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
Hip
normal at birth
but displacement later on
surgical intervention crucial
clinical assessment
hamstring tightness
pelvic obliquity
GMFCS
gross motor function classification system.
higher grading
Xray+ Annual examination
interventions
-Posture management Physiotherapy Seating -Spasticity management General Baclofen Diazepam Specific Botulinum toxin Surgery -Deformity management Soft tissue release- Adductors Hamstrings Bony realignment- Varus Derotation Osteotomy Pelvic Osteotomy
multidisciplinary effort
wheelchair services physiotherapy education support orthotics occupational therapy social work opthalmology audiology orthopaedics community paediatrics
Spina bifida
Failure to close neural tube Folic acid protective 400mcg/day Occulta – benign Meningocele Myelomeningocele Encephalocele Anencephaly
myelomeningocele
Hydrocephaly Chiari II malform Tethered cord Urinary tract problems latex allergy learning disability
muscular dystrophy
FSH, DMD, BMD, Limb girdle, Myotonic, Emery Dreifus, Oculo-pharyngeal
Muscle Bx, DNA, Blood enzymes & EMG
Cardiomyopathy…Respiratory failure
Duchenne
Sex linked recessive Failure to make dystrophin 1 in 3000 males Proximal weak 4yoa ‘pseudohypertrophy’ Wheelchair by 12yoa Most get scoliosis Surgery indicated
Becker
Same gene, ltd but poor dystrophin
Milder
Later (adolescent) onset
Wheelchair by 30yoa
MD
shoulders and arms held back belly sticks out due to weak belly knees may bend back thick lower leg muscles (mostly fat) foot drop and tip toe contractures
