Peds Neuro Flashcards
characteristics of cerebral palsy
abnormalities of motor activity and posure
non-progressive
changing
involves motor system
what can cause CP
perinatal asphyxia
complications of prematurity
perinatal infection
kernicterus
6 forms of CP
spastic/pyramidal non spastic/extrapyramidal atonic cerebellar ataxic combined
most common CP
spastic pyramidal
DDx CP
neurodegeneration: leukodystrophies
inborn errors: inherited metabolic disorders, metabolic myopathies, metabolic neuropathy, Neimann Pick, Mitochondrial disorders, lesch nyhan
developmental or traumatic lesions
neoplasms
Dx of CP
observation of slow motor development, abnormal muscle tone, unusual posture
assessment of persistent infantile reflexes is important: moro reflex
earliest signs of spasticity
resistance to passive motion, especially flexion
CP should not be Dx before what age
2 y.o
cerebral imaging for CP
CT MRI US
goals of OMT in CP patient
muscle tone
proprioceptive input to affect motor output
influences on proprioceptive input to affect motor input
primary somatosensory mapping
muscle coupling
movement strategies
complaint of chronic muscle spasms
pain
how can OMT limit contractures
changing proprioceptive input from joints, CT and muscle which affect posture, balance and movement
common complication with CP patients in wheelchairs
hip dislocation as a result of hip contractures
Signs pyramidal CP
UMN damage hypertonic and spasticity 70-80% CP patients stiff rigid limbs exaggerated reflexes jerky movements
assoc pathology with spastic CP
hip pathology, scoliosis and limb deformities
area of brain implicated in extrapyramidal CP
basal ganglia, thalamus and cerebellum
types of extrapyramidal CP
ataxic and dyskinetic
main characteristics extrapyramidal CP
impairments in involuntary movement
dyskinesias
dystonias
athetosis
types of dyskinetic CP
athetoid– involuntary movement
dystonia/dystonic–trunk mm more than limbs and results in twisted posture
most common area of LE affected by postural compensation
hamstring hypertonicity post innominate and dec lumbar lordosis extension TLJ flattened thoracic kyphosis extended OA
myotactic reflex
monosynaptic reflex with sensory input via DRG and motor output from ventral horn
Muscle energy types
isometric isotonic concentric isotonic eccentric isolytic resciprocol inhibition
isotonic concentric
same tone, shorten the muscle (let patient win)
isotonic eccentric
same tone, lengthen muscle (let physician win)
isolytic
quickly overcoming patient contraction
reciprocol inhibition
withdrawal and crossed extensor reflexes
applyin gMET to one group of mm to affect antagonist
MET is not best choice for kids under what age
8 y.o
isolytic MET is good for what
adhesions, fibrosis from long term contraction
can use directly on hypertonic mm
Reciprocol inhibition MET used for
decrease tone to hypertonic mm using mm that are better under voluntary
hemiplegia
unilateral contractures
baseline tone in spastic and non spastic CP
dec in nonspastic
inc in spastic
50% of what type CP have sensorineural hearing loss
non spastic
non spastic CP will have what eye complications
strabismus
nystagmus
postural compensations
create balance and stability shortening antigravity mm
decrease cervical lordosis, head forward posture
common orthopedic problems
common complaints postural compensation
back pain, knee, hip pain and HA
decreased cervical lordosis can lead to what
extension dysfunction of OA
shortening of suboccipital mm
chronic HA and bruxism
isotonic eccentric ME in nonspastic CP
address shortened mm (antigravity)
isotonic concentric ME in nonspastic CP
help strenghten and improve firing patterns of hypotonic mm
good technique for all types CP
myofascial release
BLT to balance tone and interosseous membrane
FPR for short restrictors
counterstrain to lengthen and relax tone in long restrictor mm
What OMT can parents do for CP patients
rib raising
diaphragms
lymph pumps
to prevent hospitalization
OMT for pneumonia and reflux
maximize O2 and ability to clear secretions: ribs thoracic vertebral motion, myofascial motion
reduce reflux: diaphragm motion middle cervicals and thoracics, also cranial base
importance when working with PC patient
recognize pattern changes that signal something may be happening
