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Paediatric Rehabilitation - Coggle Diagram
Paediatric Rehabilitation
Cerebral Palsy (CP)
Cause:
Motor disability
affecting chilidren
A. Pathogenesis
Prematurity
Born very early, before 28 weeks, with low or very low birth weights (1000–1499 g), leads to many medical problems.
Infection
Infections before and after birth, oxygen deprivation during birth, and exposure to toxins can cause cerebral palsy.
Inflammation
Kernicterus is a condition where severe jaundice causes bilirubin to build up in the brain, specifically at the basal ganglia.
Trauma
head trauma (
shaken baby
syndrome)
Coagulation Disorders
Intrauterine or perinatal strokes occur when a baby's brain is deprived of oxygen or blood flow before or during birth, leading to stroke.
Categories of Cerebral Palsy:
ataxic–hypotonic
Ataxia and/or hypotonia are the main motor issues.
It's the least common type.
dyskinetic
second most common type of CP after spastic
causes involuntary movements that are hard to manage
mixed type
Mix of spasticity and
dystonia
Dystonia: twisting movement
spastic
hypertonia
stiff muscles that resist being stretched quickly or moved to a different position.
B. Clinical Findings
1. Altered muscle tone, motor control, and movement
Hypotonic CP
makes it hard to sit up straight because the neck and trunk are weak. Legs might stick out like frog legs.
Spastic quadriplegia
can make the hips cross together or legs stiffen out. Arms might bend inward with clenched fists
Hemiplegic CP
can make a person prefer one hand over the other and struggle with using both hands together
Diplegic CP
might make it easier to sit up straight compared to quadriplegia, but balancing while moving can be hard. They might walk with their legs crossed and on tiptoes."
Dystonic or dyskinetic CP
can cause muscles to tighten and move strangely, especially when trying to do something
2. Altered or persistent reflexes
can make movements too strong or too jerky, especially in the ankles and knees. Sometimes, reflexes from infancy stick around longer than they should, which can signal problems with brain development
C. Treatment and Rehabilitation
1. Physical and Occupational Therapy
hippotherapy
2. Speech and Swallow Therapy
adaptive computer devices
3. Nutritional Supplementation
nasogastric or
gastrostomy tube
4. Management of Oromotor Problems
anticholinergic medications
Botulinum toxin
injected into the salivary glands
5. Casting, Orthotics, and Assistive Devices
a. Serial casting
b. Orthoses
Ankle-foot orthosis (
AFO
)
Upper limb orthoses
Spinal orthoses
Dynamic hand splints
c. Equipment and assistive or adaptive devices
Gait trainer and stander
6. Spasticity Management
Pharmacotherapy
Botulinum toxin
Surgical measures
orthopaedic
Duchenne Muscular
Dystrophy (
DMD
)
General Considerations
Different types of
neuromuscular disorders
Disorders of the neuromuscular junction
congenital myasthenic syndrome
Disorders of the peripheral nerve
Charcot-Marie-Tooth disease
Disorders of the
muscle
DMD
progressive muscular weakness
Pathogenesis
Mutations in the dystrophin gene on the X chromosome cause dystrophinopathies.
It is inherited in a recessive manner, affecting approximately 1 in 3500 males.
Insufficient production of the dystrophin protein leads to dysfunctional muscle cells.
Without enough dystrophin, muscle cells become weak and prone to damage.
Clinical Findings
weakness
and
gait abnormality
at age 2–3 years
short stature, by age 3–6 years
lumbar lordosis, broad-based gait, and toe-walking
by age 12
wheelchair dependence
Physical examination:
a
waddling gait
Gower’s sign
Treatment & Rehabilitation
Pharmacotherapy
Prednisolone
stop muscle breakdown and protect muscle cell walls.
gene and cell therapy
Rehabilitation
Physical therapy and exercise
passive stretching exercises
regular submaximal (ie, gentle) exercise
swimming-pool and recreation-based exercises
Orthotics
Lightweight plastic Ankle-foot orthosis
Congenital Limb
Deficiency
General Considerations
happen when a limb doesn't develop properly early in pregnancy.
Physical examination
malrotation
unstable proximal joints
The incidence is 4–8 per 10,000 live births, with a
3:1 ratio of upper to lower limbs.
Clinical Findings & Classification
Transverse deficiencies
no distal
Longitudinal/paraxial deficiencies
have distal
Treatment
prosthesis