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Test 2 Flashcards

1
Q

Cerebral palsy

A

a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non progressive disturbances that occurred in the developing fetal or infant brain
The motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems

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2
Q

Cerebral palsy definition

A 
brain lesion is static
musculoskeletal impairment is progressive
- muscle/ tendon contracture
- bony torsion
- hip displacement
- spinal deformity
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3
Q

CP primary impairments

A

spasticity
impaired postural control
impaired selective voluntary motor control
impaired sensory processing

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4
Q

CP secondary impairments

A

muscle or tendon contractures
skeletal deformities
decreased strength
limited endurance

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5
Q

CP epidemiology

A

most common motor disability in children
- 764,000 individuals with CP in the US (adults and children)
-3.1-3.6/1000 children have CP
more common in boys than girls

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6
Q

cerebral palsy risk factors

A

low birth weight: <1500g or 3.3lbs

prematurity: 28-31 weeks

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7
Q

classification of CP

A

location of brain lesion
- pyramidal, extrapyramidal, mixed
Type of movement disorder
- athetoid, spastic, dystonic, ataxia, mixed
Extent and location of limb involvement
- monoplegia, diplegia, hemiplegia, paraplegia, tetraplegia
function (GMFCS)

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8
Q

spastic CP

A

increased tone and stiff muscles
70-80% of CP
white matter injury

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9
Q

Dyskinetic type CP

A

abnormal movement patterns
athetoid vs. chorea
10-20%

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10
Q

ataxic CP

A

abnormal movement patterns

10%

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11
Q

hypotonic CP

A

low muscle tone

10%

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12
Q

monoplegia

A

one extremity

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13
Q

diplegia

A

impairment of bilateral LE and UE

LE more involved/ impaired vs UE

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14
Q

Hemiplegia

A

impairment of UE/LE of same side of body

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15
Q

Triplegia

A

3/4 extremities involved

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16
Q

quadraplegia/ tetraplegia

A

all extremities involved

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17
Q

GMFCS level 1

A

Walks without limitations

  • uses no AD
  • can walk indoors and outdoors and climb stairs with no limits
  • can perform usual activities such as running and jumping
  • has decreased speed, balance, and coordination
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18
Q

GMFCS level 2

A

Walks with limitations
is limited in outdoor activities
has the ability to walk indoors and outdoors and climb stairs with railings
has difficulty with uneven terrain, hills, or crowds
has minimal ability to run or jump

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19
Q

difference between GMFCS level 1 and 2

A

level 2 has limitations walking long distances and balancing
level 2 may need a hand held mobility device when first learning to walk
level 2 may use wheeled mobility when traveling long distances outdoors and in the community
level 2 requires the use of a railing to walk up and down stairs
not capable of running or jumping

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20
Q

GMFCS level 3

A

uses hand held mobility device
walks with assistive mobility devices indoors and outdoors on level surfaces
may be able to climb stairs using railing
may propel a manual w.c with assistance needed for long distances or uneven surfaces

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21
Q

differences between GMFCS levels 2 and 3

A

children in level 2 are capable of walking without a hand held mobility device after age 4
level 3 need a hand held mobility device to walk indoors and use wheeled mobility outdoors and in the community

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22
Q

GMFCS level 4

A

self mobility with limitations; may use powered mobility
self mobility severely limited even with AD
uses w/c most of the time and may propel their own power w/c

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23
Q

difference between GMFCS level 3 and 4

A

level 3 can sit on their own or require at most limited external support to sit
level 3 more independent in standing transfers and walk with a hand held mobility device
level 4 function in sitting (usually sitting) but self mobility is limited)
level 4 are more likely to be transported in manual wheelchair or use powered mobility

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24
Q

GMFCS level 5

A

transported in manual w/c
physical impairments that restrict voluntary control of movt and ability to maintain head and neck position against gravity
impaired in all areas of motor function
cannot sit or stand on their own even with equipment
cannot do independent mobility
- may be able to use a power chair

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25
difference between GMFCS 4 and 5
level 5 have severe limitations in head and trunk control and require extensive assistive technology and physical assistance self mobility achieved only if the child can learn how to operate a powered w/c
26
child/ family/ caregiver interview and chart review
birth-5 yrs - birth history; prenatal and perinatal problems - may not be formally diagnosed until 1-2 years of age but can still demonstrate signs of CP 6-21 yrs - focus on functional skills Adults - 65-90% of children with CP live into their adult years
27
cognition and CP
cognitive deficits are not inherent with CP | independent mobility impacts learning opportunities
28
CP participation
``` birth-12 years - play and parent/ caregiver child interactions - teacher-child and peer interactions 13-21 years - mobility needs for participation - post secondary transition - transition to adult services Adult - career/ community/ family roles ```
29
ROM and CP
``` observe AROM; measure PROM goniometry or clinical observation specific considerations/ muscle groups - test hip ext in knee flex/ext - problems with hip ABD/ ADD - knee ext ```
30
CP alignment and posture
``` postural symmetry hip joint integrity LE alignment Leg length discrepancy scoliosis growth overuse syndromes ```
31
CP and bone health
at risk for osteoporosis and osteopenia Adults with CP have increased stress and strain on their bodies over time early development of OA
32
individuals with CP are at an increased risk for pain with causes including:
``` surgical procedural GI orthopedic Neuromuscular rehabilitative ```
33
Pain assessment- FLACC
``` Face legs activity cry consolability ```
34
Spastic CP and standing
up on toes knees extended hips ADD and IR pelvis in anterior tilt
35
crouched posture and CP
ankle DF knee flex hip ADD, FLEX, IR
36
sitting posture with CP
with decreased hamstring ROM - knees in flexion - posterior pelvic tilt - compensatory lumbar and thoracic kyphosis - neck hyperextension
37
Scoliosis and CP
seen in 25% of children with CP increased incidence with increased CP severity results from: - decreased stability - atypical postures - atypical muscle pull or muscle imbalances - leg length inequality--> pelvic asymmetry
38
pelvic and hip problems with CP
result from: - body abnormalities - alignment - muscle abnormalities, length, function - ROM limitations - hypertonicity--> hip flexion, AD, IR
39
Pelvic alignment abnormalities and CP
obliquity--> leg length inequality posterior pelvic tilt--> limited hamstring ROM anterior pelvic tilt--> hip flexor tightness
40
hip subluxation or dislocation and CP
18-50% of kids with CP from both bony and muscular factors with CP, delayed motor milestones, decreased WB forces at an early age - hip instability - atypical muscle pull/ spasticity: decreased ABD rom and hip flexion contractures - critical ROM for hip stability: 30 deg ABD and avoid hip flexor contractors >20-25 deg
41
torsional conditions and CP
foot angle progression femoral anteversion and retroversion tibial torsion - thigh, foot axis
42
decreased DF ROM and CP
``` due to shortened gastroc - hypertonicity - decreased stability around the ankle - PF position during WBing Concerns: - affects positioning in orthoses or shoes - significantly reduces BOS ```
43
equinovalgus and CP
flatfoot breakdown of longitudinal arch decreases ankle/ foot balance reactions
44
motor control and balance and CP
delayed reactive and anticipatory postural control and postural sway may lower the COG by flexing the knees with feet in either excessive PF or DF greater reliance on prox muscles for balance - hip and stepping strategies more than ankle difficulty maintaining postural control in stationary postures
45
sensory function and CP
clinical observation responses and reactions to tactile, auditory, visual, and vestibular stimuli alterations in proprioception, vision, and vestibular information and integration - sensory feedback may be inaccurate,delayed, and/or insufficient for assisting with learning more coordinated movement
46
balance assessment and CP
reaching and playing in sitting, standing, walking balance during transition between positions objective measures - Movement assessment of infants - pediatric balance scale - early clinical assessment of balance - pediatric reach test
47
ambulation dysfunction classification in CP
``` jump - hip and knee flexion in stance - PF in stance Crouched - hip and knee flexion throughout stance - gastroc insufficiency Recurvatum - knee hyperextension mid to late stance Stiff - decreased flexion in swing ```
48
spasticity in CP
``` Tardieu's R1 and R2 R1- point of first catch - dynamic end point - dependent on patient position - tested with fast velocity R2- passive length - equivalent to PROM - full range when muscle at rest and tested with velocity as slow as possible ```
49
timing errors in muscle recruitment in CP due to
inability to use selective voluntary motor control recruit both agonist and antagonist simultaneously impaired reciprocal inhibition disorderly and slower motor unit recruitment - not completely activated - decreased force production and weakness Reinforcement of abnormal neural circuits - from repetitive abnormal movement patterns
50
timing errors in muscle recruitment in CP results in
delayed initiation of movement decreased rate of force production prolonged muscle contraction disrupted timing of agonist to antagonist activation difficult dissociating individual limb or joint movements
51
CP- compensate for weak musculature and poor posture control by doing what?
actively co contracting or fixing muscles - decreases DF to be controlled during activities - continued use of co contraction may lead to further muscle weakness, joint contractors, and poor postural and prime movement control
52
Gross motor function measure
clinical measure to evaluate change in gross motor function use with natural history to guide treatment samples motor skills that are typical of normal developmental milestones up to age 5
53
GMFM dimensions
``` lying and rolling sitting crawling and kneeling standing walking, running, jumping ```
54
GMFM scoring
``` 4 point scoring system for each item 0- does not initiate 1- partially initiates 2- partially completes 3- completes ```
55
GMFCS 1,2,3 treatment goals
development of gross motor skills - standing, walking, running, jumping, etc. - promotion and maintenance of ms integrity - prevention of secondary impairments - enhancement of functional postures and movement - maintenance of optimal levels of fitness and overall health
56
GMFCS 4 and 5 treatment goals
early continuous postural management programs use equipment as needed sitting- 6mos of age standing- 12 mos of age
57
infant interventions for CP
educate families - provide support with acceptance and coping - promote parent's abilities to care for and interact with their child Remain realistic about the prognosis and efficacy of PT while remaining hopeful and providing options for interventions Address handling and positioning needs facilitate optimal sensorimotor experiences and skills - postural stability - smooth mobility
58
preschool interventions for CP
``` promote functional independence development of locomotor, cognitive, communication, fine motor, self care, and social abilities prevent secondary impairments optimize gross motor skills promote independent mobility ```
59
school age, adolescent, and adult interventions for CP
``` maintain achieved level of activity participation in age appropriate activities/ interests health promotion and physical activity prevent secondary impairments considerations: - growth - pain - decreasing muscular ROM - puberty - cumulative physical overuse - more active and independent lifestyle ```
60
context focused therapy interventions for CP
participation based address changing or adapting environmental factors to help increase the child's participation and improve performance of activities
61
rationale for positioning with CP
improves head position and control increases arm control improves ability to eat, digest, and breathe postural alignment facilitates social interactions improves ability to listen, speak, and communicate encourage motor development, exploration, and play
62
physiological benefits to supported standing with CP
``` improved bone density improved hip stability improved LE ROM improved spasticity allows for more typical remodeling of the head of the femur and the acetabulum ```
63
AFOs and CP
controls PF maintain longitudinal arch reduce hyperextension during stance eliminates movement of the ankle disuse atrophy of the ankle musculature
64
Serial casting and CP
3-6 weeks of successive casting decreases resistance to passive stretch increased DF ROM helps eliminate heel cord contracture
65
tendon lengthening and CP
cut in the tendon allows it to elongate | gastrocnemius, hamstrings,hip adductors
66
tendon transfers and CP
moves the tendon to a new attachment on the bone allowing a more relaxed position and/or more efficient pull UE- extensor muscles (primarily wrists)
67
femoral derotational osteotomy and CP
used to achieve better alignment of the head of the femur and the acetabulum
68
selective dorsal rhizotomy and CP
sensory nerve rootlets from the LE are cut selectively to create a balance between eliminating spasticity and preserving function post surgery need PT to work on increasing strength GMFCS 3 and 4
69
botox and spasticity
neuromuscular junctions near the injection sites inactivated for up to 4 months common muscles targeted: - gastrocnemius, hamstrings, hip flexors, hip adductors, upper extremities
70
Baclofen and spasticity
reduces spasticity mainly in LE improvements in function and ease of caregiving may cause drowsiness
71
passive stretching and CP
may be beneficial before and after exercise to warm up and prevent injury NOT effective in increasing ROM, reducing spasticity, or improving walking efficiency in children with spasticity - maintaining current muscle length requires the muscles to be elongated for 6+ hours per day - low load prolonged stretching is more effective than manual
72
strength training and CP
does NOT increase spasticity weakness impacts function isotonic training more effective than isokinetic
73
functional physical training and CP results in improvements in what?
``` aerobic endurance anaerobic capacity walking distance agility muscle strength functional ambulation ```
74
body weight supported treadmill training and CP
improves gross motor function and functional mobility in children with CP following orthopedic surgery may be effective to improve gait, endurance, and walking not enough evidence to support earlier independent walking or improved functional outcomes
75
CIMT/ forced use therapy and CP
functional training of more affected UE while less affected UE is restrained improve hand function in those with hemiplegia improvement in motor performance, daily function, and reaching, and health related QOL compared with traditional therapy
76
hippotherapy and CP
improved - trunk/ hip muscle symmetry - posture and stability - balance - reaching - gross motor function - walking and gait - running and jumping
77
conductive education and CP
integrates education and rehab goals conductors teach children to gain control over movements and to learn new movements for improved function repetition, verbal guidance, and rhythm

Neuromuscular (3 decks)

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