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Peds > Management of CP > Flashcards

Management of CP Flashcards

1
Q

Highest risk of CP

A

Infants with VLBW
Preterms

Maternal infection now thought to be a factor in development of CP especially in full term

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2
Q

CP etiology

A 
Unknown
Congenital malformation
Placental insufficiency
Toxic embryopathy
Maternal infection/viruses
Fetal competition
Genetic susceptibility
Intracranial hemorrhage
Anoxia
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3
Q

Classification of CP

A

Types of motor impairment
Topography or distribution of impairment
GMFM level

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4
Q

CP Types of Motor Impairment

A

Spastic
Dyskinetic or Athetoid
Ataxic
Hypotonic

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5
Q

CP Topography or distribution of impairment

A 
Diplegia
Quadriplegia
Hemiplegia
Double hemiplegia
Monoplegia
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6
Q

Diplegia

A

LE > UE

Still involvement of UE

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7
Q

Quadriplegia

A

All 4 limbs as well as head and trunk

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8
Q

Double hemiplegia

A

When a child is very asymmetric

Diplegic distribution, but one side worse than the other

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9
Q

Hemiplegia

A

Slightly more frequent on the right
Seldom diagnosed at birth
Motor development slightly delayed
35-43% seizures

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10
Q

Spastic diplegia

A

Most common form of CP
2/3 cases caused by prematurity
Prognosis for independent ambulation good
Only 2% non ambul.
Intellect and speech normal or slightly impaired

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11
Q

Spastic quadriplegia

A

Both arms and both legs

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12
Q

Athetoid

A

Then to be bright kids
Basal ganglia involvement
Cognitive sparing

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13
Q

Gross Motor Function Classification System

A

A 5 level system based on descriptions of functional motor abilities with focus on posture and mobility

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14
Q

GMFM I

A

Walks sans restrictions
Limitations in more advanced gross motor skills

i.e. Balance, coordination

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15
Q

GMFM II

A

Walks without assistive devices; limitations in walking outdoor and in the community

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16
Q

GMFM III

A

Walks with an assistive mobility devices; limitations walking outdoors and in the community

ORTHOTICS DON’T COUNT

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17
Q

CP

A

Convenient category denoting a wide spectrum of conditions having certain common characteristics

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18
Q

GMFM IV

A

Self-mobility limitations; walk short distances, are transported or use power mobility outdoor and in the community

Primarily wheelchair users

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19
Q

GMFM V

A

Self-mobility is severely limited, even with the use of assistive technology

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20
Q

Communication disorders in CP

A

25%

Related to oral-motor function, central language dysfunction, hearing, and cognitive deficits

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21
Q

Seizure disorders in CP

A

25-35%

Greatest in spastic quadriplegia and hemiplegia

There’s going to be a lot more structural damage to the brain, which could be a foci for where seizure activity develops

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22
Q

Seizure treatment

A

Cannabinoids resolved seizures AND they upgraded levels

Cannabinoids target basal ganglia, too

23
Q

CP Selective motor control

A

More synergy patterns

Difficult to isolate motion

24
Q

CP Alignment and WB

A

Postural set off

Lower alignment problems in LE

25
Q

CP Strength

A

One of the underlying problems with spasticity is the underlying weakness

Focus is an exercise and strengthening and not so much on facilitory techniques

Rhizotomy (sp?) to eliminate reflex loop and then the children present as very weak

26
Q

Decorticate distribution in CP

A

Common from CORTICAL impairments

Contributes to contractures

27
Q

Decerebrate distribution in CP

A

Common in those that have quadriplegia

Contributes to contractures

28
Q

Hip sublux in CP

A

Spastic diplegia and quadriplegia a big problem

29
Q

Torsional deformities in CP

A

Femoral anteversion
Tibial torsion

Tibial torsion can go either way
External tibial torsion more common

30
Q

Scoliosis in CP

A

Secondary impairment

31
Q

Back pain in CP

A

Lower back
Often in anterior pelvic tilt

Athetoid like CP have NECK pain

32
Q

Patello-femoral dysfunction

A

Spastic diplegia - quad spasticity and get patella alta, which causes PFD

33
Q

Genu recurvatum causes in CP

A

Quad spasticity

PF spasticity

34
Q

Therapeutic interventions in CP

A 
NDT
Sensorimotor Integration
Electrical stimulation, FES, NMES, TES
Strengthening
Motor control/motor learning/dynamic systems approach
35
Q

TES in CP

A

Worn at night

Low level for a mm that looks to improve its strength and bulk

36
Q

Task practice in CP

A

Whole tasks more beneficial
Those with CP NEED to practice
Constraint reduced therapy included in this

37
Q

Aging with CP

A

Increased UTIs

Progression of or development of swallowing difficulties

Lack of dental care

Osteoporosis
***Combat by using standing devices when they’re younger so they can get used to being in an upright position

38
Q

Degenerative arthritis

A

Can lead to cessation of ambulation due to pain if subjects have not already stopped due to fatigue or inefficiency

39
Q

Spondylotic myelopathy

A

Particularly problematic in athetoid CP

40
Q

Tendon lengthening and transfers for CP

A

Gastroc/soleus, hamstring, hip flexors, ADD

Rectus, tib ant, tib post, ADD

UE - less common… you need a child who is going to participate in post-op rehab

41
Q

Boney procedures CP

A

Femoral derotation osteotomies

Femoral osteotomy

Subtalar stabilization

Triple arthodesis

Wrist fusion

Scoliosis procedures
***SEMLS - one period of recovery, one period of rehab, one bout of GA

42
Q

Rebound

A

Immediate flex up after cast removal

Pain response to cast removal

43
Q

Oral med goals

A

Decrease positive signs

Improve negative signs

44
Q

Neurolytic nerve blocks for…

A

Paresthesia complaints

Ethanol
Phenol

45
Q

Botox

A

Interferes with the release of ACh at the nm junction

No systemic affect

May be administered without anesthesia

EMG guidance for small mm

Results typically last 3-6 months

46
Q

Ethanol and Phenol disadvantages

A

Require greater skill to inject

Increased risk of paresthesias, dyesthesias

47
Q

Botox disadvantages

A

More expensive than other injections, may develop antibodies

48
Q

Surgery vs botox

A

For botox you need a DYNAMIC contracture
***A joint or limb that’s being held in a position by TONE

Focal spasticity or focal impact of spasticity

Opportunity for learning to use opposing muscle group

Can use BOTOX as a trial before surgery

49
Q

GABA

A

Inhibitory CNS transmitter
Presynaptic inhibition of Ca++
Baclofen

50
Q

Intrathecal vs oral

A

Intrathecal…

Lower doses than those required with oral administration

Potentially fewer systemic side effects

Oral…

Low BBB penetration with high systemic absorption and low CNS absorption

Lack of preferential SC distribution

Adverse effects, such as drowsiness, for some patients

51
Q

Indications for ITB therapy

Positive response to screening test

A

Pts will get a spinal injection with infused Baclofen so watch what happens to the spasticity

Full Ashworth scale before

Infusion

Full Ashworth scale after at time intervals and look for a response

Make sure it’s a family that frequently comes to their appointments – pt’s can suffer from withdrawal

52
Q

Selective Dorsal Rhizotomy

A

Dorsal sensory NR severed
Each rootlet within root is stimulated
Abnormally-responding rootlets are severed
Children 7-10 years
Usually involves 6-12 mos of intensive therapy
Complications include possible sensory loss

Need relatively good cognition
Spastic diplegia
Good cooperation
Good anti-gravity strength

53
Q

SDR disadvantages

A

Permanent - may need spasticity for fx

Potential adverse effects; spinal, sensory

Not effective for dystonia - of central origin and not from SC level

54
Q

Selection criteria SDR

A

Spastic CP
At least 2 years of age
Adequate strength
Motivation and ability to participate in PT

Exclusion - non-CP, mixed tone, rigidity, severe scoliosis, no potential for fxl gains

Peds (25 decks)

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