Flaccid Paralysis

Question 1

spina bifida

Answer 1

Caused by failure in neural tube development early in gestational period (during Neuralation)

Question 2

neonatal Brachial Plexus Palsy (NBPP)

Answer 2

Traction to brachial plexus during labour
Delivery of upper shoulder blocked by mother’s pubic symphysis (shoulder dystocia) 🡪 ipsi brachial plexus strateches when additional pressure applied to child’s head to take it out

Question 3

NBPP

Answer 3

Initial Management
Care for Upper limb = 3 S’s
Alert parents to be aware of poor SENSATION
Teach parents to carefully SUPPORT flaccid arm/hand
Teach SAFE positioning during sleep and play

Maintain and improve ROM = 3 P’s
POSITIONING to avoid contractures eg. Avoid Waiter’s tip posture
PASSIVE facilitation and mob into lim ROM
PROMOTE active movements as soon as able (can be active assist)

Throughout first year increased focus on the 3P’s
Make sure to facilitate sensory-motor development
Sensation treatment eg. Warm baths, massage

GM stim = introduce pron position, rolling, pushing up into sitting, vaulting, other UL GM
Posture and balance = teach protective, parachute, supporting reactions
Fine motor tasks

Question 4

MOVE

Answer 4

motion - reduced (muscle paralysis)
orientation - reduce (poor baseline alignment)
variety - reduced (limited activation)
ease (contracture) - reduced (compensation needed)

Question 5

MENT

Answer 5

modulation - reduced (some muscles not active)
effective - reduced (some mvmts not possible)
normal - altered as some movements not possible
timing(reaction, mvmt, coincident) - altered as some mvmt not possible
safe - reduced (protection/equilibrium & sensation)