peds final neurological conditions

cerebral palsy

a group of clinical symptoms characterized by a disorder of movement and posture due to a static lesion or defect in an immature brain

most common non-progressive movement disorder in children

motor types of cerebral palsy

spastic

dyskinetic/hyperkinetic

ataxic

mixed

spastic CP

 characterized by an excessive stiffness in the muscles when the child attempts to move or maintain a posture against gravity

associated pattern of hypertonicity in the arms

compensatory movement patterns

dyskinetic/hyperkinetic CP

characterized by abnormalities of tone and various movement disorders including dystonia, athetosis and chorea

dystonia

repetitive twisting movements

athetosis

slow writhing movements that prevent maintenance of a stable posture

chorea

random, unpredictable, rapid, involuntary movements

ataxic CP

characterized by shaky movements and affects a person’s coordination and balance. It is the least common

monoplegia

involves single extremity (upper or lower)

hemiplegia

involves one side of the body

diplegia

total body is affected with LE’s/trunk more affected than UE’s/face

quadriplegia

total body affected including face, neck, and trunk with equal involvement – typically seen in dyskinetic and ataxic types

triplegia

involves three extremities

The Manual Ability Classification Scale

used to classify level of functional hand use in a child with CP

Constraint induced movement therapy

An intensive, evidence-based intervention in which the child’s non-affected arm is constrained while the child is engaged in high intensity repetitive task practice using the affected arm

muscular dystrophy

progressive disease. In the late stages of the disease, the OT’s roles primarily include maximizing the child’s independence using adaptive equipment/technology, providing parent education to assist with care, and possibly providing splints (to prevent contractures and maximize comfort).

spinal muscular atrophy

It is a progressive disease caused by the loss of motor neurons

Muscle weakness usually worsens with age

Cognition is typically not affected

Arthrogryposis

musculoskeletal deformities involving multiple joint contractures

myelomeningocele

most severe deficits including loss of motor function below the level of the lesion, abnormal bowel and bladder function, abnormal cognition, and abnormal sensation

meningocele

deformities are only in the meninges, less severe symptoms

spina bifida occulta

least severe and may go unnoticed at birth. There is no herniation of the spinal cord or meninges and there may be no clinical deficits. In some cases, a tuft of hair will be present and minor deficits may arise later in life (if a tethered cord is present)

symptoms of a shunt malfunction

lethargy, irritability, headaches, and vomiting

tethered cord

clinical features of down syndrome that impact fine motor development

shorter digit, hypotonia