spastic quadriplegia cerebral palsy old.pptx

7/28/2019 SPASTIC QUADRIPLEGIA CEREBRAL PALSY old.pptx

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SPASTIC QUADRIPLEGIA

CEREBRAL PALSYDeniz Erdem

Muhammet Kocabyk Murat Ko

PHYSICAL MEDICINE & REHABILITATION

IV.CLASS V.COURSE

Ahmet Demirel Ahmet pek

Engin etin


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What s the Spastic Quadriplegia ?

Spastic quadriplegia is amongst the severest forms of

cerebral palsy. It may arise as a result of drug use orcomplications during the mother's pregnancy, the infant'sdelivery or the early development of the infant.Complications include prematurity, bleeding in the brain,severe asphyxiation, aspiration, severe meningitis, shakenbaby syndrome, low birth weight, and drug overdose. There

are different kinds of quadriplegia and they may vary inseverity. A child with severe spastic quadriplegia will not beable to walk even with a walker or other form of assistance,cannot move independently into a wheelchair, will havedifficulty sitting and usually is not capable of feedinghimself.


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CASE

Patient - 13 months old, premature , birth at 31gestation weeks, weight at birth- 1.6 kg, height 45 cm.Cant sit independently, makes half rotation from theback , poor hold the head (while leaning forward middleline of the head coincides with the axial line oftorso). Hip add , hip posterior group and tricepsmuscles spasticity is expressed.

In spontaneous position ,,Chandelier pose andopistotonus are expressed ( back extension musclesexcessive activity)


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Reflex Stimulation Response Duration

Babinski Sole of foot stroked Fans out toes and twists

foot in

Disappears at n

Blinking Flash of light or puff of air Closes eyes Permanent

Grasping Palms touched Grasps tightly Weakens at thdisappears at a

Moro Sudden move; loud noise Startles; throws out arms

and legs and then pulls them

toward body

Disappears at t

Rooting Cheek stroked or side of

mouth touched

Turns toward source, opens

mouth and sucks

Disappears at t

Stepping Infant held upright with

feet touching ground

Moves feet as if to walk Disappears at

Sucking Mouth touched by object Sucks on object Disappears at

Swimming Placed face down in water Makes coordinatedswimming movements

Disappears at s

Tonic neck Placed on back Makes fists and turns head Disappears at

Normal Reflex
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Patient Instructions: Ask the patient to move

their leg to the inside toward their opposite

leg

Starting Position:Patient is supine. The leg is in full adduction

Goniometer Alignment

Axis anterior superior iliac spine (ASIS).

Stationary arm aligned with opposite ASIS

Moving arm aligned with femur (center of

patella). Remember to adjust due to the

goniometer starting at a reading of 90 degree

Normal Range - The normal ROM is 15 to 25degrees

Examinations


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HIP EXTENSION

Test Position: Subject prone .Stabilize pelvis to prevent rotationand extend hip

Goniometer Alignment

Axis greater trochanter. Stationaryarm aligned with midline of pelvis.

Moving arm aligned with femur(lateral epicondyle)Normal Range: 12.0o + or - 5.4o

HIP ABDUCTIONTest Position: Subject supine. Stabilizepelvis and abduct hip with the hips andknees in flexion (Add. Longus)

Goniometer AlignmentAxis anterior superior iliac spine (ASIS).Stationary arm aligned with oppositeASIS. Moving arm aligned with femur(center of patella)Normal Range: 41.0o + or - 6.0o


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Test for abductioncontractureEvaluate range of abduction.Hips in extension and knees in

flexion (Add. Magnus)

Goniometer AlignmentAxis anterior superior iliacspine (ASIS). Stationary arm aligned with opposite ASIS.Moving arm aligned with femur

(center of patella) Normal Range:41.0o + or - 6.0o

Lower extremities evaluation inextension - m. GracilisIf abduction is limited when thehips are extended, but abd. is

better when hips and knees areflexed, the add. contracture iscaused by gracilis and medialhamstring spasticity

If hip abduction is limited in both(extension and flexion) position , the

cause is hip add. spasticity


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Test for triceps (gastrocnemius/ soleus) contracture. Lie the patientin supine position . Measure ankle dorsiflexion first with the knee inflexion (soleus testing) then in extension (gastrocnemius/ soleus)


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Evaluation of muscle spasticity

Ashworth Scale For Grading Spasticity (MeasuresResistance To Passive Stretch)

Lovett Scale - Performed Against Gravity AndAgainst Resistance

Selective motor control

Trost scale

Functional examination

Sitting

Balance Hop test


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Treatment Planning

Teaching head control

Inhibition of Chandelier positions

Inhibition spastisty of lower extremity

Range of motion

Streching spastic muscle and strengthening antagonistmuscle

Motor control Postural control and balance

Gait (walking)

Transitions

Use of assistive devices


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Head Control


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Stretching


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Gait


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Assistive Devices


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Bobath Neurodevelopmental Therapy

This is the most commonly used therapy methodin CP worldwide. It uses the idea of reflexinhibitory positions to decrease spasticity andstimulation of key points of control to promotethe development of advanced postural reactionsand to prevent contracture formation. Bobath

therapy aims to normalize muscle tone, inhibitabnormal primitive reflexes and stimulate normalmovement .


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Intervention strategies and techniques for NDT consist of:

Therapeutic handling - is used in order to influence the quality of the

patients' movements

Facilitation is a key technique used by Bobath practitioners topromote motor learning. It is the use of sensory information (tactile cuethrough manual contacts, verbal directions) to reinforce weak movement

patterns and to discourage overactive ones.


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Supports the child in the sitting position- Children who use the upper extremities for support when sittingcan not develop hand function- Provide a seating support for better head and trunk control andgive the child the opportunity to play. To develop head and trunkcontrol. With forearms supination and arms external rotation we canstimulate trunk extension


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The Vojta Method

The observation of these movements against resistance by the fixedspastic patient, announced the discovery of innate and global locomotorsystems: the reflex creeping and the reflex rolling. The reflexlocomotion is used since 1959 for the treatment of the child's motordisorders, it was later used with babies to prevent the installation ofthese disorders.

Reflex locomotion patterns (ref.creeping and ref. rolling) are global; duringthese activities, the totality of the musculature is activated according toa coordinate mode. The different levels of the CNS are concerned by thisactivation . The reflex locomotion is provoked by specific stimulations(pressures) applied on defined zones.


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MAIN STIMULATION POINTS

Medial epicondyle of humerus atthe arm face side

Processus stiloideus radii at thearm after the occipital side

Medial condyle of femur at theface side

Tubercul of calcaneus at the legafter the head

ACCESSORY STIMULATIONPOINTS

Medial side of scapula

Between 7.-8. costas

Under the jaw

Acromion

Gluteals

SIAS


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EXAMPLES OF THERAPEUTIC SITUATIONS


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Advice Of Parents

1. Keeping the head in centred position:

Parents should keep their childs head in a centred position when it lies, sits or stands.

2. Stop salivation:

In such a condition, parents can hold children head in a vertical position, knocking andpressing around children mouth and cheek with index and middle fingers.

3. Take a side-lying position:

CP children are supposed to take a side-lying position while lying or sleeping in bed, which

can bring benefits of relief of spastic muscle tone and limb symmetry 4. Thumb adduction (clasped thumb) correction:

Almost 100% of CP children have thumb adduction. Therefore, in order to correct thumbadduction, parents are supposed to give children round toys to grasp, or small balls to pullthe thumb to extend outside the center of palm, or make thumb gloves to promote thumbextension.


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5. Holding children in arms properly:

CP children lack autonomic movement, and therefore parents still hold them in thearm though they are no longer infants or young children. When CP children can nothold their neck, or control their own body very well, the holder should put forth onehand to hold childrens back, the other hand to support the bottom, and let childrenslegs be on both sides. On the other hand, when CP children can hold their neck and

keep their own body under control, parents should support childrens bottom to keepthem in sitting posture.

6. Appropriate sitting posture:

Deformity of spine can be easily caused by bad sitting position. Therefore, in orderto make spastic CP children sit straight, parents can kneel behind them, pass upperlimbs through the armpit to prevent bladebone adduction, and separate their legs andpress knee joint to make lower limbs stretch straight.

7. Hand function exercise:

Most CP children suffer more from lower limb dysfunction than that of upper limbs.Therefore, its better for parents to let children grasp objects and play with toys.Such exercise can bring benefits to both hand function and mental development.

8. Developing personal care capability:

Taking the physical disability into consideration, some parents offer full assistancefor CP children to ensure they have an easier and better life. However, it bringsnegative effects to CP children in developing their personal care ability, since they

become overdependent on parents.


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Thank you

spastic quadriplegia cerebral palsy old.pptx

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