neuromuscular Flashcards
cerebral palsy tm
PT, OT, SLP
assistive devices for mobility and ADLs, computers
sx to release tendons and improve function
no cure, treat S
cerebral palsy nc
rom to prevent contractures, involve fam, play
check skin with braces or other assistive devices, reposition often
cerebral palsy - meds
mostly for S - anx, etc
antiepileptics
stimulants - ADHD
botox (paralyzes overactive muscles)
muscle relaxants
anxiolytics
bowel regimen (same as spina bifada) - enemas, timing (30 min after dinner, magic bullet - suppository)
cerebral palsy home care
cope - support, resources
educate on school inclusion, use of assistive devices and exercise, med admin, skin breakdown and resp infection, nutrition (increased cal), play and recreation (toys to affected side, put at a distance), safety (prevent accidents - side rails, no scatter rugs)
gets harder for parents to manage as child gets older
cerebral palsy nc
assess and identify early
reinforce tm - + reinforcement to parents, offer suggestions and brain storm with parents
improve all muscle tone and control
cerebral palsy nc - health maint
freq rest, meet nutrition (g tube, supplements), skin assess, assist and advice with med admin, vaccines, safety precautions (helmets, home adaptation, modified car seat)
cerebral palsy nc - family support
cope with emotional aspects of chronic
support groups
home resources: lifts, assistive devices, pt/ot/slp, respite care
MD tm
maintain function in unaffected muscles: rom, brace, adls, sx, walker before wheel chair
genetic counseling - parents
MD nc
treat complications - contractures and atrophy: pt/ot, orthotics
nutrition - slp
resp failure - cough assist, mech vent/trach, vaccines
cardiac failure - diuretics and digoxin
slow progression - corticosteroids, CT GalNAc transferase, glutamine and creatine monohydrate
palliative: coping, program to increase independence, reduce preventable disabilities, modify home
myelomeningocele nc - preop
prevent infection: moist, sterile, NS, nonadherent, no diaper; keep genitalia clean, cath
protect sac: prone, early closure
no rectal temps - rectal prolapse or lack of bowel control
myselomeningocele nc
vs, weight, I+O, pain, prone, observe incision
feed when awake - have parents hold
orthopedic - improve locomotion and prevent deformities post op (ROM, position changes)
urinary incontinence: clean intermittent cath (can learn by 6, urinary diversion)
measure head circumgerence and contanelle
assess s/s of infection
latex free (early sx)
nutrition and hydration
promote normal dev: gh for growth hormone
myelomeningocele bowel incont
bowel training, prevent c - laxatives, digital stim, enemas
diet mod
antegrade continence enema procedure
cerebral palsy
permanent disorders of dev of movement and posture leading to activity limitation that are because of a nonprogressive disturbance in the fetal/infant brain
problem of brain, not muscle
spastic cerebral palsy
contractures, drool, more severe
scissoring (knees cross)
cerebral palsy diagnosis and cm
missed mile stones and persistent reflexes (moro, tonic neck, grasp past 6 mo), abn muscle tone (hypertonic/hypotonic), c shaped back, not sitting up at 8 mo - PT, holding up head, rolling over, sitting, crawling, smiling, floppy or limp posture, stiff or rigid arms or legs, use one side of body or only arms to crawl, hand pref before 18 mo, uncoordinated or involuntary movements, facial grimacing, writhing movements, poor suck, ataxia
no smile by 2 mo, feeding difficulties (gag, choke, tongue thrust after 6 mo), extreme irritable or cry
often to present until 6-12 mo (most milestones here)
cerebral palsy impairments
mintal impairment, seizures, contractures, incont, ADHD
nonabulatory: constipation, orthopedic issues, skin breakdown, resp infections, obesity
feeding difficulties: ftt, poor suck, tongue thrust, chew, swallow, talk, asp pna
resp problems: asp pna, chronic infections
impaired vision: nystagmus and amblyopia
impaired hearing
oral: cavities, gingivitis, malocclusion, grind teeth
muscular dystrophy
mutation in gene for protein in muscles leading to degeneration
MD early cm
btw 3-5 years of age: running, bike, stairs
rapid progressive muscular degen after initial normal dev
waddling gait, lordosis, + growers sign (walk up legs to stand)
brain intact
MD progressive cm
pesudohypertrophy: muscles look like they get bigger but just fat deposits
ambulate ability lost 10-12 yr
facial and resp atrophy
cardiac or resp failure
mild - mod cognitive impairment
27 yrs with mechanical vent
MD complications
contractures - hips, knees, ankles, spines
atrophy from disuse
infections - resp
obesity - inactivity
cardiac - end stages
spina bifida
malformation of spine - posterior portion fails to close, failure of neural plate to develop into tubular structure
from low folic acid (vit B)
can be detected prenatally - prenatal sx can happen, or c section
spina bifida occulta
only vertebrae, may not know you have it, no neuro deficits
spina bifida meningocele
missing vertebrae and protruding sac (w/o nerves), no neuro deficits
enclose area, put sac back in
spina bifida myelomeningocele
nerves in sac - neuro deficit
damage depends on where your sac is - most incont and paralyzed from waist down
myelomeningocele tm
sx to close sac w/n 24 -72 hrs, 12 - 18 hrs if possible to prevent infection and preserve roots
neuro and plastic sx
myelomeningocele cm
sac like protrusion evident at birth
hydrocephalus (s/s = enlarged head, bulging fontanelles, sunset eyes, downward displacement of brain stem/ cerebellum causing obstruction of CSF)
varying degree of sensory and neuro dysfunction
poor muscle tone in bladder and rectum, flexion or extension contracture
