Cerebral palsy is a non-progressive disorder affecting movement and posture, often with associated epilepsy, vision, speech, and intellectual impairments, resulting from brain lesions or defects during development. It is the most common motor disability in childhood, affecting 2-2.5 per 1,000 children in the US. Causes include prematurity, genetic factors, infections, and brain injuries during prenatal, perinatal, or postnatal periods. Common types are spastic diplegia, hemiplegia, and quadriplegia. Diagnosis involves assessing abnormal movements, tone, reflexes and ruling out other causes through history and examination.
FA is a very rare, genetic, recessive disease, affecting 1/50,000 people.
Originates from mutations in the “coding” of the mitochondria.
Discovered by Nicholaus Friedreich in the early 1860’s.
Both parents must have the dominant trait for a 25% chance of an offspring possessing the disease.
Not necessarily a disease that kills you, but eventually a wheelchair and regular assistance will be required.
Onset before age 20-25 year.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
FA is a very rare, genetic, recessive disease, affecting 1/50,000 people.
Originates from mutations in the “coding” of the mitochondria.
Discovered by Nicholaus Friedreich in the early 1860’s.
Both parents must have the dominant trait for a 25% chance of an offspring possessing the disease.
Not necessarily a disease that kills you, but eventually a wheelchair and regular assistance will be required.
Onset before age 20-25 year.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
Dystonia is a movement disorder in which a person's muscles contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures. Dystonia can affect one muscle, a muscle group, or the entire body.
این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
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Dystonia is a movement disorder in which a person's muscles contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures. Dystonia can affect one muscle, a muscle group, or the entire body.
این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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Outline of presentation
Introduction
Epidemiology
Etiology
Clinical manifestations
Diagnosis
Treatment
INTRODUCTION
Cerebral palsy (CP) refers to a heterogeneous group of conditions involving permanent nonprogressive central motor dysfunction that affect muscle tone, posture, and movement.
These conditions are due to abnormalities of the developing fetal or infantile brain resulting from a variety of causes.
The motor impairment generally results in limitations in functional abilities and activity which can range in severity.
The motor disorders are often accompanied by disturbances of sensation , perception, cognition, communication, and behavior as well as by epilepsy and secondary musculoskeletal problems.
CP has historically been considered a static encephalopathy, but some of the neurologicfeatures of CP, such as movement disorders and orthopedic complications can change or progress over time.
Many children and adults with CP function at a high educational and vocational level,without any sign of cognitive dysfunction
Etiology
CP is caused by a broad group of
Developmental,
Genetic,
Metabolic,
Ischemic,
Infectious, and
Other acquired etiologies
Epidemiology
CP is the most common and costly form of chronic motor disability that begins in childhood
Incidence is 3.6 per 1,000 children with a male: female ratio of 1.4 : 1.
Most children with CP had been born at term with uncomplicated labors anddeliveries
Risk factors
Prematurity and VLBW
Heavy maternal alcohol consumption,
Maternal smoking,
Maternal obesity, and
Infections during pregnancy
In 80% of cases, features were identified pointing to antenatal factors causing abnormal brain development
Fewer than 10% of children with CP had evidence of intrapartum asphyxia
Intrauterine exposure to maternal infection (chorioamnionitis, urinary tract infection) was associated with a significant increase in the risk of CP in normal birthweight infants.
Multiple pregnancy was also associated with a higher incidence of CP
Death of a twin in utero carries an even greater risk of CP
Infertility treatments are also associated with a higher rate of CP
CP is more common and more severe in boys than girls, and this effect is enhanced at the extremes of body weight
Elevated levels of inflammatory cytokines have been reported in heelstick blood collected at birth from children who later were identified with CP.
The prevalence of CP has increased somewhat as a result of the enhanced survival of very premature infants weighing < 1,000 g, who go on to develop CP at a rate of ~ 15 per 100.
However, the GA at birth adjusted prevalence of CP among 2 yr old former premature infants born at 20-27 wk of gestation has decreased over the past decade
The major lesions that contribute to CP in preterm infants are intracerebral hemorrhage and periventricular leukomalacia (PVL).
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. DEFINITION
Cerebral Palsy is a STATIC encephalopathy and may
be defined as a non-progressive disorder of posture
and movement, often associated with epilepsy and
abnormality of speech, vision and intellect resulting
from a defrct or lesion of the developing brain.
3. MAGNITUDE OF THE PROBLEM
• Cerebral palsy is the most common cause of chronic motor
disability that begins in childhood.
• It is difficult to estimate the precise magnitude of the problem
since milder cases are likely to be missed.
4. • It is the most common childhood physical disability
and affects 2 to 2.5 children per 1,000 born in the
United States.
• The exact incidence and prevalence from our country
is not known.
5. ETIOLOGY
Idiopathic (no known cause of damage to brain during pregnancy) - is the
most common cause.
CP could be classified on the basis of underlying cause of cerebral palsy-
Prenatal causes
Perinatal causes
Postnatal causes
10. POSTNATAL
CNS INFECTIONS (MENINGITIS, ENCEPHALITIS)
HYPOXIA
SEIZURES
COAGULOPATHIES
NEONATAL HYPERBILIRUBINEMIA
Head trauma from shaken baby syndrome (child abuse)
during the 1ST year of life
Lead poisoning during the 1st two years of life
11. PHYSIOLOGICAL CLASSIFICATION
Physiological classification
This is determined on the basis of the nature of the
movement disorder, muscle tone, and anatomic
distribution.
A single patient may have more than one
type. Spastic CP is the most common, accounting for
about two thirds of cases.
12. Pyramidal (or spastic) CP: This type is characterized
by neurologic signs of upper motor neuron damage
with increased "clasp knife" muscle tone, increased
deep tendon reflexes, pathologic reflexes, and spastic
weakness.
13. Extrapyramidal (nonspastic or dyskinetic) CP: This
type is characterized by prominent involuntary
movements or fluctuating muscle tone, with
choreoathetosis as the most common subtype.
Distribution is usually symmetric among the four limbs.
14. • Hypotonic CP: This type manifests as generalized
muscle hypotonia that persists with normal or increased
deep tendon reflexes. Many patients with this condition
develop cerebellar deficits of incoordination and ataxia,
and about one third of patients have severe retardation.
• Ataxic CP: Primarily cerebellar signs are seen.
• Mixed types
15. TOPOGRAPHICAL CLASSIFICATION
This is based on which limbs are involved.
• Monoplegia – Only one limb is involved.
• Paraplegia – Both the legs are involved
• Hemiplegia – Both upper and lower limbs are
involved on one side
• Triplegia – Three limbs are involved
• Quadriplegia – all the four limbs are involved
• Diplegia – The lower limbs are more involved
than the upper limbs.
17. EARLY SIGNS OF CEREBRAL PALSY
Paucity of movement or excessive
& disorganized movements
Stereotyped behaviour
Persistent tone abnormalities
Feeding problems
Hyperextension of head & neck
Consistent fisting of hands
beyond 2 months
Delayed social smile
Reduced growth of head size
Early sign of hand preference in
the 1st yr of life
Persistent moro’s reflex beyond
6months of age
21. SPASTIC HEMIPLEGIA
• Involvement of the arm and leg on one side of the body
• Upper extremity more severly involved
• Constitutes 20% of cases with spastic CP
• Manifests from 4th month – 2nd yr of life
• Incomplete Moro’s or Premature development of
handedness could be early symptom
22. • M/C form of CP
• Functional prognosis good as compared to other
forms
• Underdevelopment of affected side is common
• Will crawl with affected arm tucked under the trunk
and pushing self with the sound arm
• Cortical thumb
25. DIPLEGIA
• Patients with diplegia have motor abnormalities in all four
extremities, with the lower extremities more affected
than the upper.
• The close proximity of the lower extremity tracts to the
ventricles most likely explains the more frequent
involvement of the lower extremities with periventricular
lesions.
26. • The child uses the arms in a normal
reciprocal fashion but tends to drag
the legs behind more as a rudder
(commando crawl) rather than using
the normal four-limbed crawling
movement.
• If the spasticity is severe, application
of a diaper is difficult because of the
excessive adduction of the hips.
29. SPASTIC QUADRIPLEGIA
• Spastic quadriplegia is the most severe form of CP because of marked
motor impairment of all extremities and the high association with
mental retardation and seizures.
• In quadriplegia, all four extremities are equally involved, and many
patients have significant cognitive deficiencies that make care more
difficult.
• Head and neck control are usually present, which helps with
communication, education, and seating.
30. ATHETOID CP
• Athetoid cerebral palsy is less common than spastic
cerebral palsy.
• This type is most likely to be associated with birth
asphyxia.
31. • It is caused by an injury to the extrapyramidal tracts
and is characterized by dyskinetic, purposeless
movements that may be exacerbated by
environmental stimulation.
• The clinical picture varies based on the level of
excitement of the patient. In pure athetoid cerebral
palsy, joint contractures are uncommon.
32. • Affected infants are characteristically hypotonic with poor head
control and marked head lag and develop increased variable tone
with rigidity and dystonia over several years.
• Feeding may be difficult, and tongue thrust and drooling may be
prominent.
• Speech is typically affected because the oropharyngeal muscles are
involved.
• Seizures are uncommon, and intellect is preserved in many patients.
33. DYSTONIC CP
• The trunk muscles and the proximal portion of the limb
muscles are predominantly affected.
• Movements may be slow and persistent.
• Abnormal movements invoving the head and neck area.
34. ATONIC CP
• Hypotonicity of lower limb muscles.
• Arms may have near normal strength and coordination.
• Often associated with slow attainment of motor
milestones.
35. MIXED CP
• Manifestations of both spastic and extrapyramidal
types.
• Often an ataxic component is present.
• Have mild to moderate degree of choreoathetosis.
37. Cerebral palsy can be diagnosed using Levine (POSTER)
criteria. POSTER stands for –
P - Posturing/abnormal movements
O - Oropharyngeal problems (e.g., tongue thrusts, swallowing
abnormalities)
S - Strabismus
T - Tone (hyper- or hypotonia)
E - Evolutional maldevelopment (primitive reflexes persist or
protective equilibrium reflexes fail to develop
R - Reflexes (increased deep tendon reflexes/persistent
Babinski's reflex)
38. • In a child with cerebral palsy motor deficit is always
present.
• The usual presenting complaint is that child is not reaching
motor milestones at the appropriate age.
• Medical history establishes that the child is not losing
function.
• This history, combined with a neurologic examination
establishing that motor deficit is due to a cerebral
abnormality, establishes the diagnosis of cerebral palsy.
39. • Serial examinations may be necessary if the history is
unreliable.
• Other causes of neonatal hypotonia include muscular
dystrophies, spinal muscular atrophy, Down's
syndrome, spinal cord injuries.
40. Laboratory tests are not necessary to establish the
diagnosis. Workup is helpful for assessment of recurrence
risk, implementation of prevention programs, and medico
legal purposes.
41. Metabolic and genetic testing should be considered if on
follow-up the child has -
• Evidence of deterioration or episodes of metabolic
decompensation
• No etiology determined by neuroimaging
• Family history of childhood neurologic disorder associated
with cerebral palsy
• Developmental malformation on neuroimaging
42. • An EEG should be obtained when a child with cerebral
palsy has a history suggestive of seizures.
• Children with cerebral palsy should be screened for
ophthalmologic and hearing impairments, speech and
language disorders.
• Nutrition, growth, and swallowing function should be
monitored.
43. • Neuroimaging is recommended if the etiology has not
been established previously; for example, by
perinatal imaging.
• MRI, when available, is preferred to CT scanning
because of higher yield in suggesting an etiology, and
timing of the insult leading to cerebral palsy.
45. Neurological problems associated with cerebral palsy
include:
• Seizures and epilepsy ( As many as half of all
children with CP have one or more seizures.)
• Behavior problems
• Mental retardation ( Mental impairment is more
common among those with spastic quadriplegia than
in those with other types of cerebral palsy.)
47. Visual impairment
As many as 75 to 90 percent of children with CP may suffer from-
• strabismus,
• Amblyopia (“lazy eye”),
• optic atrophy
• nystagmus
• visual field defects
• refractive errors
49. • Communication disorder
• Gastroesophageal reflux
• Tooth decay and gum disease
• Hernia
• Constipation
• Bladder control problems
• Drooling
• Spinal deformities and osteoarthritis (Spinal deformities
can make sitting, standing, and walking difficult and cause
chronic back pain. Pressure on and misalignment of the joints
may result in osteoporosis)
50. • Contractures. Muscles can become painfully fixed
into abnormal positions, called contractures, which
can increase muscle spasticity and joint deformities in
people with CP.
• Frequent fractures
52. A LARGE AND EXTENSIVE CARE TEAM
SURROUNDS THE FAMILY WITH A
CHILD WHO HAS CEREBRAL PALSY.
53. • These care providers are roughly organized around
the educational system, primary medical care
provider, the cerebral palsy specialized medical team,
and community support services.
Significant overlap and good communication provide
the best resources to the child and the family.
54. • Because of the heterogeneous nature of cerebral
palsy, it is difficult to make generalized statements
regarding treatment, and it is best to have an
individualized approach to each patient and his or
her needs.
55. Four basic treatment principles exist -
• The first is that although the central nervous system injury,
by definition, is nonprogressive, the deformities caused by
abnormal muscle forces and contractures are progressive.
• The second, which can be a source of frustration, is that
the treatments currently available correct the secondary
deformities only and not the primary problem, which is the
brain injury.
56. • The third is that the deformities typically become worse
during times of rapid growth. For some patients, it may be
beneficial to delay surgery until after a significant growth
spurt to decrease the risk of recurrence.
• The fourth is that operative or nonoperative treatment
should be done to minimize the impact it has on the
patient's socialization and education.
57. HOME MODIFICATIONS
There are various ways to modify the home environment so
that your child will have more independence and things will
be easier on parents too. Example-
• Replace doorknobs with lever door handles.
• Replace entrance steps with ramps.
• Install a hinged arm support for help with toileting.
• Rearrange furniture in order to remove obstructions.
58. CHOOSING APPROPRIATE SEATING
Strollers, feeding chairs, tumble form sets, headrests,
seating supports, and corner chairs—all of these are
forms of adaptive seating that may benefit children with
cerebral palsy.
59.
60. PRESSURE MANAGEMENT AWARENESS
For children who use wheelchairs, the need to change
positions or relieve pressure, particularly on their
buttocks or ischial tuberosities, is critical. If is not
relieved, skin breakdown or pressure sores can occur.
61. If the child is not standing between 18 and 24 months, it is
necessary to start a child standing even when she does not
have adequate head or upper body control to stand alone.
62. Standing is important because
it allows the child to do some
weight bearing through the
legs, which in turn helps make
the bones stronger and
stimulates the development of
motor coordination and head
control.
63. WALKERS AND GAIT TRAINERS
• There are no absolute indicators for initiating the use
of a walker.
• If child is able to hold up head independently, sitting
in a chair with minimal support, and being able to
stand and accept weight through the legs are a few of
the basics that are needed.
65. • Improvements in efficiency can include decreased
energy used during a task, decreased work required
of the muscles during a task, and habituation of new
patterns of movement.
• Occupational, speech, and physical therapists as well
as educators can use NDT.
66. STRENGTHENING EXERCISES
Muscle strength is related to motor performance and should
be an integral part of a rehabilitation program that addresses
other impairments which inhibit motor performance in this
population, such as muscle–tendon shortening, spasticity,
and coordination deficits.
68. HIPPOTHERAPY
The North American Riding for the
Handicapped Association (NARHA) has
defined hippotherapy as “The use of the
movement of a horse as a tool by
therapists to address impairments,
functional limitations and disabilities in
patients with neuro musculoskeletal
dysfunction.
69.
70. AQUATIC THERAPY
• The relief of hypertonus in the spastic type of CP is one of the major
advantages of aquatic therapy.
• When a body is immersed in warm water (92°to 96°F), its core
temperature increases, causing reduction in gamma fiber activity,
which in turn reduces muscle spindle activity, facilitating muscle
relaxation and reducing spasticity, thus resulting in increased joint
range of motion and consequently creating better postural
alignment.
71. A great way to start gait
training, especially after
surgical procedures, is pool
walking. This means the pool
needs to have handles
available in the water at the
correct height.
72. M.O.V.E. (MOBILITY OPPORTUNITIES VIA
EDUCATION) CURRICULUM
• It is an activity-based curriculum designed to teach individuals
basic functional motor skills needed for adult life.
• The MOVE curriculum provides a framework for teaching the skills
necessary for individuals with disabilities to gain greater physical
independence.
73.
74. • Physical and occupational therapies are useful for promoting
mobility and the use of the upper extremities for activities of
daily living.
• Speech language pathologists promote acquisition of a
functional means of communications.
75. • Communication skills may be enhanced by the use of
Bliss symbols, talking typewriters, electronic speech
generating devices, and specially adapted computers
including artificial intelligence computers to augment
motor and language function.
76. MEDICAL MANAGEMENT
• Several oral medications have been used to reduce tone, including
diazepam, baclofen, dantrolene, tizanidine, and clonidine.
• Although they can decrease spasticity, their sedating side effects
are not well tolerated in Children.
• Intrathecal baclofen has been shown to reduce spasticity with
fewer side effects.
77. INTRATHECAL BACLOFEN PUMPS
• Use of intrathecal baclofen in the
pediatric patient having CP has
yielded as good a reduction in
tone as dorsal rhizotomy and
does not represent an ablative
procedure. This is important
because, unlike rhizotomies, it is
entirely reversible.
78. BACLOFEN
• GABA agonist -Acts on spinal cord neurons
• inhibits release of excitatory neurotransmitter at level of
spinal cord
• Dose : 2 mg/kg/day, can be given intrathecally
• ADR : hypotonia of trunk muscles, dec alertness, dec
appetite, vomiting, aggravates epilepsy
• Withdrawal: Rebound spasticity
79. BOTULINUM TOXIN A (BTA)
• Blocks acetylcholine release, with a loss of motor
end plates
• Effect – 3 to 4 months
• Multiple site intramuscular injections for selected
muscle groups
• Effective only for dynamic spasticity
• Helps delay surgery beyond 8 yrs of age
• ADR : painful injection
• systemic effects- laryngeal weakness, bladder
incontinence
80.
81. SURGICAL TECHNIQUES
Upper Extremity Procedures
1. Shoulder Adductor, Extension, and External Rotator Lengthening
2. Humeral Derotation Osteotomy (in patients with severe abduction external rotation
contractures)
3. Elbow Flexion Contracture Release
4. Pronator Release or Transfer
5. Flexor Carpi Ulnaris Transfer for Wrist Flexion Deformity
6. Proximal Row Carpectomy and/or Wrist Fusion
7. Thumb Adductor Lengthening
82. A rhizotomy procedure in which the roots of the spinal nerves
are divided produces considerable improvement in selected
patients with severe spastic diplegia.
84. • Hip Procedures- Iliopsoas Lengthening, Adductor and
Iliopsoas Lengthening with Proximal Hamstring Lengthening.
• Knee Operative Procedures- Hamstring Lengthening
• Foot and Ankle Procedures- Gastrocnemius Lengthening,
Tendon Achilles Lengthening
85. MANAGEMENT OF ASSOCIATED CONDITIONS
Strabismus is normally treated by correcting the visual
acuity in each eye, either with glasses or by patching. If a
significant strabismus remains even after these
therapies, then surgery is indicated.
86. Feeding –
Problems: Tongue thrusting
Drooling of saliva
Risk of aspiration
GERD
Mgt: Upright position during and after feeds
Thickening of feeds
Drugs - antacids, prokinetics, H2 blockers
NGT feeds
Antireflux surgery – fundoplication
For sialorrhea - glycopyrrolate
87. • Constipation –
Risk of acquired megacolon
Increased fluid intake, varied diet, lactulose, enema
• Incontinence –
Patient toilet training may be attempted according to
stage of development