Understanding the child with athetosis

1. Robyn Smith Department of Physiotherapy University of Free State 2012 Understanding the child with athetosis

2. Athetoid group • NB!!! Characterised by: • Fluctuating postural/ • muscle tone • Involuntary movements Do not confuse with ATAXIA = in co-ordinated movements

3. Athetoid group Classified according to type of involuntary movementinto 4 groups • Pure athetosis • Choreoathetosis • Athetosis with dystonic spasms • Athetosis with spasticity

4. A look at muscle tone in the athetoid group Low tone Normal tone High tone Pure athetosis choreoathetosis Athetoid with dystonic spasms Athetoid with spasticity

5. Etiology • Kericterus hyperbilirubinaemia (severe jaundice) • Rh- incompatability • Prematurity • Asphyxia • Metabolic disorders • Encephalitis/ meningitis • Heavy metal poisoning • Rheumatic fever • Degenerative disorders brain

6. Management of jaundice

7. Etiology NB!!!!!= damage to the basal ganglia Basal ganglia are NB for: • Control of movement • Scale and amplitude determination of movement • Important in the control of eye movements

8. Characteristics • High IQ –cortex not involved • However usually severely disabled • Emotionally volatile • Often frustrated–temper tantrums • Lack of proximal stability • Poor grading movement • Poor balance • Muscle contractures usually not a concern • Due to constantly changing muscle tone and movement • Repetitive asymmetrical movement patterns may lead to deformities

9. Characteristics • Muscle tone fluctuates constantly • Inconsistent motor responses, child unsure of outcome of an action • General underlying hypotonia • Ligament laxity • Hypermobile

10. Athetoid • Most are wheelchair bound • Need lap and/or cross straps in the case of dystonic spasms to prevent the spasm from throwing them out of chair • Adequate trunk and foot support is critical to their stability

11. Seating : Shona Madiba buggy • Custom made to fit patient and meet specific support needs • Cost extremely expensive R 8000

12. Associated problems Speech & hearing • Vocalisation & speech problem –speech poor and indistinct • Often hearing loss • Can hear but does not listen due constant movement head Feeding • Difficulty in swallowing due to muscle incoordination • Battle especially with liquids and runny consistencies • Extreme difficulty in feeding safely

13. Associated problems Vision • Battle to focus • May have nystagmus = rapid, rhythmic, involuntary eye movements caused by damage brain • Eyes unable move independently head • Lack of stability of head affects vision

14. Development • Fluctuating tone present sometimes birth • Initially seem hypotonic • Develop extension pattern head, neck, retraction shoulders • Persistent ATNR • Due to involuntary movements fail to develop adequate head and trunk control Athetoid very intelligent and quickly learn to use pathological reflexes for function !!!! Habitual patterns

15. Development Prone • ATNR get up on one arm • TLR and STNR to get into M-sitting Sitting • Like to M-sit as is stable position • Uses ATNR for hand function • Chair –stabilises using arm around backrest or hooks foot around leg chair • Promotes further asymmetry resulting postural deformity

16. Development Gait • Struggle to learn to walk due to fluctuating tone, poor central control and involuntary movement • Asymmetry may be noted • Lumbar lordosis and anterior tilt due to poor central control • Knees locked together for stability • Arm held together or against leg for stability • Often appears in-coordinated

17. Treatment Principles

18. References • Brown, E. 2001. NDT basic course material (unpublished) • Smith, R. 2009. Paediatric dictate, UFS (unpublished) • Smith, R. 2008. role of physiotherapy in vestibular rehabilitation, PowerPoint presentation • Images courtesy of Google images (2009)