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Neuro Rehab 1 > CP Part 2 > Flashcards

CP Part 2 Flashcards

1
Q

what is developmental monitoring and who is primarily responsible for this

A

growth & development
- normal variation vs atypical

monitored by pediatrician/ family

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2
Q

who is involved (what is the chain of referrals) w developmental and medical evals

A

primary care

refer to: developmental pediatrician, pediatric neurologist, pediatric physiatrist

PT/OT; early intervention team

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3
Q

what tests are involved and why w developmental and medical evals

A

tests to determine causes
- imaging, EEG, TIMP

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4
Q

what is the accuracy of the dx

A

many issues are transient (don’t want false positives) - but parents usually know

mod to severe CP more accurate than mild CP

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5
Q

what are the primary goals of medical management

A

improve function
dec pain

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6
Q

what are the primary foci of medical management (3)

A

spasticity management
MSK alignment
treatment of co-morbidities (ie sz)

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7
Q

what is one sx w the only effective medical management and what is it

A

dystonia
- use of botox

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8
Q

what is a key question to ask when it comes to spasticity management

A

is it a limiting factor?

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9
Q

what management is indicated if spasticity isn’t a limiting factor and why

A

perhaps don’t intervene

spasticity isn’t necessarily a bad thing:
- can be used to stay upright, WB, amb
- can be used to transfer (ie lazy susan example)

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10
Q

if spasticity is a limiting factor, what management is indicated and when

A

PT - temporary management for improved alignment as prep for functional task completion/practice

medical - when rehab isn’t enough

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11
Q

what are the 4 main goals of spasticity management

A
  1. improve acquisition of skills
  2. prevent secondary complications
  3. facilitate hygiene
  4. improve voluntary control
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12
Q

what are 3 factors in clinical decision making with spasticity management

A
  1. severity, duration, distribution
  2. co-morbidity (ie sz disorder, other health conditions)
  3. other, eg cog deficits, motor control
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13
Q

what are 4 related reasons to see improvement with spasticity management

A
  1. medical intervention for condition
  2. CNS neuroplasticity
  3. motor learning
  4. normal sensory input
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14
Q

what is the mechanism of baclofen med and how does it act

A

analog of GABA, inhibits reflex activity
- neurotransmitter helps to inhibit neuronal activity -> helps to dec spasticity

oral baclofen - centrally acting, see side effects as a result

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15
Q

what side effects are seen w oral baclofen (5)

A

drowsy
fatigue
nausea
dizziness
HA

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16
Q

what is a baclofen pump and in what cases is it utilized in

A

surgically implanted in abdomen

used in GMFCS IV or V

17
Q

what are 3 spasticity meds

A

baclofen
botox
dantrolene

18
Q

what is baclofen and dantrolene doing to dec spasticity vs

A

baclofen and dantrolene
- centrally weakening abnormal ms response (via different pathways)

botox
- local temporary ms paralysis via a neuromuscular block

19
Q

what is the mechanism of dantrolene and what does this do

A

impairs release of Ca from sarcoplasmic reticulum
- dec intensity of ms contraction -> dec spasticity

20
Q

at are 2 side effects of dantrolene

A

generalized weakness
liver toxicity (LFTs to monitor)

21
Q

what is the mechanism of botox and how does it dec spasticity

A

blocks acetylcholine @NM junction
- temporary ms paralysis (axons will sprout)

22
Q

what are 5 indications for botox in spasticity

A

improve function
prevent MS complications
dec pain
improve ease of care
appearance

23
Q

what are 2 limitations of botox

A

short term
neutralizing antibodies can be developed if used too often

24
Q

what is PT’s role w botox and what does the research say

A

PT critical - stretching, bracing, functional exercise

research: improved outcomes when PT + botox vs botox alone

25
Q

how can serial casting be utilized with botox

A

takes advantage when ms paralyzed and more flaccid w botox

casting benefits:
- stretch soft tissues
- inc PROM
- future orthotic use

26
Q

what does the evidence say ab serial casting w botox

A

research is mixed as to combo of both vs either one alone
- but good outcomes clinically when both utilized

27
Q

what is selective dorsal rhizotomy (SDR) and how does this reduce spasticity

A

neurosurgery
- sensory nerve rootlets are severed which reduces spasticity

28
Q

what is PT’s role in an SDR

A

intensive PT is required
- need to have support and resources to comply w this

29
Q

what are 5 qualities making someone an ideal candidate for SDR

A
  1. ambulatory spastic diplegic CP
  2. spasticity > dystonia
  3. adequate underlying strength
  4. able to co-operate w post-op rehab
  5. 4-8yo
30
Q

what is a spinal laminectomy

A

select dorsal roots that produce exaggerated motor response when stimulated
- cut/prune some of those to reduce exaggerated response

31
Q

what quality is focused on by medical management to improve MSK functioning

A

bony deformity and lever arm dysfunction
- root of many MSK problems

32
Q

what are 3 MSK disorders that require a referral to an orthopedist

A

spinal curvatures (prone to scoliosis)
hip migration
ms length restrictions

33
Q

what is often required since kids w CP are prone to scoliosis

A

some type of fixation
- rod or wiring to prevent further progression

34
Q

what is often the medical management for hip migration and what is the goal

A

surveillance
- process and frequency based on GMFCS level

goal - monitor integrity of hip joint and px for dislocation/subluxation
- looking at degree of acetabular coverage of femoral head

35
Q

what are the 3 main medical interventions for ms length restrictions and when do you see them

A

first try - surgical fascial release
last resort - retract ms itself

z-plasty - retract ms into tendon and cut in certain way to elongate ms
- *** PT really important in these cases

36
Q

what are 2 complications/considerations of neurosurgery as a medical intervention

A
  1. ms tone substitute for strength
    - may be allowing GMFCS III or IV to walk “on” spasticity; if remove -> wc dependent
  2. poor ability to rehab after SDR
37
Q

what are 6 complications/considerations of orthopedic surgery as a medical intervention

A
  1. lengthening = weakening
  2. lengthening when not necessary
  3. too little surgery
  4. ortho surgery w/o tone management
  5. tone management w/o correction of bony abnormalities
  6. any surgery w/o adequate rehab

Neuro Rehab 1 (27 decks)

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