Module 13: Flashcards
Common associations of ITW?
(higher frequency of ITW in those that also have?)
- MC type of toe walking is idiopathic. BL TW with / without achilles contracture in child older than 2.
- Autism
- Developmental delay
- Language disorder
Non-idiopathic TW associated with/ causes?
- TW as result of definable cause (often neurologic or muscular)
- Cerebral Palsy
- Duchenne muscular dystrophy , congenital muscular dystrophy
- Leg length discrepancy
- Tethered cord
- Spinabifida
- Acute TW secondary to Viral myositis
What is toe walking defined by?
- Absence of normal heel strike by both feet during gait.
- Forefoot engages in majority of floor contact
- ** +ve Fm Hx in many cases
what age does consistent heel-toe gait pattern develop?
- 22 months
- If TW persists beyond 2 yrs further evaluation warranted.
What test is done to measure gastroc vs achilles contracture?
- Silfverskiold test
- Gastroc contracture = DF of ankle limited w knee flexion
- Achilles contracture = DF of ankle remains the same irrespective of knee position
What are the treatment options for TW:
- Watch & wait
- Stretching
- Serial casting
- Botox
- Ankle foot orthoses
Pathophysiology of non-ITW in patients w Cerebral Palsy;
- Spasticity of foot & ankle muscles lead to progressive ankle contracture
- spasticity & flexion of hip & knee joints can lead to TW
Pathophysiology in Duchenne muscular dystrophy (progressive muscular weakness)
- Toe walking results from the relatively greater weakening of the dorsiflexors of the foot as compared with the plantarflexors
- TW also compensates for quad weakness
Clinical work to do for toe walkers
- Spinal/ peripheral joint mobs to improve & maintain function
- Fast stretch mm work
- Cerebellar work, balance & stability
- Heel walking
- Slow stretch w gravity and support
- Eye saccades down going
Homecare for toe walkers;
- Extension tone & balance work
- Heel walking w support
- Active strengthening - squat play
- Yoga, Childs pose, downward dog
What are the 3 main types of ADHD
- 1; COMBINED - inattention & hyperactive-impulsive symptoms
- 2: PREDOMINATLY INATTENTIVE
- 3: PREDOMINATLY HYPERACTIVE- IMPULSIVE
How do you notice what the patients NS can handle at that point of time?
- pupillary light reflex/ fatigue
- SNS signs
- Checking facial tone
- Pay attention to behaviour/ communication
What part of the NS dampens down the mesencephalon?
A well functioning cortex
What is an indicator of good prognosis for working with kids that have ADHD type behaviours?
If the Childs behaviour would be normal for a child a few years younger
What lobe of the brain is delayed in development for people with ADHD?
frontal lobe (inability to inhibit)
- not about inattention
- more so about attention to everything
