understanding the child with athetosis
DESCRIPTION
Robyn Smith Department of Physiotherapy University of Free State 2012. Understanding the child with athetosis. Athetoid group. NB!!! Characterised by : Fluctuating postural/ muscle tone Involuntary movements. Do not confuse with ATAXIA = in co-ordinated movements. Athetoid group. - PowerPoint PPT PresentationTRANSCRIPT
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UNDERSTANDING THE CHILD WITH ATHETOSIS
Robyn SmithDepartment of Physiotherapy
University of Free State2012
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Athetoid groupNB!!! Characterised by: •Fluctuating postural/•muscle tone
•Involuntary movements
Do not confuse with ATAXIA = in co-ordinated movements
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Athetoid group
Classified according to type of involuntary movement into 4 groups
• Pure athetosis
• Choreoathetosis
• Athetosis with dystonic spasms
• Athetosis with spasticity
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A look at muscle tone in the athetoid group
Low tone Normal tone High tone
Pure athetosischoreoathetosisAthetoid with dystonic spasms
Athetoid with spasticity
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Etiology
• Kericterus hyperbilirubinaemia (severe jaundice)
• Rh- incompatability• Prematurity • Asphyxia• Metabolic disorders• Encephalitis/ meningitis• Heavy metal poisoning• Rheumatic fever• Degenerative disorders brain
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Management of jaundice
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Etiology
NB!!!!! = damage to the basal ganglia
Basal ganglia are NB for:• Control of movement• Scale and amplitude determination of
movement• Important in the control of eye movements
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Characteristics• High IQ –cortex not involved
However usually severely disabledEmotionally volatileOften frustrated –temper tantrums
• Lack of proximal stabilityPoor grading movementPoor balance
• Muscle contractures usually not a concernDue to constantly changing muscle tone and
movementRepetitive asymmetrical movement patterns may
lead to deformities
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Characteristics
• Muscle tone fluctuates constantly– Inconsistent motor responses, child unsure of
outcome of an action
• General underlying hypotoniaLigament laxity Hypermobile
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Athetoid
• Most are wheelchair bound• Need lap and/or cross straps in the case of
dystonic spasms to prevent the spasm from throwing them out of chair
• Adequate trunk and foot support is critical to their stability
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Seating : Shona Madiba buggy
• Custom made to fit patient and meet specific support needs
• Cost extremely expensive R 8000
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Associated problems
Speech & hearing
• Vocalisation & speech problem –speech poor and indistinct
• Often hearing loss • Can hear but does
not listen due constant movement head
Feeding
• Difficulty in swallowing due to muscle incoordination
• Battle especially with liquids and runny consistencies
• Extreme difficulty in feeding safely
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Associated problemsVision• Battle to focus• May have nystagmus
= rapid, rhythmic, involuntary eye movements caused by damage brain
• Eyes unable move independently head
• Lack of stability of head affects vision
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Development
• Fluctuating tone present sometimes birth
• Initially seem hypotonic• Develop extension
pattern head, neck, retraction shoulders
• Persistent ATNR• Due to involuntary
movements fail to develop adequate head and trunk control
Athetoid very intelligent and quickly learn to use pathological reflexes for function !!!!
Habitual patterns
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Development
Prone
• ATNR get up on one arm
• TLR and STNR to get into M-sitting
Sitting
• Like to M-sit as is stable position
• Uses ATNR for hand function
• Chair –stabilises using arm around backrest or hooks foot around leg chair
• Promotes further asymmetry resulting postural deformity
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Development
Gait
• Struggle to learn to walk due to fluctuating tone, poor central control and involuntary movement
• Asymmetry may be noted• Lumbar lordosis and anterior tilt due
to poor central control• Knees locked together for stability• Arm held together or against leg for
stability• Often appears in-coordinated
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Treatment Principles
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References
• Brown, E. 2001. NDT basic course material (unpublished)
• Smith, R. 2009. Paediatric dictate, UFS (unpublished)
• Smith, R. 2008. role of physiotherapy in vestibular rehabilitation, PowerPoint presentation
• Images courtesy of Google images (2009)