Paediatric neuro Flashcards
aim of assessment
provide a baseline picture of child, evaluate child abilities and inabilities, compare function to their chronological age- motor development, place child’s abilities within context of their environment
neurological system
children are growing initially the nervous system operates by reflex activity, neurological conditions may be congenital, developmental or acquired, distribution of tone will interrupt normal motor development
subjective assessment- PC and HPC
PC- may be referred as developmental delay, may prevent MSK problem, associated with cardiorespiratory problem
HPC- often present since birth, parents may be the only ones who have noticed a problem and in young children= developmental delay
subjective assessment- PMH
other associated conditions- epilepsy, hydrocephalus (swelling and pressure on brain), cardiorespiratory condition, shunt- release pressure and fluid on brain, corrective surgery- drug history
subjective assessment- SQ= birthing process and motor history
birthing- traumatic?, very important for many neurological conditions- cerebral palsy and developmental coordination disorder- premature
motor- head control (3/12, rolling- stronger on side- 4-6/12, sitting- 6-9/12, crawling- 9-12/12, walking 12-18/12
subjective assessment- social and cognitive history, family history
social- how well they sleep/eat, how are they getting on at school, friends?, eye contact?/speech?/ hearing?
family history- both parents present (living with grandparents? less attention- slower development), siblings? support networks? work commitments? access to a vehicle?
subjective assessment- parents/child perceptions
do parents/child perceive there to be a problem? what are the parental and child goals?
location
home- see child within their own context- may be most comfortable for child, child developmental centre= formal MDT assessment process, school- special/mainstream, clinic/hospital
objective assessment
start with obs- give toys and observe (make child comfortable), movement patterns, interactions- with therapist and parents?, analysis- aware of everything?, use of arms and legs- AROM/PROM/Tone, could get them to do development stages
fine motor skills
dependant on gross motor and visual development, delay in FMS has an effect on cognitive development- writing/ thinking/ puzzles/ sensory
gross motor skills
are bigger movements- such as rolling over and sitting- that use large muscles in the arms/legs/torso and feet
at beginning and end of fine motor
objective assessment- items to include
GMS and FMS- age appropriate, ROM, muscle tone- MAS, associated reactions and primitive reflexes, muscle strength- need to make interesting enough for child to be entertained, volitional and involuntary movement- co-ordination- tap head and tap teddys head
how?- observations
general movement patterns against afe norms- GMS and FMS, observe interactions, observe at play, can and how do they get there?, can they maintain posture in sit/stand, asymmetrical symptoms, can they move within/without the postural set, do they demonstrate associated reactions or reflex activity
how?- handling
ROM- contractures- fixed? and hypermobility
passive movements- stimulating tone
muscle tone- hypertonicity/spasticity, hypotonicity
muscle strength- oxford scale
how?- standardised assessment tools
normal motor milestones, chailey level of ability, gross motor function measure (GMFM), movement ABC test (MABC)
how?- documentation
POMR- abilities, age appropriate behaviour, inabilities
individualised programme plan- person centred, highlights strengths and abilities, indicates areas of weakness
neurological and neuromuscular disorder
due to- insult on developing CNS pre/peri/postnatally, genetic or congenital conditions, trauma
conditions- cerebral palsy (CP)
a permeant impairment of movement and posture resulting from a non-progressive brain disorder due to hereditary factors or events during pregnancy, delivery, neonatal period and first 2-3/5 years of life, low birth weight, insult can occur pre/peri/post natally
CP classification
part of body- hemiplegia, diplegia, quadriplegia
type of tone- hypertonic (spasticity (80%), high reflexes) and dystonic- twisting and repetitive unplanned voluntary movement
hypotonic- athetoid- slow movement with extreme fluctuation, ataxic- uncoordinated and jerky movement, atresia- uncoordinated
conditions- spina bifida (SB)
congenital abnormality in formation of spinal vertebrae, incidence decreases, it is caused by a lack of folic acid
SB- types
Occulta- 1 or more vertebrae don’t form properly- gap small, cystica meningocele- were membranes around spinal cord push out into spine, cystidia myelomeningocele- most severe, both membrane and spinal cord push out of back
conditions- hydrocephalus
increased CSF ventricles of brain, 75-80% S.B. myelomeningocele have hydrocephalus, treated by shunt
signs= headaches and changes in arousal/treatment, physio deal with changes post op
conditions- (Duchenne) muscular dystrophy- DMD
one of most severely disabling childhood disorders, 1:3500 males, progressive genetic disease of boys, die in early 20’s from respiratory complications, gowers manoeuvre- weakness in legs and arms= lock out joints and use them as stability to climb up legs to stand up
conditions- other
acquired head injury (AHI), learning disability
physio intervention
24 hour- postural movement and management, encourage symmetry, prevent and treat deformities, facilitate movement and mobility, encourage functional independence
prevention of deformity
standing- early and in correct alignment, passive stretches, positioning- in school and home, botox injections
principles of care
access to a network of care with agreed pathways, intervention should be planned and discussed, individualised, goal focused programme developed in partnership with child/parent, condition should be monitored
physical therapy
prompt assessment by a physio and whole necessary OT, 24 hour postural management, task focused activities in short intensive programmes, progressive muscle strengthening programme, botulinum toxin A- physio essential component of management
orthoses
based on individuals needs and aimed at specific goals, pros and cons discussed with child, correctly fitted with education of child, parents/carers on checks and timetable for wearing, monitored by team
oral drugs
diazepam- rapid relief for spasm and pain, Botulinum toxin A- focal spasticity, intrathecal baclofen- more widespread spasticity with postural/functional/ care difficulties
surgery- orthopaedic
assessment of needs by paediatric orthopaedic surgeon in the team- management of spasticity, hip subluxation and dislocation, spinal deformity
selective dorsal rhizotomy GMFCS II or III
motor development- newborn
prone- baby turns head to side, hips and knees flexed with legs under body, arms by side with elbows fully flexed,
4 types of skills- GMS/FMS/ language skills/ social skills, hands tightly disted, flailing movement at objects
reflexes- rooting, suck, grasp
rooting- happens when the corner of a baby’s mouth touches the skin/nipple, suck- when the lips or cheek are tickled, the muscles coordinate to form a such response so that the child can suck and coordinate the muscles needed to ingest milk, grasp- stroking the palm of a baby’s hand causes the baby to close his or her fingers in a grasp
reflexes- moro, tonic neck, stepping
moro- causes baby to extend arms,legs and fingers and arch when startled by a loud noise or other environmental stimuli
tonic neck- when a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow
stepping- a baby appears to take steps or dance when held upright with his or her feet touching a solid surface
motor development- 3 months
babies start to extend more, head control, flexed back in supported sitting, rolling from 4/12, grasp reflex, plays with hands in midline (visual input)
motor development- 6 months
supine lift heads to see feet, braces shoulders on pull to sit, straight back in supported sitting, takes weight through legs in standing, prone support on extended arms, grasps toy within reach, take everything to mouth
motor development- 9 months
sit independently, creep/commando crawls, achieve 4-point kneeling, pull to stand, gross pincer grasp- thumb to finger, transfers from one hand to hand, begin to manipulate toys
motor development- 12 months
crawling well, cruising on furniture, may stand unsupported, walks with assistance, picks up small objects with pincer grip, holds spoon but cannot feed, plays pat-a-cake, manipulates toys
motor development- 18 months
walks well, crouches, crude catching, stairs with help, palmper grasp or primitive tripod grasp, build tower of 3 cubes, turn pages- may be few at time, attempts to feed from spoon, hold cup in 2 hands
motor development- 2 years
run safely, climbs and scoots, stairs- independent with rail, throws small ball and kicks, holding pencils nearer point/ tripod grasp, build towers of 6 blicks, turn pages singly, spoon feeds without spillage, showing hand preference
motor development- 3 years
jump and stand on 1 leg for few secs, pedals tricycle, stairs alternate feet, catch and kick, threads beads on a string, use scissors, hand preference becomes more obvious
treatment
playing games, multiple things to do- get bored easily, know children- what they like
handling
ROM- contractures (fixed), hypermobility ,passive movements- stimulating tone, tone- environment, hypotonicity, muscle strength
GMFC- levels I, II, III
I- walks without restrictions, limitations in more advanced GMS
II- walks without assistive devices, limitations in walking outdoors and in the community
III- walks with handheld assistive mobility devices, limitations in walking outdoors and in the community
GMFC levels- IV, V
IV- self mobility with limitations; children are transported or use power mobility outdoors and in the community
V- self mobility is severely limited even with the use of assistive technology
