Week 10 Flashcards
UMN and LMN lesions
UMN:
-CNS: cerebral palsy, TBI, near drownings, tumours, viral/bacteria infections
-Primary positive impairments: abnormal postures, increased reflexes, spasticity, hypertonia (increased resistance to passive movement), muscle stiffness, contracture
-Primary negative impairments: weakness, loss of dexterity, paralysis, decreased sensation
LMN:
-Neuromuscular disorders such as Duchenne muscular dystrophy, spinal muscular atrophy, spinal poliomyelitis, Guillain-Barre syndrome, Cauda equina syndrome, spinal cord injury, neural tube defects
-Impairments: weakness, decreased resistance to passive joint movement, paralysis and/or disuse atrophy, decreased and/or loss of sensation, 2nd muscle stiffness and contracture
Developmental delay
-Delayed attainment of milestones in the absence of another diagnosis
-May be associated with biological risk factors, contextual risk factors and other impairments
-Impacts participation
-Diagnosis may only be given if >2SD below mean for age (personal-social, cognitive-language, motor development)
Mild motor impairment
-Delayed attainment of motor milestones - not at an age-appropriate level
-In absence of neurological impairment
-Earliest valid predictor of general developmental difficulties in at risk populations
Developmental coordination coordination criteria and symptoms/signs
Criteria:
-Learning and execution of coordinated motor skills is below expected level for age, given opportunity for skill learning
-Motor skill difficulties significantly interfere with activities of daily living and impact academic/school productivity, prevocational and vocational activities, leisure and play
-Onset is in the early developmental period
-Motor skill difficulties are not better explained by intellectual delay, visual impairment or other neurological conditions that affect movement
Signs/symptoms:
-Clumsiness and/or poor coordination
-Handwriting/printing/copying difficulties
-Difficulty finishing academic tasks on time
-Require extra effort and attention when tasks have a motor component
-Difficulty with activities of daily living
-Difficulty with sports and on the playground
-Difficulty learning new motor skills
-May look awkward either squirmy and floppy, or rigid and stiff when trying to do coordinated activities
-Difficulty with, or reduced interest in, physical activities
Treatment of DCD
-Task orientated interventions (e.g. NTT, CO-OP)
-Motor training based interventions
-Sensory integration and kinaesthetic training not recommended
-Children need to practise skills to improve them
Cerebral palsy
-A group of permanent disorders of the developmental of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain.
-Often accompanied with affected sensation, perception, cognition, communication and behaviour by epilepsy and by secondary musculoskeletal problems
-Heterogeneous group of movement disorders
-The primary functional difficulty is in movement and posture
-CP is associated with a permanent, non-progressive pathology that formed in utero or early infancy (before 2 years of age)
-Excluded transient disease processes
-
Risk factors for CP development
Antenatal:
-Prematurity and low birth weight
-Intrauterine infections
-Multiple gestation
-Pregnancy complications
Perinatal
-Birth asphyxia
-Complicated labour and delivery
Postnatal
-Non-accidental injury
-Head trauma
-Meningitis/encephalitis
-Cardio-pulmonary arrest
Protective factors: obstetrical care
-Magnesium sulphate
-Antibiotics
-Corticosteroids
Classification of CP
Motor types:
-Spastic (>70%)
-Dyskinetic: dystonia (involuntary twisting/repetitive posture), chorea (involuntary movement fragments), athetosis (slow continuous writing, prevents maintenance of a posture) 6%
-Ataxia (6%)
-Mixed (7%)
Motor distribution:
-Uni/bilateral
-# of limbs involved
-Hemiplegia
-Quadriplegia
-Diplegia
-Monoplegia
Functional level
-GMFCS: >2 years, 2-4 years, 4-6 years, 6-12 years, 12-18 years
Gross motor function classification system (GMFCS)
-5 levels (1 is able to ambulate independently whilst 5 is dependent for all mobility)
-Describes gross motor function of children with CP
-Emphasis on sitting, walking and wheeled mobility
-Levels distinguished between function and need for assistive devices
Comorbidities of CP
-Pain
-Intellectual disability
-Non-ambulant
-Hip displacement
-Non-verbal
-Epilepsy
-Behaviour disorder
-Bladder incontinence
-Sleep disorder
-Blindness
-Non-oral feeding
-Deafness
Impairments and adaptions of CP (UMNL)
Primary positive impairments (+hyper-response):
-Spasticity
-Hyperreflexia
0Hypertonia
-Abnormal postures
Musculoskeletal adaption
-Soft tissue changes: contracture, impaired muscle development
-Biomech changes
-Bony torsion
-Skeletal deformity
-Joint instability
-Degenerative arthritis
Primary negative impairments (-hypo-response)
-Weakness
-Loss of dexterity
-Paralysis
-Decreased sensation
-Fatiguability
-Poor balance
-Sensory deficits
Negative impairments of CP often have greatest impact on function
Preventing CP
-Magnesium sulphate: protectant factor <30 weeks
-Glucosteroids: given to mothers expected to deliver before 36 weeks
-Cooling/hypothermia: used for term infants with neonatal encephalopathy
-Caffeine: given to preterm and/or extremely low birthweight infants, reduces apnea of prematurity, recent concerns regarding effect on brain structure and function
-Melatonin/EPO
Lower motor neuron conditions
Includes:
-Anterior horn cells
-The motor axon
-The muscle fibres that it innervates and
-The neuromuscular junction
Lesion may be located in the
-Ventral horn cell
-Peripheral nerve
-Neuromuscular junction or
-Muscle
Characterised by:
-Weakness
-Decreased/loss of sensation
-Paralysis and/or disuse muscle atrophy
-Decreased resistance to passive joint movement
Common LMN conditions in childhood
-Spinal cord injury
-Spina bifida (neural tube defect)
-Cauda equina syndrome
-Brachial plexus lesions
-Charcot-Marie tooth disease
-Guillain Barre
-Neuromuscular disorders such as Duchenne muscular dystrophy, spinal muscular atrophy
Spinal cord injury
Causes
-Trauma
-Secondary to developmental anomalies
-Non-traumatic
Considerations
-Respiratory dysfunction
-DVT
-Osteopenia
-Orthostatic hypotension
-Thermoregulatory dysfunction
-Spasticity and pain
-Skin breakdown/pressure ulcers
-Musculoskeletal adaptations: hip displacement, neuromuscular scoliosis
