lecture 4: CMT and ITW, blocks Flashcards
What should parental education for CMT include?
neutral head positioning (feeding both directions, positioning)
*environmental modifications to increase active ROM (crib, high chair placement)
infants who play in prone for a total of _____ per day decreases negative effects of Back To Sleep program
60 minutes
CMT Classification Scale: Grade 1
severity: early mild
age: 0-3 months
PROM: only postural/mm tightness less than 15 degrees
When should infant be referred for CMT?
early! ASAP!
CMT classification Grade 2
severity: early moderate
4-6 months
15-30 degree
CMT classification Grade 3
early severe
4-6 month
more than 30 degree tight or SCM MASS
CMT classification Grade 4
late mild
7-9 months
mm tight less than 15 degrees
CMT classification Grade 5
late moderate
10-12 month
less than 15 degrees
CMT classification Grade 6
late severe
7-12 months
more than 15 degrees
CMT classification Grade 7
after 7 months with SCM MASS
after 12 months with more than 30 degrees tight, SCM mass,
or referred after 12 months
What is the treatment plan for ITW?
- stretch gastroc/soleus
- strengthen DF/PF
- with significant tendo-achillis contractures, patients may require serial casting (10 degree DF goal)
Should you perform surgery for ITW?
NO VERY RARE
*causes iatrogenic gait deviation, disrupts plantarflexion knee extension couple!
true or false: a group of children that have a family history of idiopathic toe walking
TRUE
*autosomal dominant pattern
Association between ITW and _____ delays
language!
*need to have speech and language milestones examined
children with ____ often exhibit toe walking
autism
sensory integration disorder/issues
on-going, random-appearing
sequence of one or more discrete movements
or movement fragments varying in timing,
duration, direction and body location
chorea
slow, continuous, involuntary
writhing that prevents maintenance of a stable
posture
athetosis
rhythmic back-and-forth or
oscillating involuntary movement about a joint
axis
tremor
refers to a gross lack of coordinated
movements that generally originates from
damage to the cerebellum
ataxia
When children with neuro disorders “freeze the degrees of freedom” when doing a challenging/new task…what could it mistakenly look like?
SPASTICITY
*need to assess
What are blocks?
Compensations that help baby achieve mvmt goals, blocking normal development.
Assist in setting the atypical motor development process
THEY HAVE STRONG EXTENSORS but antigravity flexion components don’t develop well…
a lot of the time, babies with “blocks” have ___ tone
learn to hold themselves with “fixing”
hypotonic postural tone even if they have strong extensors!
What are the four common blocks?
- neck
- shoulder
- pelvic hip block:APT
- pelvic hip block: PPT
what does neck block look like?
- neck hyperextension, lack of tucking/midline
- elevated shoulders to stabilize head
*typical development of scapula is BLOCKED, affecting UE and oral motor development
With a shoulder block, what does not develop?
- scap stability does not develop
- lack of scap rotation will not allow free UE mvmt
- lack of forearm WB
- UE development is blocked
What will you see in a neck block later with development?
What reflex will b dominated?
Lack of bilateral symmetrical head and neck
flexor muscle action, may see dominance by
ATNR
Blocks bilateral UE development, bilateral
ocular development, spine rotates in
direction of head, emphasizes spinal
extension
*poor BUE use, poor body awareness, poor ocular control, maybe scoliosis, hip sublux
What is a pelvic hip block APT?
Lumbar extensors and hip
flexors are tight shifting pelvis into an anterior tilt.
FROG POSITION PRONE
increased hip F/ABD/ER increases anterior pelvic tilt and lumbar extension
What does APT pelvic hip block cause?
- block lateral weight shifts, righting reactions
- immature quadruped, can’t dissociate LEs, leads to BUNNY HOPPING
- sitting: ring sitting
What is a pelvic hip block PPT?
pelvis stuck in PPT: hip extensors are tight, pulling pelvis into posterior pelvic tilt, INACTIVE PELVIC MMS
often stuck, unable to weight shift,
SACRAL SITTING
What does a PPT pelvic hip block lead to?
rounded, flexed spine in sitting
W-sitting
unable to laterally WS
creeping: bunny hopping
standing: narrow BOS, adduction of LEs (scissoring later)
unable to WS or dissociate LEs
When child tries to stand/take steps with PPT pelvic hip block, what will you see?
adduction/ scissoring of LEs
What bony structure will be affected due to pelvic hip blocks?
HIPS! ACETABULUM
did you take x rays of the hip???
review the 10 neuroplasticity principles!
- Use it or Lose it
- Use it and Improve it
- Specificity
- Repetition
- Training Intensity
- Time
- Salience
- Age
- Transference
- Interference
