Neuro Peds - 02 - CP - Treating Flashcards
what are the stages of Physical Therapy as they pertain to CP?
Stage 1: Early Intervention - Common Assessment Tools to ID CP Stage 2 and 3: - Outpatient Center Based Programs - Pre School and School Physical Therapy Stage 4: Adulthood
what is the duration of Stage 1 - Early Intervention?
the first three years
what happens during Stage 1 - Early Intervention?
- you see the most gains with therapeutic gains – many diagnoses, not just CP
- federally funded state run org. CDSA is what it is called around here. Or PIE.
- Accurate diagnosis at 8 months, over diag at 4 months
Natural environment – don’t take anything in that you don’t mean to leave.
IFSP – individualize family specialized plan
don’t need nursing to get physical therapy
Each state has different testing tool
Here is Peabody – show 30% delay in one area or 25% in two or more areas to qualify for services. With age adjustment.
What is IFSP?
Individualized Family Service Plan
IFSP – developed with the family – PT will write two evals – one for legal/ insurance and one for family
what happens during Stage 2/Stage 3?
- Transition to school services
- IEP individualized education plan at school
- If cognitive is fine, and do well in classes, can’t get PT at school
- If something happens, maybe get 501
- Or, outpatient therapy
what happens during Stage 4?
Adult – Medicaid is great, but slow with equipment
what is the PTA’s role as caregiver?
Family leads the charge!
PT will have ideas, but if family doesn’t agree, goals will need to change.
Educate family or change goals
You will be calling a thousand people when you are working with kids
PTA will need to express thoughts out loud, not just in note
As a team member, proficient in skills, aware of additional things. If things are not going as expected, notice it and bring it up to PT. Diagnosis could change
What are the physical therapy goals?
Goals – positioning, development of functional skills, promote sensorimotor development, postural awareness, educate parent, foster infant/parent interaction
Be aware that it is overwhelming – parent might shut down – interaction shuts down – help them
what are some general obstacles to motor development?
Muscle Tone Abnormal Movement Patterns Reflexes Lack of Motor Control and Coordination Muscle Weakness Abnormal Sensory Awareness
What kind of muscle tone will most CP patients have?
- the spastic, dependent on velocity kind
what is the treatment approach for hyper tone?
break it up!
flex the ankle and knee and hip.
get the pt sitting up
why does the CP patient have abnormal movement?
reflexes persistent or absent
no reciprocal movement
which reflexes are likely to persist?
what are some general therapy activities for the patient with CP?
- Bearing weight with good posture
- Controlled Weight Shifting -in good posture
- Closed Kinetic Chain Exercises
- Joint Stabilization
- Functional Skills
what are treatment strategies for Spastic CP?
- Improving base of support - wide to narrow
- Head and trunk alignment with postural activities (neck strength)
- Gaining mobility
- Getting the child to move
What are treatment strategies for Hemiplegic CP?
- Work towards a more correct midline (ML) perception of the head and trunk
- Stability for both sides
- Work towards midline then away from midline; using uninvolved side to lead at first
what are treatment strategies for Athetoid CP?
- Building postural control in trunk
- Weight bearing in midline
- Isolate head movement from trunk
- Be careful with wording/volume
- Thoracic extension with rotation
- Joint approximation
- Weighting extremities
- Shifting upper body over lower body
why is it important to be careful with wording while treating Athetoid CP?
need to be easy for kid to understand
volume changes can cause startle/extensor thrust
– so not just the words but how you say them
what is the most important strategy in treating Athetoid CP?
trunk and posture
Isolate head from trunk – because using eyes and head to move, which controls trunk.
– do things that involve just moving head
what is important about treating for thoracic extension and rotation in treating child with Athetoid CP?
child with Athetoid CP is hunched.
what is the difference between adaptive device and assistive device?
Adaptive technologies refer to special versions of already existing technologies or tools, usually used by people with disabilities such as limitations to vision, hearing, and mobility.
Assistive technology is a broader term encompassing any light-, mid-, or high-tech tool or device that helps people with disabilities perform a tasks with greater ease and/or independence.
why won’t a child with Athetoid CP be using an assistive device?
because of the highly fluctuating tone
because he needs to walk with hands clasped
what are treatment strategies for Ataxic CP?
- Establish visual attention and sustained visual gaze - to retrain brain and eyes
- Visual attention combined with movement - train away from watching feet
- in to Midline then out of Midline
- Use actual situations for learning; can’t generalize
what are treatment strategies for Hypotonic CP?
- Alignment - they are so floppy
- Repetitive joint approximation - weight/unweight to get joints to develop as they should
- Vestibular, Vibration - wake up system
- Active trunk with rotation - need child to actively do this himself.
- Abdominals - airplanes, supermans, fun planks
- Weight shifting with alignment - controlled mobility
what are some tips for Supine Positioning?
Bent knees and flexed upper trunk
-bend the knees first, get them out of extension
Encourage midline play
what are some tips for Side Lying Positioning?
Decreases tonic reflexes
- most neutral for head
- but don’t allow too much lateral neck flexion
Preps for rolling and coming to sit
- can do manual between shoulder and hip – add resistance.
- make sure they are elongated – not all curled up on the side
what are some tips for Prone Positioning?
- Increases UE weight bearing
- Stretch to LEs - really posterior tilt pelvis
- Promotes eye-hand relationships
- Promotes protective extension and weight shifting - move toys farther out
- Help with crawling and other reciprocal activities
What Will You Work On To Achieve Independent Sitting
- Proximal stability
- Balance reactions
- Rotation - Dissociate trunk from LE – break up extensor tone - may need special seating to break up tone
- Muscle length/extensibility
- Pelvic mobility
why will you work on achieving independent sitting?
great for function
can do ADLs
work on balance here before in standing
why is Quadruped position important?
- Promotes both UE and LE weight bearing
- Increases core strength
- Encourages dissociation
- Hemiplegia – using both sides – gets them out of bottom scoot
- Controlled mobility
what are some tips for Quadruped positioning?
- encourage Weight bearing though UE
- Break up the extensor response
- Extend wrist and fingers
- Weight shifting back and forth
- Keep back flat/neutral - works on core strength – avoid sagging
- There is fancy equipment, or just use a sheet – especially good in home therapy (pvc pipe)
- Dissociation – weight shift side to side
why is Kneeling position important?
- Encourages dissociation - Upper LE doing diff than lower LE
- Stretches hip flexors
- Increase balance responses
usually Tall Kneel - facilitate extensor strength
What Will You Work On to Achieve Independent Standing?
- Proximal stability
- Tissue Extensibility
- Decreased primitive reflexes
- Increased sensory awareness
- Balance reactions
- Muscle activation/co-activation - to get away from sway
- Weight shifting
- Increased abductor strength
- Full foot flat for weight bearing
Some kids will use their moving muscles for standing, which is not really standing
What are the 3 Predictors of that a child with CP will achieve Gait?
Type of CP
which Milestones are acheived by the age of two
What are the hoped for Predictor of Gait Milestones by age 2?
- sitting independently
- scooting on the bum
and by 2 1/2 - 3, crawling
What kind of Vision is a good Predictor of Gait?
What kind of CP indicates “least likely to walk”?
then Spastic Quad
remember to take into account how involved the patient is