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PTA Neuro 10.20.09

Children w/Spina Bifida

what is the best defense against spina bifida? women who are sexually active should take 40 mg (400 mcg) of folic acid/daily
myleodysplasia is? interrupts the signal to the nerves
why can you see some stg in a muscle but limited at the level of dmg? redundant nervous system - many nerves join others
musculoskeletal deformities postural, scoliosis, joint deformities/contractures, crouched gait, vertical tali, hip dislocation
neurology impairments motor paralysis, sensory dysfunction, (these 2 are like SCI), hydorcephalus, cognitive dysfunction, language dysfunction, seizures (10-30%), neurogenic bowel, neurogenic bladder (these are unique to SB)
How to tx hydrocephalus? shunt to drain
in what way and what level is cognitive dysfunction L5, typically low end of normal, often lack executive functioning skills (plan, execute), "cocktail party" syndrome, have good knowledge on a very limited amt of information
if L1 - L2 involvement affects..... have no LE
S1 - S2, neurology impairment neurogenic bowel & neurogenic bladder, sphincter doesn't close all the way, causes skin breakdown b/c they cannot feel when they are wet
what is a determining factor in ambulation & independence? CNS INVOLVEMENT, primary determining factor, not just physical level.
what is a way to deal with cognitive dys? use note cards with ICONS to help them through a process, like how to go transfer to a chair from a wheel chair.
when does the dmg occur causing SB? in utero
primary focus of PT for SB? focus on independence
PT care for SB joint contractures & deformities, pressure sores, brace/wheelchair assessment, independent mobility/self-care
what causes a static joint contracture? contracts at rest
dynamic joint contracture is caused by? antagonistweak apposing muscle such as the anterior and posterior tibia,
what if they are L4 involvement but no CNS involvement? functioning 100%
Habitualization is teaching something new
rehabilitation teaching something they once knew
if they are L4, what would you expect to see and why? no paraneal, opposing muscle, 45 deg DF & inversion or forefoot abd
hip flexor contracture due to? unapposing gluts
knee flexion contracture due to? unapposing quads
PF contracture due to? unapposing Tib anterior
Tx for contractures low load/long duration (strap on brace to pull into position), ROM, positioning
with a 20 degree hip flexion contracture, w/AFO & crutches, what affect on gait? diminish gait velocity to 44% of normal
10 degree hip flexion does what to gain? reduces gait velocity to 20% of normal
what type of surgery would help dynamic joint contracture/deformity? split posterior tib & put half the tendon higher up on leg to even pull
what causes pressure sores usually due to lack of sensation of buttock, joint deformities & dec activity level are inc factors
what can help prevent pressure sores? catheter thru belly button, pressure mapping, hourly wt shifts
why do SB develop severe pes planus don't have dynamic stabilizers, spring lig & tibialis anterior & anterior
what level SB would require AFO? L4, L5
what kind of AFO for S1? orthotic
what level requires a KAFO? L3, don't have control of hips, quads, locking jt for knee
what is GRAFO? ground reaction AFO. gives advantage of longer lever arm
HKAFO is what level? is it functional? includes a hip joint, L1, L2. not function, w/c is easier
THKAFO not too functional b/c so difficult to get on & off
RGO's reciprocating gait orthotic, walk with a circumduct, cost $5K, not functional. easier to get along w/wheel chair
Parapodium, how does it work and at what age? helps develop the acetabulum w/WBing. Also helps with head (must have head control) and rotational control. Start around 9 mo. should use 20-30 min, 4-5 x day, not a passive device, add some tilting if possible
standing/ambulation benefits improved bowel/bladder, prevention of bone loss, improved heart endurance, prevention of pressure sores & joint deformities, improved upper extremity stg & coordination, endurance
L1, L2 what ambulation trend? Therapeutic or household walking in childhood or adulthood
T2-T12 ambulation most use wheel chair in adulthood
Thoracic 2 to Thoracic 12 ambulation therapeutic walking in childhood
L3 - L4 ambulation household or community ambulation in childhood/adulthood, KAFO, loftstands maybe but wheel chair more efficient
functional trend of L3 most use wheelchairs as primary mode
how many L3 will achieve independence? how many working? 60% Ind, 20% actively in full time employment
L4, percentage ambulate as adults? independence? community ambulation? 20%, 60% Ind, 20% comm
L5 to S1 ambulation trend community in childhood & adult
muscles affected at L5-S1 all gluts, hamstrings, gastroc (not soleus, will at L1)
L5 ambulation - what AD? crutches are suggested in adults to dec energy expenditure & maintain alignment
L5, what % independent? full time work? part time work? 80% ind, 30% FT, 20% PT, (50% empl as adults)
S1 functional excellent long term, some studies suggest high risk for heel ulcers, infection & amputation, use of heel cups may limit (no sensation)
how are independent skills assessed? PT -new survey in SDC to evaluate function level ( 9 categories)
do they have to walk to be independent? NO
how is independence defined for SB? toilet transfers, bowel/bladder maintenance, dressing/self-care, indoor/outdoor mobility, level surface transfer, car transfer, bed mobility, tub/shower transfer
what is the primary reason for not obtaining independence? limited cognitive skills
Created by: djbari



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