Paediatric Neuromuscular Conditions Flashcards
(44 cards)
A child or young person is defined as having Complex Exceptional Needs if:
There is severe impairment in at least 4 categories together with enteral/parenteral feeding
OR
Severe impairment in at least two categories and ventilation
AND
Impairments are sustained for more than 6 months and ongoing
Cerebral Palsy
This is a permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 years of life. It effects the cerebrum which disrupts the ability of the body to exhibit coordinated body control.
How many children with complex needs are accounted for by cerebral palsy
7%
Epidemiology of Cerebral Palsy
Occurs in 2/1000 births.
Perinatal risk factors for cerebral palsy
Prematurity, anoxic injuries, infections, kernicterus (a rare but serious complication of untreated jaundice in babies), erythroblastosis fetalis (abnormal presence of erythroblasts in the blood)
Prenatal risk factors for cerebral palsy
Placental insufficiency, toxaemia, smoking, alcohol, drugs, infection (TORCH)
Postnatal risk factors for cerebral palsy
Infections (cytomegalovirus, rubella), head trauma.
Spastic
Effects the pyramidal system and or the motor cortex. There will be an increase of tone on passive stretch of muscle.
Athetoid (dyskinetic)
Effects the extrapyramidal system and or the basal ganglia. Combination of spastic and dystonic with involuntary movements.
Ataxia
Cerebellum and the brainstem. Poor balance, often with low trunk muscle tone.
Rigid or dystonic
Basal ganglia and motor cortex. An increase in tone on voluntary movement, change of position or posture.
Hemiballistic
Ballismus or ballism (called hemiballismus or hemiballism in its unilateral form) is a very rare movement disorder. It is a type of chorea caused in most cases by a decrease in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of flailing, ballistic, undesired movements of the limbs.
Monoplegia
One limb involved
Hemiplegia
One side of the body involved
Diplegia
Lower limbs
Quadriplegia
Total body involvement
Neurological examination of a child with cerebral palsy and spasticity will reveal sign of an upper motor neurone lesion:
Weakness Poor control of fine movements Increased tone Brisk deep tendon reflexes Lack of voluntary control Sensory impairment
Hemiplegic cerebral palsy is frequently associate with
Haemorrhage or ischameia in the territory of the middle cerebral artery.
Diplegic Cerebral Palsy is associated with
Damage to the periventricular white matter
Quadriplegic Cerebral Palsy is associated with
Wide-spread damage in watershed areas between vascular territories and in severe cases may result in severe atrophy of the brain with cystic changes.
Dynamic Contractures in Cerebral Palsy
selective spasticity of some muscles and weakness of others.
Fixed muscle contractures
Persistent spasticity resulting in contractures, shortened muscle tendon units and the deformity cannot be overcome.
Fixed contractures
joint subluxation/dislocation and secondary bone changes
Orthopaedic Priorities in Cerebral Palsy
Spine (posture), hip, feet, torsional lower limb problems (profound gait abnormalities over time due to rotation of the hip joint