This document discusses spinal cord injuries and peripheral nerve injuries that can occur in neonates during birth. It notes that spinal cord injuries are rare but can be devastating, most often occurring at the C4 vertebrae during cephalic births and lower cervical/upper thoracic vertebrae during breech births. Peripheral nerve injuries discussed include brachial plexus injuries, phrenic nerve paralysis, and facial nerve palsy. Brachial plexus injuries are the most common and usually involve the C5-C6 nerve roots, often recovering spontaneously. Phrenic nerve paralysis can cause respiratory issues. Treatment focuses on immobilization, positioning, and physical therapy.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Treatment for brachial plexus injury would depend on the extent of the injury, its type, the period of time since the injury occurred and other conditions.
Brachial plexus injury treatment addresses severe damage to the brachial plexus, a set of nerves that runs between your spine and your shoulders, arms and hands.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Treatment for brachial plexus injury would depend on the extent of the injury, its type, the period of time since the injury occurred and other conditions.
Brachial plexus injury treatment addresses severe damage to the brachial plexus, a set of nerves that runs between your spine and your shoulders, arms and hands.
Birth injuries are inflicted during the time of delivery of the baby. it can occur in different parts of the body such as head, shoulder, eyes, nerves, etc. these injuries may be minor which resolve themselves with time while others are major and require prompt treatment. it is also very important to focu upon the prevention of occurence of such birth injuries. these injuries can be head injury, paralysis, fracture, soft tissue injury, visceral injury etc.
Management of Posterior Glenohumeral Instability with Large Humeral Head DefectPeter Millett MD
Traumatic posterior instability may occasionally cause a large osteochondral lesion when the anterior humeral head is compressed against the posterior glenoid rim. This is termed a reverse Hill–Sachs lesion. Such osteochondral defects may be very large in the case of chronic locked dislocations. Even in acute posterior disclocations, closed reduction may be difficult when the humeral head is locked posteriorly over the glenoid. In such cases closed or open reduction under general anesthesia with muscle relaxation may be necessary. In cases where the anterior humeral head defect is large, reconstruction may be necessary to maintain stability. Management must be tailored to the individual patient and depends on several factors, which include the size of the defect, the duration of the dislocation, the quality of the bone, the status of the articular cartilage, and the patient’s overall health. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Similar to Nelson 21 spinal and peripheral nerve disease in neonate by birhanu alehegn (20)
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Nelson 21 spinal and peripheral nerve disease in neonate by birhanu alehegn
1. University of Gondar
Ppt from Nelson 21st edition
On spinal and peripheral nerve disease in neonate
By Birhanu Alehegn
Sep 2021
2. 120.5 Spine and Spinal Cord
See also Chapter 729 .
Injury to the spine/spinal cord during birth is rare but can be devastating.
Strong traction exerted when the spine is hyperextended or when the direction of pull is
lateral, or forceful longitudinal traction on the trunk while the head is still firmly engaged
in the pelvis, especially when combined with flexion and torsion of the vertical axis, may
produce fracture and separation of the vertebrae.
Such injuries are most likely to occur when difficulty is encountered in delivering the
shoulders in cephalic presentations and the head in breech presentations.
The injury occurs most often at the level of the 4th cervical vertebra with cephalic
presentations and the lower cervical–upper thoracic vertebrae with breech presentations.
Transection of the cord may occur with or without vertebral fractures; hemorrhage and
edema may produce neurologic signs that are indistinguishable from those of transection,
except that they may not be permanent.
3. Areflexia, loss of sensation, and complete paralysis of voluntary motion occur below the
level of injury, although the persistence of a withdrawal reflex mediated through spinal
centers distal to the area of injury is frequently misinterpreted as representing voluntary
motion.
If the injury is severe, the infant, who from birth may be in poor condition because of
respiratory depression, shock, or hypothermia, may deteriorate
rapidly to death within several hours before any neurologic signs are obvious.
Alternatively, the course may be protracted, with symptoms and signs appearing at birth
or later in the 1st wk; Horner syndrome, immobility, flaccidity, and associated brachial
plexus injuries may not be recognized for several days.
Constipation may also be present. Some infants survive for prolonged periods, their initial
flaccidity, immobility, and areflexia being replaced after several weeks or months by rigid
flexion of the extremities, increased muscle tone, and spasms.
Apnea on day 1 and poor motor recovery by 3 mo are poor prognostic signs
4. The differential diagnosis of neonatal spine/spinal cord injury includes
amyotonia congenita and myelodysplasia associated with spina bifida occulta
spinal muscular atrophy (type 0),
spinal vascular malformations (e.g., arteriovenous malformation causing
hemorrhage or stroke), and
congenital structural anomalies (syringomyelia, hemangioblastoma)
US or MRI confirms the diagnosis
Treatment of the survivors is supportive, including home ventilation; patients often
remain permanently disabled
When a fracture or dislocation is causing spinal compression, the prognosis is related to
the time elapsed before the compression is relieved.
5. 120.6
Peripheral NerveInjuries
BrachialPalsy
Brachial plexus injury is a common problem, with an incidence of 0.6-4.6 per 1,000 live
births. Injury to the brachial plexus may cause paralysis of the upper part of the arm with
or without paralysis of the forearm or hand or, more often, paralysis of the entire arm.
These injuries occur in macrosomic infants and when lateral traction is exerted on the
head and neck during delivery of the shoulder in a vertex presentation, when the arms are
extended over the head in a breech presentation, or when excessive traction is placed on
the shoulders.
Approximately 45% of brachial plexus injuries are associated with shoulder dystocia.
In Erb-Duchenne paralysis the injury is limited to the 5th and 6th cervical nerves
The infant loses the power to abduct the arm from the shoulder, rotate the arm externally,
and supinate the forearm
The characteristic position consists of adduction and internal rotation of the arm with
pronation of the forearm
6. Power to extend the forearm is retained, but the biceps reflex is absent; the Moro reflex is
absent on the affected side (Fig. 120.10 ). The outer aspect of the arm may have some
sensory impairment
Power in the forearm and hand grasps is preserved unless the lower part of the plexus is
also injured; the presence of hand grasp is a favorable prognostic sign
When the injury includes the phrenic nerve, alteration in diaphragmatic excursion may
be observed with US, fluoroscopy, or as asymmetric elevation of the diaphragm on chest
radiograph.
7. FIG. 120.10Schematicrepresentation of the brachial plexuswithits terminal branches.The majorsitesof brachial plexusinjury
are shown.(Courtesyof Netter Images,Image ID 19943. www.netterimages.com.)
,
8. Klumpke paralysis is a rare form of brachial palsy in which injury to the 7th and 8th
cervical nerves and the 1st thoracic nerve produces a paralyzed hand and ipsilateral ptosis
and miosis (Horner syndrome ) if the sympathetic fibers of the 1st thoracic root are also
injured.
Mild cases may not be detected immediately after birth. Differentiation must be made
from cerebral injury; from fracture, dislocation, or epiphyseal separation of the humerus;
and from fracture of the clavicle.
MRI demonstrates nerve root rupture or avulsion.
Most patients have full recovery. If the paralysis was a result of edema and hemorrhage
around the nerve fibers, function should return within a few months; if it resulted from
laceration, permanent damage may result. Involvement of the deltoid is usually the most
serious problem and may result in shoulder drop secondary to muscle atrophy.
In general, paralysis of the upper part of the arm has a better prognosis than paralysis of
the lower part
9. Treatment consists of initial conservative management with monthly follow- up and a
decision for surgical intervention by 3 mo if function has not improved
Partial immobilization and appropriate positioning are used to prevent the development
of contractures
In upper arm paralysis, the arm should be abducted 90 degrees with external rotation at
the shoulder, full supination of the forearm, and slight extension at the wrist with the
palm turned toward the face
This position may be achieved with a brace or splint during the 1st 1-2 wk.
Immobilization should be intermittent throughout the day while the infant is asleep and
between feedings
In lower arm or hand paralysis, the wrist should be splinted in a neutral position and
padding placed in the fist
When the entire arm is paralyzed, the same treatment principles should be followed
Gentle massage and range-of-motion exercises may be started by 7-10 days of age. Infants
should be closely monitored with active and passive corrective exercises
10. If the paralysis persists without improvement for 3 mo, neuroplasty, neurolysis, end-to-
end anastomosis, and nerve grafting offer hope for partial recovery
The type of treatment and the prognosis depend on the mechanism of injury and the
number of nerve roots involved
The mildest injury to a peripheral nerve (neurapraxia ) is caused by edema and heals
spontaneously within a few weeks
Axonotmesis is more severe and is a consequence of nerve fiber disruption with an intact
myelin sheath; function usually returns in a few months
Total disruption of nerves (neurotmesis ) or root avulsion is the most severe, especially if it
involves C5-T1; microsurgical repair may be indicated
Fortunately, most (75%) injuries are at the root level C5-C6, involve neurapraxia and
axonotmesis, and should heal spontaneously. Botulism toxin may be used to treat biceps-
triceps co-contractions
11. PhrenicNerve Paralysis
Phrenic nerve injury (3rd, 4th, 5th cervical nerves) with diaphragmatic paralysis must be
considered when cyanosis and irregular and labored respirations develop
Such injuries, usually unilateral, are associated with ipsilateral upper brachial plexus
palsies in 75% of cases
Because breathing is thoracic in type, the abdomen does not bulge with inspiration
Breath sounds are diminished on the affected side
The thrust of the diaphragm, which may often be felt just under the costal margin on the
normal side, is absent on the affected side
The diagnosis is established by US or fluoroscopic examination, which reveals elevation of
the diaphragm on the paralyzed side and seesaw movements of the 2 sides of the
diaphragm during respiration
It may also be apparent on chest or abdominal radiograph
12. Infants with phrenic nerve injury should be placed on the involved side and given oxygen
if necessary. Some may benefit from pressure introduced by continuous positive airway
pressure (CPAP) to expand the paralyzed hemidiaphragm
In extreme cases, mechanical ventilation cannot be avoided. Initially, intravenous feedings
may be needed; later, progressive gavage or oral feeding may be started, depending on the
infant's condition
Pulmonary infections are a serious complication. If the infant fails to demonstrate
spontaneous recovery in 1-2 mo, surgical plication of the diaphragm may be indicated.
13. Facial Nerve Palsy
Facial palsy is usually a peripheral paralysis that results from pressure over the facial
nerve in utero, during labor, or from forceps use during delivery. Rarely, it may result
from nuclear agenesis of the facial nerve
Peripheral facial paralysis is flaccid and, when complete, involves the entire side of the
face, including the forehead. When the infant cries, movement occurs only on the
nonparalyzed side of the face, and the mouth is drawn to that side.
On the affected side the forehead is smooth, the eye cannot be closed, the nasolabial fold is
absent, and the corner of the mouth droops.
Central facial paralysis spares the forehead (e.g., forehead wrinkles will still be apparent
on the affected side) because the nucleus that innervates the upper face has overlapping
dual innervation by corticobulbar fibers originating in bilateral cerebral hemispheres.
The infant with central facial paralysis usually has other manifestations of intracranial
injury, most often 6th nerve palsy from the proximity of the 6th and 7th cranial nerve
nuclei in the brainstem.
14. Prognosis depends on whether the nerve was injured by pressure or the nerve fibers were
torn; improvement occurs within a few weeks in the former case.
Care of the exposed eye is essential. Neuroplasty may be indicated when the paralysis is
persistent.
Facial palsy may be confused with absence of the depressor muscles of the mouth, which is
a benign problem or with variants of Möbius syndrome.
Other peripheral nerves are seldom injured in utero or at birth except when they are
involved in fractures or hemorrhage.