WS Content Flashcards
CP: Subjective - What information would you obtain regarding medical history?
- Pregnancy and neonatal history
- Birth complications (birth weight, premature, APGAR, 02 support necessary, NVD/C- Section)
- Relevant past medical history (respiratory, cardiac, surgical history, fracture history)
- Medications
- Heary assessment
- Vision assessment
CP: Subjective - What information would you gather?
- Developmental history eg Gross motor function, sitting, standing, etc
- Pain
- Other health professionals involved
- Home environment (indoor eg internal steps, surfaces, etc. Outdoor eg steps, ramp, hilly yard & rails)
- Home (mobility, fatigue, participations in ADL’s)
- Activities
- Goals of the family
Red flags GMF: 6 months
Not rolling
Not holding head and shoulders up when on tummy
Red flags GMF: 9 months
Not sitting without support
Does not take weight well on legs when held by an adult
Red flags GMF: 12 months
Not crawling or bottom shuffling; not pulling to stand
Not standing holding on to furniture
Red flags GMF: 18 months
Not attempting to walk without support
Not standing alone
Red flags GMF : 2 years
Unable to run; unable to use stairs holding on
Unable to throw a ball
Red flags GMF: 3 years
Not running well; cannot walk up and down stairs
Cannot kick or throw a ball
Cannot jump with 2 feet together
Red flags Fine motor: 6 months
- Not reaching for and holding (grasping) toys
- Hands frequently clenched
Red flags: Fine motor: 9 months
- Unable to hold and/or release toys
- Cannot move toy from one hand to another
Red flags: Fine motor 12 months
- Majority of nutrition still liquid/puree
- Cannot chew solid food
- Unable to pickup small items using index finger and thumb
Red flags: Fine motor 18 months
- Not holding or scribbling with a crayon
- Does not attempt to tower blocks
Red flages Fine motor: 2 years
- No interest in self care skills (eg feeding, dressing)
Red flags Fine motor: 3 years
- Difficulty helping with self care skills (feeding, dressing)
-Difficulty manipulating small objects (eg threading beads)
Red flag Fine motor: 4 years
- Not toilet trained by day
- Unable to draw lines and circles
Objective assessment
- Gross motor function eg head control, rolling, jumping, walking
- Fine motor function eg grasp
- Respiratory: breathing pattern, cough, sputum, airway clearance
- Neurological: tone/spasticity/clonus, deep tendon reflex, tremor
- Skeletal: ROM limbs, neck. Head shape, hip dysplasia, foot deformities, spinal palpation, asymmetries/side preference
- Muscular: strength, unusual positioning of limbs, movement against gravity, endurance of postural muscles, sit-stand, on/off floor
- Sensory: vision/hearing. Tactile/proprioception/Vestibular
- balance: protective responses, tandem walking, single leg stance
- Socialisation: eye contact, verbal communication, non-verbal communication, play skills, babbling/language
Gross motor function measure (GMFM)
- Target pop?
- Purpose?
5 months to 16 years old
Measure change in gross motor function over time in children with cerebral palsy (evaluation)
Gross motor function measure (GMFM)
- Advantages
- Disadvantages
Advantages
- Criterion references
- Age range: 5 months to 16 years
- Sensitive to change
- Computer scoring is easy to use
Disadvantages
- Does not assess quality of movement
- Takes time and preparation
- GMFM-88 all items must be administered
Gross motor function measure: Interpretation of results?
The GMFM assesses motor function (how much of a task the child can do) rather than the quality of the motor performance (how well the child performs the task).
Botox (intervention for children with spastic CP)
- Mechanism
- Goals
- Strengths/weaknesses
- Mechanism: Botulinum Toxin A blocks the release of acetylcholine, a neurotransmitter responsible for muscle contractions. This results in a reduction in muscle tone and spasticity in the targeted muscles, allowing for more flexibility and improved range of motion.
- Goals: reduction of spasticity and dystonia. Improvement in function
Strengths/weaknesses
- Effective in reducing spasticity in specific muscles
- Can be used in both ULs and LLs
- Can cause weakness
- Only lasts for 3-6 months so requires repeat injections
- Weakens muscles overtime (long term implication of this should be considered)
Selective dorsal rhizotomy
- Mechanism
- Goals
- Strengths/weaknesses
- Mechanism: permanently interrupting the abnormal spinal reflex arc by dividing the dorsal sensory spinal roots of L1/L2-S1, stimulating each one with EMG and surgically sectioning the sensory nerve rootlets with abnormal, excessive and contralateral responses.
Goals: Reduction of spasticity in the lower limbs. Improvement in function
Strengths & weaknesses
- Can permanently reduce spasticity
- Improves walking ability, balance and muscle control
- Only appropriate for a small group of children with diplegic CP (GMFCS II/III) aged 4-6 years
- Does not correct existing contractures or deformities and does not cure the primary effects of cerebral palsy, which include loss of motor control, weakness and balance problems
- Invasive and irreversible
- Can result in complications such as bladder dysfunction, sensory changes, spinal deformity and unmasking weakness
Serial casting
- Mechanism
- Goals
- Strengths/weaknesses
Mechanism: Imposes a continuous stretch on a group of muscles, leading to an increase in muscle fibre length due to an increase in the number of sarcomeres. This increased muscle length reduces the overall soft tissue contracture.
Goals: improve muscle length
Strengths/weakness
- Non-invasive
- Well-tolerated
- Only provides short-term benefits and often needs to be repeated at regular intervals
- Weakens muscle temporarily
Assistive device
- Define
- Purpose?
- Principles for assistive device prescription
An Assistive Device is any device that helps someone do something that they might not otherwise be able to do well or at all. Generally the term is used for devices that help people overcome a handicap such as a mobility, vision, mental, dexterity or hearing loss.
Purpose:
- Provide better support for long term growth
- Minimize secondary problems/complications e.g scoliosis, contracture etc.
- Provide support for movement
- Assist with mobility for the affected child and the carer
Principles
- Should improve and not worsen the comfort and care of the child
- Should not promote contractures or pressure areas
-Use should form part of the daily routine of the affected child
- Should enhance participation with the natural environment
