lecture 5: POC/TX Neuro conditions Flashcards
CP, BP, DCD, autism, myelodysplasia are examples of
neurologic/neuroMSK diagnoses
CMT, ITW, OI, arthrogryposis are examples of
MSK diagnoses
congenital heart conditions, cystic fibrosis, asthma, long term mechanical ventilation are examples of
cardiopulmonary diagnoses
motor disorders of ___ are often accompanied by disturbances in sensation, cognition, communication, perception, and/or behavior, and/or a seizure disorder
cerebral palsy
T or F: CP is a specific term giving information about the functional level of the individual
F
CP = nonspecific term
does not give info about functional level
the most common motor disability in childhood
CP
more than half kids have a co-occurring condition
prenatal risk factors of CP during pregnancy
STORCH
CHEAP
maternal seizure disorder
maternal high BP
maternal toxin exposure
bleeding in 3rd trimester
thyroid/hormone disorders
multi gestation
hypoxia
metabolic disorders
malformation of brain structures
vascular insults
abdominal trauma
preemie (less than 32 weeks, less than 2500 grams)
Blood incompatibiltiy
asphyxia
infection
placental abruption
instrumented delivery
Seizures w/in 48 hrs. after birth
Cerebral Infarction
Hyperbilirubinemia
Sepsis
Respiratory Distress/Chronic lung disease
Meningitis
What does CHEAP stand for
Chicken Pox
Hepatitis (B,C,E)
Enterovirus
AIDS
Parvovirus
What does STORCH stand for
Syphilis
Toxoplasmosis
Other: varicella zoster virus,
parvovirus B19, or lymphocytic choriomeningitis virus),
Rubella/measles
CMV
Herpes
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
CP
patient with CP: pure spasticity
what is damaged?
pyramidal system
patient with CP: athetoid cerebral
what is damaged?
extrapyramidal system is involved
mixed pattern CP: what is damaged
both pyramidal and extrapyramidal systems
postnatal risk factors for CP later in infancy/early childhood
- infections/meningitis
- shaken baby (trauma)
- accidental trauma TBI right after birth
- asphyxia: choking, near drowning
- PVL
bilateral white matter necrosis that is most commonly observed in preemies but can be seen in full term infants
*high correlation with CP
PVL (periventricular leukomalacia)
What is the most common intraventricular hemorrhage in neonatal IVH?
*subependymal germinal matrix IVH
thin walled vessels bleed easily in this area
Grade _ and _ IVH correlate with neurodevelopmental sequelae
3 and 4
goes from grade 1-4
4 CP classifications based on location, 4 based on mvmt patterns
location:
1. diplegia
2. hemiplegia
3. triplegia
4. quadriplegia
mvmt patterns:
1. spastic
2. athetoid
3. ataxic
4. mixed
Is cognition impaired in CP?
No
Most spastic CP is what kind? hemi, diplegic, or quadraparesis?
- diplegic 35-45%
- quadraparesis 23-30%
- hemiparesis 10-15%
What is the most common kind of dyskinetic CP?
- Athetosis 5 to 8%
- Dystonic 2 to 3%
- Chorea/Ballismus: Rare
What percent is mixed CP? What about hypotonic CP
mixed: 10-15%
hypotonic: rare
GMFCS level 1
walk without limits
(can run, jump, but speed balance and coordination are limited)
GMFCS level 2
walk with limitations
(climb stairs with railing, **may **walk with WC or HHD over long distances. hard time on uneven terrain, inclines, crowded spaces. Min ability to run/jump)
GMFCS level 3
walk using hand held device
in most indoor settings
(climb stairs with railing and supervision/assistance, WC for long distances)
GMFCS level 4
self mobility with limitations
may use powered WC
may walk for short distances at home with physical assistance, or body support walker when positioned.
GMFCS level 5
transported in manual WC (not self propelled)
*limited ability to maintain head and trunk posture or control extremities
Is CP progressive?
no and yes-bc children grow
mm grow due to stretch
stretch = growth hormones
growth hormones = signal adding sarcomeres at musculotendinous junction
kids with CP cannot move through ROM, inadequate stretch, inadequate growth
What is lever arm dysfunction?
abnormal muscle forces, lack of normal movement and/or weight bearing, disuse and compensatory mechanisms can alter the bony lever
arms
Although bones are genetically preprogrammed for shape, it also depends on magnitude and direction of ___ -__ and _______ acting on bone
internal mm forces
external ground reaction forces
Abnormal muscle forces combined with the lack of normal growth stimulation** alter bone _______
The rate of child’s bone growth depends on variety of factors including:
Abnormal muscle forces combined with the lack of normal growth stimulation** alter bone growth
both in shape and orientation**
The rate of child’s bone growth depends on variety of factors including physiological stresses,
nutrition and presence of growth hormone
What is autism spectrum disorder?
a spectrum of developmental disability characterized by:
-verbal, nonverbal communication and social interaction impacts
-impaired motor performance, coordination/apraxia, toe walking
-possible intellectual impairments
-poor eye contact
-sensitivity to touch/sensory stimuli
autism spectrum disorder ASD is generally evident before __ years of age
3 years
An autism spectrum disorder characterized by significant difficulties in social interactions
aspergers
Surgeons
sensory integration disorder = sensory processing disorder
deficits in _ _ and _ response to sensory information
perception
organization
coordinated response
what is SPD caused by?
neurological immaturity or malfunction in brain processing
behavioral manifestation of sensory processing
which leads to modulation and praxis
sensory integration
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
considered an over responsiveness or under responsiveness to stimulation and may be reflected in sensory
seeking or sensory avoiding
sensory modulation dysfunction
may have neuroanatomic origins in neural activity before motor execution causes dyspraxia and postural disorder
Sensory Based Motor Disorders
family of assessments providing
standardized tools to help evaluate a child’s sensory processing patterns in the context of home, school, and community-based
activities
sensory profile 2
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.
Infant/Toddler Sensory Profile
Measures sensory processing patterns and effects on functional performance
Adolescent/adult sensory profile
Provides school-based clinicians the ability to evaluate a child’s sensory processing skills and how these skills affect classroom behavor and performance
SPSC Sensory Profile School Companion
How is SPD diagnosed?
through comprehensive eval
includes standardized testing
observations
review of child’s development
series of tests assessing how a child processes sensory input
Sensory Integration and Praxis Tests (SIPT)
What are the 6 sensory systems
- proprioception
- vestibular
- tactile
- vision
- auditory
- taste/smell
Motor skills disorder with marked impairment in motor coordination interfering with academic achievement or ADLs
developmental coordination disorder (DCD)
DCD frequently occurs with _ and _ disorders
learning disabilities and attention deficit (ADD/ADHD)
true or false: DCD = decreased mm tone, mm weakness, motor incoordination
true
Genetic disorder in which majority of individuals have
extra 21st chromosome
Down Syndrome
Down Syndrome is characterized by:
- generalized low tone
- mm weakness
- joint laxity
- slow postural reactions
- intellectual impairment
- possible HEART DEFECTS
- possible CERVICAL INSTABILITY
TBIs are caused by external force to head.
Deficits vary, including:
- altered tone
- motor control issues
- weakness
- balance issues
- impaired gross and fine motor
- intellectual, behavioral, emotional, speech deficits
Acute traumatic lesion of the spinal cord or cauda equina
resulting in temporary or permanent sensory and/or
motor deficits
SCI
Group of congenital disorders characterized by varying
degrees of incomplete closure of the embryonic neural tube
Spina Bifida
REMEMBER LATEX ALLERGY
3 classifications of spina bifida
- occulta
- meningocele
- myelomeningocele
protrusion of posterior elements of spine with **extrusion of meninges and CSF **but without involvement of neural
elements
SB meningocele
extrusion of neural elements such as nerves
and spinal cord as well as the meninges and CSF
exact cause unknown, combo of genes and environment
SB Myelomeningocele
relationship between inadequate __ and __ intake and neural tube deficits cause MYELOMENINGOCELE
vitamin and folic acid intake
myelomeningocele deficits depend on level of injury: T or F
true
myelomeningocele deficits include:
- diminished/absent trunk or LE strength and sensation
- impaired B&B
- Possible poor motor control
- Changes in posture and alignment
- Decreased mobility and activity tolerance
*depend of LOI
*monitor for SCOLIOSIS
What are 4 considerations with SB myelomeningocele?
- monitor for scoliosis
- observe/assess hydrocephalus (VP shunt may be intact)
- know about shunt malfunctions
- know about tethered cord
SS of tethered cord
- tufts of hair, dimples, skin discoloration in LB
- LBP worse with activity, better with rest
- leg pain/numbness
- gait disturbances
- foot or spinal deformities (sudden change in foot posture)
- B&B
- repeat UTIs
SS of shunt malfunctions
*may only see 1 of these
- Headaches
- Vomiting
- Lethargy (sleepiness)
- Irritability
- Swelling or redness along the shunt tract
- Decreased school performance
- Periods of confusion
- Seizures
Pattern of neurological and physical defects that
can develop in a fetus when a woman drinks during
pregnancy
FAS: fetal alcohol syndrome
Fetal alcohol syndrome leads to what deficits?
- intellectual
- learning disabilities
- communication deficits
- fine motor deficits
genetic disorders that cause tumors to grow in nervous system
neurofibromatoses
neurofibromatoses cause what impairments?
- impaired function of joint and bones
- impaired mobility
- self care issues
- interventions to prevent 2ndary impairment, optimize activity and participation
