Transcript Children with Athetosis

Children with
Athetosis
Margo Prim Haynes, PT, DPT, MA, PCS
Mary Rose Franjoine, PT, DPT, MS, PCS
2009
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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
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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
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Video of Kevin
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Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
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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
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Cognition
Functions:
• Motivated to Move - Fearless
• Sociable (enjoys being with people)
• Intelligence - very bright
Impairments
• Emotional swings
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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
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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
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Neuromuscular System
Impairment of Timing and Sequencing
• Lack of coordination between agonist
and antagonist muscles
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Neuromuscular System
Insufficient Force Generation (muscle
strength)
• Postural Muscles
• Movement Muscles
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Sensory System
• Sensory Processing Impairment:
fluctuates
• Visually and auditory aware of
environment (fluctuates)
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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
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Musculoskeletal System
Secondary Impairments
• Repetitive asymmetrical movements
stress the following joints:
– Occiput on C1
– C6 - C7
– T12 - L1
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Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
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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
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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
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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)
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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
•
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Prone
Postures:
• Difficult position for function because of
pull of gravity
Movement
• Equally difficult to initiate movement
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Pictures
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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
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Pictures
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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
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Pictures
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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
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Pictures
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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
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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
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Pictures
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Oral-Motor Skills
• Mouth used for stability
• “Fixes” with the jaw, severely limiting
articulation
• May grind the teeth
• Drooling
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Video
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Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
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Activities & Activities Limitation
Locomotor Skills
Communicates
Basic ADL’s
Feeding
2009
May or May not
require assistance &
AT
Requires AT
Full time assistance &
AT
Possible feeding tube
as transition to adult
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Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
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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
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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
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Treatment Comments
1. Treat up against gravity
2. Creative play allows for smoother
transitions and action
3. Be careful with mobile surfaces but make
sure that they move
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Children with
Athetosis
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