Neuromuscular Dysfunction Flashcards
what is the most common permanent physical disability in childhood?
cerebral palsy
what is cerebral palsy?
group of disorders affecting movement and posture
non progressive disturbances to the developing brain
abnormal muscle tone and coordination
what does CP affect?
sensation
perception
cognition
communication
behaviour
MSK problems
epilepsy
what are the causes of CP?
prenatal brain abnormalities
- chorioamnionitis
- preterm infants
- perinatal ischemic stroke
- meningitis
- periventricular leukomalacia
- shaken baby syndrome
what are the 3 types of CP movement disorders?
- spastic
- dyskinetic
- ataxic
what is spastic CP?
increased stretch reflexes
hypertonic
poor posture/balance/coordination
impaired motor skills
what is dyskinetic CP?
non spastic
athetoid
dystonic
drooling
dysarthria
what is athetoid?
chorea
- involuntary jerking
slow, worm-like movements
what is dystonic?
slow twisting movements
abnormal posture
what is ataxic CP?
wide gait
rapid, repetitive movements
inability to hold objects
what are some possible signs of CP?
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
persistence of what reflexes are a sign of CP?
tonic neck
moro
crossed extensor
what are some signs of CP related feeding difficulties?
tongue thrusting
gagging
choking
what are some other problems that might be a sign of CP?
poor bladder control
urinary retention
RT infection
aspiration pneumonia
GER
poor nutrition
late toilet training
ADHD
vision abnormalities
what are the therapeutic interventions for CP?
ankle-foot braces
wheelchairs
orthopaedic surgery
antispastics
baclofen pump
antiepileptic drugs
dental hygiene
physiotherapy
what are the anti spastics for GENERAL spasms?
dantrolene sodium
baclofen
diazepam
what is the antispastic for LOCAL spasms?
botox (botulinum toxin A)
how does the implanted baclofen pump work?
infuses baclofen directly into intrathecal space around spine
what are the anti epileptic drugs?
carbamazepine
divalproex
why is dental hygiene important for CP?
to prevent gum hyperplasia
what is spina bifida?
failure of osseous spine to close
what are the 2 types of spina bifida?
- occulta
- cystica
what is occulta SB?
not visible
lumbosacral area
what is cystica SB?
visible saclike protrusion
what are the 2 types of cystica SB?
- meningocele: encases meninges + spinal fluid
- myelomeningocele: encases meninges + spinal fluid + nerves
what are the clinical manifestations of spinal bifida?
hydrocephalus
partial paralysis of lower extremities
incontinence
lack of bowel control
kyphosis
scoliosis
hip dislocation
how is spina bifida diagnosed?
based on clinical manifestations
anatomical ultrasound (second trimester)
what is muscular dystrophy?
degeneration of muscle fibres
muscle weakness and wasting
what is the most common and severe form of muscular dystrophy?
Duchenne muscular dystrophy
what is Duchenne muscular dystrophy?
psuedohypertrophic muscular dystrophy
what causes Duchenne muscular dystrophy?
x-linked recessive trait
male children inherit from carrier mothers
__________ are more affected by Duchenne muscular dystrophy
males
what is the age of onset for Duchenne muscular dystrophy?
2-7 years
what are some clinical manifestations of Duchenne muscular dystrophy?
waddling (weak glute muscles)
lordosis (weak pelvic muscles)
frequent falls
Gower sign
enlarged muscles (eventually atrophy)
cognitive impairment
with Duchenne muscular dystrophy, ambulation is impossible by _________________
12 years
what are some complications associated with Duchenne muscular dystrophy?
osteoporosis
fractures
constipation
obesity
respiratory and cardiac failure
how is Duchenne muscular dystrophy diagnosed?
which is the most reliable?
creatinine kinase
EMG
muscle biopsy*
DNA test
when do CK levels rise in Duchenne muscular dystrophy?
first 2 years
(before symptoms present)
what does an EMG measure?
electrical pattern of muscle contraction
what are the mechanisms of spinal cord injuries?
indirect trauma
MVAs
sports injuries
birth trauma
surgery
how do sports injuries cause spinal cord injuries?
vertebral compression
what birth position is more likely to result in spinal cord injury?
breech
with spinal cord injuries, the _____________ the damage, the more _______________ the injury
high damage = more extensive
what are the 3 types of spinal damage?
- paraplegia
- tetraplegia
- high cervical cord injury
what is paraplegia?
complete or partial paralysis of lower extremities
what is tetraplegia?
lack of function in all 4 extremities
what does a high cervical cord injury affect?
phrenic nerve
what does a high cervical cord injury cause?
paralyzed diaphragm
ventilator dependent
what are some clinical manifestations of spinal cord injuries?
flaccid paralysis
loss of sensation
loss of motor function
autonomic dysfunction
what is flaccid paralysis?
below level of damage
spinal shock syndrome
what are some manifestations of autonomic dysfunction?
hypotension
poor thermoregulation
loss of bladder and bowel control
dysreflexia
