Management of hypertonia

Question 1

[BF&S] - Neurological

Answer 1

Abnormal muscle tone - hypertonia
Spasticity
Abnormal movement patterns - dyskinesia, abnormal synergies, persistent/obligatory infant patterns of movement
Seizures - epilepsy

Question 2

Management of spasticity

Answer 2

General and reversible = oral medication, ITB
Focal and reversible = casting, BTX-A
Focal and permanent = orthopaedic surgery
General and permanent = elective dorsal rhizotomy

Question 3

[BF&S] - MSK

Answer 3

Altered development of bony shape and alignment 
Muscle tightness
Muscle weakness and poor endurance
Greater risk for dislocation
Scoliosis

Question 4

[BF&S] - Voluntary movement control

Answer 4

Impaired voluntary motor control 
- muscle weakness
- poor selective muscle activation 
- agonist-antagonist co-contraction
- decreased isolated movement 
Pathological movement patterns
- consistent/fixed thumb adduction
- scissoring of LL
- opisthotonos 
- stereotypical extensor/flexor synergies/patterns

Question 5

Evidence for training

Answer 5

Treadmill training for gait - improves gait and postural control
Aquatic Physio and swimming - physical benefits, enjoyment and recreation
Hippotherapy - improves GM and P&B function

Question 6

[BF&S/Activity] - Posture and balance

Answer 6

Postural control dysfunction is a defining feature of CP

BESTest is the most comprehensive assessment

Question 7

CO-OP

Answer 7

Cognitive orientation approach
Child is encouraged to be involved in their own movement outcome learning within the context of a range of activities
Throughout the movement the child may be facilitated or stimulation may be used as well as positive communication to encourage them to achieve

Question 8

[BF&S] - Sensory - Pain

Answer 8

Management of causes important

• hip dislocation
• pressure areas
• sleep position management
• dystonia/spasticity
• abnormal crouch gait
• GIT function
• selection and updating of orthoses and wheelchairs