Flashcards in Neuromuscular Dysfunction Deck (66):
What is cerebral palsy?
A permanent disability associated with prenatal, perinatal, and post natal causes; "Brain paralysis"
What are some possible causes for cerebral palsy?
Prenatal and birth asphyxia, kernicterus, maternal infection, ELBW, Shaken baby syndrome, severe hypoglycemia
What is Kernicterus?
High bilirubin levels
What is the pathophysiology of CP?
Anoxia (total depletion of oxygen) with vascular occlusion, atrophy, loss of neurons, and degeneration of neurons that causes severe brain damage.
What are the four types of CP?
Spastic, Dyskinetic/Athetoid/Dystonia, Ataxia, Mixed Dystonic
What are characteristics of Spastic cerebral palsy?
Increased muscle tone with increased deep tendon reflexes and clonis, fine and gross motor movements are impaired.
What muscles are involved in spastic cerebral palsy?
Flexor, adductor, and internal muscles
What is clonis?
Sudden dorsiflexion of ankle with spasms
What are some symptoms of spastic CP?
Crouched gait, toes are in, scissoring (crossed legs), heel cord contracture, sculiosis
What is spastic CP associated with?
Prematurity, preexisting abnormalities
What do 40% of patients with spastic CP have seizures?
BC of the location of it in the brain
What are the 3 S's associated with spastic CP?
Seizures, Scissor, Sculiosis
What are some characteristics of Dyskinetic/Athetoid/Dystonia CP?
Purposeful, involuntary, uncontrollable movements of face and extremities. Movements increase with stress and puberty. Deep tendon reflexes are normal.
What is dyskinetic?
Choreoid movements of involuntary jerking
What is dystonia?
Decrease in muscle tone
What is athetosis?
Slow movements iwth increased drooling and dysarthria
What is dysarthria?
Problems with speech articulation.
What are characteristics of athetoid CP?
Slow, wormlike movements, increased drooling, dysarthria
What are characteristics of ataxic CP?
Flaccid; Wide gait, disturbed coordination, unsteady gait, slurred speech, nystagmus (dancing eyes), cant gauge distance or speed
What are characteristics of mixed CP (spasicity and athelosis)?
Individual is tight and rigid, pronounced reflexes, combined symptoms.
How is CP diagnosed?
Prenatal history, assessment- walking, crawling, assess reflexes, MRI for brain lesions, EEG for seizures, genetic evaluation at 16 weeks
What is hypotonia?
"Floppy" baby- when lifted they cant support t hemselv. With Dyskenetic.
What are goals of treatment?
To establish locomotion and communicatio, gain optimal appearance, correct defects, educational opportunities, provide socialization
What does evidence show about magnesium sulfate treatment?
When given to pregnant women with eclampsia 2 hours before delivery, it decreases the risk of cerebral palsy to newborns at risk.
What are some musculoskeletal treatments and interventions?
AFO- ankle food orthosis, wheelchairs, orthopedic devices, surgical interventions
What are some surgical interventions for CP patients?
Tendon lengthening, heel cord lengthening, muscle releases, hip and adductor muscle correctment, Dorsal rhizotomy
What is Dorsal Rhizotomy surgery?
Releasing some nerves to decrease spascity and improve balance and walking
What do medications try to treat with CP?
Muscle spasms and seizures
What are some medications for muscle spasms?
Dantrolene, Baclofen, Diazepam, Botulinum
What is botulinum?
Botox injections into muscles to decrease spascity- causes muscle to relax
Which routes can baclofen be given?
Orally or intrathecal (through the spine)
What are some side effects of Baclofen intrathecal injections?
hypotonia, somnolence, seizures, n/v, headaches, cath pump problems
What are some anti-epileptic drugs?
Tegretol, Depakote, Dilantin (has bleeding risks)
What are some physical therapy and occupational therapies?
Programmed exercises, usually outpatient, conditioning and patterning muscles, also speech therapy.
What is the prognosis of CP individuals?
Normal intelligence but 30-50% can be mentally retarded, decreased growth, 50% live individually.
What are some nursing care goals related to CP patients?
Aquire mobility, communication skills, self help activities, appropriate education, positive self image, appropriate hospitilization.
What is myelomeningocele?
Spina Bifida- an abnormality that is derived from the embronic neural tube when it does not close. Can be extensive or minimal.
What is the pathophysiology of spina bifida?
Neural tube defect with failure of the neural tube to close during the first 3-5 weeks of embryonic life. The degree of neurologic dysfuntion depends on where the sac protrudes through the vertebral column.
Where is the most common place for spina bifida to occur?
Lumbar or Lumbosacral
What is a complication of spina bifida?
Hydrocephalus- 80-90% of pts have it.
What are possible causes of spina bifida?
Drugs- dilantin (depletes folic acid), radiation exposure, chemo, maternal malnutrition, lack of folic acid in diet, alcohol, tobacco, genetic mutation, maternal obesity, previous NTD
What are some significant neural tube defects?
cranioschisis, exancephaly, anencephaly, spina bifida oculta or cystica
What is cranioschisis?
Incomplete closure of the cranium
What is anencephaly?
Only a small portion of the brain is developed, usually respiratory function.
What is exancephaly?
When the brain is exposed.
What are the two types of spina bifida?
Oculta- less severe
Cystica- more severe
What is a meningocele?
Fluid in a sac protruding from the spine, type of spina bifida.
What is a myelomeningocele?
Nerve roots in the sac that protrudes from the spine.
What are clinical manifestations of spina bifida cystica?
Sensory disturbance with parallel motor dysfunction- usually affects senses, bowel control
What is effected below the 2nd lumbar vertabrae?
Flaccid paralysis, sensory deficits, lack of bowel control, and rectal prolapse
What is affected below the 3rd sacral vertebra?
Usually no motor impairment besides weakeness, saddle anesthesia (numbness across hips)
What are some common joint deformities associated with spina bifida cystica?
Clubbed feet, outward feet, kyphosis, scoliosis, hip dislocation
What are some clinical manifestations of spina bifida occult?
Little/no symptoms. Dark tufts of hair, skin depression, progressive gait disturbance, bowel and bladder sphincter disturbances.
How are NTD diagnosed?
Assessment of symptoms, MRI, CT scan, ultrasound, myelography, prenatal detection, high alphafetoprotein levels in amniotic fluid.
How are infants with NTD treated?
Prevent infection, assess neuro status, keep moist with sterile saline and gauze, keep prone, shunt procedure
How does orthopedic care help with NTD?
Prevent joint contractures with ROM, corect deformaties, minimize motor and sensory defects, prevent skin breakdown, use of orthodonics like braces, walking devices, wheelchairs, also may have surgery.
How is neurogenic bladder dysfunction treated?
Cath schedule, medications to improve bladder storage, surgery to create a drainage system and reduce pressure.
What are some bowel control programs?
Maintain diet to promote normal bowel evacuation, use laxatives, fluids, MACE- irrigate the colon every few days.
What are some care guidelines for the myleomeningocele sac?
Positioning, prevent infection, prevent drying
What is innovated therapeutic management?
Early surgical closure of the myelomingocele sac through fetal surgery on the mother while in utero- good outcome, danger of misscarraige
What are some preventive measures for NTD?
Increase folic acid
What are some latex precautions?
Children with spina bifida are at greater risk for latex allergies- avoid latex products and foods associated with it- bananas, kiwi, peaches, avocado, chestnut, test for allergies with RAST
What is a latex allergy?
An allergic response to rubber products- patient may be sensitive or allergic
What is an irritation reaction to latex?
Sensitivity- redness, crusting, peeling, sores from contact with latex. Remove irritant.
What is a type 1 latex reaction?
An anaphylaxis shock reaction- hives, pink raised areas, itching, wheezing, difficulty breathing, high pulse, nausea, increased BP= EMERGENCY!