Last Chapters Flashcards

1
Q

Guillain-Barre Syndrome (GBS)

A

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

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2
Q

progression of GBS

A
  • 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
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3
Q

GBS Early Onset Disease

A

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

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4
Q

GBS Late onset disease

A

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

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5
Q

GBS OT Intervention

A

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.

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6
Q

Meningitis

A

Inflammation of the
meninges secondary to
bacterial or viral
infection, which can be
life threatening

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7
Q

Meningitis Symptoms

A

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

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8
Q

Kernig’s and Brudzinski’s Sign

A

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

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9
Q

Encephalitis

A
  • Infection or inflammation of
    the brain tissue
  • manifested by altered
    consciousness, fever,
    headaches, and /or focal
    neurological signs.
  • Usually preceded by viral
    infection.
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10
Q

Encephalitis: Symptoms

A

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

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11
Q

Seizure Disorders

A
  • 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
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12
Q

Seizure Disorder: Incidence

A
  • 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
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13
Q

FEBRILE SEIZURES

A

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

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14
Q

Partial Seizures: Simple

A

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

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15
Q

Complex Partial Seizures

A

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

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16
Q

Generalized Seizures

A

both sides of brain involved.
* 40% of all seizures.
Four types of Generalized seizures:
1. Absence
2. Tonic-clonic
3. Myoclonic
4. Atonic

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17
Q

Generalized Seizures: Absence
Seizures

A

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

18
Q

Generalized seizures: Tonic-Clonic Seizures

A

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

19
Q

Generalized seizures: Myoclonic Seizures

A
  • 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
20
Q

Generalized seizures: Atonic Seizures

A

Occur between 2 and 7 years
* Sudden loss of muscle tone followed by a fall to the floor and loss of consciousness

21
Q

Syndromes Involving Seizures

A
  • West’s Infantile Spasms
  • Lennox-Gastout
  • Aicardi
  • Febrile Convulsions
22
Q

Medical Treatment for Seizures

A

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).

23
Q

Traumatic Brain Injury
(TBI)

A

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

24
Q

Symptoms of TBI

A

Child may or may not lose consciousness
* May develop:
lethargy, Confusion, severe headaches, Irritability, Vomiting, speech impairments, and motor impairments

25
Q

Glascow Coma Scale

A

Severity of TBI is determined by this scale, an effective
indicator that assesses 3 areas:
* Motor response: 6 = obeys to 1 = none
* Verbal response: 5 = oriented to 1 = none
* Eye-opening: 4 = spontaneous to 1 = none
* Total score of 8 or less is considered severe

26
Q

Spina Bifida Occulta

A

Most common type
* Abnormal opening of the spine because the arches of
the vertebrae do not fuse
* Spinal cord usually is not damaged and neurological
function is usually intact
* May see dimples, tufts of hair, or no visible sign at all
at the site of the defect
* May be bowel and bladder problems and lower-
extremity motor-control problems in a small minority
of cases
* May not be identified until adolescence or later
when individual or adult presents with low back pain

27
Q

Spina Bifida: Meningocele

A

Least common type
* Meninges are pushed out through the opening to
form a sac that is covered by skin
* Sac contains CSF and meninges
* spinal cord remains intact
* Similar to occulta
* May have no neurological deficit after repair

28
Q

Spina Bifida: Myelomeningocele

A

Motor deficits at and below the level of
the lesion, and at times for several
segments above
– Lesion level determines the extent of sensory and
motor deficits

29
Q

Encephalocele

A

A Sac-like protrusion
* Usually a defect in midline fusion of the cranial
bones, usually occipital, which leads to protrusion of
the cerebral tissue
* Typically results in multiple handicaps
* Problems depend on extent of brain damage
* May present more like a child with cerebral palsy or
like a high-level spinal-cord injury

30
Q

Factors impacting hips

A
  • Subluxation with greatest incidence at the L3-L4
    motor level
  • Coxa Valgus (distal more lateral)
  • Coxa Varus (medial)
  • Femoral Anteversion
31
Q

Factors impacting Knees

A
  • Flexion Deformity
  • Valgus
  • Extension Deformity
  • Genu Valgus
  • Genu Varus
32
Q

Factors Impacting Ankle/Foot

A

Equinovarus Foot
* Valcaneous Foot
* Calcaneal Valgus Foot
* Vertical Talus
* Flexion Contracture of the Toes (toe clawing)

33
Q

Factors Influencing Ambulation

A

-Motor level is the most significant factor
* Presence or absence of quads
* Upper-extremity involvement (spasticity adversely
effects ambulation)
* Spinal deformities
* Hip deformities
* Knee and foot deformities
* Fractures
* Weight/presence of obesity
* Motivation

34
Q

Urologic Problems

A
  • Neurogenic bladder
  • Urinary-tract infections
  • Kidney involvement
35
Q

Incomplete Transection of Spinal Cord

A
  • Flaccid paralysis with exaggerated reflex activity
    distally, or
  • Flaccid paralysis with reflex activity elicited by direct
    stimulation, or
  • Spasticity with some voluntary movement and
    sensation, or
  • Mixed flaccidity and spasticity
36
Q

Syringohydromyelia (Syringomyelia,
Hydromyelia, Syrinx)

A
  • Abnormal fluid-filled cavities in the spinal cord
  • Symptoms dependent on location
  • If cervical, see ocular and swallowing problems (cervical
    paravertebral muscles)
  • May see changes in upper-extremity function and gait;
    sensory and motor deterioration of arm and hand function
  • Scoliosis, proximal to the level of the cavity
37
Q

Tethered Cord

A

Adherence of the spinal cord to a fixed boney structure
* Symptoms:
* Deterioration in gait
* Decreased lower extremity function
* Increased incontinence or change in previously
acquired bowel and bladder function

38
Q

Frontal Lobe seizures

A

may cause disruptive behavior, running, screaming, fear, anger, undirected aggression, swearing

39
Q

Occipital Lobe seizures

A

may cause visual distortions and images of people or things that are not actually there

40
Q

Temporal Lobe seizures

A

may cause changes in sense of smell, block speech, chewing, picking at clothes, repetitive body movements, alter consciousness & mood, person stares blankly, can’t understand directions, unresponsive, illusions of sounds, ringing in the ears