C Ppresentation


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C Ppresentation

  1. 1. <ul><li>Pam Angelakis </li></ul><ul><li>Tietta Gowans </li></ul><ul><li>Sarah Peagler </li></ul><ul><li>Kara Trachtenberg </li></ul><ul><li>Mariah Valentine </li></ul>
  2. 3. <ul><li>- Define Spastic Cerebral Palsy </li></ul><ul><li>- Describe Types of Cerebral Palsy </li></ul><ul><li>- Understand the causes </li></ul><ul><li>- Explain the gross motor functionality and affected areas </li></ul><ul><li>- Analyze the gait analysis </li></ul><ul><li>- Describe treatments </li></ul>
  3. 4. <ul><li>Neurodevelopmental condition starting in early childhood and persisting through the lifespan. </li></ul><ul><li>  </li></ul><ul><li>-Affects development of movement and posture </li></ul><ul><li>-Disturbances of: sensation </li></ul><ul><li>                            communication </li></ul><ul><li>                            perception </li></ul><ul><li>                            and/or behavior </li></ul><ul><li>                            and/or seizures </li></ul><ul><li>Bax, Martin, et al. &quot;Proposed Definition and Classification of Cerebral Palsy, April 2005&quot;. Developmental Medicine and Child Neurology. 47 (2005). 571-576. </li></ul>
  4. 5. <ul><li>What is it? </li></ul><ul><li>    - form of hypertonia </li></ul><ul><li>    -Muscles receive the signals to contract continuously </li></ul><ul><li>    - Might produce contractures due to a marked loss of sarcomeres in the muscle, increased stiffness in the spastic muscle, and changes in the connective tissues within the muscle. </li></ul><ul><li>  </li></ul><ul><li>Ostensjo, Singrid. &quot;Motor Impairments in Young Children With Cerebral Palsy: Relationship to Gross Motor Function and Everyday Activities&quot;. Developmental Medicine and Child Neurology. 46:9 (2004). 580-589.   </li></ul>
  5. 6. <ul><li>  </li></ul>http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe002g/dwe00211g20.gif
  6. 7. <ul><li>Brain lesions in the upper motor neuron system </li></ul><ul><li>Effect nervous systems ability to receive certain neurotransmitters responsible for movement </li></ul>McNeil, M. R. Clinical Management of Sensorimotor Speech Disorders . New York: Thieme Medical, 2007. Print
  7. 8. <ul><li>Periventricular leukomalacia (PVL) </li></ul><ul><li>Cerebral atrophy </li></ul><ul><li>Post-hemorraghic porencephaly </li></ul><ul><li>Middle cerebral artery infract </li></ul><ul><li>Multicystic encephalomalcia </li></ul><ul><li>Congenital brain malformations </li></ul><ul><li>Polymicrogyria </li></ul>Kulak, W., et al. &quot;Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy.&quot;  Advances in Medical Sciences. 53:1 (2008). 42-48.
  8. 9. http://www.scielo.br/scielo.php?pid=S0004-282X2001000100007&script=sci_arttext
  9. 10. www.indianjournals.com
  10. 11. www.cerebralpalsysymptoms.org
  11. 12. <ul><li>Grey & White Matter </li></ul><ul><li>Beginning of 3 rd Trimester-White Matter </li></ul><ul><li>End of 3 rd Trimester- Grey Matter </li></ul>themindperspective.files.wordpress.com Krageloh-Mann, Inberg,MD, et al. &quot;The Role of Magnentic Resonance Imaging in Elucidating the Pathogenesis of Cerebral Palsy: a Systematic Review.&quot; Developmental Medicine and Child Neurolology. 49:2 (2007). 144-151.
  12. 13. <ul><li>Bilateral Spastic CP </li></ul><ul><li>In-term: maldevelopments, PVL, grey matter lesions </li></ul><ul><li>Pre-term: 89% PVL </li></ul><ul><li>Unilateral Spastic CP </li></ul><ul><li>In-tem: PVL, grey matter lesions </li></ul><ul><li>Pre-term: 85% PVL </li></ul>www.neonatalagy.ucsf.edu Krageloh-Mann, Inberg,MD, et al .
  13. 14. <ul><li>Low birth weight </li></ul><ul><li>Multiple births </li></ul><ul><li>Infections during pregnancy </li></ul><ul><li>Blood type incompatibility </li></ul><ul><li>Exposure to toxic substances </li></ul><ul><li>Mothers with thyroid abnormalities </li></ul><ul><li>Complications during labor & delivery </li></ul><ul><li>Breech Presentation </li></ul><ul><li>Small for gestational age </li></ul><ul><li>Low apgar score </li></ul><ul><li>Jaundice </li></ul><ul><li>Unknown </li></ul>www.ninds.nih.gov
  14. 15. <ul><li>- Decrease Spasticity, Increase function Ross, Sandy A., et al. &quot;Relationships Between Spasticity, Strength, Gait, and the GMFM-66 in Persons With Spastic Diplegia Cerebral Palsy&quot;. Archives of Physical Medicine and Rehabilitation. 88:9 (2007). 1114-1120.   </li></ul><ul><li>- Children walking unaided had significantly less leg spasticity, fewer deviations in ROM, and better selective dorsiflexion (Ostensjo, Singrid, et al.). </li></ul><ul><li>-As deviations in ROM increase, the level of spasticity increased (Ostensjo, Singrid, et al.) .  </li></ul><ul><li>- In gait, children using mainly the tibialis anterior for dorsiflexion seemed to have less leg spasticity than children using mainly the toe extensors (Ostensjo, Singrid, et al.) . </li></ul>
  15. 16. <ul><li>Wiley, Mary Elizabeth, et al. &quot;Lower-Extremity Strength Profiles in Spastic Cerebral Palsy&quot; studied spastic hemiplegia and diplegia.  Developmental Medicine and Child Neurology. 40:2 (1998). 100-107. </li></ul><ul><li>The findings: - Muscle tightness can prevent a muscle for achieving an effective length for generating force. </li></ul><ul><li>                      - stronger knee extensors are more likely to perform better on gross motor skills, walk quicker, crouch, and have greater energy economy when walking. </li></ul><ul><li>                    - Children with hemiplegia had diminished power generation during gait compared to those with no pathology.  </li></ul><ul><li>                    - Knee extensor and flexor strengths of the involved side were respectively 42 and 52% of the uninvolved side in hemiplegia. </li></ul><ul><li>                    - The weakest muscles were: hip extensors, ankle dorsiflexors, and plantar flexors. </li></ul>
  16. 17. <ul><li>  </li></ul><ul><li>- The weakness of the hip extensors, hip flexors (1 side), and plantar flexors (1 side) points to the need for increased power of the uninvolved plantar flexors for propulsion (Wiley et al.) </li></ul><ul><li>-Muscle tightness can prohibit a muscle from achieving an effective length for generating force. </li></ul><ul><li>Hemiplegic Gait </li></ul><ul><li>Diplegic Gait </li></ul>
  17. 18. <ul><li>Gross Motor Function Measure </li></ul><ul><li>-developed to document motor status and to measure change over time ( </li></ul><ul><li>-5 dimensions </li></ul><ul><li>    lying and rolling </li></ul><ul><li>    sitting </li></ul><ul><li>    crawling and kneeling </li></ul><ul><li>    standing </li></ul><ul><li>    walking, running, jumping </li></ul><ul><li>There are five levels of classification, children in level I have the fewest limitations in gross motor function and mobility, and children in level V have the greatest number limitations, meaning that very little voluntary movements are possible. </li></ul><ul><li>Damiano, Diane. &quot;Relation of Gait Analysis to Gross Motor Function in Cerebral Palsy.&quot; Developmental Medicine and Child Neurology . 38: (1996) 389-396 </li></ul><ul><li>Hanna, Steven E., et al. &quot;Reference Curves for the Gross Motor Function Measure: Percentiles for Clinical Description and tracking over time among children with cerebral palsy&quot;.   Journal of Physical Therapy. 88:5 (2008). 596-607 </li></ul>
  18. 19. <ul><li>used to discover the precise gait problems and to better facilitate ambulation </li></ul><ul><li>identifies the specific walking pattern that is causing the person to have difficulty walking </li></ul><ul><li>results of the gait analysis are than used to predict what type of muscle, tendon, and joint surgery would be most benefit, evaluate the success of previous orthopedic surgery, and suggest changes in a person’s exercise program </li></ul><ul><li>&quot;Types of Cerebral Palsy.&quot;, &quot;Gait Analysis of Cerebral Palsy&quot; 4MyChild- Help and Hope for Life. 4MyChild, Web. 20 Oct 2009. http://www.cerebralpalsy.org/. </li></ul>
  19. 20. <ul><li>spasticity is unilateral (occurring on one side) </li></ul><ul><li>The most common accepted classification is that reported by Winters et al. (1987) </li></ul><ul><li>patterns are divided into 4 types based on the sagittal plane </li></ul><ul><li>Rodda, J. and Graham, H.K. &quot;Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm&quot;. European Journal of Neurology 8: (suppl. 5) (2001). 98-108. </li></ul>
  20. 21. <ul><li>Type I </li></ul><ul><ul><li>During Stance phase, dorsiflexion is normal </li></ul></ul><ul><ul><li>During Swing phase, there is drop foot present </li></ul></ul><ul><li>Type II </li></ul><ul><ul><li>Equinus is present in all phases of gait </li></ul></ul><ul><li>Type III </li></ul><ul><ul><li>Equinus in ankle </li></ul></ul><ul><ul><li>Flexed, stiff knee </li></ul></ul><ul><li>Type IV </li></ul><ul><ul><li>Equinus in ankle </li></ul></ul><ul><ul><li>flexed-stiff knee </li></ul></ul><ul><ul><li>flexed hip </li></ul></ul><ul><ul><li>an anterior pelvic tilt </li></ul></ul><ul><ul><li>Rodda, J. and Graham, H.K. &quot;Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm&quot;. European Journal of Neurology 8: (suppl. 5) (2001). 98-108. </li></ul></ul><ul><ul><li>Winters, Thomas F., et al. &quot;Gait Patterns in Spastic Hemiplegia in Children and Young Adults&quot;. The Journal of Bone and Joint Surgery. 69:3 (1987). 437-441. </li></ul></ul>
  21. 22. http://chestofbooks.com/health/anatomy/Human-Body-Construction/images/Fig-598-Talipes-equinus.jpg http://www.foot-care.org/images/dropfoot.jpg http://www.emergingp.com/images/CerebralPalsy3.jpg http://hb3.seikyou.ne.jp/home/t-matsu2/Efig25a_copy.jpg
  22. 23. <ul><li>ankle is equinus </li></ul><ul><li>the knee and hip are in flexion </li></ul><ul><li>there is an anterior pelvic tilt </li></ul><ul><li>There is an increase in knee flexion in the early stance phase of gait, with the correction of the knee to normal or near normal extension in mid- and late stance. </li></ul><ul><ul><li>Rodda, J. and Graham, H.K. &quot;Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm&quot;. European Journal of Neurology 8: (suppl. 5) (2001). 98-108. </li></ul></ul><ul><li>Becher, J.G. MD,PhD. Pediatric Rehabilitation in Children with Cerebral Palsy: General Management, Classification of Motor Disorders&quot;. Journal of Prosthetics and Orthotics . 14:4 (2002). p 143. </li></ul>
  23. 24. <ul><li>Excessive dorsiflexion at the ankle </li></ul><ul><li>Excessive flexion at the knee and hip </li></ul><ul><ul><li>Excessive hip flecion causes a pelvic tilt in the anterior position </li></ul></ul><ul><li>Overactivity of the rectus femoris, iliopsoas, and hip adduction </li></ul><ul><li>Rodda, J. and Graham, H.K. &quot;Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm&quot;. European Journal of Neurology 8: (suppl. 5) (2001). 98-108. </li></ul>
  24. 25. <ul><li>The foot deformities are varus and valgus </li></ul><ul><li>Torsional deformities is when either the femur or tibia are turned inside or outside so that the toes of the feet do not point straight ahead. </li></ul><ul><li>Wiley, Mary Elizabeth, et al. &quot;Lower-Extremity Strength Profiles in Spastic Cerebral Palsy&quot;. Developmental Medicine and Child Neurology. 40:2 (1998). 100-107. </li></ul>
  25. 26. www.healthforcevictoria.com/therasuit.asp
  26. 27. <ul><li>Strengthens trunk muscles used in posture </li></ul><ul><li>Increases mobility of the pelvis, lubar spine, and hip </li></ul>http://www.equestrianzone.org/services
  27. 28. <ul><li>-100% oxygen at 1.5-1.75 atmospheres </li></ul><ul><li>-constricts blood vessels </li></ul><ul><li>-optimal environment for new tissue growth </li></ul><ul><li>-reactivates dormant cells </li></ul><ul><li>Adverse effects </li></ul><ul><li>-ear pain, bleeding </li></ul><ul><li>-seizures </li></ul><ul><li>-myopia </li></ul>www.hhi-kc.com/whatis.htm
  28. 29. <ul><li>Commonly called Bo-tox </li></ul><ul><li>Injected into muscle </li></ul><ul><li>Denervation muscle paralysis </li></ul><ul><li>Adjunctive therapy </li></ul><ul><li>Minor side-effects </li></ul>
  29. 30. <ul><li>http://www.youtube.com/watch?v=VTkwv-Izb-E&feature=related </li></ul><ul><li>http://www.youtube.com/watch?v=UDgxjRyPe2w&feature=related </li></ul>