Children with athetosis
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Children with Athetosis. Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009. Role of Basal Ganglia. Associated with a variety of functions: motor control, cognition, emotions, & learning. Select muscle to work and energizes them appropriately

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Children with athetosis l.jpg

Children with Athetosis

Margo Prim Haynes, PT, DPT, MA, PCS

Mary Rose Franjoine, PT, DPT, MS, PCS

2009

Prim Haynes & Franjoine




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Role of Basal Ganglia

  • Associated with a variety of functions: motor control, cognition, emotions, & learning.

  • Select muscle to work and energizes them appropriately

    • Helps maintain posture and control automatic movements

    • Organizes the antagonist & agonist muscles to work together

Prim Haynes & Franjoine


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General Comments

  • Children with athetosis have damage to basal ganglia

  • Holding the body upright against gravity is challenging

  • Movement appear uncontrolled and involuntary even though client has intent and purpose

  • Children with athetosis often seen in combination with spasticity & ataxia

Prim Haynes & Franjoine


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Video of Kevin

Prim Haynes & Franjoine


Ndt enablement classification model of health and disability l.jpg
NDT Enablement Classification Model of Health and Disability

+ Domains -

Dimensions

From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009

Prim Haynes & Franjoine

7


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Body Structure & Body Function

  • Basal ganglion damage

    • Damage to Structure: Result of Global Anoxic Event

    • Interferes with BG ability to function

      • Select muscle to work and energizes them appropriately

Prim Haynes & Franjoine


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Cognition

Functions:

  • Motivated to Move - Fearless

  • Sociable (enjoys being with people)

  • Intelligence - very bright

    Impairments

  • Emotional swings

Prim Haynes & Franjoine


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Neuromuscular System

Impaired Muscle Activation

  • Co-activation from excessive to minimal (stiffness fluctuates from high to low) during task

  • Oscillations of trunk, hands and tongue: high amplitude and low frequency

Prim Haynes & Franjoine


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Neuromuscular System

Impaired Muscle Activation

  • Latency in initiating, sustaining and terminating postural muscle activity

  • Impaired muscle synergies

    • Stereotyped patterns of movement simplify demands on CNS

Prim Haynes & Franjoine


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Neuromuscular System

Impairment of Timing and Sequencing

  • Lack of coordination between agonist and antagonist muscles

Prim Haynes & Franjoine


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Neuromuscular System

Insufficient Force Generation (muscle strength)

  • Postural Muscles

  • Movement Muscles

Prim Haynes & Franjoine


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Sensory System

  • Sensory Processing Impairment: fluctuates

  • Visually and auditory aware of environment (fluctuates)

Prim Haynes & Franjoine


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Musculoskeletal System

Secondary Impairments

  • High risk for scoliosis and hip dislocation

  • Repeative over use of jaw my led to TMJ problems

Prim Haynes & Franjoine


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Musculoskeletal System

Secondary Impairments

  • Repetitive asymmetrical movements stress the following joints:

    • Occiput on C1

    • C6 - C7

    • T12 - L1

Prim Haynes & Franjoine


Ndt enablement classification model of health and disability17 l.jpg
NDT Enablement Classification Model of Health and Disability

+ Domains -

Dimensions

From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009

Prim Haynes & Franjoine

17


Posture and movement l.jpg
Posture and Movement

General Characteristics: Posture

  • Underlying postural tone low with fluctuations

  • Hyper mobile Joint Structure

  • Asymmetry = poor midline orientation

  • Use superior lateral visual fixes

Prim Haynes & Franjoine


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Posture and Movement

General Characteristics: Posture

  • Alignment: Tend to lock distal extremities into end ranges for stability

  • Head used consistently for stability

  • Wide BOS to help stabilize so postural muscles do not have to work

Prim Haynes & Franjoine


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Posture and Movement

General Movement Characteristics

  • Moves with asymmetrical phasic bursts

  • Initiates movement with asymmetrical extension

  • Prefer large amplitude wide range movement (characteristic of fluctuating tone)

Prim Haynes & Franjoine


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Posture and Movement

General Movement Characteristics

  • Balance insufficient to prevent from falling

  • Prefers to move in sagittal plane for added stability

Prim Haynes & Franjoine


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Prone

Postures:

  • Difficult position for function because of pull of gravity

    Movement

  • Equally difficult to initiate movement

Prim Haynes & Franjoine


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Pictures

Prim Haynes & Franjoine


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Supine

Postures:

  • An equally difficult position = pull of gravity into the surface

    Movement

  • Push off surface with feet and head (asymmetrical)

    • Pushing in this position often becomes a means of mobility

Prim Haynes & Franjoine


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Pictures

Prim Haynes & Franjoine


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Sitting

Position

  • Sitting is an easier position

  • Independent in W sit – wide BOS

    Movement

  • Stabilize with upper body to get lower body mobile

Prim Haynes & Franjoine


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Pictures

Prim Haynes & Franjoine


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Mobility in Quadruped

Posture:

  • Alignment: arms internally rotated elbows hyperextend, weight bearing on dorsum of hand

    Movement:

  • Bunny hop = pelvis behind knees

Prim Haynes & Franjoine


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Pictures

Prim Haynes & Franjoine


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Kneeling

Posture

  • Hips in increased flexion and abduction supporting the wide BOS (pelvis posterior)

    Movement

  • Stabilize with upper body to move

Prim Haynes & Franjoine


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Standing & Walking

Postures

  • Often a difficult posture to maintain.

  • Uses end ranges in LE to assist with stability.

    Movement

  • Weight shift by rotating the head and jaw to obtain extension

Prim Haynes & Franjoine


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Pictures

Prim Haynes & Franjoine


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Oral-Motor Skills

  • Mouth used for stability

  • “Fixes” with the jaw, severely limiting articulation

  • May grind the teeth

  • Drooling

Prim Haynes & Franjoine


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Video

Prim Haynes & Franjoine


Ndt enablement classification model of health and disability35 l.jpg
NDT Enablement Classification Model of Health and Disability

+ Domains -

Dimensions

From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009

Prim Haynes & Franjoine

35


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Activities & Activities Limitation

Prim Haynes & Franjoine


Ndt enablement classification model of health and disability37 l.jpg
NDT Enablement Classification Model of Health and Disability

+ Domains -

Dimensions

From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009

Prim Haynes & Franjoine

37


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Participation

  • Due to cognitive ability have potential to go to college and hold down a job.

  • Our role “dream big”

    • Think Mobility Equipment & AC

Prim Haynes & Franjoine


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Treatment Strategies

  • Focus on active BOS: align from wide to narrow

  • Postural system must be “awakened”

  • Strengthen in midranges and end ranges but emphasize work in midranges

  • Emphasize diagonal and rotational postures and movement

Prim Haynes & Franjoine


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Treatment Comments

  • Treat up against gravity

  • Creative play allows for smoother transitions and action

  • Be careful with mobile surfaces but make sure that they move

Prim Haynes & Franjoine


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Children with Athetosis

Prim Haynes & Franjoine


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