1 / 60

Cerebral Palsy, Stroke, and Traumatic Brain Injury

Cerebral Palsy, Stroke, and Traumatic Brain Injury. Chapter 25. Introduction. Individuals have common needs Primarily a motor disorder Often in conjunction with sensory, perceptual, and cognitive disorders Participation in physical activity varies. Introduction.

alamea
Download Presentation

Cerebral Palsy, Stroke, and Traumatic Brain Injury

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cerebral Palsy, Stroke, and Traumatic Brain Injury Chapter 25

  2. Introduction • Individuals have common needs • Primarily a motor disorder • Often in conjunction with sensory, perceptual, and cognitive disorders • Participation in physical activity varies

  3. Introduction • CP-ISRA - Cerebral Palsy-International Sports and Recreation Association • NDSA - National Disability Sports Alliance • Special Olympics or INAS-FID if dual diagnosis with mental retardation • Programming is challenging

  4. Definitions, Etiologies, and Incidence Orthopedic Impairments - IDEA • Cerebral Palsy (CP) • Stroke Separate category - IDEA • Traumatic Brain Injury (TBI)

  5. Cerebral Palsy (CP) • Neurological disorder of movement and posture • Cause - damage to the immature brain • Not hereditary, contagious, or progressive • Varies from mild to severe

  6. Cerebral Palsy (CP) • Prenatal causes - before or during birth • Maternal infection • Chemical toxins • Injuries to the mother • Difficult deliveries

  7. Cerebral Palsy (CP) • Acquired causes - before age 2 • Brain infections • Brain traumas • Chemical toxins • Oxygen deprivation • More common in males

  8. Stroke • Sudden onset of neurological impairment that occurs when the flow of oxygen and nutrients to the brain is disrupted by blood clot blockage or bleeding • Most common over age 60

  9. Types of Stroke • Ischemic strokes • Associated with heart disease • Associated with high cholesterol levels • Hemorrhagic strokes • Linked with high blood pressure • Weak or malformed arteries and veins within the brain • Leukemia

  10. Types of Stroke • Left-brain strokes • Weakness or paralysis of the right side • Speech/language deficits • Behavioral style - slow, cautious • Memory deficits in language

  11. Types of Stroke • Right-brain strokes • Weakness or paralysis of the left side • Spatial/perceptual deficits • Behavioral style - quick, impulsive • Memory deficits in performance

  12. Types of Stroke • Transient ischemic attacks (TIAs) • Incomplete strokes • Occur in both children and adults • Characterized by total recovery • Cause several hours of dysfunction • Warning signs

  13. Stroke • Progression of recovery • More common in males until age 75 • Early childhood strokes - often mistaken for CP in the past • Resulting conditions include hemiparesis, seizure disorders, learning disabilities, visual perception problems, memory deficits, and speech deficits

  14. Traumatic Brain Injury (TBI) • Acquired injury to the brain • Closed- or open-head injuries result in total or partial functional disability and/or psychosocial impairment • Various sequelae that alter sensation, perception, emotion, cognition, and motor function

  15. Traumatic Brain Injury (TBI) • Occur most often in males • Prediction of recovery - Glasgow Coma Scale • Eye opening • Motor response • Verbal response • Attention, memory, and visuomotor difficulties most common in school-age persons

  16. Soft Signs • Soft Signs - indicators of CNS dysfunction • Behavior indicators of brain damage • Attention deficits • Hyperexcitability • Perseveration • Conceptual rigidity • Emotional lability • Hyperactivity

  17. Associated Dysfunctions • Mental retardation • Speech problems • Learning disabilities • Visual problems • Hearing problems • Perceptual deficits • Seizures • Reflex problems

  18. Associated Dysfunctions • Determine appropriate sport placement • Special Olympics - mental retardation • NDSA - average or better intelligence • Caution - many misdiagnosed as MR because of communication and speech that cannot be understood

  19. Associated Dysfunctions • Strabismus - inability to focus both eyes simultaneously on the same object • Seizures - do not contraindicate sport participation • Reflex problems - interfere with learning to sit, stand, and walk

  20. Number of Limbs Involved • Diplegia - lower extremities much more involved than upper • Quadriplegia - all four extremities involved • Hemiplegia - entire right or left side involved • Triplegia - three extremities involved, usually both legs and one arm

  21. Types of Motor Disorders • Motor disorder described in terms of abnormal muscle tone and postures • Three types of CP are recognized • Spasticity • Athetosis • Ataxia • Hypotonia

  22. Spasticity o Cerebral Origin • Abnormal muscle tightness and stiffness • Hypertonic muscle tone during movement • Hypertonic state - muscles feel and look stiff • Cocontraction - no relaxation of muscles • Interferes with release of objects • Interferes with precise movements

  23. Spasticity of Cerebral Origin • Exaggerated stretch reflex - exaggerated response to stretch receptor input • Associated gaits • Scissors gait - both legs involved • Hemiplegic gait - arm and leg on same side involved • Abnormal postures

  24. Athetosis • CUP - constant, unpredictable, purposeless movement as a result of fluctuating muscle tone • Interferes with facial expression, eating, speaking, visual pursuit and focus, handwriting and other fine motor skills • Walking is unsteady or staggering

  25. Ataxia • Disturbance of balance and coordination • Hypotonia or low postural tone • Cerebellar-vestibular origin • Voluntary movements are clumsy and uncoordinated • Varies from mild to severe

  26. Flaccidity/Hypotonia • Low muscle tone • Problems in persons with hypotonia • Poor head and trunk control • Absent postural and protective reactions • Shallow breathing • Joint laxity or hypermobility

  27. Profiles to Guide Assessment and Programming • Sport classifications can be used to develop IEPs and IFSPs • Determine nonambulatory versus ambulatory • Use sport specific classifications

  28. Profiles to Guide Assessment and Programming • Track and field classifications • Class 1 - Motorized Chair • Class 2 - Athetosis; 2L or 2U • Class 3 - Moderate triplegic or quadriplegic • Class 4 - Diplegic • Class 5 - With or without assistive devices • Class 6 - Athetosis, ambulatory • Class 7 - Hemiplegic • Class 8 - Minimal involvement

  29. Class 1 - Motorized Chair • Uses motorized wheelchair • Severe involvement in all four limbs • Limited head and trunk control • Limited range of motion • Difficulty in grasp and release • May need one-on-one assistance

  30. Class 2 - Athetosis; 2L or 2U • Propels chair with feet and/or very slowly with arms • Severe to moderate involvement in all four limbs • Uneven profile - subclassifications • 2 Upper - (2U) - upper limbs have greater ability • 2 Lower - (2L) - lower limbs have greater ability • Severe control problems in accuracy tasks

  31. Class 3 - Moderate Triplegic or Quadriplegic • Propels chair with short, choppy arm pushes but generates fairly good speed • Moderate involvement in three or four limbs and trunk • Can take a few steps with assistive devices • Not functionally ambulatory

  32. Class 4 - Diplegic • Propels chair with forceful, continuous arm pushes • Demonstrates excellent functional ability for wheelchair sports • Involvement primarily in lower limbs • Good strength in trunk and upper extremities • Minimal control problems

  33. Class 5 - With or Without Assistive Devices • Typically uses assistive devices • Moderate to severe spasticity of either arm and leg on same side (hemiplegia) or both lower limbs (paraplegia) • May choose to participate as a Class 4 in the Paralympics system

  34. Class 6 - Athetosis, Ambulatory • Ambulates without assistive devices • Severe balance and coordination difficulties • Moderate to severe involvement of three or four limbs • Problems less prominent when running than walking

  35. Class 7 - Hemiplegic • Includes only those with hemiplegia • Ambulates well, but with a slight limp • Moderate to mild spasticity in arm and leg on same side • Work well in an integrated setting

  36. Class 8 - Minimal Involvement • Runs and jumps freely without noticeable limp • Demonstrates good balance and symmetric form but has obvious (although minimal) coordination problems • Has normal range of motion

  37. Coping With Special Problems • Delayed motor development • Postural reactions • Reflexes and abnormal postures • Spasticity problems • Athetosis problems • Surgery and braces • Hip dislocation, scoliosis, and foot deformities • Attitudinal barriers

  38. Delayed Motor Development • Delays in all aspects of motor development • Limits physical, mental, and emotional stimulation • Early intervention is essential • Emphasis on integration of reflexes (0-7) • Instruction in sports, dance, and aquatics after age seven • Teach to compensate and/or use reflexes

  39. Postural Reactions • Emphasis on protective extension to protect during falls • Development of equilibrium • Sports to work on weaknesses • Sports to develop strengths and enhance peer interactions to prevent social rejection

  40. Reflexes and Abnormal Postures • Holding and carrying • Help with transfers may be needed • Extensor tone - hold close in tucked positions • Flexor tone - hold in positions that maintain head and limbs in extension • Use Velcro, padding, and cushioning to achieve proper alignment when using apparatus

  41. Reflexes and Abnormal Postures • Strapping and positioning • Good alignment in sitting • Hips are at 90˚ flexion and in contact with back of the chair • Thighs are slightly abducted and in contact with the seat • Knees, ankles, and elbows are positioned at 90˚ flexion • Strapping may be required to maintain proper position

  42. Reflexes and Abnormal Postures • Strapping and positioning • Essential in sports for safety • Extensor pattern will pull body down and out of chair • A bolster will help inhibit the crossed extension reflex

  43. Reflexes and Abnormal Postures • Contraindicated activities • Creeping on all-fours - may increase flexor spasticity • Frog or W sitting position - worsens hip joint adduction-inward rotation-flexion pattern • Bridging in supine - worsens abnormal neck extension and scapulae retraction • Walking on tiptoes or pointing the toes - if already have tight calf muscles

  44. Spasticity Problems • Handling techniques • Correcting common problems • Rotation of the trunk decreases spasticity • Active exercises and stretching

  45. Handling Techniques • Maintain symmetry - keep body parts in midline • Use inhibitory actions that are the opposite of the undesired pattern • Work from designated key points to central control - grasp body parts as close to the joint as possible

  46. Correcting Common Problems • Fisted hand • Scissoring in supine position • Abnormal arm position

  47. Rotation of the Trunk • Decreased overall spasticity • Rhythmic rolling activities • Gentle rocking movements • Also develop equilibrium reactions

  48. Active Exercises and Stretching • Active exercises - utilize correct handling • Rotatory and rocking - utilize for warm-up and relaxation • Water play and exercises in a warm pool • Daily stretching helps prevent contractures

  49. Athetosis Problems • CUP movements may cause a hindrance in aiming activities but can also excel in bowling and boccia • Promote proper warm-up • Main goal in early childhood is head and trunk control which serves to decrease undesired limb movement • Upright activities versus prone are stressed

  50. Surgery and Braces • Various surgical procedures to correct or relieve problems caused by severe spasticity • Tenotomy • Myotomy • Arthrodesis • Braces are used to control spasticity and provide needed stability

More Related