CP medical management

Question 1

pain in adolescents with CP

Answer 1

64% girls and 50% boys, ave age 15 years have had pain

pain most frequent in feet ankles, knees, low back

Question 2

CP in adulthood - secondary patholofy

Answer 2

pain 67-82%
walking dysfunction
orthopedic injury
falls
fracture
fatigue

Question 3

neurological procedures for pain/management

Answer 3

oral baclofen
baclofen pump
botox injections
selective dorsal rhizotomy

Question 4

baclofen

Answer 4

synthetic GABA
stimulates GABA receptors in SC-GABAb
decrease excitation of alpha motor neuron
cant be adminitstered orally (PO) or intrathecal (ITB)

Question 5

adv/disadv baclofen

Answer 5

adv: decreases muscle tone/spasticity
dis: adequate dose to decrease spasticity
drowsiness

Question 6

adv/dis baclofen pump

Answer 6

adv:
muscle tone decreases in LE

decreased overflow

some improved function

simplified seating and positioning

dis:
size
refills (every 2-6 months depending on the dose)
cathetar pulling out of intrathecal space
infections

Question 7

Botox

Answer 7

Injected into selected
muscles
* Relaxation 3-7 days;
longevity 4-6 months
* Complications:
* Local irritation
* Potential for antibody
production
* Muscle
weakness/atrophy
* Cost

Question 8

selected dorsal rhizotomy

Answer 8

electrical stimulation to afferent dorsal rootlets (L2-L5) to identify which rootlets elicits a spastic response (ie, uninhibition of the stretch reflex)

selected rootlet neuroctomy to unihibited rootlets

spasticity permanently alleviated without loss of other posterior root functions

Question 9

indications for selective dorsal rhizotomoy

Answer 9

Velocity-dependent spasticity
* Overactive EMGs
* Continuous activity
* Out-of-phase activity
* Spastic diplegia 4+ years
* Good cognitive function
* Ambulatory potential
* Therapy resources

Question 10

relative contraindications for selective dorsal rhizotomy

Answer 10

weakness
poor motor contrl
dyskinesia
ataxia

Question 11

orthopedic procedures: single event multi level surgery (SEMLS)

Answer 11

tendon or fascia release/lengthening

muscle transfer

distal femoral extension osteotomy

acetabular/femoral osteotomies (varus derotation osteotomy)

hemi-epiphysiodesis

Question 12

tendon achilles lengthening

Answer 12

subcutaneous (open surgery) or percutaneous (closed surgery)

Question 13

key takeaways

Answer 13

children with CP commonly have medical procedures for spasticity management and joint/bony abnormalities

medical management can help reduce pain and improve function

disadvatages and risks need to be carefully considered and reviewed with the fam

Question 13

potential consequences of spinal asymmetry from NM conditions

Answer 13

scoliosis
pelvic obliquity
postural control limitations
pulmonary function
GI function
pain