
what are reasons for surgery pertaining to adductor tightness
- prevention of hip subluxation
- migratory percentage 25-60
- age 2-8
- improvement of scissor gait
- improved care of perineum
what is the most common cause of a hip IR deformity?
femoral anteversion
derotation osteotomy usually w/medial ham release
conservative management for hamstring contractures
in addition to Botox, soft immobilizers, casting, standing regime
Indications for hamstring contracture surgery
- kyphotic seating due to tight hams
- fixed knee flexion contractures
- popliteal angle of greater than 40-45º
- knee flexion of 20-30 at foot contact
- knee flexion of 20-30 at midstance
how may PF contractures present?
- Toe walking
- hyperextension of the knee → back-knee
what is Pes Valgus and what are the causes?
eversion, PF and FF Abd
causes → spastic peroneals, PF contracture, neonatal talar position
surgical management of pes valgus
- grice
- triple arthrodesis
varus deformities are more common __________
in hemiplegia
weak peroneals, spastic posterior or anterior tibialis
PT Intervention in Infancy
- focus on edu family, facilitating caregiving and 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 hypo-extensible muscles
- use positions that promote functional voluntary movement of limbs with as little assistance as possible
PT Intervention in Preschool age
- children begin to interact with outside world
- impairments may limit socialization and participation
- parents more aware of differences
- goals → prevent secondary impairments
- optimize gross motor skills, fitness, play, communication, self care, problem solving
PT Intervention School Aged and Adolescent Period
- For most → optimal level of functioning has been achieved
- participation
- maintenance, prevention
- potential changes
- weight gain, pain, loss of muscle extensibility, puberty, cumulative physical overuse, more demanding lifestyle
- progressive resistance training
