wk3- neuro diseases

Question 1

what is cerebral palsy

Answer 1

motor function disorder

caused by a permanent, non progressive brain defect or UML present from birth or slightly after birth

Question 2

types of cerebral palsy

Answer 2

1. spastic- most common
   -diplegia, quadplegia, hemiplegia
   cerebral motor cortex lesion
2. ataxia
   cerebellar lesion
3. dyskinetic
   basal ganglia lesion
4. mixed

determined by where the lesion is

Question 3

lesions on cerebral motor cortex result in what?

Answer 3

CMC is responsible for voluntary movements

resulting in
- paralysis and weakness
-voluntary control lost
-spastic cerebral palsy

Question 4

lesions on basal ganglia result in what

Answer 4

muscle movement directed by motor cortex

results in
-disturbance in posture and muscle tone
-tremors/involuntary movements
-dyskinetic cerebral palsy (long, slow, uncontrolled writhing)

Question 5

lesions of the cerebellum

Answer 5

C is in charge of timing and patterns of muscle contraction

results in
-loss of smooth muscle contraction
-clumsy
-ataxic cerebral palsy

Question 6

clinical features of cerebral palsy

Answer 6

-abnormal muscle tone
-loss of selective motor contorl
-impaired coordination
-weakness
-LOPS
-loss of proprioception

Question 7

what happens in gait for spastic hemiplegia

Answer 7

• increased plantarflexion- weak tib ant and tight posterior calf muscles, this resulting in loss of heel strike (foot drop)

-ankle equinus and RF varus

-excessive knee and hip flexion for foot drop

Question 8

most common deformity in hemiplagia is

Answer 8

equinovalgus

Question 9

what happens in gait for diplagia

Answer 9

-tight hamstrings causing over activity of quads with increased knee flexion

-increased hip flexion and anterior pelvic tilt giving a crouching gait look

Question 10

what happens in quadriplegia gait

Answer 10

-increased plantarflexion (foot drop)
-increased knee flexion during stance
-reduced knee flexion during swing
-increased hip flexion with a forward lean and anterior pelvic tilt

Question 11

key takeaways from gait in cerebral palsy

Answer 11

-instabily in stance
-poor foot clearance in swing
-inadequate heel strike
-inadequate step length
-excessive energy expenditure

Question 12

typical manifesttions in hip, knee, ankle and foot of cerebral palsy

Answer 12

hip- flexed
knee- flexed
ankle- equinas
foot- valgus or varus and toe deformities

Question 13

treatment options for cerebral palsy - mechanical aids

Answer 13

1. foot orthoses- to stabilise STJ motion
2. ankle foot orthoses (AFO)- to stabilise STJ, ankle and knee motion

Question 14

what is spina bifida

Answer 14

failure of closure of spinal column causing a defect in the neural tube

occurs early in foetal development

Question 15

types of spina bifida

Answer 15

occulta- absence of small portion of vertebrae which rarely affects nervous system

cystica- lump/cyst formation
-meningocele
-myelomeningocele

Question 16

meningocele

Answer 16

herniation of spinal meninges

Question 17

myelomeningocele

Answer 17

severe form

open cyst and exposure of CSF, spinal canal and cord/nerves

Question 18

clinical features of myelomeningocele

Answer 18

-flaccid paraparesis/paraplegia, leg weakness
-posterior chain atrophy
-steppage gait, apropulsive, poor ankle plantarflexion control

Question 18

types of CMT

Answer 18

type 1- demyelination (onset in teens/twenties)

type 2- axonal degeneration (onset in adult life)

Question 18

what is CMT

Answer 18

hereditary motor and sensory neuropathy

autosomal dominant condition

Question 19

patho of CMT

Answer 19

nerve conduction dysfunction results in weakness and atropy of the leg muscles and the posterior medial muscles gain advantage leading to lateral ankle instability/cavus foot type

this usually plateaus in adulthood

Question 20

clinical features of CMT

Answer 20

-weakness of leg muscles
-lateral ankle instability
-cavus foot type
-muscle wasting focal to anterolateral comp
-glove and stocking sensation loss
-lesser toe contracture

Question 21

treatment for CMT

Answer 21

-splinting
-surgical - PT tendon transfer
- orthoses and footwear aid

Question 22

what is duchenne muscular dystrophy

Answer 22

hereditary myopathy (progressive muscle atrophy)

Question 23

patho of DMD

Answer 23

Muttion at position 21 chromosome (short arm of X) so more common in men

Question 24

clinical features of DMD

Answer 24

most appear before age 5

-delayed independent walking
-muscle weakness
-abnormal gait
-falls
-difficulty with stairs
-muscle cramping/spasms

Question 25

gait patterns in DMD

Answer 25

waddling gait
lumbar lordosis
gowers sign
psudeohypertrophy of calf muscles (adipose)
toe walking due to proximal weakness

Question 26

prognosis of DMD

Answer 26

weelchair by 12 years
death early twenties

important to avoid immobilisation to offset contracture but also not overuse as it can speed up muscle breakdown

Question 27

treatment of DMD

Answer 27

-splints
-braces
-orthoses/footwear in youth
-surgery- tendon transfers for ROM
-physiotherapy

Question 29

What is autism

Answer 29

Restricted or hyper focused behaviours along with impaired social interaction

Question 30

Diagnosis checklist for autism

Answer 30

• impaired social interaction/communication
  -preservative motor movements
  -need for routine
  -restricted range of interests/focuses
• intense or diminished sensitivity to sensory/tatile stimuli
  -developmental regression

Question 31

Clinical features of autism

Answer 31

-regression of milestones
-hypotonia
-awkward motor skills
-neurocutaneous abnormalities
-seizures

Question 32

How to run a session with someone with autism

Answer 32

-run on time
-remove stimulus like bright lights or loud noises

Question 33

What is idiopathic toe walking

Answer 33

Typically seen in children when their gait does not begin with a heel strike

Question 34

What does idiopathic toe walking have a link to

Answer 34

Equinas

Question 35

Treatment of idiopathic toe walking

Answer 35

Equinas
- splinting
-serial casting series
-BTX-A
-surgery (tendo-Achilles lengthening)

Non Equinas
- FF plate
- raise
- orthoses