Term
| Disorders assoc c spasticity |
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Definition
| CP, TBI, CVA, SCI, neurodegenerative disorders, myelodysplasia |
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Term
| "Disorder of mm tone characterized by velocity dependent increase in resistance of a limb at rest to externally imposed joint motion" |
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Definition
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Term
| Proposed theory behind UMNL+spasticity |
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Definition
| lack of descending inhibitory input to alpha motor neuron |
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Term
| Ways in which spasticity can be helpful: |
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Definition
| transfers, amb (co-contraction), ↓ risk for skin breakdown, ↓ risk of thromboses |
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Term
| Ways in which spasticity can be harmful |
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Definition
| impairs volitional mvmt, pain, jt dislocation>>pain, ↑ risk of contracture, ↓ weight (mm use ↑ caloric need) |
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Term
| Pharmacologic mgmt of spasticity: oral meds |
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Definition
| Baclofen, Dantrolene, Tizanidine, Benzodiazepenes |
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Term
| Central side effects common to pharmacologic Rx of spasticity |
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Definition
| sedation, confusion, dizziness, ↓ cognition, ↓ bladder control, lethargy |
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Term
| Pharmacologic mgmt of spasticity: possible categories |
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Definition
| oral meds, botox/phenol injections, ITB |
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Term
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Definition
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Term
| Mechanism of action: botox |
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Definition
| binds at neuromuscular jxn >> ↓ ACh release >> ↓ mm contraction |
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Term
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Definition
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Term
| Age of CP pts for which botox is used |
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Definition
| ≤10yo (not effective in larger mm) |
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Term
| Peak effect of botox injection after ___ days |
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Definition
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Term
| Therapeutic uses of Botox |
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Definition
| ↓ spasticity & painful spasms; ↓ post-op pain; ↑ UE fxn; ↑ amb; facilitate bracing, positioning, therapy; in conjunction c serial casting |
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Term
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Definition
| focal injection of benzyl alcohol PERINEURALLY (locate site using EMG) |
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Term
| Mechanism of action: phenol |
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Definition
| demyelination & Wallerian degeneration |
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Term
| Advantages of phenol injection |
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Definition
| immediate effect; 9-15m duration; cheaper (and longer-lasting) than Botox |
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Term
| Disadvantages of phenol injection |
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Definition
| cooperative pt or conscious sedation; difficult to localize motor nerve; time consuming; more painful than Botox |
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Term
| Risks of phenol injection |
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Definition
| dysethesia; vascular/skin side effects |
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Term
| Location of catheter of ITB determined by… |
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Definition
| level of spine based on child's spasticity |
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Term
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Definition
| intrathecal baclofen pump |
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Term
| Pt selection criteria for ITB |
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Definition
| over 2yo; specific weight (usually >25lb); spastic quad, diplegic, hemiplegic, triplegic; non-ambulatory or ambulatory |
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Term
| Oral Baclofen v ITB: oral |
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Definition
| low blood/brain barrier; high systemic absorption, low CNS absorption; lack of preferential sp cord distribution >> cognitive delays; side effects (e.g. sedation); 60mg dose |
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Term
| Oral Baclofen v ITB: pump |
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Definition
| delivered directly to CSF; fewer systemic side effects; greater results; 600µg dose |
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Term
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Definition
| pump, catheter, programmer |
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Term
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Definition
| inject bolus of Baclofen intrathecally to target area >> observe response; refill every 3-6mos after implantation; dosing process takes weeks to months |
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Term
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Definition
| hypotonia, HA, dizziness, constipation |
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Term
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Definition
| respiratory depression, reversible coma, LOC |
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Term
| Causes of ITB pump overdose |
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Definition
| pump malfxn, catheter breakage, poor programming |
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Term
| Surgical mgmt of spasticity: possible categories |
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Definition
| selective dorsal rhizotomy (SDR), orthopedic sx |
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Term
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Definition
| interruption of afferent pathway >> ↓ 'noise' to efferent nn >> ↓ spasticity & ↑ volitional mvmt |
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Term
| Pt selection criteria for SDR |
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Definition
| ≥4yo; must be ambulatory s spasticity; committed/involved family (year-long process) |
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Term
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Definition
| no implanted equipment, clinically proven to ↓ spasticity |
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Term
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Definition
| Permanent; variable outcomes dependent on % rootlets cut |
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Term
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Definition
| both improve LE fxn (SDR>ITB) |
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Term
| SDR v ITB: future orthopedic procedures |
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Definition
| fewer procedures in children c SDR than ITB |
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Term
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Definition
| SDR permanent; ITB replaced every 5 yr |
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Term
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Definition
| SDR: child must be ambulatory |
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Term
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Definition
| ITB can be for younger pts |
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Term
| SDR v ITB: pt/parent satisfaction |
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Definition
| equal for both procedures |
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Term
| SDR v ITB: PT required post-procedure |
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Definition
| both require intensive & lengthy PT |
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Term
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Definition
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Term
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Definition
| strengthen trunk & LE (proximal stability first; hip+knee /) |
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Term
| Reasons for orthopedic sx |
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Definition
| most skeletal deformities NOT present at birth (occur despite early/aggressive mgmt); mm grow in response to stretch (mm imbalance >> contractures + lever arm dysfxn) |
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Term
| Pt selection criteria for ortho sx |
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Definition
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Term
| Common ortho sx 2º to spasticity |
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Definition
| lengthening procedures (tenotomy), mm transfers, correction of lever arm dysfxn, jt reconstruction, osteotomies, scoliosis corrections, S/P multilevel sx |
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Term
| Common types of tenotomies |
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Definition
| TAL (tendo-achilles lengthening), medial hamstring lengthening, adductor lengthening |
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Term
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Definition
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Term
| Indications for medial hamstring lengthening |
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Definition
| ↓ popliteal angle, crouched gait, post pelvic tilt (sitting) |
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Term
| Indications for adductor lengthening |
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Definition
| computerized gait analysis to differentiate btwn add and IR (determine tissue at fault) |
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Term
| Common types of mm transfers |
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Definition
| RFT (rectus femoris transfer), SPLAT (split ant tibialis transfer) |
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Term
| RFT: transfer rectus to new attachment to… |
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Definition
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Term
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Definition
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Term
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Definition
| stiff knee, toe drag, tripping; positive prone knee bend test |
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Term
| SPLAT: transfer half of ant tib to new attachement to… |
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Definition
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Term
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Definition
| inverted gait (calcaneus); WB on lateral foot in PF |
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Term
| Common types of lever arm dysfxn correction sx |
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Definition
| PTA (patellar tendon advancement) |
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Term
| PTA: patellar t reattached to… |
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Definition
| distal to tibial tuberosity |
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Term
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Definition
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Term
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Definition
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Term
| Common types of jt reconstruction sx |
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Definition
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Term
| Purpose of acetabuloplasty |
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Definition
| ↑ curvature of acetabulum >> ↑ convergence of femur in jt |
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Term
| Indications for acetabuloplasty |
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Definition
| frequent hip sublux/dislocation |
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Term
| Common types of osteotomies |
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Definition
| VDRO (varus derotational osteotomy), valgus osteotomy |
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Term
| VDRO effect on angle of inclination |
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Definition
| DECREASE angle of inclination (to normal) |
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Term
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Definition
| intoeing; ↑ angle of inclination; hip sublux; frequently in conjunction c acetabuloplasty |
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Term
| Valgus osteotomy effect on angle of inclination |
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Definition
| INCREASE angle of inclination >> femoral hd does not sit in acetabulum |
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Term
| Indications for valgus osteotomy |
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Definition
| NON-ambulatory child c hip pain 2º to impingement |
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Term
| Indications for scoliosis correction |
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Definition
| >40º of curvature (Cobb method); ↓ UE fxn; ↓ respiratory fxn; noncompliance c bracing |
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Term
| PT intervention during recovery from multilevel sx: 0-3 wks |
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Definition
| PROM, CPM; osteotomies: immobilizers, NWB transfers |
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Term
| PT intervention during recovery from multilevel sx: 3-6 wks |
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Definition
| out of immobilizers; PWB/FWB; PROM/AROM; strengthening |
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Term
| PT intervention during recovery from multilevel sx: 6-12 wks |
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Definition
| ↑ strengthening & stretching; ↑ endurance |
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Term
| PT intervention during recovery from multilevel sx: 12+ wks |
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Definition
| gait training, stander, etc. |
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