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- Nonprogressive but often changing impairment syndrome caused by a defect, anomaly, or lesion of the developing brain.
- May occur before, during, or after birth.
Cerebral Palsy
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What poses a high risk for CP?
Prematurity
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Whole body involved but LE's more involved than UE's.
Diplegia
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Whole body involved - trunk and extremities.
Quadriplegia
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Only one side of the body is involved.
Hemiplegia
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Only one UE or less frequently one LE is involved, very rare.
Monoplegia
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Three extremities involved, often one UE is spared.
Triplegia
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Both LE's involved, true form very rare. Usually a diplegia with involvement of UE's so mild it is not noticed.
Paraplegia
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What are the different types of CP? (4)
- Spastic (hypertonic)
- Athetoid
- Ataxic
- Hypotonic
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What type of CP has low tone in the neck and trunk, and high tone in extremities?
Spastic
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What type of CP has excessive sustained muscle contractions with certain muscle groups tending to overpower others?
Spastic
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What type of CP has:
- global low tone, proximal to distal
- fluctuating muscle tone in extremities
- movement tends to be asymetrical and forceful
Athetoid
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- Movement occurs between one extreme of range to the other extreme with little control in midranges.
- Difficulty co-activating to get smooth reciprocal motion.
What typt of CP?
Athetoid
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- Muscle tone fluctuates from low to low normal, decreased muscle force generation.
- Disturbance in balance and kinesthesia.
- May have tremor and dysmetria.
What type of CP?
Ataxic
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- Movement disorganized due to unreliable proprioceptive and vestibular information.
- Movement away from midline is difficult because they cannot control center of mass.
What type of CP?
Ataxic
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- Floppy babies
- Have difficulty generating, grading, and sustaining movement.
What type of CP?
Hypotonic
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What is the second most common birth defect after Down's Syndrome?
Myelomeningocele
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- Vertebral arch fails to close.
- The spinal cord herniates through the vertebral column resulting in injury to the spinal cord.
Myelomeningocele
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- Herniation of part of the brain downward.
- CSF is blocked.
Arnold-Chiari malformation
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Results when CSF is obstructed and accumulates, causing pressure on surrounding areas.
Hydrocephalus
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What are some signs and symptoms of shunt malfunctions?
- Bulging fontanelle
- High-pitched cry
- Sun-set sign of the eye - indicates raised intracranial pressure
- Edema and redness along shunt tract
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Name some congenital or aquired orthopedic deformities?
- Club feet and other foot deformities
- Dislocated hips and congenital contractures
- Kyphoscoliosis
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After many years of catheterization and other medical procedures, a person with spina bifida has an increased chance of developing ____________.
Latex allergy
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Fixation of the spinal cord in an abnormal location usually associated with scar tissue.
Tethered cord
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Tethered cord signs and symptoms?
- Decreasing strength
- New spasticity
- Back pain
- Changes in urological function
- Changes in coordination
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What are the major PT goals of a myelomeningocele patient?
- Prevent contractures and skin breakdown
- Facilitate normal sensorimotor development
- Increase independent mobility
- Introduce conpensatory strategies
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Hereditary myopathy characterized by progressive muscular weakness, deterioration of muscle fiber, and replacement of muscle fiber with fibrous and fatty tissue.
Duchenne muscular dystrophy
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- Cardiac and GI muscles involved
- Tendon reflexes regress to weak and then none
- No sensory loss
- Muscles innervated by cranial nerves are spared, except SCM
- Bowel and bladder spared
Duchenne muscular dystrophy
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What are the 3 phases of muscular dystrophy?
- Phase I: Early phase
- Phase II: Postural change
- PhaseIII: Non-ambulatory phase
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What phase of MD?
- Early signs of muscle weakness beginning to be noticed
- Delayed coordination - primarily in gross motor
- Slow, labored gross motor activities
- Walking becomes slower - tires easily
Phase I: Early phase
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What phase of MD?
- Continue muscle weakness and functional loss
- Will see anterior pelvic tilt, wide BOS, shoulders and head arched to balance in standing
- Child moves using momentum and lateral sway rather than weight shifts
Phase II: Postural change
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What phase of MD?
- May spend 90% of the day using a WC
- UE wekness more apparent - shoulder subluxation
- Accelerated development of joint contractures
- Marked difficulty with ADL's
Phase III: Non-ambulatory phase
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A child that presents with:
developmental delay
hypotonia
ataxia
Down syndrome
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