L4 CP/Down Syndrome Flashcards
Cerebral Palsy
motor disability related to early damage of brain in areas controlling motor behaviors
early brain damage in utero, during birth, or shortly after birth
presentation is impacted by etiology, location, and extent of injury
CP of Cerebral Palsy
muscle weakness
dysfunction in motor recruitment
decreased balance
decreased endurance
intellectual impairments
dysfunction in sensory integration
Functional impacts of CP
- ADLs
- delayed developmental milestones
- challenges walking distances
- decreased activity tolerance
- decreased ability to maintain sustaiined active play
- participation in organized sports and recreational activities
Distribution of Involvement
Quadriplegia
Hemiplegia
Diplegia
difficult to classify due to subtle involvement in all extremities, as well as asymmetries with presentation
Displegia
primarily LE involvement
Classifications of CP
Distribution of involvement
Muscle tone or motor control
Degree
Muscle Tone Classification
spastic
Dyskinetic
Ataxic
Mixed
Degree classification
mild
moderate
severe
Dystonia
involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements and/or postures
Chorea
on going, random appearing sequence of one or more discreate movements or movement fragments varying in timing, duration, direction, body location
Athetosis
slow, continuous, involuntary writhing movement that prevents maintenace of stable posture; characterized by smooth continous random movements not composed of identifiable fragments of movement
Tremor
rhythmic back and forth or oscillating involntary movement about a joint axis, rhythmic alternatic movement with relative symmetry in speed
Ataxia
gross lack of coordinated movements
Pelvis and Hip in CP
- may have bony involvement, either due to shape/muscle involvement/length
- pelvic obliquity or leg length discrepancy
- pelvic tilt
- W sitting
- hip sublux, dislocation, instability
Foot and Ankle in CP
- shortened gastroc
- reduced DF ROM associated with PF position during WB
- breakdown of longitudinal arch with difficulty stabilizing foot (flatfoot)
Spine and CP
- may develop scoliosis and/or thoracic kyphosis
- leg length discrpancy contributes to pelvic asymmetry and compensation in spine
- may stand on toes, knees extended, hips adducted, hips IR, pelvis anteriorly tilted
Intervention for CP MSK
- WB to mold bones
- stretching before and after exercise
- night splinting
- orthotics
- surgery
- strength training
- functional training
Gross Motor Function Classification System (GMFCS)
- classification system of gross motor function of kids with CP
- 5 point scale describing functional abilities in sitting, walking, wheeled mobility
- used before 2nd bday, between 2-4, 4-6, 6-12, 12-18
Level 1 of GMFCS
walks without limitations
can run, jump, skip
participates in age appropriate activities
Level 2 GMFCS
walks with limitations
difficulty walking long distances
may need min assist
struggles with different environments
Level 3 GMFCS
walks using a hand-held mobility device
uses AD in home and community
STS needs min assist
w/c for long distances
Level 4 GMFCS
self-mobility with limitations, possible use of powered mobility
requires AD for most to all settings
adaptive seating
needs help with transfers
Level 5 GMFCS
transported in manual w/c
may crawl, roll, creep for short distances
powered or manual w/c
needs seat belt for positioning
Manual Ability Classification System (MACS)
- how children with CP use thier hands in daily activities
- levels based on child’s need for assistance for activities in most settings
- 5 levels
- good correlation between GMFCS and MACS
Levels for MACS
Level 1 = handles objects easily and successfully
Level 5 = child does not handle objects and challenged with simple tasks
Communication Function Classification System
- determine communication abilities of kids with CP
- based on ability to speak, receive, pace, adapting to different context
- 5 levels, with level 1 being the most competent
Interventions for CP
- Medical: botox, oral meds
- surgery
- nutritional management with g tube
- posture
- alignment
- ROM
- strength
- activities
- participation
What categories does the GMFCS test?
lying and rolling
sitting
crawling/kneeling
standing
walking, running, jumping
Down Syndrome
Genetic disorder in which majority of individuals have extra 21st chromosome
non disjunction of two homologos chromosomes during first or second meiotic division
CP of down syndrome
generalized low muscle tone
muscle weakness
slow postural reactions
joint laxity
intellectual disabilites
increased BMI
Functional Impacts of Down Syndrome
- delay of developmental milestones
- decreased ability to maintain sustained active play with peers or family
- decreased participation in organized sports and active recreation activities
- surgery to correct any congenital heart defects
Interventions for Down Syndrome
- early focus on developmental milestones
- strengthening with resistance
- balance
- treadmill/gait training
- orthotics
- aerobic conditioning
- wellness plans and programs
- incorporation of technology
Atlantoaxial instability
enlarged space between first and second cervical vertebrae
present in 15% of individuals with Down Syndrome
risk of excessive motion and spinal cord compresison
Things to avoid with AA instability
tumbling
boxing
diving
horseback riding
gymnastics
things that cause excessive neck flexion or extension
When should initial radiographs be taken for AA instability?
3-5 years and repeated screening is not indicated
special olympics requires screening
Examples of adaptive equipment
- w/c
- go baby go
- strollers
- walkers
- gait trainers
- standers
- adaptive seating
- orthotics
- adaptive cycles
- toilet and bath chairs
- car seats
- communcation tablet
- beds, hoyer lift, ramps
Justification of medical necesity
work with family and equipment vendor to determine need
Chromosome Disoders Types
Structural
Numerical
Structural abnormalities
deletion
translocation
inversion
other
Numerical abnormalities
addition
deletion
