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Test that depicts how children with CP use their hands in daily activities
Manual ability classification system (MACS)
GMFCS level:
- Walk using a handheld mobility device most indoor settings
- Seated may require seat belt for pelvic alignment and balance
- Sit to stand and floor to stand transfers require physical assistance of a person or support surface
- Long distances use some form of wheeled mobility
- May walk up and down stairs holding onto a railing with supervision or physical assistance
- Limitations in walking may necessitate adaptations to enable participation in physical activities and sports
Level III -- Walks using a hand-held mobility device
Test eating and drinking ability of children with CP ages 3 to adulthood
The eating and drinking abilities classification system
T/F: Children with CP typically co-contract hamstrings and quads to walk instead of properly recruiting muscles throughout the gait cycle
True
What are the (3) predictors for best chances for independent gait?
1. Spastic hemiplegia
2. Mild to moderate spastic diplegia
3. Mild ataxia ***
GMFCS level:
- Walk at home, school, outdoors, and in the community
- Able to walk up and down curbs without physical assistance
- Stairs without the use of a railing
- Gross motor skills such as running and jumping but speed, balance and coordination are limited
- May participate in physical activities and sports depending on personal choices and environmental factors
Level I -- Walks without limitations
Test developed to determine communication abilities
Communication function classification system (CFCS)
Descriptors at each age band are based on self initiated movement with particular emphasis on sitting (trunk control), walking, and wheel mobility. There are 5 classification levels within each of five age bands: (1) before second birthday, (2) between second and fourth birthdays, (3) between fourth and sixth birthday, (4) between sixth and 12th birthdays, (5) between 12th and 18th birthdays
Administration of GMFCS for CP
What is the issue with prescribing an AFO for a child with CP?
Takes away ankle strategy; you're taking away balance strategy from someone who has balance issues
- Timing errors in motor recruitment
- Selective voluntary motor control - inability to isolate activation of specific muscles in pattern according to postural or voluntary movement demands
- Recruit both agonist and antagonist muscle groups at same time - limits movement and speed
- Inability to isolate certain muscles for action
- Recruitment of motor units is disorderly and slower than normal
- Muscle is not completely activated
- Decreased force production and weakness
- Decrease in myelination
- Differences in motor control
- Abnormal timing and muscle activation patterns
Impairments of body structures and functions related to motor performance
To establish a mechanism for classifying children with cerebral palsy according to their functional abilities, including the need for assistive technology (handheld AD for gait) or wheeled mobility. The quality of movement is not emphasized. Children are unlikely to change classification levels after 2 years of age, regardless of intervention.
Purpose of GMFCS for CP
GMFCS level:
- Methods of mobility that require physical assistance or powered mobility in most settings
- Require adaptive seating for trunk and pelvic control
- Physical assistance for most transfers
- At home - use floor mobility (roll, creep, or crawl), walk short distances with physical assistance, or use powered mobility. When positioned, children may use a body support walker at home or school
- At school, outdoors, and in the community, children are transported in a manual WC or use powered mobility. Limitations in mobility necessitate adaptations to enable participation in physical activities and sports
Level IV -- Self mobility with limitations: may use power mobility
GMFCS level:
- Walk in most settings
- May experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas, confined spaces, or when carrying objects
- Walk up and down stairs holding onto a railing or with physical assistance if there is no railing
- Outdoors and in the community - may walk with physical assistance, hand held mobility device, or use wheeled mobility when traveling long distances
- At best minimal ability to perform gross motor skills such as running and jumping
- Limitations in performance of gross motor skills may necessitate adaptations to enable participation in physical activities and sports
- Protect from external injury
- Watch for respiratory or cardiac problems
- Increasing/changing symptoms - physician contacted
- Increased brain damage might occur with every seizure
- Potential for decline
- Pharmacologically controlled: Dilantin and Tegretol
- Medications mat cause sedation
- Caution with vestibular stimulation (EX: swinging, spinning) movement might trigger seizure
- Hard to make progress with therapy when they are actively having seizures
- Usually decline for a while after episode
Seizures
First seizure = medical emergency
Typical seizure = protect patient
T/F: In standing, children with CP may lower their center of gravity by flexing the knees, with feet in either excessive DF or PF
True
GMFCS level:
- Mobility that require physical assistance or powered mobility in most settings
- Require adaptive seating for trunk and pelvic control
- Physical assistance for most transfers
- At home, children use floor mobility (roll, creep, crawl), walk short distances with physical assistance, or use powered mobility
- When positioned, may use a body support walker at home or at school
- At school, outdoors, and in the community, children are transported in a manual WC or use powered mobility
- Limitations in mobility necessitate adaptations to enable participation in physical activities and sports
Level V -- Transported in manual WC
What side of the brain does language live on?
L side **
- Multisystem impairments
- Associated secondary conditions
- Movement difficulties
- Decreased physical activity levels and endurance
- Decreased walking abilities and overall participation
Restrictions in activities and participation
1. Initiation of movement to be delayed
2. Rate of force development to be slowed down
3. Muscle contraction time to be prolonged
4. Timing of agonist to antagonist activation to be disrupted
- Extremity movements may appear slow and stiff and are coarse
- Might move in mass flexion or extension patterns without being able to dissociate individual limb or joint movements
- Retained primitive reflexes
Movement patterns
- Early Activity Scale for Endurance (EASE)
- 6 minute walk test
- CP Longitudinal trajectories across GMFCS levels and 6 minute walk tests for children with CP developed and published to assist clinicians in developing interventions and goals
- Activity Scale for Kids (ASK) demonstrates sound psychometric properties in measuring activity limitations in children with CP
Restrictions in activities and participation
Best prognosis for independent gait if patient begins walking by age ____ if going to attain independent ambulation. Usually lose ambulation by when?
8 yo
Usually lose it by teenager/early adulthood
- Early clinical assessment of balance (ECAB)
- TUG
- BERG
- Pediatric reach test
- Gait deviations
- ADLs
- Range of interventions diverse
- PDMS-2/BOT-2
Functional tests
- Cognitive impairments
- Behavioral and psychological problems
- Visual impairments
- Hearing impairments
- Sensory impairments - sensation and perception
- Communication
- Behavior
- Seizure disorders
- Neuromuscular impairments related to motor performance
- Severity and impact vary depending on location and the extent of injury to brain
- Screen and make referrals
- Secondary MSK problems
Associated medical issues
Good prognosis of independent gait if patient can sit independently by ___ years old.
2 yo
- Bimanual training - intervention and activities that use both UE
- Constraint induced movement therapy
- Context-focused therapy - changing the task or environment to allow to improve motor outcomes
- Fitness training
- goal directed behavior
- HEP to improve motor activity performance and cardiovascular endurance
- Strength training
- Intensive treadmill training to improve gross motor function, gait speed, and endurance
- AD for mobility and other aids for ADLs
- Orthotics to improve energy expenditure - ankle ROM, and gait kinematics, including control of equinus, improved heel strike at initial contact, and increased step/stride length and gait velocity
- Orthotics improve gait parameters at body structure level - mixed results about effects at activity level, including walking, running, and jumping as observed on the GMFM and PEDI
Interventions with evidence