3: Peds Neuro

Question 1

What is cerebral palsy

Answer 1

Defined as brain damage that happens before, during or soon after birth
o Does not reach motor milestones
o Exhibits abnormal muscle OR
o Shows qualitative differences in movement patterns

Question 2

CP is classified by?

Answer 2

· type of muscle tone
· topography (if spastic muscle tone)
· GMFCS level (I-V)

Question 3

o Motor types

Answer 3

spastic, dyskinetic, ataxic, mixed

Question 4

Spastic

Answer 4

Most common
“Stiff” or permanently contracted muscles in synergy pattern

Question 5

Dyskinetic

Answer 5

Alternating tone with slow, uncontrolled writhing movements

Question 6

Ataxic

Answer 6

rare form
poor coordination
difficulty with quick or precise movements

Question 7

Mixed-

Answer 7

a child with two or more forms
most common mixed form is a blend of the spastic and dyskinetic

Question 8

Mono

Answer 8

one limb affected

Question 9

Hemiplegia

Answer 9

half body

Question 10

Diplegia

Answer 10

legs more affected than arms

Question 11

Triplegia

Answer 11

3 limbs affected, more affected on one side

Question 12

Quad

Answer 12

both arms and legs equally affected

Question 13

Common impairments/symptoms-CP

Answer 13

Hip Dysplasia and spasticity

Question 14

Common PT treatments-CP

Answer 14

o Exercise and range of motion
o Braces Ex: AFOs, Hip braces
o Careful positioning and activities which decrease tone Ex: Seating, sleeping position
o Strategies to reduce/inhibit tone Ex: PNF
o Proper use of equipment

Question 15

Hip dysplasia-

Answer 15

-Caused by forces on the joint by spastic muscles, positioning
- shallow acetabulum

Question 16

Hip dysplasia prevention

Answer 16

· BC Hip Surveillance Program
· Assessment every 6-12 months
· early intervention= fewer salvage treatment operations

Question 17

Hip dysplasia tx

Answer 17

· Standing programs, weightbearing
· Bracing, specialized taping
· Positioning
· Addressing muscle imbalances

Question 18

What is Spina Bifida

Answer 18

· Neural tube fails to close in utero, due to a defect

Question 19

Classification of SB by type/severity

Answer 19

Occulta- defect present, but structures are intact- may not know that you have it (least severe)
Meningocele- defect present, meninges protrude out of the canal

Myelomeningocele- defect present, meninges & spinal cord protrude out of the canal

Question 20

Occulta

Answer 20

• hairy patch at birth
• dimple’ in back
  - Often symptom free
  -May lead to tethered cord

Question 21

Meningocele

Answer 21

· Fluid filled sac, containing meninges, present at birth
· Rare
· Needs surgery
· May have abnormal development of spinal cord
· May have minor neurological symptoms & issues with bowel & bladder

Question 22

Myelomeningocele

Answer 22

· Fluid filled sac, containing meninges & spinal cord, present at birth
· Needs surgery
· Loss of function below level of injury
· Full motor and sensory loss (like a spinal cord injury)

Question 23

Chiari II

Answer 23

· Think of a balloon stretching downwards
· characterized by beaked midbrain, downward displacement of the tonsils, and cerebellar vermis, and spinal myelomeningocele

Question 24

Hydrocephalus

Answer 24

· May require shunt
· Can cause cognitive defecits

Question 25

Clubfoot:

Answer 25

Plantarflexion and inversion caused by a shortened Achilles tendon

Question 26

Secondary Orthopedic Issues: Spina Bifida

Answer 26

o Caused by decreased functional movement of joints & lack of mobility
o Can result in: loss of ROM, contractures, pain, weakness, injuries, etc.
o Examples: Club foot, knee flexion contracture, dislocated or subluxed hips, kyphosis, scoliosis, osteoporosis with or without fractures

Question 27

SB ROM limitations

Answer 27

Common limitations:
· Tightness in hip flexors & hip adductors
· Tightness in the dorsiflexors or evertors of the ankle

Question 28

SB Common PT treatments

Answer 28

· Maximize ROM
· Increase/maintain strength
· Maintain alignment of the extremities and joints
· Stabilize the spine and extremities
· Maximize function
· Provide comfort
· Skin protection

Question 29

What is Muscular Dystrophy

What kind is most common, who gets it more?

Answer 29

Inherited disorder
o Most common type is Duchenne’s Musclar Dystrophy (DMD)only shows in males
o More common in male

Question 30

o how do you get MD?

Answer 30

X-Linked recessive

Question 31

o Pathophysiology of MD

Answer 31

· Muscle tissue is replaced by fat
· Characterized by rapidly progressive muscle weakness which starts in the legs and pelvis and later affects the whole body
· Pseudohypertrophy- looks like muscle but is fat

Question 32

MD symptoms:

Answer 32

weakness due to progressive loss of myofibrils

Question 33

Secondary Symptoms MD

What do you see a child do

Answer 33

o contractures
o postural malalignment, especially in antigravity postures
o Scoliosis etc. From postural issues
o Gowers sign: “walks” hands up thighs =due to weakness in proximal muscle groups

Question 34

Early childhood: ROM fairly normal (changes at 5 years +)

Answer 34

· Mild tightness in some muscles=Generally notice gastroc, soleus and TFL first
· Normal lordotic curve increased with accompanying winging of the scapula
· Scoliosis typically develops at or just before adolescence

Question 35

Childhood:

Answer 35

· Clumsiness
· Falling
· Inability to keep up with peers
· Difficulty with stair climbing
· Difficulty rising from sitting
· Gait pattern changes (ex: Trendelenberg, toe walking, retracting of shoulders, decreased reciprocal arm swing)

Question 36

Adolescence MD:

Answer 36

· Increased disability
· Progression of weakness
· Contractures
· Walking may be lost
· Walking cessation (stopping) usually occurs by the age of 10 to 12

Question 37

Physiotherapy: MD

Answer 37

o Family- centered approach
o Exercise can be controversial- eccentric exercise can be detrimental
o Best exercise is isometric- weight bearing
o ROM, stretching and positioning to prevent contracture
o Supportive bracing (Ex: AFOs)
o Focus on scoliosis prevention

Question 38

What is pediatric TBI & why is it different than adult TBI?

Answer 38

Because it is happening in a brain that has not fully developed yet

Question 39

EtiologyTBI- Infants

Answer 39

· 2/3+ caused by falls

Question 40

Etiology TBI Preschool Children

Answer 40

falls 55%, MVA 22%

Question 41

Etiology TBI: School-age children

Answer 41

: MVA 31%, falls 31%, sports and recreation activities 32%

Question 42

Etiology: Adolescents

Answer 42

sports & rec 43%

Question 43

Other reasons for TBI in children

Answer 43

Shaken Baby Syndrome
Near drowning (under 4 and adolescents most common)
Brain tumours

Question 44

Common impairments/Symptoms TBI

Answer 44

· Can depend on the stage of development of the brain
· Some symptoms will look much like adults and be based on part of the brain affected
· Damaged areas may never get a chance to develop

Question 45

DCD

Answer 45

o Developmental Coordination Disorder
o General clumsiness, lack of coordination, poor strength

Question 46

Down’s Syndrome

Answer 46

o Trisomy 21 (extra chromosome)
o Low tone, late achieving motor milestones
o Ligamentous laxity

Question 47

Other:· General population physiotherapy goals:

Answer 47

· Children with low tone and joint hypermobility need to be stabilized
· Children with increased muscle tone and limited joint range need mobility and muscle extensibility
· All children must be able to move freely from one position to another

Question 47

· General Pop. PT treatment strategies (including equipment):

think techniques

Answer 47

Hands on
* Manual stretching, PNF & other facilitation techniques, positioning, manual resistance
Exercise (play based!)
* Varied positions to encourage therapy goals
Other techniques
* Adapted activities (ex: Hippotherapy), partial WB treadmill for gait training, pool therapy, sports