Last Chapters Flashcards
Guillain-Barre Syndrome (GBS)
Rapid progressive ascending paralysis due to peripheral
nerve involvement.
* Temporary paralysis
* Usually preceded by a viral infection in the upper respiratory or GI tract.
* GBS may be the result of an autoimmune response to the viral infection.
* Results in de-myelinization of the nerve roots and nerve
conduction is thus affected.
Diagnostic Tests: EMG, Spinal tap, blood/urine
Treatment: plasmapheresis, intravenous immunoglobulin
progression of GBS
- Usually begins in the lower extremities and affects proximal muscles more than distal musculature
- Diaphragm and upper extremities often involved; may require mechanical ventilation
- Sensory loss often present
- Lasts for three weeks or more
- Facial weakness
GBS Early Onset Disease
onset in first week of life
leading cause of sepsis in neonates
can also cause pneumonia, meningitis
acquired by fetus in utero or during birth
GBS Late onset disease
usually occurs 1-4 weeks after birth, but may occur up to 3 months of life
wider clinical spectrum
may cause: meningitis, sepsis, septic arthritis, osteomyelitis, pneumonia
GBS OT Intervention
Preventative role during course of disease (positioning, maintenance of ROM, prevention of contractures, splinting)
* Sensory stimulation and orientation programs in the case of coma
* Intense rehab program based on presenting neuromuscular and
functional needs once child is medically stable
* Attempt to return child to functional level that existed prior to GBS.
* Adapted equipment to compensate for weakness during the recover process
* Management of/compensatory for residual deficits as needed.
Meningitis
Inflammation of the
meninges secondary to
bacterial or viral
infection, which can be
life threatening
Meningitis Symptoms
Neonates: Neonates show irritability, poor feeding, and
vomiting, Lethargy, seizures, bulging anterior fontanels
Infants: tonal abnormalities, High fever (both neonates and older infants)
Older Children:
* fever, nausea, vomiting, lethargy, headache, confusion,
and light sensitivity
* Focal neurological signs such as paresis, ataxia, hearing
deficit, may be present
* Long-term sequelae result from brain-cell destruction
secondary to edema and /or vascular disease.
* May include hearing deficit, seizures, language
disorders, MR, motor abnormalities, visual impairment, ADHD, learning disorders, lower IQ scores
Kernig’s and Brudzinski’s Sign
Kernig’s Sign: Report of pain or resistance of knee
extension by the child suggests meningeal
irritation
Brudzinski’s Sign: Elicited by passively flexing the neck. If knee and hip flexion result, sign of meningeal irritation
Encephalitis
- Infection or inflammation of
the brain tissue - manifested by altered
consciousness, fever,
headaches, and /or focal
neurological signs. - Usually preceded by viral
infection.
Encephalitis: Symptoms
Signs and symptoms assist in identifying location of infection
* Upper-respiratory symptoms
* Nausea, vomiting or headache
* Lethargy or drowsiness which may lead to coma
* Confusion, hallucinations, disorientation
* Seizures, hemiplegia, ataxia, dysarthria, dysphagia, and
hemianopsia
Seizure Disorders
- A sudden, involuntary, time-limited alteration in
neurological function secondary to an abnormal
discharge of neurons in the CNS - Manifested by involuntary motor, sensory or
autonomic events, alone or in any combination, often
accompanied by alteration or loss of consciousness
Seizure Disorder: Incidence
- May occur after a transient metabolic, traumatic, anoxic
or infectious insult, or - Reoccur without evident time-limited cause, as in
epilepsy - Boys at greater risk than girls
FEBRILE SEIZURES
Convulsions that can happen when a young child has a fever above 100.4°F
usually last for a few minutes and stop on their own
Partial Seizures: Simple
Involve one side of brain
no loss of consciousness
occurs ages 4-12
-Motor manifestations are dependent on the area of the
motor cortex where seizure is initiated
-Autonomic nervous system symptoms include
abdominal pain, tachycardia, pupil dilation, and flushing
-Todd’s paralysis: paralysis of muscles involved in
the seizures which can last from minutes to hours
-Somatosensory symptoms involve sensory functions
such as: Numbness, unpleasant odors, falling, or feeling like one is floating in space
-Psychic symptoms (Aura): illusions, delusions, hallucinations, or paranoia
-Etiology is early birth trauma, subarachnoid
hemorrhage, or encephalitis
Complex Partial Seizures
must occur in temporal lobe
resembles absence seizures
Last for 30 seconds to 5 minutes
-50% thought to have an aura that precedes the main
seizure
-May include upset stomach, odd smell or taste,
hallucination, fear
-Involve involuntary motor activity during a period of altered consciousness that may be ictal or postictal (eye blinking, staring, lip smacking, chewing, swallowing, hand gestures, crying, laughing, or repeating a word or phrase
-Amnesia, confusion, fatigue often follow
-Etiology includes temporal-lobe insults, asphyxia,
head injury, tumor, infections
Generalized Seizures
both sides of brain involved.
* 40% of all seizures.
Four types of Generalized seizures:
1. Absence
2. Tonic-clonic
3. Myoclonic
4. Atonic
Generalized Seizures: Absence
Seizures
petit-mal seizures
* Onset from 3 to 15 years
* No aura
Lapses in consciousness or blank stares lasting about 10 seconds
* Cannot be interrupted by touching or talking, and therefore can be
differentiated from daydreaming
-Involuntary movements may include lip licking,
chewing, smiling, or scratching
* Child recovers rapidly without confusion or
fatigue as if nothing happened
* May result in poor school performance
Generalized seizures: Tonic-Clonic Seizures
Most common type of generalized seizures
* Most dramatic and can occur at any age
* Formally known as grand-mal seizures
* Begin with vague aura or crying, with a loss of
consciousness, and the child falling to the floor
-Tonic phase is with rigid extension of arms and legs which lasts 30 seconds to 1 minute and may be accompanied by apnea;
tongue biting may also occur
* Clonic phase results in intermittent muscle relaxation and contractions that appear as body jerks that may last several minutes, incontinence may occur afterwards
-Sleep and lethargy after the seizure is over
* Impairments from the seizure depend on length
of seizure
* Etiology is often unknown, but seen with metabolic disturbances, trauma, infection, degenerative disorders, brain tumors, intoxication
Generalized seizures: Myoclonic Seizures
- Present between 2 and 7 years
- Characterized by abrupt jerking in muscles of one
or more groups - Brief and involuntary
- Consciousness is only briefly altered if at all
Generalized seizures: Atonic Seizures
Occur between 2 and 7 years
* Sudden loss of muscle tone followed by a fall to the floor and loss of consciousness
Syndromes Involving Seizures
- West’s Infantile Spasms
- Lennox-Gastout
- Aicardi
- Febrile Convulsions
Medical Treatment for Seizures
Tegretol, Klonopin, Zarontin, Phenobarbital, Dilantin,
Mysoline, Depakote
* Therapeutic dose = Amount of drug needed to
control the seizures and minimize the side effects
* Almost all traditional seizure medications have
side effects (drowsiness, lethargy, gum swelling).
Traumatic Brain Injury
(TBI)
One of the most common types of injury that causes death among children
Common causes:
* Falls
* Motor vehicle accidents
* Assault
* Child abuse
* Sports and recreational activities
Open-Head Injury – a visible injury that causes penetration of the skull which exposes brain substance
Closed-Head Injury – is enclosed in the skull. Caused from rapid acceleration and deceleration of the head
Symptoms of TBI
Child may or may not lose consciousness
* May develop:
lethargy, Confusion, severe headaches, Irritability, Vomiting, speech impairments, and motor impairments
