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Peds 3rd

CP, Seizure Disorders, Positioning

What is the definition of Cerebral Palsy? A non-progressive insult injury to the developing brain that affects typical development
When does the brain insult of CP usually occur? before, at or shortly after birth
What problems associated with CP change over time? muscular problems
What disorders typically occur with CP? disorders of movement, posture & other neurological components
What are some causes of CP? Congenital - prenatal infections in mom (german measles), toxins; Perinatal - low birth wt, premature birth, multiples, birth trauma (cord wrap); Post natal: acquired 1st few wks of birth, trauma, hypoxia, infection, metabolic
What areas are evaluated for a CP diagnosis? (by team): Primitive reflexes, asymmetry, clonus & variable tone, involuntary movement, discrepancy in cognitive development
What are 5 concerns often related to CP Cognitive delay (50%); Seizure d/o (50%); Speech problems (30%); Visual/perceptual (40%); Hearing (25%); Sensory processing - due to primary & secondary
Diplegia All four limbs are impacted but LE are more impaired than UE
Paraplegia No limitations in UE - just LE
Where in the brain do lesions occur to cause spasticity & flaccidity? Motor cortex
Where in the brain do lesions occur to cause athetoid movements? Basal ganglia
Where in the brain do lesions occur to cause ataxic (little drunk) movements cerebellum
Treatments for high tone/spasticity Braces, stretching, serial casting, surgery to cut contracted muscles,
Meds for high tone baclofen (often via pump)
Surgery for spasticity selective posterior rhizotomy - cut dorsal nerve roots in lumbar area
OT tx for spasticity slow movements when positioning, handling, ROM w/emo support, functional hand skills, adaptive equip, Rood (slow rocking), ball, warmth,
Goals of tx with athetoid pt stability - since movement not a problem, prevent deformity, facilitation of mobility & speech,
Characteristics of ataxic CP pts staggering, poor righting, incoordination, tremors, poor fine motor, may be afraid of movement b/c falls
Which kind of CP often changes to another classification with age? Flaccid/hypotonic
Appropriate TX for hypotonic CP bouncing, positioning, increase tone, increase movement, ADLs,
Precautions for hypotonic CP choking
Definition of a Seizure A sudden, temporary, involuntary change of consciousness, behavior, motor activity, sensation or automatic functioning
What are the two main types of seizures? Generalized seizures (40%) that involve entire cerebral cortex; Partial seizures (60%) that are usually localized or on one side of the brain
What are the four generalized seizure types? 1) tonic-clonic (Grand mal); 2) Myoclinic; 3) Absence (petit mal); Atonic (akinetic)
What is a mixed seizure disorder? when a person experiences both generalized and partial seizures
What are the two kinds of partial seizures? simple & complex
What is a complex partial seizure? Usually originates in temporal lobe, may show automatic reactions (lip smacking, chewing, buttoning/unbuttoning clothes), similar to absence seizures, may be confused or report sensory experiences
What is a simple partial seizure? Usually involve motor cortex, clonic reactions in face or extremities; sensory hallucinations, nighttime awakenings w/twitching to face & hands
What is a myoclonic seizure? Mild form of generalized seizure in which a single muscle or muscle group has a series of contractions
What is an akinetic seizure? A mild generalized seizure in which patient goes limp -
What is it called when a child has an extended seizure of 30 min or longer? status epilepticus - requires medical management to maintain body functions and hydration
What is an absence seizure? A type of generalized seizure in which there is a momentary loss of awareness & motor activity except for blinking /eye-rolling, No aura or postictal period, usually in children up to age 10. May be mistaken for daydreaming
What is a tonic-clonic seizure? A type of generalized seizure (grand mal). Aura & postictal period of 1-2 hrs., brain storm of neuronal firing followed by loss of consciousness, rigidity (tonic) & rhythmic clonic contractions of extremities, incontinence common.
If a child is having a seizure should you restrict them & lay them on their back? don't restrict but move items around them. lay on SIDE, stay until over, time seizure, remain calm
Roll of OT with seizures Educate child & parents, help child be advocate, use head gear, restrict spinning, avoid high climbing, oral hygiene for medications, go with a buddy, reinforce development
Positioning / techniques for child with low tone Stomach positioning, carry in forward facing position or football hold to get them to hold head up, bounce in seated posture, fast movements, swinging, bolster seating, quick depression on shoulders
Positioning/techniques for child with high tone hands to midline, use body to help control child's body position, side lying, rocking, leave in side position as prep for feeding, rocking on ball, slight forward head for feeding, hands on lap tray,gently shake arm before dressing
Created by: sherryama