Neuromuscular Dysfunction

Question 1

what is the most common permanent physical disability in childhood?

Answer 1

cerebral palsy

Question 2

what is cerebral palsy?

Answer 2

group of disorders affecting movement and posture

non progressive disturbances to the developing brain

abnormal muscle tone and coordination

Question 3

what does CP affect?

Answer 3

sensation

perception

cognition

communication

behaviour

MSK problems

epilepsy

Question 4

what are the causes of CP?

Answer 4

prenatal brain abnormalities
- chorioamnionitis
- preterm infants
- perinatal ischemic stroke
- meningitis
- periventricular leukomalacia
- shaken baby syndrome

Question 5

what are the 3 types of CP movement disorders?

Answer 5

1. spastic
2. dyskinetic
3. ataxic

Question 6

what is spastic CP?

Answer 6

increased stretch reflexes

hypertonic

poor posture/balance/coordination

impaired motor skills

Question 7

what is dyskinetic CP?

Answer 7

non spastic

athetoid

dystonic

drooling

dysarthria

Question 8

what is athetoid?

Answer 8

chorea
- involuntary jerking

slow, worm-like movements

Question 9

what is dystonic?

Answer 9

slow twisting movements

abnormal posture

Question 10

what is ataxic CP?

Answer 10

wide gait

rapid, repetitive movements

inability to hold objects

Question 11

what are some possible signs of CP?

Answer 11

persistent primitive reflexes (4+ months)

poor head control > 3 months

stiff/rigid limbs

arching back

floppy tone

unable to sit without support > 8 months

clenched fists > 3 months

no smiling > 3 months

feeding difficulties

Question 12

persistence of what reflexes are a sign of CP?

Answer 12

tonic neck

moro

crossed extensor

Question 13

what are some signs of CP related feeding difficulties?

Answer 13

tongue thrusting

gagging

choking

Question 14

what are some other problems that might be a sign of CP?

Answer 14

poor bladder control

urinary retention

RT infection

aspiration pneumonia

GER

poor nutrition

late toilet training

ADHD

vision abnormalities

Question 15

what are the therapeutic interventions for CP?

Answer 15

ankle-foot braces

wheelchairs

orthopaedic surgery

antispastics

baclofen pump

antiepileptic drugs

dental hygiene

physiotherapy

Question 16

what are the anti spastics for GENERAL spasms?

Answer 16

dantrolene sodium

baclofen

diazepam

Question 17

what is the antispastic for LOCAL spasms?

Answer 17

botox (botulinum toxin A)

Question 18

how does the implanted baclofen pump work?

Answer 18

infuses baclofen directly into intrathecal space around spine

Question 19

what are the anti epileptic drugs?

Answer 19

carbamazepine

divalproex

Question 20

why is dental hygiene important for CP?

Answer 20

to prevent gum hyperplasia

Question 21

what is spina bifida?

Answer 21

failure of osseous spine to close

Question 22

what are the 2 types of spina bifida?

Answer 22

1. occulta
2. cystica

Question 23

what is occulta SB?

Answer 23

not visible

lumbosacral area

Question 24

what is cystica SB?

Answer 24

visible saclike protrusion

Question 25

what are the 2 types of cystica SB?

Answer 25

1. meningocele: encases meninges + spinal fluid 2. myelomeningocele: encases meninges + spinal fluid + nerves

Question 26

what are the clinical manifestations of spinal bifida?

Answer 26

hydrocephalus partial paralysis of lower extremities incontinence lack of bowel control kyphosis scoliosis hip dislocation

Question 27

how is spina bifida diagnosed?

Answer 27

based on clinical manifestations anatomical ultrasound (second trimester)

Question 28

what is muscular dystrophy?

Answer 28

degeneration of muscle fibres muscle weakness and wasting

Question 29

what is the most common and severe form of muscular dystrophy?

Answer 29

Duchenne muscular dystrophy

Question 30

what is Duchenne muscular dystrophy?

Answer 30

psuedohypertrophic muscular dystrophy

Question 31

what causes Duchenne muscular dystrophy?

Answer 31

x-linked recessive trait male children inherit from carrier mothers

Question 32

__________ are more affected by Duchenne muscular dystrophy

Answer 32

males

Question 33

what is the age of onset for Duchenne muscular dystrophy?

Answer 33

2-7 years

Question 34

what are some clinical manifestations of Duchenne muscular dystrophy?

Answer 34

waddling (weak glute muscles) lordosis (weak pelvic muscles) frequent falls Gower sign enlarged muscles (eventually atrophy) cognitive impairment

Question 35

with Duchenne muscular dystrophy, ambulation is impossible by _________________

Answer 35

12 years

Question 36

what are some complications associated with Duchenne muscular dystrophy?

Answer 36

osteoporosis fractures constipation obesity respiratory and cardiac failure

Question 37

how is Duchenne muscular dystrophy diagnosed? which is the most reliable?

Answer 37

creatinine kinase EMG muscle biopsy* DNA test

Question 38

when do CK levels rise in Duchenne muscular dystrophy?

Answer 38

first 2 years (before symptoms present)

Question 39

what does an EMG measure?

Answer 39

electrical pattern of muscle contraction

Question 40

what are the mechanisms of spinal cord injuries?

Answer 40

indirect trauma MVAs sports injuries birth trauma surgery

Question 41

how do sports injuries cause spinal cord injuries?

Answer 41

vertebral compression

Question 42

what birth position is more likely to result in spinal cord injury?

Answer 42

breech

Question 43

with spinal cord injuries, the _____________ the damage, the more _______________ the injury

Answer 43

high damage = more extensive

Question 44

what are the 3 types of spinal damage?

Answer 44

1. paraplegia 2. tetraplegia 3. high cervical cord injury

Question 45

what is paraplegia?

Answer 45

complete or partial paralysis of lower extremities

Question 46

what is tetraplegia?

Answer 46

lack of function in all 4 extremities

Question 47

what does a high cervical cord injury affect?

Answer 47

phrenic nerve

Question 48

what does a high cervical cord injury cause?

Answer 48

paralyzed diaphragm ventilator dependent

Question 49

what are some clinical manifestations of spinal cord injuries?

Answer 49

flaccid paralysis loss of sensation loss of motor function autonomic dysfunction

Question 50

what is flaccid paralysis?

Answer 50

below level of damage spinal shock syndrome

Question 51

what are some manifestations of autonomic dysfunction?

Answer 51

hypotension poor thermoregulation loss of bladder and bowel control dysreflexia