CP Part 3 Flashcards
what is the focus of PT management of CP
participation
- address impairments as it impacts that
what has been the philosophical shift of the view of PT’s role in managing CP
shift to a wellness approach from “fixing”
what does Rosenbaum’s Tyranny of Normal mean
not focusing on the fix, accept as they are
what are the two main components of a PT examination
- observation
- clinical & standard tests/measures (BSF)
what is a critical component of observation in the PT exam
individual and parent/caregiver observations
what are 2 components that should be observed in the PT exam
- overall functional and/or developmental abilities
- equipment (currently used vs prescribed)
what are 5 functional/developmental abilities that should be observed in the PT exam
- communication
- behavior
- eating/drinking
- motor (gross/fine)
- ADLs (IADLs as applicable)
what are 9 BSF impairments to assess in the PT exam
- ms tone (extremities, trunk)
- reflexes (DTR, developmental/primitive)
- ROM (passive, active - taking care w alignment)
- selective control
- strength
- sensation (gross screen)
- integ (screen)
- cardiorespiratory
- pain
how are developmental reflexes screened in the BSF PT exam
are they present, are they integrated
- if older ask for tasks and see if patterns that may indicate a reflex (rather than testing explicitly for that) -> more informative on restriction of motor control
how is ms tone examined in CP
tardieux
- modified ashworth not reliable in CP
how is ROM assessed in a PT exam
goniometry not reliable
- standardize approach w individual instead
why is goniometry not a reliable assessment of ROM in CP
movement disorder
ms tone
skeletal alignment may not be conducive
how is selective control assessed in PT exam
ACOM
how is strength assessed in a PT exam
functional testing - STS, developmental positions
- doc conc/ecc contractions & # of reps (standardize per individual)
use make test
- MMT or HHD might not be reliable
- eval ACOM to determine if MMT/HHD is appropriate
what makes assessing strength in CP so challenging (3)
age
cognition
selective control
how is sensation assessed in PT exam
clinical exam procedures, modified prn (age, comprehension)
how is integ assessed in PT exam
pending screen
- note/doc explicitly what skin you were able to observe
how is cardiorespiratory assessed in PT exam
6MWT** - very valid/reliable
field tests
- shuttle run/walk
- shuttle wheel
how is pain assessed in PT exam
self report (where and # pain)
r-FLACC for nonverbal
what is the r-FLACC assessment for and what does it stand for
nonverbal pain scale (both children and adults)
revised (respiratory) -
Face
Legs (positioning, relaxation)
Activity (quiet, squirming)
Cry
Consolability
what are 5 activities assessed in the PT exam
- functional mobility (transfers, bed mobility, wheeled mobility, amb)
- trunk control
- balance
- gait
- developmental skills (depending on age)
what are 2 tools to assess trunk control
GMFM
SATco
how is the GMFM used to assess trunk control
trunk as unit
quiet sitting
reaching
what is the SATco and what does it determine
segmental assessment of trunk control
- used to measure ability to maintain trunk control while sitting during static, active, and reactive states
determines highest level of trunk support at which child loses postural control
- evaluator shifts hands from at neck down to pelvis (in stages as assessing)
what should the evaluator be looking out for other than the trunk when assessing trunk control
use of UE to create trunk stability
- either on table or up in air
what are tools used to assess balance
clinical exam
tests/measures:
- pedi berg
- pedi TUG
what are 7 common gait analysis findings in CP
- abnormal timing/phasing
- lower amp (EMG) -> weakness
- co-activation vs reciprocal inhibition
- mechanoelastic changes in spastic ms -> shortening
- gastroc - atypical firing
- limited DF (slows gait)
- impaired hip motions
what ms plays a significant role in genu recurvatum
gastroc
what gait finding is especially common in cases of severe CP
impaired hip motions
what is the role of gastroc/PFs w gait
- control ground rxn forces during loading response
- control tibial progression over planted foot
- knee stability, foot posture @ stance
- propulsion for swing
what is higher PF strength correlated with
higher GMFM scores
what are 3 tools to assess development (atypical vs typical)
- AIMS
- TIMP
- PDMS-2
what is the AIMS and what does it test for
Alberta Infant Motor Scale
- predictive of motor outcomes @18mo esp if used at 4mo
for very young infants
what is the TIMP and what does it test for
Test of Infant Motor Performance
- geared toward younger children
what is the PDMS-2 and what does it test for
Peabody Developmental Motor Scale - 2nd ed
both gross and fine motor
what tool is used to assess gross motor skill
GMFM (Gross Motor Function Measures)
what are 4 measures to assess function/activity
- PEDI (pediatric eval disability inventory)
- weeFIM
- TUG (balance)
- TUG downstairs
what can be used to assess participation
pediatric quality of life inventory
elements of PEDI
several measures are validated for population
what is involved in a PT eval
analysis of data
- impairments
- activity limitations
- participation restrictions
identify causal relationships
what does a PT dx guide
prognosis
intervention/POC
what is a main consideration when developing a prognosis for improved activity
levels of GMFCS
what is prognosis for improved activity influenced by (4)
- individual assets
- co-morbid health conditions (ie sz disorder)
- impairments of BSF
- family support
what are 4 ways that the GMFCS is utilized in pt POC
develop prognosis
informative to parents
planning (goal setting)
judging progress over time
according to Montgomery, what was a positive prognosis for ambulation
head control in prone by 9mo AND (I) sitting by 24mo
according to Montgomery, what was a negative prognosis for ambulation
retention of primitive reflexes 18-24mo
lack of (I) sitting by 3yo
utilization of Montgomery today
still relevant, but use gross motor curves more often now
what did Begnuche say was a predictive ability to walk
ability to sit to stand & stand to sit is predictive of ability to take 3 steps independently 1yr later
in general what was Montgomery looking at when predicting ability to walk
head and sitting control
what are the implications of Begnuche’s prognosis for ambulation
may assist w understanding when child may be read for task directed training for amb
what is a con of Begnuche’s prognosis for ambulation
more research is needed
what is participation influenced by (4)
activity limitations overall
hand function
cognition
communication
what does the research show w participation in children w CP
less socially and physically active than non-disabled peers
- lower self-esteem, lower perceived confidence
why is participation so important
participation in leisure activities enhances quality of life & overall health
what are the 4 F’s of valued components of leisure
fun
freedom of choice
fulfillment
friendships
what are 4 key “active ingredients” for a PT intervention
- early dx & begin interventions asap
- interventions should incorporate exploratory learning
- child initiated & executed movement - child makes things happen!
- include problems to solve, variation of problems/solutions, failures and successes and LOTS of practice
what are 6 general goals of PT interventions
- maximize functional movement
- maintain optimal fitness
- address participation
- promote and maintain MS integrity
- prevent secondary impairment
- promote physical fitness
what is the lifespan approach of PT interventions in infancy
within context of family
- enriched environments
- teaching/coaching
what is the importance of enriched environments in infancy PT interventions
promote learning
(+) impact on brain plasticity
- capitalize on this to foster new neuronal connections
what are 3 components to teach in an infancy PT intervetnion
- impairment level as affects postural control & daily care
- experiences to move and explore body abilities
- equipment early to participate (ie adapted stroller, walker, power mobility)
what is the lifespan approach to PT interventions in early childhood
abilities w/i wider context
- impairment
- function/activity
- participation
what are main differences in school age/teenagers w CP vs TD peers
lower QOL for motor/social functioning in CP
psychosocial issues such as poor self-esteem, social interaction, coping skills
what is a consideration of lower QOL and psychosocial issues seen in teens w CP
may complicate transition to adulthood
what are 2 strategies for treating teens w CP
compensation
environmental accommodations
what are 5 pros to a strategy of compensation w environmental accommodations for teens w CP
- inc independence
- prevent disability
- prevent secondary complications (ie w growth)
- health and wellness/inclusive fitness
- “ownership” of care and advocacy
what are 3 major considerations of PT interventions as transition to adulthood
- dec # of available supports & programming
- lack of continuity of care
- lack of medical professionals w experience
what are 3. significant issues that adults w CP experience
pain
physical function
social functioning
why do you see 1/2 of adults w CP who were walking at 18yo, aren’t walking anymore
d/t accessibility issues, inc effort to walk, by choice
amb adults w CP have lower levels of what
physical fitness & less physically active than able-bodied peers
what is a consideration when treating an adult w CP
have access to fewer health care resources than they did as teens
why is research on specific PT interventions difficult
children changing d/t development or interventions
what is the optimal dosing for a specific PT intervention
still to be determined
what is the NAPA model for PT specific interventions
intensive surfaces for shorter time, then maintained over time
what is important when setting up a PT interventions for children to promote optimal learning
implement interventions in a natural setting
what are 4 principles of activity/context-focused PT interventions
- identify constraints hindering performance (ie factors in task, environment, child)
- change identified constraints w/i task and/or environment
- treatment in natural environments
- compensatory strategies when necessary to prevent disability
what are examples of impairment focused PT interventions (5)
stretching
casting
splinting
strength training
sensorimotor training
when should impairment focused interventions be implemented
as needed to aid activity/participation and health/wellness/fitness
what are 4 ways to prevent contractures formation/exacerbation
passive stretching
sustained load
integration into daily routines
overnight stretching
what types of interventions are used to work on strengthening
functional activities
what are 5 functional activities that can be used as strengthening interventions
- transitional movements against gravity
- treadmill use
- tri/bicycle riding
- ascending/descending stairs
- ambulation (target eccentric PFs)
what is the importance of using functional activities to strengthen
specificity of practice
what CP population and age range was progressive & functional resistance training in LEs found most effective
GMFCS I-III
younger children
what are 8 functional resistive exercises utilized in progressive & functional resistance training (LEs)
STS
heel raises
squats
step-ups
stairs
half-knee rises
isometric ex w cuff wts
leg presses
what are the benefits of NMES and FES (3)
dec spasticity
inc strength
improve gait (via FES on PFs or DF)
how can NMES or FES be implemented as a PT intervention
reduces spasticity on a temporary basis
- can use session to dec tone and inc activation of antagonist ms
what does the research show about use of CIMT with UE function
improved movement quality/efficiency of UE compared to SOC
what is bimanual HABIT training
Hand Arm Bimanual Intensive Therapy
- structured, bimanual training for children w CP
recent studies have shown what (+) impacts of CIMT and HABIT
(+) impact on impairment level (BSF, activity, participation) not just on functional levels
what does the evidence show about treadmill training
tough to get conclusive results b/c varied protocols but:
(+) endurance
(+) gait speed
(+) community amb
what are the benefits of BWSTT or PBWS
offers learning opportunities
safe, task-specific gait training
- provides learning opportunity in a safe and controlled environment
what are 6 examples of assistive tech
orthotics
ADs
wc/seating systems
positioning devices
communication devices
environmental control units
what role does orthotics play in various levels of CP
GMFCS I-III: improve movement patterns, gait
GMFCS IV-V: provide alignment, prevent deformity
what 2 things do w/c provide pts
postural support
independent mobility
what are 2 examples of positioning devices
standers
sidelyers
what are 4 goals of LE orthoses
- promote biomechanical alignment
- prevent contracture, hyper-extensibility, & deformity
- enhance standing postural control and balance
- reduce energy cost of standing & walking
what gait impairment are GRAFOs good for
people w crouched gait
- facilitates ext via ground rxn force
what does a PLS AFO encourage
DF - spring forward
what motions are hinged AFOs good for
STS
what is a post walker better for
better opportunity for ext through trunk
CP is a chronic developmental disability which is affected by (3)
growth
maturation
life management
