Orthopedic Surgery & Neurological Treatments in Pediatrics

Question 1

Soft tissue releases for functional gait

Answer 1

• Adductors: need 40º abduction
• Hamstrings: need 50º SLR
• Heelcords: need 5º DF
• Rectus Femoris/lliopsoas: need 5º of extension

Question 2

Test for femoral anteversion

Answer 2

• Compare ER to IR in prone
• Increased IR/ER ratio = more anteversion

Question 3

PT treatment following soft tissue release

Answer 3

• May be casted followed by splinting
• Gentle ROM, Strengthening
• Weight bearing for standing/gait may be allowed: varies with MD & procedure

Question 4

PT treatment for boney surgery

Answer 4

• Non-weight bearing for 6 wks
• May be in spica cast
• :limit sitting time: prone sidelying & reclined better
• Avoid internal rotation & adduction

Question 5

Define tone

Answer 5

• Resistance to passive movement

Question 6

Define hypertonicity

Answer 6

• Abnormally increased resistance to externally imposed movement
• Not always “bad”, tone may assist standing

Question 7

Define hyperkinetic movement

Answer 7

• Any unwanted excess movement

Question 8

Define spasticity

Answer 8

• Velocity dependent resistance to PROM

Question 9

Define dystonia

Answer 9

• A movement disorder in which involuntary or sustained muscle contractions cause twisting & repetitive movements, abnormal postures, or both

Question 10

Pathophysiology of dystonia

Answer 10

• Basal Ganglia: stroke; dopamine metabolism
• Cerebellum
• Thalamus: sensory dysfunction; abnormal sensory maps
• Motor Cortex: psychogenic dystonia; frontal lobe epilepsy

Question 11

Management techniques for spasticity & dystonia

Answer 11

• Muscle flexibility, strength, coordination, & function
• Selective dorsal rhizotomy
• Baclofen pump
• Botox
• Oral medication

Question 12

Describe the muscle function in children with CP

Answer 12

• Loss of muscle mass
• Reduced contractile tissue
• More connective tissue & fat
• Overstretched sarcomeres

Question 13

Effects of a selective dorsal (sensory) rhizotomy

Answer 13

• Very weak muscles following surgery
• Focus on strengthening
• Functional retraining
• ROM if contractures are present

Question 14

Describe a baclofen pump

Answer 14

• Intrathecal consistent dosage direct to spinal canal
• Total body relaxation effect
• Pump located in abdomen
• Must monitor levels closely & refill each month

Question 15

Describe botox injections

Answer 15

• 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

Question 16

Define Phenol

Answer 16

• Injection to denervate nerve temporarily with Wallerian degeneration

Question 17

Medications for dystonia only

Answer 17

• Trihexyphenidyl (Artane)
• Carbidopa/Levodopa (Sinemet)

Question 18

New approaches to tone management

Answer 18

• Deep brain stimulation to Basal Ganglia: for dystonia ONLY
• Hyaluronan hypothesis: injection to decrease Hyaluron
• Collagen hypothesis: inject collagenase to decrease collagen

Question 19

What percentage of children with CP is also diagnosed with seizures

Answer 19

• 40%

Question 20

Oral medications for management of seizures

Answer 20

• Divalproex sodium (Depakote)
• Diazepam (Valium, Diastat)
• Phenytoin (Dilantin)
• Clonazepam (Klonopin)
• Carbamazepine (Tegretol)
• Ethosuximide (Zarontin)

Question 21

_______________ should be used with caution, especially in ambulatory children due to increased incidence of sarcopenia

Answer 21

• Botulinum toxin