Myelodysplasia Part 2 Flashcards
Prevention of Secondary
Orthopedic Deformities for wheelchair:
Seat cushion design.
Biking gloves for community mobility.
Environmental adaptations to minimize overhead reaching.
Angle desktop for improved postural alignment.
Prevention of Secondary
Orthopedic Deformities for ambulatory:
Angle walker/crutch handgrips to avoid wrist hyperextension.
Avoid excessive wrist pressure to prevent carpal tunnel syndrome.
Knee joint deterioration/arthritis – possible long-term effects of surgical interventions and weightbearing on insensate joints
Co-morbidities
neurogenic bowel/bladder cognitive and perceptual dysfunction language dysfunction visuoperceptal deficits seizures upper limb dyscoordination skin breakdown osteoporosis obesity cranial nerve palsies latex allergies
Neurogenic bowel/bladder
Bowel/bladder incontinence common; fewer than 5% develop voluntary sphincter control Anal sphincter (S2-S4) - flaccid, hypotonic, or spastic
What causes bladder dysfunction?
bladder wall and bladder dyssynergy
What is upper limb dyscoordination attributed to?
cerebellar ataxia, secondary to hydrocephalus, or ‘motor learning deficits due to use of upper limbs for balance and support
What percentage have seizures?
10-30% of cases
What causes skin breakdown?
loss of sensation, prolonged sitting, ill-fitting orthoses, circulation
Decubitus ulcers - 95% occurrence by young adulthood
Perineal decubiti:
over apex of kyphotic curve
Cranial Nerve Palsies
Cranial nerves IX, X may cause swallowing difficulties, apneic episodes, symptomatic Arnold Chiari II malformation that can be life threatening
PT exam in infancy:
participation restrictions
exam of impairments
PT exam in toddlers and preschoolers
strength weightbearing gait training Focus on improving independence, efficiency, and effectiveness of ADL, dressing and toileting by kindergarten skin inspection
PT in school age and adolscence:
joint and postural alignment, muscle strength, prevent contracture
bracing
WC mobiity
gait training
flexibilty
focus on independent, safe and efficient mobility
Mobility Prognosis for thoracic level:
No volitional lower limb movement.
Possible strong upper limb, upper thoracic, neck muscles.
Other CNS involvement, i.e., cognitive deficits possible
Mobility Prognosis for T10 or above:
Weak lower trunk musculature affecting unsupported sitting balance, respiratory function.
Maintain spinal, pelvic, lower limb alignment.
Sliding board wheelchair transfers
Mobility Prognosis for T12:
Strong trunk, good sitting balance, weak hip hiking.
Ambulation using a parapodium for exercise only, w/c for functional household and community mobility
Mobility Prgnosis for L1-L2 lesions:
short distance household ambulation using KAFOs or RGOs and upper limb support early; wheelchair use after age 10
Weak hip movements, flexion and adduction
L2 function:
hip flexors, adductors, rotators (grade 3) may cause dislocation
Mobility Prgnosis for L3:
Strong hip flexion/adduction, weak hip rotation.
Weak knee extension, if grade 3 may ambulate with KAFOs and forearm crutches (household, short community distances).
Wheelchair - long community distances, primary mobility in adulthood.
60% achieve independent living, 20% participate in full time competitive employment
Mobility Prgnosis for L4:
Antigravity knee flexion, knee extension usually strong.
Grade 4 ankle dorsiflexion with inversion.
Medial HS and anterior tibialis (grade 3).
Calcaneal deformities (unopposed tibialis anterior).
Learning to walk - KAFOs, walker, or both.
Functional ambulators - AFOs, forearm crutches, w/c for long distances.
Many stop ambulating in adolescence; knee and ankle valgus deformities, elbow/wrist pain.
Patellar tendon-bearing, ground reaction force orthotic protects knee and increases knee extension moment.
Prognosis for independent living similar to L3
Mobility Prognosis for L5:
Grade 3 lateral HS strength and either grade 2 gluteus minimus/medius (L4-S1), grade 3 posterior tibialis (L5-S1), or grade 4 peroneus tertius (L4-S1).
Antigravity knee flexion and weak hip extension using HS.
Possible weak abduction and plantar flexion with inversion, strong dorsiflexion with eversion, or both.
Hindfoot valgus or calcaneal foot deformities; weak toe movement.
Ambulate without orthoses - foot alignment, substitute for lack of push-off.
Gluteal lurch typical.
Upper limb support for community distances.
Wheelchair - long distances, rough terrain.
80% independent living, 30% employed full time, 20% part-time
Mobility Prognosis for S1:
At least two of the following: gastroc/soleus (grade 2), gluteus medius (grade 3), or gluteus maximus (grade 2).
Hip stability allows walking without orthoses or upper limb support.
Weak push-off when running or climbing stairs. Mild-mod gluteal lurch. Crutch use may improve pelvic and hip kinematics. Strong toes.
Increased gait deviations/activity limitations after adolescent growth spurt.
Foot deformities not common, but AFOs provide medial-lateral ankle stability for adequate push-off
Mobility Prognosis for S2, S2-S3 and no loss levels:
Plantar flexors at least grade 3 and gluteals grade 4.
Decreased push-off and stride length in rapid walking or running.
‘No loss’ level - normal bowel and bladder function and lower limb strength (MMT); possible functional deficits.
Orthoses maintain subtalar neutral, optimize muscle length and ankle function
Best predictor of ambulation?
iliopsoas strength
Best predictor of requirements for aids/orthoses
gluteus medius (hip abduction)
Key Muscle Groups for
Community Ambulation
Iliospoas Gluteus strength Quads Anterior Tibialis Hamstrings
