Transcript Document
Children with Ataxia • Margo Prim Haynes, MA, PT • Mary Rose Franjoine, PT, DPT, MS, PCS • 2009 2009 Prim Haynes & Franjoine 1 Cerebellum http://en.wikipedia.org/wiki/Cerebellum 2009 Prim Haynes & Franjoine 2 Role of Cerebellum • Integration of sensory perception, coordination and motor control • Neural palthways from cerebellum: – Link with motor cortex telling muscles to move – Link with spinocerebellar track proving proprioceptive feedback on position of body in space • Fine tunes motor movement (feedback) 2009 Prim Haynes & Franjoine 3 General Comment • Children with ataxia have damage to cerebellum • Cerebellum’s inputs & outputs connected to motor cortex & brainstem are faulty • Specific systems vary with area of cerebellum that is affected • Ataxia often seen in combination with spasticity and athetosis 2009 Prim Haynes & Franjoine 4 2009 Prim Haynes & Franjoine 5 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 M Prim R Franjoine Haynes&&MFranjoine P Haynes 6 Video 2009 Prim Haynes & Franjoine 7 Body Structure & Body Function • Cerebellum Damage • Damage to Structure: – Interferes with Cerebellum ability to function • Controls execution of movement – Corrects for deviations • Modulates muscle stiffness 2009 Prim Haynes & Franjoine 8 Body Structure & Body Function – Interferes with Cerebellum ability to function • Computes position of body segments • Involved in motor timing and sequencing • Provides appropriate force during rapid sequential movement. 2009 Prim Haynes & Franjoine 9 Cognition Functions: • Cognitive challenges • Communicates Impairments: • Cognitive challenges include processing problems & motor planning • Communication concerns: articulation issues 2009 Prim Haynes & Franjoine 10 Cognition Impairments: • Emotional inconsistencies • Fearful of movement • Perceived as shy and unsociable – Bland affect 2009 Prim Haynes & Franjoine 11 Neuromuscular System Impaired Muscle Activation • Co-activation from moderate to low (stiffness fluctuates from moderate to low) during task • Oscillations of trunk, hands and tongue: small amplitude and large frequency 2009 Prim Haynes & Franjoine 12 Neuromuscular System Impaired Muscle Activation • Latency in initiating, sustaining and terminating postural muscle activity during tasks • Impaired muscle synergies – Stereotyped patterns of movement due to limited movement repertories 2009 Prim Haynes & Franjoine 13 Neuromuscular System Impairment of Timing and Sequencing • Lack of coordination between agonist and antagonist muscles – Overshoot- Dysmetria – Latency response 2009 Prim Haynes & Franjoine 14 Neuromuscular Insufficient Force Generation (muscle strength) • Postural Muscles • Movement Muscles 2009 Prim Haynes & Franjoine 15 Sensory System • Sensory Processing Impairment fluctuates: – Hypo-sensitive – Hyper-sensitive – Gravitational Insecurity • Poor motor planning 2009 Prim Haynes & Franjoine 16 Musculoskeletal System Secondary Impairments • Rib cage mobility may lead to upper respiratory problems • Feet position in prontation may lead to foot problems 2009 Prim Haynes & Franjoine 17 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 M Prim R Franjoine Haynes&&MFranjoine P Haynes 18 Posture and Movement General Characteristics: Posture • Underlying postural tone low to moderately low with fluctuations • Hyper mobile Joint Structure (elbows & knees) for stability • Poor midline orientation =mild asymmetry • Use visual fixes 2009 Prim Haynes & Franjoine 19 Posture and Movement General Characteristics: Posture • Alignment: – Lock distal extremities into end ranges for stability – Anterior or posterior position of pelvic for increased stability • Wide BOS helps stabilize & lower COG so postural muscles do not have to work 2009 Prim Haynes & Franjoine 20 Posture and Movement General Movement Characteristics • Moves with small amplitude phasic bursts of extension or flexion • Initiates movement with cervical extension and upper body • Prefer small amplitude small range movement (characteristic of fluctuating tone) 2009 Prim Haynes & Franjoine 21 Posture and Movement • Balance insufficient to prevent from falling • As Speed ↑ see ↓ in accuracy and adaptability of movement • Prefers sagittal plan movements 2009 Prim Haynes & Franjoine 22 Prone Postures: • Not a position for function because of pull of gravity Movement • Initiates movement with phasic bursts 2009 Prim Haynes & Franjoine 23 Pictures 2009 Prim Haynes & Franjoine 24 Supine Postures: • Learns to function in this position because feels safe and close to surface Movement • Push off surface with cervical extension and upper body work (slight asymmetrical) 2009 Prim Haynes & Franjoine 25 Pictures 2009 Prim Haynes & Franjoine 26 Sitting Position • Sitting is easier position to function • Independent sitting (ring sit, long sit & W sit) with wide BOS Movement • Phasic bursts of head & neck extension before pushing with arms • Prefer sagittal plan movements 2009 Prim Haynes & Franjoine 27 Pictures 2009 Prim Haynes & Franjoine 28 Mobility in Quadruped Posture: • Alignment: arms internally rotated elbows hyperextend, weight bearing on hand with wide BOS Movement: • Bunny hop or creeps (small excursions) =pelvis behind knees • Move in phasic bursts 2009 Prim Haynes & Franjoine 29 Pictures 2009 Prim Haynes & Franjoine 30 Kneeling Posture • Hips in increased flexion and abduction supporting the wide BOS (pelvis anterior or posterior) Movement • Stabilize with upper body to move 2009 Prim Haynes & Franjoine 31 Pictures 2009 Prim Haynes & Franjoine 32 Standing & Walking Postures • Often independent standers but prefer a support surface for Upper Extremities • Uses wide BOS, knees hyper-extended or flexed to assist with stability Movement • Staggering movement • Latency response interferes with reaction time 2009 Prim Haynes & Franjoine 33 Pictures 2009 Prim Haynes & Franjoine 34 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 M Prim R Franjoine Haynes&&MFranjoine P Haynes 35 Activities & Activities Limitation 2009 Locomotor Skills Ambulatory with or without assistance Communicates Communicates without assistance Basic ADL’s Typically independent with ADL or needs occasional assistance Prim Haynes & Franjoine 36 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 M Prim R Franjoine Haynes&&MFranjoine P Haynes 37 Participation • Due to cognitive ability and motor ability often need assistance in school • Need support to complete high school years and hold down a job • May need a group living arrangement or live with family member in adult years 2009 Prim Haynes & Franjoine 38 Treatment Strategies • Alignment of BOS from wide to narrow for efficient activation • “Awaken” postural system and wait for response • Emphasize diagonal and rotational postures and movement 2009 Prim Haynes & Franjoine 39 Treatment Comments 1. Gravitationally insecure 2. Does not enjoy movement 3. Stabilizes with eyes so remember this when treat in front of a mirror 4. Patience important 2009 Prim Haynes & Franjoine 40 Video 2009 Prim Haynes & Franjoine 41 Children with Ataxia 2009 Prim Haynes & Franjoine 42