CP Flashcards

Question

what are the levels of the MACS: manual ability classification system for children w/ CP 4-18 y/o?

Answer 1

Level I: handles objects easily and successfully Level II: handles most objects but with somewhat reduced quality and/or speed of achievement Level III: handles objects with difficulty; needs help to prepare and/or modify activities Level IV: handles a limited selection of easily managed objects in adapted situations Level V: does not handle objects and has severely limited ability to perform even simple actions

Answer 2

describe a current level or motor function evaluate change overtime in gross motor function in children with CP and DS assist to determine functional tx goals

Answer 3

validated for sensitivity to change over a 6 month period in children from 5 months to 16 y/o

Answer 4

``` 1- lying and rolling 2- sitting 3- crawling 4- standing 5- walking, running, jumping ```

Answer 5

each section can be administered individually scored based upon a 4 point scale that measures how much of the item the child completes dimension scores and total scores are achieved and then converted into the percentage of the max score for the dimension time required: 45-60 min GMFM-66- computer scoring available - interval scale - improves ability to quantify changes in motor function - relates changes in one child to another - from one period of time to another in the same child

Answer 6

developed for children with CP concerned with quantity of functional movement, not quality measures change over time

Answer 7

no normative data many items are scored based on length of time in a position which may not correlate to functional movement not concerned with quality of movement

Answer 8

involvement in LEs scissoring gait lordosis limited LE disassociation- moves in total movement patterns- flexion- extension good head and upper body control

Answer 9

affects all 4 extremities poor balance b/w flexors and extensors extensors overpowering underlying low tone in trunk poor head control easily develop muscle tightness leading to hip dislocations trunk deformities

Answer 10

one side involvement tendency to ignore involved side scoliosis retracted pelvis, hip IR, ADD, ankle PF, forefoot inversion

Answer 11

total body poor head and trunk depending on involvement shoulder instability leading to limited fine motor control hip instability- ER and ABD of hips W-sitters scoliosis, kyphosis standing- knee hyperextension and pronated feet

Answer 12

continuous movement fluctuation in tone flexion and extension poor control in mid ranges don't develop as many contractures may develop hamstring tightness- use to stabilize trunk- underlying low tone

Answer 13

jerky, unsteady movements increases with excitement trunk- low muscle tone shoulder and hip instability need a lot of support in standing and sitting

Answer 14

trunk deformities due to muscle imbalance prone to scoliosis, increased kyphosis or lordosis difficulty with rotation skills shallow respirations short vocalizations

Answer 15

tight hip flexors, adductors and IRs, medial hamstrings hip subluxation/dislocation femoral anteversion limited disassociation high riding patella from spastic quad tibial torsion gastroc tightness calcaneal plantarflexion leg length discrepancy

Answer 16

limited or excessive trunk mobility limited active trunk rotation with increased lordosis hips remain flexed increased adduction and IR knees remain flexed or may be hyperextended valgus foot or decreased BOS in plantar flexion hemiplegia- decreased WS onto affected side, posturing of involved UE

Answer 17

features: legs involved more than arms. 50% preterm ambulation potential: 90% walk associated sensory & developmental impairments: strabismus, learning, attention & communicative disorders are common ADL function: independent in self-care and spinster control

Answer 18

features: combo of diplegia and hemiplegia ambulation potential: 50% walk associated impairments: strabismus, cognitive, communicative, learning and attentional disorders are common ADL function: difficulty with manual dressing tasks, climbing stairs and perennial hygiene

Answer 19

features: one side of body, arm more involved than leg. At least 50% are prenatal in origin. ambulation potential: 100% walk Associated impairments: visual field cut, mild-mod cognitive and communicative disorders. High rate of partial seizures. ADL function: difficulty with fasteners for dressing, independent in basic self-care and spinster control tasks

Answer 20

features: significant involvement of all 4 limbs ambulation potential: 25% walk, however 100% walk who have sitting balance by 2 years associated impairments: epilepsy and significant mental retardation in 50% (IQ<50). Deafness and severe visual impairment in 50%. ADL function: high rate of self-care, communicative, and contingency limitations

Answer 21

important to know type of tone predominates as well as underlying tone in trunk based on normal movement constantly adjust handling and movement functional stretching and strengthening challenge child during therapy bracing and adaptive equipment important to enhance function work closely with family and other professionals

Answer 22

use of moving surface such as a therapy ball fun challenging used to momentarily alter tone and enhance movement control increase strength increase ROM improve balance and equilibrium responses improve protective reactions

Answer 23

slow rhythmical movement of a child on moving surface elongation rotation in trunk disassociation of extremities weight bearing with weight shift (long ranges of movement) fast rotational (passive) movement through the trunk works sometimes- need to be cautious vibration- with exhalation

Answer 24

active movement by the child- straight or diagonal plane weight bearing: body over limb (small range of movement) compression: increased loading on joint- must have good normal alignment- should be intermittent or intermittent with movement (bouncing on a ball) tapping- direct stimulation to the muscle belly resistance- using gravity

Answer 25

rehab therapy intrathecal baclofen (ITB therapy) Oral meds injection therapy neurosurgery orthopedic surgery

Answer 26

child and family physicians - physiatrist - neurologist - neurosurgeon - orthopedic surgeon - PCP nurse/nurse practitioner social worker PT OT SP dietician psychologist educator

Answer 27

Baclofen (Lioresal) Diazepam (Valium) Tizanidine (Zanaflex) Dantrolene sodium (Dantrium)

Answer 28

non-invasive, not permanent effective management for some patients

Answer 29

difficult to achieve a steady state following a schedule may be difficult side effects: drowsiness, hypotonia, weakness -- may limit effectiveness

Answer 30

neurectomy myelotomy anterior rhizotomy selective dorsal rhizotomy cordectomy thalamotomy

Answer 31

reversible non-invasive dose adjustments potential for fewer side effects than oral drugs evidence to support efficacy in reducing spasticity may improve function, comfort and care

Answer 32

complications: infection, catheter problems, OD, baclofen withdrawal refills- approx every 3 months cost

Answer 33

presently admitted for trial also down on OP basis in pediatric imaging pre-ashworth assessment by PT/OT catheter trial or bolus injection re-assessed using ash worth scale at 2 and 4 hours post injection also, re-assess functional skills- sitting, transfers, and ambulation if applicable successful trial is a decrease of average LW ash worth score of at least 1 point

Answer 34

symptoms of OD symptoms of withdrawal

Answer 35

somnolence (excessive drowsiness) respiratory depression seizures rostral progression of hypotonia loss of consciousness progressing to coma

Answer 36

pruritus without rash diaphoresis hyperthermia hypotension neurological changes, including agitation or confusion sudden generalized increase in muscle tone, spasticity and muscle rigidity

Answer 37

avoid excessive trunk movement to avoid a catheter dislodgment - no hip flexion >90 - no passive trunk rotation or twisting - log roll child - avoid forward trunk flexion beyond 45 - no vigorous hamstring stretching avoid heat producing modalities in area of pump progress with activity level per child's tolerance

Answer 38

sidelying- pillow under top leg for support and to avoid rotation of trunk prone on stomach- as tolerated- good position for playing sitting: - avoid side and long sitting - no hip flexion >90 - when sitting unsupervised use chest strap or tray to avoid forward flexion - support feet

Answer 39

stand pivot transfers: may initially need increase support secondary to decreased muscle tone for support 1 person lift: support one arm along back and other under hips 2 person lift: 1 person supports back and other supports under hips keep back straight as possible. Do not flex hips past 90

Answer 40

dorsal sensory roots are severed each rootlet within root is stimulated abnormally- responding rootlets are severed often performed on children 7-10 y/o usually involves 6-12 months of intensive therapy post-op if improved function is the goal complications include possible sensory loss

Answer 41

decrease positive signs -spasticity (multi-segmental) improve negative signs -lack of motor control (use rehab to address) consider other negative signs -lack of strength (consider whether decreasing hypertonia will be detrimental to posture and function)

Answer 42

permanent- one time procedure evidence for efficacy in reducing spasticity and improving function in children with spastic diplegia

Answer 43

permanent- may need spasticity potential adverse effects: spinal, sensory not effective for dystonia

Answer 44

soft tissue operations: - lengthenings - releases - tendon transfers bony operations - osteotomies - fusions

Answer 45

effects usually last a few years

Answer 46

anesthesia risks non- weight bearing after bony procedures risk of weakness, decreased function

Answer 47

anesthetic/diagnostic nerve blocks - procaine - lidocaine neurolytic nerve blocks - ethanol - phenol botulinum toxin

Answer 48

Clostridium botulinum injected into the muscle interferes with release of ACh at the NMJ no systemic effect may be administered without anesthesia EMG guidance for small muscles results typically last 3-6 months

Answer 49

not permanent evidence to support efficacy in reducing spasticity and improving function effects are localized- not systemic

Answer 50

not permanent- may need to repeat ethanol and phenol- require greater skill to inject, increased risk of paresthesias, dysesthesas botulinum toxin: more expensive than other injections, may develop antibodies

Answer 51

non-invasive, non-surgical procedure short leg cast applied using soft cast rolls casted at present end range of ankle dorsiflexion with knee extension re-casted weekly series of casts for 3-4 weeks or until full ROM is achieved able to be removed without cast saw

Answer 52

improve muscle length improve ankle-foot alignment in ambulation improve gait pattern in functional ambulation improve comfort with use of orthotics enhanced functional motor control limit need for repeat orthopedic surgery

Answer 53

no restrictions regarding activity level however, limit outdoor and running activities for safety child should wear cast shoes at all times while ambulating outdoors no skid socks can be used indoors take extra precautions on rainy/snowy days to prevent cast from getting wet child should take sponge baths or apply effective plastic cover with tape to form complete seal

Answer 54

evidence of painful muscle spasm evidence of presence of a pressure or friction sore evidence of an allergic reaction to casting materials swelling or other signs of circulatory constriction refusal to bear weight on casted foot if cast becomes wet

Answer 55

noninvasive active involvement of the patient and/or family emphasis on functional gains

Answer 56

casting, orthoses, positioning: skin integrity at risk cost of treatments, equipment requires patient motivation and participation for functional gains, motor learning