Neuromuscular Dysfunction Flashcards
What is cerebral palsy?
Loss of control or weakness in movement
Usually what causes these kids to get diagnosis with cerebral palsy?
Some form of injury that results in them not having enough oxygen in the brain
Cerebral palsy may involve what? (5)
Major problems
Sensation
Perception
Communication
Cognitive
Behavior
About 80% of kids with cerebral palsy usually end up having ___
Resulting them to be on a medication called ___
Epilepsy
Anti convulsants
What is spasticity? (3)
Painful mass muscle spasms
Rigid posturing of limbs
Increased reflexes
What type of condition can you get with spasticity?
Hypertonia
Which is exaggerated reflexes
What are the 4 types of cerebral palsy?
Spastic ( pyramidal )
Dyskinetic ( extrapyramidal)
Ataxic ( extrapyramidal)
Mixed type
What is the main thing to note about each type of cerebral palsy?
Spastic?
Dyskinetic
Ataxic
Mixed
Hypotonia
Jerking movement ; chorea
Wide gait
Everything is mixed
What are the main things we are looking for in children with cerebral palsy? Like what is usually a great diagnosis treatment?
Following the development milestones of a child!
Around 2 year old, we are going to diagnosis them
What is the type of test we might do for cerebral palsy to diagnose them?
CT scan
MRI scan
Metabolic and genetic testing
Remember, we are assigning and trying to diagnose cerebral palsy, we are assessing those development milestones in these children
So what might we see ?? (7)
Persistent primitive reflexes
Poor head control after age 3 months
Stiff or rigid limbs
Arching back ; pushing away
Floppy tone
Unable to sit without support at age 8 months
Clenched fists after age 3 months
At what age should head control be achieved?
At what age should a child sit up without support?
At what age should babies hands be open ?
Remember primitive reflexes should be gone before 4-6 months !
1-3 months before hand
6 months
3 months
What is the therapeutic management for cerebral palsy?
Establish locomotion, communication and self help skills
Optimal appearance and intervreation of motor functions
Correct associated defects as effectively as possible
Provide adapted education opportunities
Promote socialization experiences with other affected and unaffected children
What are some intervention we might see with cerebral palsy? (6)
Physical therapy ( stretching )
Occupational therapy
Speech therapy
Casting & bracing
BOTOX
Oral medications
What are your main 4 types of medications we might use on these children with cerebral palsy?
Antispamodics
Anti epileptics
Anti inflammatory
Analgesia
It’s important to remember they may have alternation of their speech, motion and fine details
However there is something to note
About 70% of these patients have a normal IQ and can achieve many amazing things
So how are we going to talk to them?
Normally !!
Neural tube defects
What is it?
When the brain, spinal cord and vertebrae are developing in the uterus and there is a failure to close of a neural tube
When does neural tube defects happen?
1-2 weeks of the pregnancy
What are some things we are going to do and educate patients about the prevention of a neural tube defect?
How much?
Folate acid!!
0.4 mg/day
What are some causes of a neural tube defect?
There is 1 main one
Low folate levels !!
Drug, chemical or radiation exposure
Genetic mutation in folate pathways
Syndrome like downs
Pre-pregnancy obesity
DM
Low vitamin b12
What are some foods that may help increase the folic acid intake?
Cereals!
What Is another diagnosis with may use to help detect a neural tube defect in children?
At what weeks do we test this at?
Elevated Alpha fetoprotein (AFP) in amniotic fluid
6-18weekz
What are the two main types we see with neural tube defects?
Anencephaly
Spina bifida myelomeningocele
What is anencephaly?
Absense of cerebral hemispheres and only a brain stem ( there is no brain ! )
( AN - means NO! )
Is anencephaly incompatible with life?
And if so what’s the main cause of death?
Yes, most kids die within a few days of life
Most kids die to respiratory failure e
What is spina bifida occulta?
Tethered cord
- abnormal adhesion to a bony or fixed structure
So the spinal cord is attached to fatty growth
So for spinal bifida occulta
It puts traction on the cord because the abnormal fatty growth attached to the spinal cord
What might this effect? (3)
Altered gait
Bowel and bladder problems
Foot deformities
Spinal bifida occulta can be seen in which section of the spine?
L5 to S1
What are some skin indicators of spina bifida occulta? (4)
Sacral dimple
Sacral angioma of port wine nevus
Sacral tufts of dark hair
Sacral lipoma
What is mainly the diagnosis though once we see one of the 4 skin indicators, like that pig tail?
Another thing to note about this, what might be happening to the baby lower legs?
Usually an ultrasound!!
CT, MRI, X-ray
They won’t be moving
What is spina bifida cystica?
Visible defect with external sac-like protrusion
So like a visible sac outside of the back!
What are the 2 types of spina bifida cystica?
Meningocele
Myelnomeningocele
What is meningiocele?
So we have that massive sac, however there is no spinal cord in the sac
Usually easier to close up
What is myelomeningocele?
The spinal cord wraps around in the sac
With the myelomeningocele, a good portion of things that you can see with these patients is that once you located the location and magnitude of the defect, it can show what?
Like if the defect is below the second lumbar vertebra
- flaccid paralysis of lower extremities
- sensory deficit
The paralysis or main sensory issue they will develop
What issues will these children with spinal bifida have?
Bowel
And urine issues
Since patients with spinal bifida have issues with bowel and urination what might that indicate?
What might he the treatment?
However with doing the treatment so much, what does that poses them to have?
- so they are on what?
They can’t control when they go
Urine Incontience : improper emptying of the bowel
End up with residual urine
- an infection risk
Straight catheter
Latex allergy
Latex precautions
Anyone that has paralysis or has loss of sensation
What’s is the biggest thing to do?
Because if they constipation
What happens?
Bowel regiment stuff
Impaction
What is spinal muscular atrophy ?
It’s a degeneration of ?
What is the onset?
Main death?
Type of progressive weakness and wasting of skeletal muscules
Spinal cord and brainstem - resulting in atrophy in skeletal muscles
Usually early in life
Respiratory failure because it weakens the body so much and also they lose the ability to swallow so they can’t eat
What are some symptoms of muscular atrophy? (6)
Fatigue
Difficulty swallowing
breathing difficult
GI issues
Scoliosis
Muscle weakness
What is the diagnosis of progressive muscle atrophy? (2)
Genetic testing
Muscle biopsy
So it’s important to note that with muscule atrophy, it’s a multi organ implications!!!!
What is muscular dystrophies?
Progressively disable
Just a main term
What is duchenne muscular dystrophy?
Mainly boys, X-linked
Life long disable and usually death is soon around 20
What is gower sign?
A child is laying down on the belly
But the child has weakness in the buttocks and legs
- therefore they do a progressive walking up their legs
They can’t just stand up!
What is the theraupetic management of DMD? Duchenee
No real treatment
Keep kids active !!
ROM!
Genetic testing
What is Guillain-Barré syndrome?
Infectious polyneutritis
Happens more in adults
Males more than females
Acute demyelinating polyneuropathy with progressive paralysis
What is the clinical manifestation of GBS?
Name the steps (5)
Muscle tenderness
Paraesthesia
Muscle weakness
Ascending paralysis weakness from the lower extremities to the top
Loss of reflexes
Frequent urinary incontience or retention and constipation
Be careful because it can be life threatening respiratory paralysis
What are the main causes of GBS?
Viral
Bacterial
Vaccine infections
therapeutic management of GBS? (5)
Steroids
IV immunoglobuin
Heparin, stool softeners
Respiratory support
Plasmapheresis
What is botulism?
Giving Honey to kids under 2 years old
When does botulism symptoms occur?
12-36 hours after ingestion
What are the general signs and symptoms of botulism?
Weakness
Dizziness
Headache
Diplopia
Speech difficulties
Vomiting
Progressive life threatening respiratory paralysis
What is the treatment of botulism?
However what is sad about this?
IV botulism antitoxin
Kids under 2 can’t receive this :( so they usually end up dying
Why can’t we give honey to kids under 2 years old?
It isn’t pasteurized
Hypotonia usually is associated with botulism
What is it?
Decreased muscle tone
Usually head tone is completely gone :(
What is myasthenia gravis?
Acetylocholine is blocked and doesn’t get to the muscle cell
What is the main clinical manifestation of myasthenia gravis? (7)
Think of the anagram
Ptosis- eyelids dropping
Muscle weakness
Fatigue
Blurry or double vision
Limited facial expression
Trouble walking
Speech,swallow,chew problems
people
Make
Faces
But
Limited
To
Seven!
Myasthenia gravis
Patients have a hard time with what with their eyes?
But not a hard time with what with their eyes?
They have hard time closing eyes, but easy to open the eye
Usually patients with MG, they will get so exhausted just by talking so they will need to what?
And some patho behind this ^
Rest
So it allows the acetacholyin to accumulate in the receptor which then allows them to contuine on
What is spinal cord injury
Diving
Hyper extension of the neck
Hyper Flexion of the neck
What are the top 5 causes?
Vehicle crashes
Falls
Violence
Sports
Others
C4 spinal injury
C6 spinal injury
T4 spinal injury
L1 spinal injury
What is the paralysis
C4 - neck down
C6 - shoulder down
( shoulder still move )
T4 - below chest paralysis
L1 - waist below paralysis
What is spinal cord injury management?
What type of turning movement ?
It’s what?
Organized event
LOG roll movement
- control the head how we move !!
Steroids, surgery
With spinal cord injury there is something called autonomic dysreflexia!
What is it?
Above the injury (3)
Below the injury (2)
Above the injury
Sudden flushed
Bradycardia
Throbbing headache
Down below
Pale, cool, clammy skin
Hypertension
What is the safety with autonomic dysreflexia?
Solve the problem?
90 degrees angle
Sit up!!
