Unit 3: Developmental Neuro conditions

3 main principles of family centered practice

- each family is unique

- the family is the constant in the child’s life

- the family is the expert concerning the child’s needs and abilities

Ways to actively engage a child

- just right challenge

- must be valuable to the child

- child has autonomy

- they are accepted, respected and safe

ASD is comorbid to:

- ADHD

- Anxiety

- Learning disability

Who is diagnosed more for ASD

Boys 4x more

Before age of 5

Signs of ASD

- special interest

- lack of interest in other kids

- behaviour issues (self-isolation, self injury)

- impaired social interaction

- likes to have things a certain way (routines are important)

Early intervention for ASD

- skill development (communication, play, self help)

Adolescence intervention for ASD

- social skills

- communication

- self-regulation and emotional literacy

- life skills

- recreation and leisure

Adulthood intervention for ASD

- IADL’s

- communication

- housing and employment

- relationship building

OT goals for ASD

- sensory processing

- fine motor/school skills

- self help skills (ADLS)

- play skills

PT goals for ASD

- gross motor

- PE participation in school

- balance, coordination

- playground navigation

What is cerebral palsy defined?

Paralysis of the cerebrum

Explain what CP is

- non progressive disorders affecting motor function, movement and posture

Cause of CP

Result of injury to CNS during gestation, or injury at the time of birth or writhin first 2 years of life

Prenatal causes of CP

- metabolic and chromosomal abnormalities

- multiple births

- fetal prematurity

- C section or breech

- brain malformation

- perinatal stroke

- smoking or drugs

Postnatal cause of CP

- TBI

- near drowning

- poisoning

CP classification

1. Area involved

2. Movement disorder

3. Functional ability

Monoplegic

1 limb affected

Hemiplegic

1 side of body

Triplegic

Trunk and three extremities

Diplegic

Trunk and all limbs but L/E affected more than U/E

Quadriplegic

Trunk and all extremities affected

Muscle tone affected in CP

- body position

- presence of primitive reflexes

- outside forces

- emotional stress

- effort

Spastic CP

- most common

- motor cortex affected

- resistance to full ROM

- increased tone

Athetoid/dyskintetic CP

- basal ganglia affected

- fluctuating muscle tone

- dysarthria and dysphagia

- in coordination

- slow, involuntary, continuous purposeless movements

Ataxic CP

- rare

- damage to cerebellum

- low tone

- poor coordination

- wide based gait, dysmetria

- poor balance

Hypotonic CP

- decreased muscle tone

- hyperelasticity of joints

- postural instability

- decreased ability to generate voluntary muscle force

Mixed type CP

- abnormal muscle tone and involuntary movement

Diagnosing CP

- observing child’s movment patterns and developmental milestone achievement

CP goals of OT/PT

- mobility

- sensory and cognitive stimulation

- maintain skin integrity

- ADL practice

- education for parents

What is musclar dystrophy

- disorder characterized by progressive weakness and wasting of voluntary muscles that control body functions

Primary symptom of MD

primary progressive voluntary muscle weakness

Duchenne MD

- inherited x-linked recessive gene

- affects Boyd (girls are carriers)

Cause of DMD

- protein abnormality

- unstable cell membrane

- muscle fibre size variation

- skeletal muscle tissue replaced by connective and fatty tissue

DMD signs and symptoms

- weak hip/pelvic muscles = waddling

- contractures in plantar flexion, hip flexion, IT band

- flat feet

- toe walking

- scoliosis is common

Age of onset of DMD

- 3-5 yeaRs

- survive to mid 20s

Tests used to diagnose DMD

- EMG

- muscle biopsy

- DNA screening

- Kinase levels

DMD progression (infant - toddler)

- less active

- delayed motor skills

- clumsy

- wide BOS

- toe walking

DMD progression (childhood)

- trouble running

- toe walking and wide BoS

- trouble with stairs, rising from floor

- alteration of posture

- age 5: symmetrical weakness

Beckers MD

- onset 10-15 y/o

- boys > girls

Fascioscapulohumeral dystrophy

- affects girls and boys equally

- onset = teens

Limb girdle dystrophy

- onset = early 20s

Myotonic MD

- onset = young adulthood

- myotonia (muscle contraction with slow relaxation

What is SMA

- spinal muscular atrophy

- progressive loss of anterior horn cells

Type I SMA

- severe proximal weakness

- death before 2

- does not achieve normal motor milestones

- onset = 3-6 months

Type II SMA

- weakness legs>arms

- swallowing problems

- fails to meet or loses motor milestones

- onset = 7-18 months

- lifespan = late childhood to early 20s

Type III SMA

- hip weakness (waddling gait)

- slowly progressive

- W/C use by 30

- onset = older than 18 months

Type IV SMA

- slow progression

- onset = older than 35 years

- not common

- speech and swallowing problems

Complications for type 1,2 and 3 SMA

- resp problems

- skeletal deformities

PT/OT goals for SMA

- maintain ROM

- prevent contracture

- maintain strength

- provide appropriate aids

- maintain support/resp hysigen

- maximize independence

Spina bifida definition

- split spine

What is spina bifida

Congenial spinal defect where there is incomplete clause of the bony vertebral elements in the midline

Results of spina bifida

- paralysis and loss of sensation in the L/E

- vision, hearing and learning challengeS

Risk factors for spina bifida

- lack of folic acids

- anticonvulsants

- pollution

Spina bifida signs and symptoms

- can’t use lower limbs

- loss of bowel and bladder function

- self care requires assitance

- weakness

- cognitive delays

- visual problems

- seizures

- altered sensation

Spina bifida occulta

- Mildest form of SB

- small hole in lower spine

- skin covers lesion, may have dimple at the site of defect

- usually no neurological deficits

SB meningocele

- bones do not close around spinal cord

- meninges form CSF sac outside of spine

- covered by skin

- may be motor or sensory changes after sac is surgically repaired

- spinal cord remains in spinal column

Myelomeningocele SB

- most severe

- bone does not close around spinal cord

- Sac forms outside of spine = CSF, meninges and spinal cords

- not covered by skin

- hydrocephalus

SB complications

- syringomyelia: abnormal pocket of CSF forms inside spinal cord

- contractures

- hip dislocation

- foot and ankle deformities

- pressure ulcers

- scoliosis, lordosis, kyphosis

Hydrocephalus

- water on the brain

- increased CSF in the brain

- can cause skull to enlarge

VP shunt malfunction in SB in infants

- bulging soft spot

- marked scalp veins

- downward deviation of eyes

VP shunt malfunction in toddler SB

- fever, vomitiing and nausea

- loss of ability

- swelling or redness along shunt tract

VP shunt malfunction children/adults SB

- headache, personality changes, decrease in balance and coordination, vision issues

- redness along shunt tract

Arnold Chiari II malformation

- cerebellum and brainstem protrude down into the spinal canal through foramen magnum

- associated with hydrocephalus

- occurs in nearly all children with myelomenigocele

T10-1012 SB

Chest, back and stomach

L1-L3 SB

Hips and thighs

L4-L5

Knee and front of lower leg

S1-S3 SB

Ankles, feet, calves, buttocks, bowel and bladder

T12-L1 SB mobility

W/c users

L2-L3 SB mobility

- W/c for longer distances

- may walk with KAFO

L4 SB mobility

Usually walk with AFO or KAFO

L5-SI SB mobility

Usually walk with AFO or short ankle braces or crutches

S2-S4 SB mobility

Usually walk, may need shoe inserts

OT/PT goals SB

- education

- maximize ROM, strength, balance

- prevent contracture

- mobility independence

Down syndrome co-morbid conditions

- neurodevelopmental disorders

- congenital heart disease

- leukaemia

- eye problems

- epilepsy and Alzheimer’s

Down syndrome presentation

- distinctive physical presentation (facial features, shorter stature, lower tone)

- functional difficulties

- behaviour challenges (impulsive, short attention spans)

- cognitive delay impacting learning

How does OT/PT work with Down syndrome

- development of fine and gross motor skills

- ADL’s

- feeding difficulties

- play and social skills

- safety awareness

What is developmental coordination disorder

- more common in boys

- may be identified as clumsy

- may impact physical skills, physical activity

How does OT/PT work with a child with DCD

- break down skills

- practice

- educate adults

- focus on finding success

- build self esteem