CP Part 2 Flashcards
what is developmental monitoring and who is primarily responsible for this
growth & development
- normal variation vs atypical
monitored by pediatrician/ family
who is involved (what is the chain of referrals) w developmental and medical evals
primary care
refer to: developmental pediatrician, pediatric neurologist, pediatric physiatrist
PT/OT; early intervention team
what tests are involved and why w developmental and medical evals
tests to determine causes
- imaging, EEG, TIMP
what is the accuracy of the dx
many issues are transient (don’t want false positives) - but parents usually know
mod to severe CP more accurate than mild CP
what are the primary goals of medical management
improve function
dec pain
what are the primary foci of medical management (3)
spasticity management
MSK alignment
treatment of co-morbidities (ie sz)
what is one sx w the only effective medical management and what is it
dystonia
- use of botox
what is a key question to ask when it comes to spasticity management
is it a limiting factor?
what management is indicated if spasticity isn’t a limiting factor and why
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)
if spasticity is a limiting factor, what management is indicated and when
PT - temporary management for improved alignment as prep for functional task completion/practice
medical - when rehab isn’t enough
what are the 4 main goals of spasticity management
- improve acquisition of skills
- prevent secondary complications
- facilitate hygiene
- improve voluntary control
what are 3 factors in clinical decision making with spasticity management
- severity, duration, distribution
- co-morbidity (ie sz disorder, other health conditions)
- other, eg cog deficits, motor control
what are 4 related reasons to see improvement with spasticity management
- medical intervention for condition
- CNS neuroplasticity
- motor learning
- normal sensory input
what is the mechanism of baclofen med and how does it act
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
what side effects are seen w oral baclofen (5)
drowsy
fatigue
nausea
dizziness
HA
what is a baclofen pump and in what cases is it utilized in
surgically implanted in abdomen
used in GMFCS IV or V
what are 3 spasticity meds
baclofen
botox
dantrolene
what is baclofen and dantrolene doing to dec spasticity vs
baclofen and dantrolene
- centrally weakening abnormal ms response (via different pathways)
botox
- local temporary ms paralysis via a neuromuscular block
what is the mechanism of dantrolene and what does this do
impairs release of Ca from sarcoplasmic reticulum
- dec intensity of ms contraction -> dec spasticity
at are 2 side effects of dantrolene
generalized weakness
liver toxicity (LFTs to monitor)
what is the mechanism of botox and how does it dec spasticity
blocks acetylcholine @NM junction
- temporary ms paralysis (axons will sprout)
what are 5 indications for botox in spasticity
improve function
prevent MS complications
dec pain
improve ease of care
appearance
what are 2 limitations of botox
short term
neutralizing antibodies can be developed if used too often
what is PT’s role w botox and what does the research say
PT critical - stretching, bracing, functional exercise
research: improved outcomes when PT + botox vs botox alone
how can serial casting be utilized with botox
takes advantage when ms paralyzed and more flaccid w botox
casting benefits:
- stretch soft tissues
- inc PROM
- future orthotic use
what does the evidence say ab serial casting w botox
research is mixed as to combo of both vs either one alone
- but good outcomes clinically when both utilized
what is selective dorsal rhizotomy (SDR) and how does this reduce spasticity
neurosurgery
- sensory nerve rootlets are severed which reduces spasticity
what is PT’s role in an SDR
intensive PT is required
- need to have support and resources to comply w this
what are 5 qualities making someone an ideal candidate for SDR
- ambulatory spastic diplegic CP
- spasticity > dystonia
- adequate underlying strength
- able to co-operate w post-op rehab
- 4-8yo
what is a spinal laminectomy
select dorsal roots that produce exaggerated motor response when stimulated
- cut/prune some of those to reduce exaggerated response
what quality is focused on by medical management to improve MSK functioning
bony deformity and lever arm dysfunction
- root of many MSK problems
what are 3 MSK disorders that require a referral to an orthopedist
spinal curvatures (prone to scoliosis)
hip migration
ms length restrictions
what is often required since kids w CP are prone to scoliosis
some type of fixation
- rod or wiring to prevent further progression
what is often the medical management for hip migration and what is the goal
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
what are the 3 main medical interventions for ms length restrictions and when do you see them
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
what are 2 complications/considerations of neurosurgery as a medical intervention
- ms tone substitute for strength
- may be allowing GMFCS III or IV to walk “on” spasticity; if remove -> wc dependent - poor ability to rehab after SDR
what are 6 complications/considerations of orthopedic surgery as a medical intervention
- lengthening = weakening
- lengthening when not necessary
- too little surgery
- ortho surgery w/o tone management
- tone management w/o correction of bony abnormalities
- any surgery w/o adequate rehab
