BOTOX dosage in Lower Limb Spasticity.pptx

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Botox injections are noted primarily for the ability to reduce the appearance of facial wrinkles. They're also used to treat conditions such as neck spasms (cervical dystonia), excessive sweating (hyperhidrosis), an overactive bladder and lazy eye. Botox injections may also help prevent chronic migraines

Health & Medicine

BOTOX DOSAGE IN LOWER
LIMB SPASTICITY
Dr Joe Antony
JR2
PMR

FACTORS AFFECTING DOSAGE
Higher dosage
Higher grade spasticity
Bigger muscle
Less number of muscles injected
simultaneously
Higher body weight
Poor response last time
Frequency of injection is less
Lower dosage
Lower grade spasticity
Small/ Atrophied muscle
Higher number of muscles
injected simultaneously
Low body weight
Muscle weakness last time
Higher frequency of injection
THE HELP GUIDE TO CP 2

DILUTION
100U diluted in 2 ml 0.9%NaCl
Each 0.1ml will have 5IU
4

PRECAUTIONS
Maximum dose per session- 400IU
Maximum dose per site- 50IU
Frequency- Not more than once in 3 months
Usually atleast 6 months interval
THE HELP GUID TO CP 5

THANK YOU Refernce
 The HELP Guide to CP
6

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Most CTEV children will need the tenotomy, which is a minor procedure usually done with local anaesthetic. Children need the tenotomy because their heel (Achilles) tendon is short and tight and it pulls the heel up.If it is not corrected the child will walk on tiptoes. Some doctors use general anaesthetic for older patients. After the tenotomy a final POP cast is applied and left on for three weeks. During this time the tendon regenerates in the lengthened position and the foot can be bent up easily towards the front of the leg (dorsiflexion). If your baby is unhappy after the tenotomy, it is fine to use some paracetamol as you would after vaccinations

Tendo Achilles tenotomy as a part of Ponsetti technique

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Prosthetic management of individuals with upper extremity amputations presents all health professionals, including prosthetists and therapists, with a set of unique challenges. For those wearing an upper extremity prosthesis, the terminal device (TD) of the prosthesis is not covered or obscured by clothing in the same way that a lower extremity prosthesis is “hidden” by pants, socks, and shoes. The person with upper extremity amputation must cope with not only physical appearance changes, but the loss of some of the most complex movement patterns and functional activities of the human body. In addition, upper extremity limb loss deprives the patient of an extensive and valuable system of tactile and proprioceptive inputs that previously provided “feedback” to guide and refine functional movement. Even the simplest tasks related to grasp and release become challenging. The ability to position the prosthetic limb segments in space, as well as the ability to maintain advantageous postures needed to manipulate objects, challenge the medical community to continuously improve the functional and aesthetic outcomes of prostheses for patients in this population.

Upper limb prostheses

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Pelvic floor disorders include a wide-ranging group of potentially disabling, embarrassing, and often painful conditions that can greatly affect a person’s quality of life. The pelvic floor consists of muscles, fascia, and ligaments that support the pelvic organs and help to provide control for bodily functions. Pathology within the musculoskeletal and neurologic structures of the deep pelvis can lead to the development of pelvic pain, dyspareunia, voiding dysfunction including urinary incontinence or urinary urgency, fecal incontinence (FI), constipation, and pelvic organ prolapse (POP) . Both women and men can develop pelvic floor disorders, although women are at increased risk compared with men because of their unique anatomy and biomechanics. The female pelvis is broader and shallower, requiring greater muscular and ligamentous stiffness to provide support and stability. Women are also more likely to incur injury to the pelvic floor as a result of pregnancy and childbirth. As a result, abnormal biomechanics of the pelvic floor muscles (PFMs) may lead to changes in contraction, relaxation, muscle strength, and myofascial pain. In a 2014 study, the prevalence of symptomatic pelvic floor disorders in the United States was estimated to be approximately 25%. It is important to note that this percentage does not consider women with pelvic pain due to high-tone pelvic floor dysfunction. People with pelvic floor disorders benefit from an interdisciplinary rehabilitation approach to improve function and reduce pain. Physiatrists with experience in acute and chronic pain, neurologic and musculoskeletal conditions, and neurogenic bowel/bladder management are well suited to direct such a patient’s care.In addition to diagnosing and managing the patient’s pelvic floor disorder medically, the physiatrist plays a key role in providing a detailed prescription for physical therapy.

PELVIC FLOOR REHABILITATION

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It was estimated that about 40.7 % of the global population was surfing the computers in the year 2012 as compared to 2006 of only 26.2%. [1] Marshall et al study reveal that on average, six out of 10 employees used a chair at work and the number was expected to grow.[2] Many researchers report that working 5.41 hours sitting at desk and 7 hour sleeping at night had a great impact on the physical and mental health.[2] Sitting on a chair is one of the most common positions adopted by humans. children and adults spend approx. 55% of their working hours or 7.7 hours/day in sitting postures.[2] The ergonomic fit workstations have become a standard practice in various developed countries

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Total contact cast is rigid or semi-rigid molded cast which extends from the patient’s foot to just below the knee, maintaining contact with the entire plantar surface of the foot and lower leg and immobilizing surrounding joints and soft tissue while allowing the patient to remain ambulatory. Considered as gold standard of offloading techniques Started in early 1930s as a treatment modality for post hansens neuropathic ulcer Effective , Rapid and ambulatory

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What do you want for your child’s current life and future? The goals should answer this critical question. Without goals, a life care plan will have a lot of details but no direction. Rely on your trusted experts and your family to help you develop the goals to give your child the best life possible. The life care plan for a child with cerebral palsy has several purposes and is essential for several reasons. The main reason to have a care plan is to have something that acts as a roadmap for your child’s best life. Get Matched with a Leading Cerebral Palsy Attorney in Your Area GET HELP NOW It includes everything you need to give them the best life, from a complete diagnosis and evaluation of their condition, limitations, and abilities, to an assessment of how much care will cost over a lifetime. The primary purpose of having goals as part of the life care plan is to fuel the efforts you and your care team are making to give your child a great life and enable them to live their best life. Goals may be short-term and health-related, such as changing the diet to make sure your child has no nutritional deficits. They may also be long-term, like achieving living independence or finding a job. Experts Help You Develop Goals Your child’s care plan will include a diagnosis, evaluation, and the establishment of a care team. The team of specialists, caregivers, and supportive family and friends will help you decide on the goals for your child. Once you have those goals lined up—and these will change and adapt over time—you can start making a plan for achieving them, the actual roadmap for your child’s care. Developing goals will seem overwhelming, especially when the only goal you can think about is a healthy child. Rely on the expertise of your care team. People such as educational experts, neurologists, nutritionists, and therapists can help you understand what is possible for your child and their future and will guide you as you create the goals. Goal Categories As you develop your care plan and start to think about the goals you have for your child, it can help to break them down into categories. Your child’s condition is complex, and organizing it in this way makes a complicated situation a little easier to understand. Managing the primary disability. Cerebral palsy is complicated, but the first goal you should consider is how to manage the prime condition. This is an overreaching kind of objective and one that your neurologist and pediatrician can help you develop. Managing complications. Cerebral palsy often comes along with co-existing conditions like seizure disorders and cognitive impairment. Setting goals for managing these is the next important step. Improving mobility. Mobility is a significant issue for most children with cerebral palsy.[2] Some will be severely impaired and unable to walk. In contrast, others may have more minor disabilities. Goals that address how well your child moves are essential for making them comfortable

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Hand dominance is the preferential use of one hand over the other for motor tasks. 90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less dexterous, non-dominant hand. When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer There are innate differences in dexterity influenced by hand dominance. Although most activities are accomplished bimanually, the dominant hand acts as the more dexterous, main executor while the non-dominant hand acts as supporter. In the context of rehabilitation, permanent loss of dexterity in dominant hand is more devastating because dexterity skill previously endowed to dominant hand must be transferred to non-dominant hand Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Leading cause of upper limb amputations is trauma occurring in males ages 15-25 years, Most of traumatic amputation happen on dominant limb vascular complications of diseases. No limb prefernces cancer/tumors (common cause of more proximal amputations such as a shoulder disarticulation or forequarter amputation)

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Amputation is the most ancient of all surgical procedures. Neolithic man is known to have survived amputation as evidenced from the skeletons with amputated stumps and from the knives and saws made of stone used at that time. Even the murals of La Tene and the drawings on the Peruvian pottery depict human figures with amputated stumps. In the olden times, amputations were practiced not only for disease but also as a punishment for criminals and as rituals to appease Gods or even in the practice of Black Magic. It is considered that the first account of amputation as a purposeful medical procedure is found in the Hippocratic Treatise and it was concerned with amputation for vascular gangrene. Indications for amputations vary according to availability of skill, facilities and line of treatment adopted. Many limb cancers are treated by amputations, but in some advanced centers limb preservation surgeries are done. A severely traumatized limb where the circulation is good may be amputated if the facilities for reconstruction are not available. Although the designs and the usability of the prostheses continue to advance, a well performed amputation is necessary for optimum results. when the blood supply of a limb is irreparably destroyed or when the limb is so severely damaged that reasonable reconstruction is impossible, amputation of the limb is indicated. In injuries of limbs, if three or more out of the five components (blood vessels, nerves, skin, muscles and bones) are badly damaged, amputation can be considered . The amputation can be early, intermediate or late depending on the timing after injury as will be discussed later in type of amputation. Thermal burns, frostbite or electrical burns are other injuries that may require amputation. Residual short stump can have excellent function.1 In the past, amputation through specific levels was necessary for proper fitting of prosthesis. The accepted ideal stump lengths are 23–28 cm from greater trochanter in above-knee amputations, 13 cm from the tibial articular surface in below-knee amputations, 10 cm above elbow in amputations through arm, and 17 cm from olecranon in forearm amputations. With modern prosthetic fitting techniques, a prosthesis can be fitted to any well-healed nontender stump. Determining the level of amputation requires an understanding of the trade-offs between increased function with more distal level of amputation and a decreased complication rate with a more proximal level of amputation.

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Spasticity is a common motor control disorder frequently encountered in the spectrum of the upper motor neuron (UMN) syndrome. It can result in pain, fatigue, joint restrictions, functional impairments, and skin breakdown that may negatively affect many domains of life by causing social avoidance and diminished life satisfaction . Spasticity was originally defined as a velocity dependent increase in tonic stretch reflexes or muscle tone with exaggerated tendon jerks resulting from increased excitability of the stretch reflex . This definition has been criticized for being too narrow and inadequately depicting the clinical sequelae. In 2005, a European Thematic Network to Develop Standardized Measures of Spasticity (the SPASM consortium) suggested broadening the definition to reflect a more clinical entity . They defined spasticity as “disordered sensory-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles.

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ithin the fi eld of physiology, there are a number of fundamental principles. Some of these key principles are (a) homeostasis, (b) the linkage between gene expression and physiology, and (c) structure–function relationships. It is this latter principle that forms the foundation of the current chapter. The concept of structure–function relationships extends across the organism-to-molecule spectrum. At the organism level, one can think about a number of examples. For instance, the structural relationship between the glenoid fossa and the head of the humerus gives the shoulder six degrees of motion—a motion that is uncommon among other joints. At the molecular level, one can think about the structure of myosin heavy chains (MHCs) and how this translates into certain functional properties like the force–velocity relationship. The discipline of exercise physiology really represents a subdiscipline or an extension of the fi eld of physiology; and, as such, the fundamental principles are essentially the same except that they are examined typically under conditions where physical activity has been altered. In this context, a great deal of interest has been given to understanding the effects of both activity and inactivity on the structural and functional properties of skeletal muscle during the past 30 to 35 years. Of any cell/tissue type, skeletal muscle certainly exhibits some of the clearest structure–function relationships. Given this perspective, one of the key objectives of this chapter is to provide a backdrop for some of the more detailed discussions that follow in successive chapters. The current chapter is organized into three distinct sections. The fi rst section provides an overview of some of the key structural properties of skeletal muscle (macroscopic to molecular anatomy). The second part of the chapter addresses the linkage between structure and function and the topic of skeletal muscle plasticity as infl uenced by altered physical activity. The fi nal section of this chapter examines issues of muscle plasticity from a comparative perspective and introduces the concept of symmorphosis, a concept related to the optimality of design

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