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Chapter 28 part 1: CP

Terms in this set (50)

Cerebral palsy facts
-1/500 births
-1.5x more common in males
-800,000 people in US with CP
-brain injury may occur: prenatal, perinatal, or postnatal
-prevalence of CP stable since the 1950s
cerebral palsy
-difficulty with postural control and movement against gravity
-best treatments focused on goal-directed activity provide better outcomes than treatment focused on performance components
posture
the alignment of body parts in relation to each other and the environment
postural mechanism components
-muscle tone/postural tone
-emergence of righting, equilibrium, and protective extension reactions
-integration of early/primitive reflexes
-intentional, voluntary movement against gravity
-combining movement patterns for functional performance
righting and equilibrium reactions
allow us to maintain upright posture with dynamic stability
righting reactions
realign the head with the body
equilibrium reactions
coordinated responses of the trunk, neck, and extremities
Protective extension reactions
reactions used to catch ourselves when righting and equilibrium reactions are not sufficient enough to keep upright posture
CP and atypical movement
-decreased ability to control co-activation and reciprocal innervation of muscle groups
-abnormal movement compensations and motor patterns which can sometimes create barriers to ongoing motor skill development
muscle tone
force with which a muscle resists being lengthened; muscle's resting stiffness
spasticity
velocity-dependent resistance to stretch
abnormal muscle tone
hypertonicity, spasticity, hypotonicity, fluctuating tone
sensory and motor problems in children with CP
-persistence of primitive reflexes
-atypical righting, equilibrium and protective responses
-poor sensory processing
-joint hypermobility or stiffness
- muscle weakness or poor co-activation
-delays in typical progressing of motor movement skills affecting adaptive function
classification of CP
-classified by lesion in CNS, distribution of abnormal muscle tone (trunk and extremities) and type of movement disorder
distributions of abnormal muscle tone
-monoplegia
-paraplegia
-hemiplegia
-quadriplegia
-tetraplegia
monoplegia
one extremity effected
paraplegia
legs are effected
hemiplegia
one side impacted LE and UE
quadriplegia
all limbs effected
tetraplegia
all limbs and head/neck effected
types of movement disorders
-spastic
-dyskinetic
-ataxic
-mixed
spastic CP
hypertonia and muscle spasticity (velocity-dependent resistance to stretch); associated with extensor plantar response and persistent primitive reflexes. most common type
dyskinetic
movement patterns include: athetoid, choreoathetoid, and dystonic; excessive abnormal movement that is involuntary and jerky
ataxic
poor balance and coordination, clumsy and demonstrate involuntary tremor; lesser degree than dyskinetic
mixed
combos of high and low tone, distribution typically quadriplegic for this type
hand skills and UE functions
-weakness in shoulder girdle
-contractures
-tone issues
-postural instability
-using their UE to stabilize so can not use it for functional task easily
primary impairments
immediate and direct result of cortical lesion in brain
secondary impairments
results of these are not static:
- risk for joint contractures, deformities, spinal or joint misalignment, skin breakdown, decreased bone density
-other problems: medical conditions not related to CP (Seizures, etc)
cognition/language functions
-frontal lobe lesions: may impact cognitive function
-lesions affecting primary motor and temporal lobes: may impact language and speech development
-dysarthria: disorder of speech production secondary to decreased muscle coordination, paralysis, or weakness
sensory function
-may have visual or sensory impairment
-50% kids with CP have visual difficulty like: blindness, visual impairment, uncoordinated eye movements, eye muscle weakness. Nystagmus, strabismus (eyes not aligned)
-25% auditory reception and processing difficulties
-tactile sensitivities including oral sometimes
assessment
-clinical observation of occupational performance
-early identification of atypical postures to minimize impairment
-MUUL, QUEST, JTTHF
- CP QOL, CP QOL teen
interventions
-goals to promote function and independence
-prevent secondary deformity and difficulties
-treatment: adaptive equipment training, casting/orthotics, CIMT, functional goal-directed therapy
adaptive equipment
-serve to modify or control degrees of freedom required to engage in activities
-match motor needs and child's sensory function
-need to be familiar with wide range of options
casting and orthotics
-improve hand function
-prevent joint contracture
-improve hygiene
-relive pain of specific joint
-serial splints and casting: to lengthen and correct deformity
-when combined with an active therapy program can have positive effects on function
constraint induced movement therapy
-EBP intervention targets functional use of affected UE in child with CP
1. some method of constraint
2. intensive repetitive practice of motor activities up to 6 hours per day 2-4 weeks
3. shaping of complex functional motor acts by identifying the movements of a targeted task and rewarding actions that are successive approximations to the task
signature CIMT
constraint of upper limb, high dose of practice (3-6 hours every day over consecutive days), use of shaping techniques, natural setting, a transition or post CIMT program to maintain gains (at least 2 weeks)
modified CIMT
constraint less than 3 hours per day, variation in where tx provided, variation in dosage- less, mass practice by professional but may be OT or PT
E-stim
to strengthen antagonist muscles most effective with functional activity combined
heat
used for stretching
rigid tape
used to limit joint movement, protect joint during functional movement
kinesiotape
used to facilitate improved movement patterns
functions of kinesiotape
-support weak muscle
-improve circulation
-reduce pain
-improve joint alignment
facilitated weight bearing and weight shifting
can build strength, improve co-contraction, and improve postural symmetry and alignment in children with CP
community recreation
-at risk for limited participation
-more involved in informal vs. formal recreation
-OTs to know community resources, assist with modifications tasks
rehabilitation robotics
use of robotic devices to restore or improve function for a person with a disability
most rehab robotics
connected to a computer so child can receive feedback from game graphics
botulinum neurotoxin (botox)
injections for reducing tone of spastic muscle; causes paralysis of specific muscle; typical effect lasts 3-4 months; limited number per year; OT can pair with orthoses or serial casting
balcofen
injected directly to CSF by pump or taken orally to reduce muscle tone throughout the persons body
surgical procedures
tendon transfer (change insertion of muscle to change action) , muscle release or lengthening (allows for more movement)
alternative medicine
-yoga
-chiropractors
-osteopathy
-homeopathic treatments
-massage (most popular)
-OTs with special training may try: guided imagery, myofascial release, yoga, and meditation (to engage in leisure and increase QOL)
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