Neurological Assessment and Intervention in Children Flashcards
what is discussed during a subjective assessment
presenting condition - new Dx, parental concerns, referred to physio
referral route - is there an existing intake assessment other clinical interactions
pregnancy complications
birth hx - early/late delivery, twin/birth weight/delivery
developmental history
med history
medication
investigations
family history
social history
siblings - hobbies,
how is spina bifida classified
by the diagnostic subtype - occulta, meningocele, myelomeningocele
functional level
describe the functional hallmark and ambulatory capacity of spina bifida in the thoracic and upper lumbar region
lack of quads function
require hip-spanning orthosis for ambulation(RGO, HKAFO)
Most will require wheelchair for mobility
describe the functional hallmark and ambulatory capacity of spina bifida in the lower lumbar region
lack of glute med and max function
retain quadriceps and medial hamstring function
require crutches and AFOs
most retain community ambulation as adults
describe the functional hallmark and ambulatory capacity of spina bifida in the sacral region
retain quads and glute med function
describe the functional hallmark and ambulatory capacity of spina bifida in the high sacral region
lack gastroc-soleus function
ambulate w/ AFO and no support
describe the functional hallmark and ambulatory capacity of spina bifida in the low sacral region
retain gastroc-soleus function
ambulate w/ o brace or support
how is the brachial plexus injury classified
I - classic erbs palsy level C5-C6
II - extended Erb’s palsy level C5-C7
III - total palsy w/o Horner’s syndrome or oculosympathetic paresis level C5-T1
IV - total palsy w/ horner’s syndrome level C5-T1 and sympathetic chain involvement
describe the clinical presentation of classic erb’s palsy
C5C6
absent shoulder abduction,
external rotation,
elbow flexion,
forearm supination
describe the clinical presentation of extended erb’s palsy
C5-C7
Absence of wrist and digital extension
describe the clinical presentation of total palsy w/o horner’s syndrome or oculosympathetic paresis
complete flaccid paralysis involving all plexus roots
describe the clinical presentation of total palsy w/ horner’s syndrome
complete flaccid paralysis w/ horners syndrome indicating sympathetic chain involvement and avulsion injury
describe the functional mobility scale
to review mobility in children w/ CP
Rated at 5m(home), 50m(school), 500m(community) separately
1 = use w/c can stand for t/f and step supported or w/ walker
2 = uses walker or fram independent
3 = uses crutches independent
4 = uses sticks 1 or 2 independent
5 = independent on level surface, requires rails for stairs
6 = independent on all surfaces
what is the typical physio assessment
biomechanics/posture
ROM - tone and contracture
strength and selective motor control
gait
aids, equipment, orthotics
leg length
spinal alignment
foot posture
questionnaire - GOAL, CP-QoL
how is a childs walking function assessed
observational/video analysis -can be limited by mis-interpretation of rotation
walking capacity - 6MWT, TUG
3D Gait Analysis - highly standardised
What are the possible interventions available for paediatrics
tone management - botox, selective dorsal rhizotomy
orthotics - rigid AFO, flexible AFO, DAFO, SMO, dictus, KAFO
insoles
24 hour postural management
CIMT
Mobility training
Treadmill training
contracture alignment - hip surveillance botox and casting, scoliosis surgey, lower limb casting
what must be considered when reviewing the tone
the muscle tone peaks at age 3 then steadily declines
benefits of rigid AFO
Control inclination of tibia in stance phase
* Maintain an extended knee in stance
* Protect/control foot structure
* Hold gastroc in optimal position
Features of dictus splint
- Less support
- Less impaired
- Foot drop
- Limited foot control
what conditions are KAFO used for
- Where impaired knee
control/weakness is present - Knee may be locked (mostly)
- E.g. Spina Bifida
- Previously polio
purpose of insoles
Equalise for leg length issues
Comfort/accommodation
what is the purpose of 24hour posture management
for non ambulant children
provide support, prolonged stretch
weight bearing to prevent contractures and deformities
what equipment can be involved in posture management
- Seating (wheelchairs/ activity chairs/relaxation
chairs) - Standing frames (prone/ upright/supine)
- Sleep systems
- Orthoses
explain the research in posture managemnt
No strong evidence to support effectiveness
in preventing need for surgical intervention
later on (especially for standers and sleep
systems)
* The difficulty with current research is that it
is difficult to isolate the use of individual
equipment
where is physio intervention
primary care
childhood disability network team
specialist clinics
