Lecture 5: Management Of Neurologic Conditions Flashcards
CP, BP, DCD, Autism (ASD), Myelodysplasia
These are examples of what kind of diagnosis
Neurologic
What describes a group of disorders of the
development of movement and causing activity
limitation, that are non-progressive disturbances
that occur in the developing fetal or infant brain
Cerebral palsy
What are motor disorders of CP often accomplished by
Disturbances in sensation , cognition , communication . Perception and/or behavior and/or seizures
What is the most common motor disability in cildhoood
CP
T/f: greater then half of the children with CP have a co occurring condition
True
When can distrubances in the brains function/development occur for CP
prenatal
Birth
Postnatal
CP can also bc caused by a CNS lesion and what may it result in
Spastic , athetoid , ataxic or mixed movement impairment
What system is damaged if the patient has pure spasticity only for CP
Pyramidal
If a patient has athetoid cerebral palsy what system is invovled
Extrapyramidal
What are the prenatal risk factors during pregnancy for CP (7)
- STORCH infections
- CHEAP torches
- maternal seizure disorder
- maternal high BP
- maternal toxin exposure
- bleeding in 3rd trimester
- thyroid hormone disorder
What are the prenatal risk factors for CP (12)
- Multiple Gestation
- Hypoxia
- Metabolic disorders
- Malformation of brain structures
- Vascular Insults
- Abdominal Trauma
- Premature birth (< 32 weeks or < 2500 grams)
- blood incompatibility
- asphyxia
- infection/chorioamniotis
- placental abruption
- instrumented delivery
What are the post natal risk factors for CP
Seizures w/in 48 hrs. after birth
Cerebral Infarction
Hyperbilirubinemia
Sepsis
Respiratory Distress/Chronic lung disease
Meningitis
What are the postnatal risk factors/events later in infant/early childhood for CP
Infections/meningitis
Non-accidental trauma (shaken-baby)
Accidental trauma – TBI – shortly after
birth
Asphyxia – choking, near drowning
What is preiventricular leukomalacia
Bilateral white matter necrosis
Who is periventricular leukomalacia most commonly observed in
Premature infants
< 32 weeks
What does PVL have a high correlation with
Development of CP
What is the most common variety of neonatal interventricular hemorrhage
Subependymal germinal matrix IVH
What grades of Interventricular Hemorrhage (IVH) are correlated with CP
Grades 3 and 4
Grades 3 and 4 of Interventricular Hemorrhage (IVH) are highly correlated with what
CP
CP classifications
Diplegia
Hemiplegia
Triplegia
Quadriplegia
Diplegia- both legs
Hemiplegia- one side of body
Triplegia- 3 limb s
Quadriplegia- all 4 limbs
T/F: invovlement for CP is always symmetrical from 1 side to another
False it is rarely symmetrical from side to side
What is the most common type of CP
Diplegic Spastic CP
What are the GMFCS levels 1-5
Level 1 – walks w/out limitations
◦ Level 2 – walks w/ limitations but with no walker or anything
◦ Level 3 – walks using a hand-held device
◦ Level 4 – self-mobility w/ limitations; may
use powered mobility
◦ Level 5 – transported in a manual wheelchair
What GMFCS levle is the most mild and most severe
Level 1= mild
Level 5= severe
Is CP progressive ?
The lesion in the brain that causes CP is not progressive
But in terms of MSK issures it is bc the kids grow
Poor motor control affects the timing and coordination of mm activity but what does it also affect
Mm growth bc mms grow in response to stretch
This is how mm grow
For example, a child gets up in the morning and her bone
has grown slightly from day before
As she runs and plays during the day the muscles that
span that bone are being stretched.
It is this stretch in conjunction with the presence of
growth hormones which signals the muscles to grow in
length by adding sarcomeres at the musculotendonus
conjunction
For kids with CP it is different .. how
Kids with CP are unable to move thru the entire joint ROM repeatedly so then the mms can’t stretch correctly so then the mm cant grow since they grow in response to stretch
What does tight PF lead to in the foot
Pronates
What is the bony lever arm
Moment arms upon which the mm act on
What does moment =
Center x distance
What alter bone growth both in shape in orientation
Abnormal mm forces combined with the lack of normal growth stimulation
Abnormal mm forces combined with the lack of normal growth stimulation alters what
Bone growth both in shape and orientation
What are the factors that the depend on the rate of child’s bone growth
- physiological stresses
- nutrition
- presence of growth hormones
The bones have a preprogrammed blue print for shape but the blueprint is also dependent on the magnitude and direction of what kind of forces
Internal mm and external mm forces that act on the bone
What can alter the bony lever arms in CP that is often referred to as lever arm dysfucntion
Abnormal mm forces , lack of Normal movement and/or weight bearing , disuse and compensatory mechanisms
What does autism significantly affect
Verbal and non verbal communication
Social interaction
When is ASD generally evident before
3 y/o
What is often impaired with ASD
- motor performance
- apraxia
- coordination
- toe walking
What is Asperger characterized by
Significant difficulties in social interactions
Sensory integration disorder defects lie in what
Perception , organization and coordination response to sensory information
What is sensory integration dysfucntion caused by
Neurological immaturity or malfunction in brain processing
What is is the behavioral manifestation of sensory processing which leads to modulation and praxis
Sensory integration
What is a neurophysiologic term that reflects the reception, modulation, integration, and organization of sensory stimuli, but not
necessarily the adaptive environmental interaction that we observe.
Sensory processing
What is considered an over responsiveness or under responsiveness to stimulation and may be reflected in sensory seeking or sensory avoiding
Sensory modulation dysfucntion
What disorders may have neuroanatomic origins in neural activity before motor execution causes dyspraxia and postural disorder
Sensory based motor disorders
What is a standardized testing that has a family of assessments provides standardized tools to help evaluate a child’s sensory processing patterns in the context of home, school, and community-based activities
Sensory profile 2
What was developed to evaluate sensory processing patterns in the very young. The
results provide understanding of how sensory processing affects the child’s daily functioning performance.
The infant/toddler sensory profile
What Does the adolescent/adult sensory profile help measure
Sensory provessing patterns and effects on functional performance
How is sensory processing disorder diagnosed through
A comprehensive evaluation that includes standardized testing , obersevation and a review of a Childers development
What is Sensory Integration and Praxis Tests (SIPT)
A series of tests that assess how a child processes sensory input
What are the 6 sensory systems
Proprioception
Vestibular
Tactile
Vision
Auditory
Taste and Smell
What are the common sings and SYMTOMS for DCD
Frequently occurs with learning disabilities and attention
deficit disorders
Decreased muscle tone
Muscle weakness
Motor incoordination
What is a Genetic disorder in which majority of individuals have extra 21st chromosome
DS
What aer the signs and symptoms of DS
Generalized low tone
Muscle weakness
Joint laxity
Slow postural reactions
Intellectual impairment
Possible heart defects**
Possible cervical instability**
What does deficits of a TBI depend on
The degree of injury
What are common things seen with TBI
Altered tone
Motor control issues
Weakness
Balance Dysfunction
Impaired gross and/or fine motor ability
Intellectual, behavioral, emotional and/or speech deficits
What is a Group of congenital disorders characterized by varying degrees of incomplete closure of the embryonic neural tube
Spina bifida
What a kind of allergy does spina bifida have
Latex
What are the 3 classifications of spina bifida based on the degree of neutral tube deficit
- occulta
- meningocele
- myelomningocele
What is occulta as a degree of neutral Tude deficit
Mildest form , sometimes called hidden.. may only see a turf of hair
What is meningocele
Protrusion of posterior elements of spine with extrusion of meninges and CSF but without involvement of neutral elements
What is myelomingocele
Extrusion of neutral elements such as nerves and spina cord as well as the meninges and CSF
Most severe
There is Relationship between inadequate ____ and ___ __ intake and neural tube deficits
Vitamins
Folic acid
What is diminished and impaired for myelonmeningocele
- diminished trunk or LE strength and sensation
- impaired bowel and bladder
What should u monitor for myelomeningocele
Scoliosis
What is importance to observe and assess for myelomeningocele
Hydrocephalaus
Knowledge of what 2 things should be known about with patients with Myelomeningocele
Shunt malfunctions
Tethered cord
What should u look for when thinking tethered cord involement for SB/ mylingenolcele
Cutaneous tufts of hair or dimples or skin disocolroation in the low back region
What are signs of tethered cord
- LBP that worsens with activity and improves with est
- leg pain or numbness
- gait disturbance
- foot or spinal deformities
- difficulties with bowel and bladder
- repeat UTI’s
What are shunt malfunctions warning signs
- Headaches
- Vomiting
- Lethargy (sleepiness)
- Irritability
- Swelling or redness along the shunt tract
- Decreased school performance
- Periods of confusion
- Seizures
What can fetal alcohol syndrome result in
Intellectual impairments
Learning disabilities
Communication deficits
Fine motor deficits
What is Neurofibromatoses
Generic disorders that cause tumors to grow in the nervous system
What can Neurofibromatoses result in
Impairs function of the joints and bones
Potential impaired mobility
Potential self-care issues
What are the interventions for Neurofibromatoses
to prevent secondary impairment and optimize activity and participation
What is STORCH infections
- Syphilis
- toxoplasmosis
- other infections (varicella zoster(
- rubella
- CMV (cytomegalovirus)
- herpes
What is CHEAP torches
- chicken pox
- hepatitis (B,C,E)
- Entervirus
- AIDs
- parovirus
