6
Coma duration:
Lasting 20 minutes to 6 hours
Moderate
Coma duration:
Lasting 6-24 hours
Severe
- CNS damage and its outcome determine survival and long term morbidity
- About 1/3 survive have significant neurologic damage caused by hypoxic-ischemic encephalopathy
- Poor outcome:
- Prolonged cardiopulmonary resuscitation
- Fixed and dilated pupils
- GCS of 3
Prognosis - Anoxia
Where is the most common area for tumor in children?
Cerebellum: ataxia, low tone in trunk, nystagmus, visual issues
- Gross motor function measure - not validated for children with ABI - but may provide useful objective date
- Alberta infant motor scale - birth-18 months
- Bayley scales of infant development III-birth to 42 months
- Peabody developmental motor scales - birth to 72 months of age
- Bruininks-oseretsky test of motor proficiency: 4.5 to 21 years of age
Motor performance
Coma duration:
longer than 24 hours
Very severe
Coma duration:
Lasting less than 20 minutes
Mild
Are brain tumors focal or generalized?
Name Rancho level in adults and children:
Global description: higher level response
Examination strategies: testing should focus on more complex, two or more staged functional and nonfunctional instructed tasks
- DGI, FGA, dual task TUG
Adult: VI-X
Pediatric: I
- Muscle atrophy and weakness typically result after prolonged bed rest or sedentary behavior
- Bed rest for 30 days can result in 18% to 20% reduction in knee extensor peak torque
- MMT if can follow testing instructions (RLA VI should be able to do MMT)
- Functional when able
AROM/Muscle strength
Which numbers from GCS is severe?
3-8
Which numbers from GCS are moderate?
9-12 points
- Adequacy of oxygenation
- Optimal ventilator strategies
- Minimize brain and lung injury
- Provide cardiovascular support
- Avoid iatrogenic complications
Minimize secondary brain damage after anoxic event
- Traditional approaches commonly used to facilitate motor and postural control (NDT, PNF, Brunnstrom approach)
- Almost no evidence suggests improved functional outcome to support the use of traditional approaches
- Traditional approaches continue to influence practice today
- Proximal control and midline alignment
- Isolated joint movement
- Selective control
- Developmental postures to enhance outcome for functional tasks
- Target the impairment
Intervention for TBI
- Younger children have a greater reliance on visual input
- Adult like patterns might be present at the age of 7 years and older
- Impairments in equilibrium and righting reactions may be observed
- The pediatric clinical test of sensory interaction for balance - children 4-9 yo
- Clinical test of sensory interaction for balance - children 8 years +
- The pediatric balance scale
- The functional reach test has excellent within session test retest reliability for children with TBI
- TUG - good within session test retest reliability values for children with ABI
Postural control and balance
Which numbers in GCS are mild?
13-15
- Children who sustain TBI - 95% survive
- Severe TBI - 65% survive
- Highest mortality rate: children younger than 2 years old
- Decline in mortality rate until age 12 years
- Second peak at age 15 years
Mortality
- Most common form of solid tumors in children
- Second most common form of pediatric cancer overall
- 38 cases per million children
- Occur most frequently in children ages 1 to 10 years
- Slightly more common in boys than in girls
- Symptoms based on location and treatment
- Headaches
Brain tumors
Limitations to ROM might be associated with:
- Prolonged bed rest
- Immobilization
- Pain
- Peripheral nerve injury
- Spasticity
- Side effects of medical treatment
- Skeletal injury due to periarticular new bone formation
Passive ROM
- Task specific training
- Clinical trials that specifically examine treatment efficacy in children with ABI are sparse
- Evidence from CP and adults post stroke basis for design of trials for children with ABI to identify the interventions that optimally and efficiently improve function
- Greater benefit from task oriented specific training that from impairment focused intervention
- Intensity matters!
Intervention - contemporary
- Any injury caused by tissue oxygen deficiency
- Drowning
- Near drowning
- Inhalation of a foreign body
- Hanging and strangulation
- Suffocation
- Asphyxia
- Apnea
Hypoxic injury
Name Rancho level in adults and children:
Global description: none to early response
Examination strategies: testing should focus on passive manipulation and observation of spontaneous or stimulus-induced movements
Adult: I-III
Pediatric: III-V
Name Rancho level in adults and children:
Global description: agitated, confused
Examination strategies: testing should focus on observation of spontaneous and simple instructed tasks
- Sit to stand, walking, standing balance
Adult: IV-V
Pediatric: II
Prevention of MSK complications
- Positioning in bed
- Passive movement
- Splints or serial casting (NOT serial casting IV and V)
- Assisted sitting and standing
Multisensory stimulation
Family education
Nonresponse to early response stage
- May follow simple commands
- Impaired judgement and problem solving ability
- Constant supervision to prevent injury
- Adaptive task practice
- Main procedural interventions and patient related instructional strategies
- Directed activity
- Increasing the childs motivational for activity
- Family education
- Simple task training
- Modification of tasks to ensure success
- Building a structures environment
- Carrying out many short interval txs
Agitation/confused stage