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Neuromuscular > Test 2 > Flashcards

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
Q

difference between GMFCS 4 and 5

A

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

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26
Q

child/ family/ caregiver interview and chart review

A

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

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27
Q

cognition and CP

A

cognitive deficits are not inherent with CP

independent mobility impacts learning opportunities

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28
Q

CP participation

A 
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
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29
Q

ROM and CP

A 
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
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30
Q

CP alignment and posture

A 
postural symmetry
hip joint integrity
LE alignment
Leg length discrepancy
scoliosis
growth 
overuse syndromes
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31
Q

CP and bone health

A

at risk for osteoporosis and osteopenia
Adults with CP have increased stress and strain on their bodies over time
early development of OA

32
Q

individuals with CP are at an increased risk for pain with causes including:

A 
surgical
procedural
GI
orthopedic
Neuromuscular
rehabilitative
33
Q

Pain assessment- FLACC

A 
Face
legs
activity
cry
consolability
34
Q

Spastic CP and standing

A

up on toes
knees extended
hips ADD and IR
pelvis in anterior tilt

35
Q

crouched posture and CP

A

ankle DF
knee flex
hip ADD, FLEX, IR

36
Q

sitting posture with CP

A

with decreased hamstring ROM

  • knees in flexion
  • posterior pelvic tilt
  • compensatory lumbar and thoracic kyphosis
  • neck hyperextension
37
Q

Scoliosis and CP

A

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
Q

pelvic and hip problems with CP

A

result from:

  • body abnormalities
  • alignment
  • muscle abnormalities, length, function
    • ROM limitations
    • hypertonicity–> hip flexion, AD, IR
39
Q

Pelvic alignment abnormalities and CP

A

obliquity–> leg length inequality
posterior pelvic tilt–> limited hamstring ROM
anterior pelvic tilt–> hip flexor tightness

40
Q

hip subluxation or dislocation and CP

A

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
Q

torsional conditions and CP

A

foot angle progression
femoral anteversion and retroversion
tibial torsion
- thigh, foot axis

42
Q

decreased DF ROM and CP

A 
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
Q

equinovalgus and CP

A

flatfoot
breakdown of longitudinal arch
decreases ankle/ foot balance reactions

44
Q

motor control and balance and CP

A

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
Q

sensory function and CP

A

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
Q

balance assessment and CP

A

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
Q

ambulation dysfunction classification in CP

A 
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
Q

spasticity in CP

A 
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
Q

timing errors in muscle recruitment in CP due to

A

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
Q

timing errors in muscle recruitment in CP results in

A

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
Q

CP- compensate for weak musculature and poor posture control by doing what?

A

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
Q

Gross motor function measure

A

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
Q

GMFM dimensions

A 
lying and rolling
sitting
crawling and kneeling
standing
walking, running, jumping
54
Q

GMFM scoring

A 
4 point scoring system for each item
0- does not initiate
1- partially initiates
2- partially completes
3- completes
55
Q

GMFCS 1,2,3 treatment goals

A

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
Q

GMFCS 4 and 5 treatment goals

A

early continuous postural management programs
use equipment as needed
sitting- 6mos of age
standing- 12 mos of age

57
Q

infant interventions for CP

A

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
Q

preschool interventions for CP

A 
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
Q

school age, adolescent, and adult interventions for CP

A 
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
Q

context focused therapy interventions for CP

A

participation based
address changing or adapting environmental factors to help increase the child’s participation and improve performance of activities

61
Q

rationale for positioning with CP

A

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
Q

physiological benefits to supported standing with CP

A 
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
Q

AFOs and CP

A

controls PF
maintain longitudinal arch
reduce hyperextension during stance

eliminates movement of the ankle
disuse atrophy of the ankle musculature

64
Q

Serial casting and CP

A

3-6 weeks of successive casting
decreases resistance to passive stretch
increased DF ROM
helps eliminate heel cord contracture

65
Q

tendon lengthening and CP

A

cut in the tendon allows it to elongate

gastrocnemius, hamstrings,hip adductors

66
Q

tendon transfers and CP

A

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
Q

femoral derotational osteotomy and CP

A

used to achieve better alignment of the head of the femur and the acetabulum

68
Q

selective dorsal rhizotomy and CP

A

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
Q

botox and spasticity

A

neuromuscular junctions near the injection sites inactivated for up to 4 months
common muscles targeted:
- gastrocnemius, hamstrings, hip flexors, hip adductors, upper extremities

70
Q

Baclofen and spasticity

A

reduces spasticity mainly in LE
improvements in function and ease of caregiving
may cause drowsiness

71
Q

passive stretching and CP

A

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
Q

strength training and CP

A

does NOT increase spasticity
weakness impacts function
isotonic training more effective than isokinetic

73
Q

functional physical training and CP results in improvements in what?

A 
aerobic endurance
anaerobic capacity
walking distance
agility
muscle strength
functional ambulation
74
Q

body weight supported treadmill training and CP

A

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
Q

CIMT/ forced use therapy and CP

A

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
Q

hippotherapy and CP

A

improved

  • trunk/ hip muscle symmetry
  • posture and stability
  • balance
  • reaching
  • gross motor function
  • walking and gait
  • running and jumping
77
Q

conductive education and CP

A

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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