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EP4133: Exe for Clinical Populations > Final Lecture 11 > Flashcards

Final Lecture 11 Flashcards

1
Q

a group of disorders of movement and posture causing disability

  • Due to disturbances in fetal or infant brain
  • condition is non-progressive
  • disability may worsen
  • the most common cause of motor disability in children
A

cerebral palsy

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2
Q

4 types of CP

A

Spastic
Athetoid
Ataxic
Mixed forms

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3
Q

Prevalence of CP

A
  • 500,000-764,000 people in U.S.

- 3.3 per 1,000 8 year old children

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4
Q

Incidence of CP

A

1.5- 2.5 per 1,000 births

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5
Q

Total direct cost of CP

A

$2.2 billion per year

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6
Q

Average lifetime cost of CP

A
  • $11.5 billion for people with CP born in 2000

- $921,000 per person

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7
Q

Pathophysiology of CP

A
  • caused by injury:
  • prenatal (75% of cases)
  • during birth
  • post-natal
  • Impairment in voluntary motor control
  • damage to different brain areas affect people in different ways
  • symptoms vary between people
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8
Q

Risk factors of CP

A
  • Premature births; low weight births
  • smoking
  • alcohol abuse
  • poor management of maternal conditions (diabetes, infections, hypertension)
  • multiple births
  • prolonged hypoxia during births
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9
Q

(affects 70-80% of patients)

  • hypertonia; spasticity; contractures; stiff muscles
  • named by limbs affected
A

Spastic CP

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10
Q

(affects 10-20% of patients)
-uncontrolled and slow movements in hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling; increase with stress; speech problems

A

Athetoid CP

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11
Q

(affects 5-10% of patients)
-usually due to damage in cerebellum; hypotonia; tremor; motor control affected; balance problems; unstable and wide gait

A

Ataxia CP

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12
Q

Combinations of symptoms from other types (most commonly: spastic + athetoid)

A

Mixed Form CP

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13
Q

Spastic symptoms

A
  • symptoms may affect one or both side
  • tight & weak muscles
  • abnormal gait
  • paralysis
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14
Q

Other CP types symptoms

A
  • abnormal movements (jerking, tremors, writhing)
  • unsteady gaits
  • loss of coordination
  • floppy muscles
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15
Q

Percentage of 8 year old children with CP who walk independently

A

58.2%

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16
Q

Percentage of 8 year old children with CP who uses hand-held mobility device

A

11.3%

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17
Q

Percentage of 8 year old children with CP who have limited or no walking ability

A

30.6%

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18
Q

Additional Symptoms

A
  • cognitive or learning disabilities
  • speech problems
  • hearing or vision problems
  • seizures
  • pain
  • difficulty sucking or feeding in infants
  • problems with chewing and swallowing in other children and adults
  • vomiting or constipation
  • increased drooling
  • slower than normal growth
  • breathing difficulties
  • urinary incontinence
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19
Q

Associated Clinical Conditions

A
  • components of the primary disabling condition

- not preventable

20
Q

Secondary Clinical Conditions

A

Physical or psychosocial health problems resulting from the primary disabling condition
-preventable

21
Q

Comorbid Clinical Conditions

A

health problems independent of primary conditions

22
Q
  • Bowel/Bladder problems
  • cognitive impairment
  • musculoskeletal problems
  • oral motor dysfunction
  • respiratory problems
  • seizures/ epilepsy
  • sensory impairments
  • vision problems
A

Associated Conditions

23
Q
  • Cardiovascular conditions
  • deconditioning
  • fatigue
  • mobility problems
  • communication disorders
  • depression
  • obesity
  • pain
  • pressure sores
A

Secondary Conditions

24
Q

Diagnosis of CP

A
  • Physical Exam-maternal and infant medical history, motor skill testing, reflexes, muscle tone, spasticity, posture, ruling out other conditions
  • EEG
  • Hearing and vision testing
  • imaging of the brain: CT, MRI
25
Q

True/False: no cure for CP

A

true

26
Q

Treatment for CP

A
  • management to improve independence
  • medication
  • positioning and walking aids (braces, splints)
  • hearing aids
  • glasses
  • rehabilitation
  • orthopedic surgery
  • electrical stimulation
  • lifespan similar to general population
27
Q

Multi-disciplinary team

A
  • pediatrician/family practitioner
  • orthopedic surgeon
  • neurologist
  • ophthalmologist
  • dentist
  • nurse
  • orthotist (specializes in making braces and splints
  • rehab medicine specialists
28
Q

improvements in:

  • VO2 peak
  • leg strength
  • sub-maximal VO2 (decrease)
  • gross-motor function
A

Endurance Exercises

29
Q
  • Improvements in:
  • muscle strength
  • walking ability

-does not cause spasticity

A

Resistance Exercises

30
Q
  • Prevention of contractures

- increased ROM

A

Flexibility Exercises

31
Q

Effective combinations of exercise

A

resistance and endurance

32
Q

Functioning ICF components include:

A
  • Health Condition,
  • (Functioning) body functions and structures, activities, and participation
  • (Contextual Factors) :environment factors, personal factors
33
Q

Functional environmental factors include:

A

accessibility, attitude towards people with disability

34
Q

Functional Personal factors include:

A

income, attitude towards life

35
Q

Disability ICF components include:

A
  • Health Condition
  • disability; impairments, activity limitations, participation restrictions
  • Environmental and personal factors
36
Q

Exercise Testing includes:

A
  • Medical Clearance
  • health related quality of life
  • gross motor skills
  • posture, balance, and gait
  • cardiovascular fitness:
    - GXT with mild increases
    - consider heterogeneity of responses
    - upper-body exercise common
  • Muscular strength and endurance (exercise machines preferred)
  • Flexibility - similar to non-disabled populations
  • expect low fitness
37
Q

Exercise Prescription for CP

A
  • General principles apply
  • FITT for people with CP not known
  • modifications based on function, mobility associated and secondary conditions
38
Q

Cardiovascular fitness training for CP

A
  • non-weight bearing recommended
    • to avoid joint & muscle pain
    • consider swimming/water activity, cycling
    • upper-body common
39
Q

Cardiovascular fitness intensity level

A
  • start at low intensities (40-50% VO2R)
    • formulas that estimate VO2 cannot be used
    • evaluate potential for fatigue

-consider interval training

40
Q

Equipment used in muscular fitness training for CP

A

Machines, cuffed weights, elastic bands, hydrotherapy

41
Q

Muscular fitness training in CP

A

Exercises for weak muscle groups opposing hypertonic muscles (ex: elbow extension)

- improve strength of agonists 
- normalize tone in antagonists
42
Q

neuromuscular electrical stimulation and whole-body vibration improves ______

A

strength (no adverse effects on spasticity)

43
Q

T/F: speed of contraction should be slow in order to avoid stretch reflex activity of opposing muscles

A

true

44
Q

Types of stretching in CP flexibility training

A

active and passive

45
Q

t/f: Tai chi and yoga improves flexibility in people with CP

A

true

46
Q

Special considerations for training in people with CP

A
  • during growth, hyper tonicity may change
  • medical interventions may drastically change functional potential
    - botox injections for spasticity
  • good positioning may help control primitive reflexes
    - simple modifications may improve positioning (cuffed weights; Velcro straps)

-Persons with CP are susceptible to overuse injuries

EP4133: Exe for Clinical Populations (10 decks)

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