Orthopedic Surgery & Neurological Treatments in Pediatrics Flashcards
Soft tissue releases for functional gait
- Adductors: need 40º abduction
- Hamstrings: need 50º SLR
- Heelcords: need 5º DF
- Rectus Femoris/lliopsoas: need 5º of extension
Test for femoral anteversion
- Compare ER to IR in prone
- Increased IR/ER ratio = more anteversion
PT treatment following soft tissue release
- May be casted followed by splinting
- Gentle ROM, Strengthening
- Weight bearing for standing/gait may be allowed: varies with MD & procedure
PT treatment for boney surgery
- Non-weight bearing for 6 wks
- May be in spica cast
- :limit sitting time: prone sidelying & reclined better
- Avoid internal rotation & adduction
Define tone
- Resistance to passive movement
Define hypertonicity
- Abnormally increased resistance to externally imposed movement
- Not always “bad”, tone may assist standing
Define hyperkinetic movement
- Any unwanted excess movement
Define spasticity
- Velocity dependent resistance to PROM
Define dystonia
- A movement disorder in which involuntary or sustained muscle contractions cause twisting & repetitive movements, abnormal postures, or both
Pathophysiology of dystonia
- Basal Ganglia: stroke; dopamine metabolism
- Cerebellum
- Thalamus: sensory dysfunction; abnormal sensory maps
- Motor Cortex: psychogenic dystonia; frontal lobe epilepsy
Management techniques for spasticity & dystonia
- Muscle flexibility, strength, coordination, & function
- Selective dorsal rhizotomy
- Baclofen pump
- Botox
- Oral medication
Describe the muscle function in children with CP
- Loss of muscle mass
- Reduced contractile tissue
- More connective tissue & fat
- Overstretched sarcomeres
Effects of a selective dorsal (sensory) rhizotomy
- Very weak muscles following surgery
- Focus on strengthening
- Functional retraining
- ROM if contractures are present
Describe a baclofen pump
- Intrathecal consistent dosage direct to spinal canal
- Total body relaxation effect
- Pump located in abdomen
- Must monitor levels closely & refill each month
Describe botox injections
- Injected directly into spastic muscles
- Dosage dependent on child’s weight/size
- Temporary; >6 months with peak effect at 3 months
- Works well with serial casting for contracture
Define Phenol
- Injection to denervate nerve temporarily with Wallerian degeneration
Medications for dystonia only
- Trihexyphenidyl (Artane)
- Carbidopa/Levodopa (Sinemet)
New approaches to tone management
- Deep brain stimulation to Basal Ganglia: for dystonia ONLY
- Hyaluronan hypothesis: injection to decrease Hyaluron
- Collagen hypothesis: inject collagenase to decrease collagen
What percentage of children with CP is also diagnosed with seizures
- 40%
Oral medications for management of seizures
- Divalproex sodium (Depakote)
- Diazepam (Valium, Diastat)
- Phenytoin (Dilantin)
- Clonazepam (Klonopin)
- Carbamazepine (Tegretol)
- Ethosuximide (Zarontin)
_______________ should be used with caution, especially in ambulatory children due to increased incidence of sarcopenia
- Botulinum toxin
