paediatric orthopaedics, neuromuscular conditions Flashcards
complex needs
a child with multiple and complex disabilities has at least two different types of severe or profound impairment such that no one professional/ discipline has monopoly on assessment and management
complex exceptional needs
learning and mental functions communication motor skills self care hearing vision Definition: child<19 severe impairment in 4 categories together with enteral or parenteral feeding OR severe impairment in 2 and ventilation AND impairments sustained for more than 6 mths ongoing
cerebral palsy
permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life.
The lesion is static but the clinical picture is not.
causes of cerebral palsy
Prenatal: placental insufficiency, toxaemia, smoking, alcohol, drugs, infection such as toxoplasmosis, rubella, CMV and herpes type II (TORCH)
Perinatal: prematurity (most common), anoxic injuries, infections, kernicterus, erythroblastosis fetalis
Postnatal: infection (CMV, rubella), head trauma
classification
Spastic (pyramidal system, motor cortex)
Athetoid (extrapyramidal system, basal ganglia)
Ataxia (cerebellum and brainstem)
Rigid (basal ganglia and motor cortex)
Hemiballistic
Mixed (combination of spasticity and athetosis)
anatomical
Monoplegia (one limb involved)
Hemiplegia (one side of the body)
Diplegia (lower limbs)
Quadriplegia or total body involvement
diagnosis 1
spasticity lack of voluntary control weakness poor coordination sensory impairment persistence of primitive reflex: parachute, tonic neck
diagnosis 2
dynamic contractures
fixed muscle contractures
fixed contractures with joint subluxation/ dislocation and secondary bone changes
management
motor sensory cognitive problems epilepsy feeding difficulties
orthopaedics priorities
spine
hip
feet
torsional lower limb probs
system goals
sitting balance
standing posture
gait
functional problems
keeping clean no longer able to stand feet too deformed to fit in spints and skin is breaking down in pain knees too sore to walk
prerequisites of normal gait
Stability in stance Clearance in swing Preposition of foot Adequate step length Energy conservation
muscle actions
concentric
- shortening
- power generation
- acceleration
eccentric
- controlled lengthening
- power absorption
- deceleration
spine in CP
scoliosis common
surgery to
maintain seating and respiratory function
