spastic quadriplegia cerebral palsy.pptx

7/28/2019 SPASTIC QUADRIPLEGIA CEREBRAL PALSY.pptx

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Deniz 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 31

gestation 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 triceps musclesspasticity 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 twistsfoot 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 armsand legs and then pulls themtoward body

Disappears at t

Rooting Cheek stroked or side ofmouth touched

Turns toward source, opensmouth and sucks

Disappears at t

Stepping Infant held upright withfeet 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 headto the right Disappears at

Normal Reflex
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Examination of hip add is 10degreeWith the Ashworth Scale of romis 5 degreeFor Grading Spasticity is 3

Examinations


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Exemination of Hip Extension is 0oWith the Ashworth Scale ForGrading Spasticity is 2

Exemination of Hip Abduction (Add.Longus) is 15 o -20 oWith the Ashworth Scale For Grading

Spasticity is 3


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Exemination of triceps (gastrocnemius/ soleus) is 5oWith the Ashworth Scale For Grading Spasticity is 2


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Evaluation of muscle spasticity

Ashworth Scale For Grading Spasticity (Measures ResistanceTo Passive Stretch)

Lovett Scale - Performed Against Gravity And AgainstResistance

Selective motor control

Trost scale ( to early our patient)

Functional examination

Sitting

Balance

We just evaluate with ashworth scale because for selective motorcontrol and functional examination too small


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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

Teaching ofReflex crawling,Reflex rolling

Motor control

Postural control and balance

Assistive Devices


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Head Control


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Stretching


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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. Bobaththerapy 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 movementpatterns and to discourage overactive ones.


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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 humerusat the arm face side

Processus stiloideus radii atthe arm after the occipitalside

Medial condyle of femur atthe face side

Tubercul of calcaneus at theleg after 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, whichcan 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 holdthem in the arm though they are no longer infants or young children. WhenCP children can not hold their neck, or control their own body very well,the holder should put forth one hand to hold childrens back, the otherhand to support the bottom, and let childrens legs be on both sides. Onthe other hand, when CP children can hold their neck and keep their ownbody under control, parents should support childrens bottom to keep themin sitting posture.

6. Appropriate sitting posture:

Deformity of spine can be easily caused by bad sitting position. Therefore,in order to make spastic CP children sit straight, parents can kneel behind

them, pass upper limbs through the armpit to prevent bladeboneadduction, and separate their legs and press knee joint to make lowerlimbs stretch straight.

7. Hand function exercise:

Most CP children suffer more from lower limb dysfunction than that ofupper limbs. Therefore, its better for parents to let children graspobjects and play with toys. Such exercise can bring benefits to both hand

function and mental development.


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spastic quadriplegia cerebral palsy.pptx

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