Complex Needs, CTEV, Scoliosis Flashcards Preview

Muscluloskeletal Systems > Complex Needs, CTEV, Scoliosis > Flashcards

Flashcards in Complex Needs, CTEV, Scoliosis Deck (58):
1

What is the Scottish Government definition of complex needs?

A child with multiple and complex disabilities has at least 2 different types of severe or profound impairment such that no one professional, agency or discipline has a monopoly in the assessment and management

2

Give some examples of complex needs?

-Cerebral Palsy
-Spina Bifida
-Muscular Dystrophy
-Arthrogyrposis Multiplex Congenita
-Neurofibromatosis
-Syndromes (Down's, Turner's)

3

What is Arthrogryposis Multiplex Congenita?

AMC, or simply arthrogryposis, describes congenital joint contractures in two or more areas of the body.

Children born with one or more joint contractures have abnormal fibrosis of the muscle tissue causing muscle shortening, and therefore are unable to perform passive extension and flexion in the affected joint or joints.

4

Describe basically the 3 types of Arthrogryposis Multiplex Congenita

Amyoplasia
-Characterized by severe joint contractures and muscle weakness.

Distal arthrogryposis
-Mainly involves the hands and feet.

Types of arthrogryposis with a primary neurological or muscle disease belong to the syndromic group.

5

Describe the 3 types of Neurofibromatosis

Neurofibromatosis type I,
-In which the nerve tissue grows tumors (neurofibromas) that may be benign and may cause serious damage by compressing nerves and other tissues.

Neurofibromatosis type II,
-In which bilateral acoustic neuromas (tumors of the vestibulocochlear nerve or cranial nerve 8 (CN VIII) also known as schwannoma) develop, often leading to hearing loss.

Schwannomatosis,
-In which painful schwannomas develop on spinal and peripheral nerves.

6

What is Neurofibromatosis?

Neurofibromatosis (NF) refers to several genetically inherited conditions that are clinically and genetically different and carry a high possibility of tumor formation

7

A child or young person (

Severe impairment in at least 4 categories together with enteral/ parenteral feeding

OR

Severe impairment in at least 2 categories and ventilation/ CPAP

AND

Impairments are sustained for more than 6 months and ongoing

8

What are the categories for complex exceptional needs?

Learning and mental functions
Communication
Motor skills
Self care
Hearing
Vision

9

What is cerebral palsy?

A permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life

10

How common is cerebral palsy?

2 per 1000 live births

11

What can some of the prenatal causes of cerebral palsy be?

Placental insufficiency
Toxaemia
Smoking
Alcohol
Drugs

Infection such as toxoplasmosis, rubella, CMV and herpes type II (TORCH)

12

What can some perinatal causes of cerebral palsy be?

Prematurity (most common)
Anoxic injuries
Infections
Kernicterus
Erythroblastosis fetalis

13

What is Kernicterus?

Kernicterus is a bilirubin-induced brain dysfunction.

Hyperbilirubinemia may cause bilirubin to accumulate in the gray matter of the central nervous system, potentially causing irreversible neurological damage.

Depending on the level of exposure, the effects range from clinically unnoticeable to severe brain damage and even death. Newborns are especially vulnerable to hyperbilirubinemia-induced neurological damage and therefore must be carefully monitored for alterations in their serum bilirubin levels.

14

What is erythroblastosis fetalis?

Hemolytic disease of the newborn, is an alloimmune condition that develops in a fetus, when the IgG produced by the mother pass through the placenta.

Among these antibodies are some which attack the red blood cells in the fetus' circulation, causing hemolysis. The fetus can develop reticulocytosis and anemia.

This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur.

When the disease is moderate or severe, many erythroblasts (immature red blood cells) are present in the fetal blood, and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis).

15

What can some postnatal cerebral palsy causes?

Infection (CMV, rubella)
Head trauma

16

What are the physiologic classifications of cerebral palsy?

Spastic (pyramidal system, motor cortex)

Athetoid (extrapyramidal system, basal ganglia)

Ataxia (cerebellum and brainstem)

Rigid (basal ganglia and motor cortex)

Hemiballistic

Mixed (combination of spasticity and athetosis)

17

What are the 4 anatomical classifications of cerebral palsy?

Monoplegia (one limb involved)

Hemiplegia (one side of the body)

Diplegia (lower limbs)

Quadriplegia or total body involvement

18

WHat percentage of cerebral palsy patients have some form of learning disability?

50%

19

Persistence of how many primative reflexes usually means the child will be non-ambulatory?

Give some examples of these reflexes

2 or more primative reflexes

Moro startle reflex
Parachute reflex
Tonic neck reflex
Neck righting reflex
Extensor thrust

20

Describe the character and deformity in dynamic contractures

Increased muscle tone and hyperreflexia

No fixed deformity of joints

Deformity can be overcome

21

Describe the character and deformity in fixed muscle contractures

Persistent spasticity and contracture

Shortened muscle tendon units

Deformity cannot be overcome

22

What are the orthopaedic priorities in CP?

Spine
-Tendency to get scoliosis

Hip
-Dislocating
-May be difficulty getting to perianal area

Feet
-Varus and valgus

Torsional problems

KEEP THE PATIENT AS ACTIVE AS POSSIBLE AS LONG AS POSSIBLE

23

What 5 prerequisites of normal gait should you look for?

Stability in stance
-Stable or unstable?

Clearance in swing
-Dragging feet?

Preposition of foot
-Are they placing their foot or does it just dangle below their leg?

Adequate step length

Energy conservation
-Bouncing around inefficiently?

24

How can you analyse gait (in CP)?

(5 marks)

By observation
By video
By 3D instrumented analysis
+/- EMG, energy expenditure

25

What is kinematics (in medicine)

What is the unit used?

How many orthogonal planes are used?

"How the body moves through space"

Unit = meters

3 orthogonal planes

26

Describe the actions of concentric and eccentric muscles in gait

Concentric
-Shortening
-Power generation
-Acceleration

Eccentric
-Controlled lengthening
-Power absorption
-Deceleration

27

Is the rectus femoris muscle concentric or eccentric at hip and knee joints?

Concentric at hip flexion

Eccentric at knee limiting knee flexion

28

Hips are normal at birth in cerebral palsy but displacement is likely in how many patients?

What does hip displacement depend on?

1/3

GMF kinetcs and forces on hip

29

What leads to better long term outcomes for hip problems in cerebral palsy?

Early surgical intervention

One study reduced dislocation from 10% to 0%

30

Describe clinical assessment of cerebral palsy

UNRELIABLE

Sitting, lying and prone if possible
-Look at spine without lower body interfering

Hip ROM- pain

Hamstring tightness

Pelvic obliquity

Spine in coronal and sagittal planes

Record and reassess later

31

Describe th 5 GMFCS levels

Level I
-Walks without limitations

Level II
-Walks with limitations

Level III
-Walks using a hand held mobility device

Level IV
-Self Mobility with limitations; may use powered mobility

Level V
-Transported in a Manual Wheelchair

32

The higher the GMFCS the higher the risk of what?

Dislocation

(Pretty much a linear increase in risk)

33

What interventions can you use for posture management?

Physiotherapy
Seating

34

What interventions can you use for spasticity management?

General
-Baclofen
-Diazepam

Specific
-Botulinum toxin
-Surgery

35

What interventions can you use for deformity management?

Soft tissue release
-Adductors
-Hamstrings

Bony realignment
-Varus derotation osteotomy
-Pelvic osteotomy

36

What are the pros and cons of surgery for cerebral palsy?

Pro
-Reduced risk dislocation
-reduced risk pain
-Better seating

Con:
-Not all would have gone on to dislocate
-BIG surgery

37

What is the medical term for club feet?

Congenital Talipes Equinovarus

38

What is the epidemiology of congenital talipes equinovarus?

Most common congenital deformity
-1 to 2 in 1000 live births

3 Male: 1 Female

50% bilateral

Risk for 2nd child 1 in 35

39

Give some aetiologies of congenital talipes equinovarus

Pressure theories
-Oligohydramnios
-Abnomal fetal position
-Unstretched uterus

Placental insufficiency
Constriction bands
Toxin
Temperature
Infective pathogen (entovirus)
Drugs
EM radiation
Chromosomal abnormality
Sex linked
Single dominant
Single recessive
Polygenic

MULTIFACTORIAL

40

How many cases of congenital talipes equinovarus can be identified prenataly by ultrasound?

60%

41

What percentage of babies who recieve a prenatal diagnosis of congenital talipes equinovarus have defects in other systems?

Give some examples

50%

Hip dysplasia(?)
Down's and larsen's syndrome
Arthrogryposis
Neuro-muscular disorders
Others

42

What are the treatment options for congenital talipes equinovarus

Strapping
-Positional talipes only

Series casting

Dennis browne boots

Surgery (VERY VERY RARE)
-Postero-medial release
-Ilizarov frame

43

Who was the master of club foot treatment?

Professor Ignacio Ponseti

44

Describe the 4 anatomical features of club foot

Cavus
Adductus (midfoot)
Varus (hindfoot)
Equinus (hindfoot)

45

How many casts are usually required to fix congenital talipes equinovarus?

Average of 5 casts

(works 95% of time)

46

What small procedure can be used to correct equinus?

Percutaneous tenotomy of achilles tendon

(90% will need this)

47

What is the definition of scoliosis?

When is it clinically significant?

Any deviation in coronal plane is a scoliosis

Clinical significance > 10 degree deviation

48

Describe structural and non structural scoliosis

Structural
-Abnormal rotation of the vertebrae and is an intrinsic spinal problem.
-It has a propensity to progress

Non-structural
-Due to extrinsic cause: a leg length discrepancy, a hip problem etc.
-Resolves when causal factor is addressed

49

You can classify scoliosis by aetiology

Give some examples

Congenital deformity
Idiopathic
Neuromuscular
Traumatic
Infection
Others - neurofibromatosis, neoplasm etc

50

How can you classify scoliosis by age?

(3 marks)

Infantile (10y)

51

Descibe the 4 geographical classifications of scoliosis

Thoracic
Lumbar
Thoracolumbar
Double

52

What are the risk factors for progression of scoliosis?

Female, premenarchal

53

Is scoliosis painful?

NO

54

What are the 4 broad aetiologies of back pain

Mechanical
Developmental
Neoplastic
Inflammatory

55

What investigations can you do for scoliosis?

AP Erect whole spine +/- lateral

MRI:
-Cerebellar tonsils
-Syrinx
-Tethering
-Vertebral anomalies

Bone scan- pain

56

Severe curves have less favourable outcomes

Give some examples

Cardiorespiratory compromise

Pain from rib/pelvic abutment

Seating issues

Surgical challenge

57

What is the management of scoliosis?

Bracing

Surgery
-Anterior
-Posterior
-Combined

58

What are the complications of scoliosis surgery?

(4 marks)

Nerve root damage

Cord traction injury

Vascular injury

Problems of growth
-Growing rods
-Changing rods
-Crackshaft pnenomenon