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NM PEDS and Brain tumor - Coggle Diagram
NM PEDS and Brain tumor
Pediatrics
Spina bifida
Spina bifida Occulta
- no neurologic defect
L5-s1 most common
- hair tuft
-
Spina bifida Meningocele:
- incomplete skin coverage means CSF leak, neurologic signs might be normal, 75% might be lumbosacral
- sac with no spinal nerves in it
-
Myelomeningocele
- SC in the baloon.
- will gave impaired bowel, bladder, and sensory
- most are lumbar-lumbosacral
-
-
Down Syndrome
Screening:
- ultrasound
- blood tests
- amniocentesis
Outcome measures:
- Alberta infant mototr assessment
- GMFM - validated in DS
- PDMS
- Sensory profile
- SICSIT
-
Typical presentation
- Decrease Max HR
- Decreased endurance
- Can have heart valce dysfunction
- cardiac malformation
- High risk for Leukemia
Interventions
Foundation exercise
- squats
- planks
- push ups
- bridges
- Hip strengthening in functional patterns
Vestibular and coordination
- Wt shifts
- rotational exercise
- 13 or older should begin resistive training
PT goals
- in general they are to enhance acquisition rate of motor skills
- co create goals with child and family
treadmill training
- 0.2 m/s for 8 min/d 5 days a week
CNS involvement
- Depression
- ALL have hypotonia
-
MSK presentation
- Joint laxity (check AA)
- Hypotonia
- Hypermobility
- flat feet
-
Autism
Screening
- MCHAT (16-30m)
- PDQ-1 (18-36m)
DSM-5 Criteria for diagnosis
- Deficits in social communication and social interaction
- Restricted repetitive patterns of behavior, interest, or activities
- Symptoms must be present at from early developmental period
- Symptoms must cause clinically significant impairemnt in social, occupational, or other function
- isnt better explained by other thing
- ADOS tool used
Outcome measures tools
- MABC -2 for fine motor
- SP-2 for a sensory profile
Common comorbidities
- Intellectual disability
- ADHD 28%
- anxiety, depression
- OCD
Interventions
Motor learning
- task specific
- need visual supports
- delayed feedback for motor skill acquisition
Exercise and PA
- decreases in stereotypical behaviors and aggression
- increase on task behavior
- can use wt training, aerobic, bikes, swimming
Sensory training
- Use the SP 2 to identify sensory strength and barriers
-
Brain Tumors
-
Meningiomas
- typically slow growing
- most are benign
- 2x more likely in F
Metastatic Tumors
- secondary tumors formed from a primary elsewhere
- can spread anywhere
- Increased ICP and its symptoms
- Seizures
- Altered mental state
- Focal neural signs based on location
Avastin
- used to treat
- nose bleeds
-diarrhea
- muscle weakness and jt pain
Primary intraspinal tumors
- intradural-medulary invade SC
- intradural extramedulary- cause spinal cord compression
Seizures
Phases of Seizures
1st ish- Prodrome phase(hours - days)
- not always experienced
- anxiety
- difficulty sleeping or staying focused
- behavior changes
1st ish phase Aura
- deja vu
- odd smells
- diziness
- nubness in body parts
- panic
- doesnt always progress
Ictal phase
- Defined as the time from the first symptom to end of seizure activity
- loss of awareness
- feeling confused
- difficulty speaking or saying strange words
- twitching / convulsions or loss of control
Post ictal
- The recovery phase, they dont always remember the seizure
- confusion or LOC
- thirst
- nausea
- fear or anxiety
- sore muscles depending on how active it was
Seizure classifications
Focal onset
Focal Aware
Where awareness is retained with preservation of consciousness
- focal motor sympoms likee atonia, clonic activity, myoclonus, tonic muscle contractions
- Focal sensory symptoms- localized parasthesia, numbness verutigo
Focal impaired
Characterized by loss of awareness of consciousness
- Temporal lobe - deja vu
- Occipital lobe - aura
- They appear dazed and confused
- 45-90s duration followed by minutes of confusion or disorientation
Generalized onset
Tonic clonic seizures and is the more common generalized seizure
- potentially a 24h recovery phase
- can have various traumas and fractures associated
- Get things out of their way and move them to their side so they wont asperate
Generalized NON-motor
AKA Absence Seizure
- cessation of ongoing consciousness
- Start and end abruptly less than 10s
- They are unaware they occurred
- more frequent in children
Status epilepticus
Defined by 5min of continuous seizures
- Emergent as it could be fatal
PT considerations in Seizures
- activity restrictions i first 2-3
- limit activity if antiepileptic durgs are discontinued
Functional Movement Disorders
FMD is an involuntary but learned habitual movement pattern that is dirven by abnormal self directed movement
Types:
- Tremor (most common)
- dystonia
- jerks
- gait disorders
- Parkinsonism
One positive motor sign for FMD are that attentional focus on the body part causes worsened or altered movement capacity
Patients who are appropriate will be
- Have diagnosis that is referring professional agrees with
- confidence and openness to the FMD diagnosis and believe symptoms can improve
- Patient needs to have goals to work towards and desire to improve
PT should focus on:
- Education
- demonstration that normal movement can occur
- retraining movement
- changing maladaptive behaviors
General treatments
- Dual tasking
- use mirrors
- less hands on and more guiding
- be honest about relapse
- avoid adaptive equipment
EXTERNAL FOCUS
- use weighted equipment
Functional Neurological Disorder
- often come in after being dismissed alot
- this is a problem with the functioning of the NS without structural damage
good prognostic factors
- understanding of diagnosis
- young age
- early diagnosis
Poor prognosis
- long duration of symptoms
- personality disorders
4 subtypes
Functional Seizures
- non epileptic
- LAST longer than 2min
- eyes are closed
- Ictal awareness, shaking
- post ictal weeping
- VIDEO EEG gold standard
-
Functional cognitive
- cognitive symptoms with clear evidence of internal inconsistency
- awareness of ones own thought processing and cognitive failures
- they feel they have severe impairments despite normal cognitive tests
- more concerned about their symptoms
PPPD
- chronic dizziness
- swaying or rocking
- high body vigilance
FND diagnosis is not one of exclusion
- Hoover sign - hip extension that was weak gets stronger with CL hip flexion
- Entrainment test - functional tremor patient moves one limb and we see if functional tremor changes
- whack a mole- reemergence of involuntary movement in a different body part after patient suppresses movement in affected body part