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Children with Athetosis

Children with Athetosis. Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009. Role of Basal Ganglia. Associated with a variety of functions: motor control, cognition, emotions, & learning. Select muscle to work and energizes them appropriately

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Children with Athetosis

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  1. Children with Athetosis Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009 Prim Haynes & Franjoine

  2. Prim Haynes & Franjoine

  3. Prim Haynes & Franjoine

  4. 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 Prim Haynes & Franjoine

  5. 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 Prim Haynes & Franjoine

  6. Video of Kevin Prim Haynes & Franjoine

  7. NDT Enablement Classification Model of Health and Disability + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82 2009 Prim Haynes & Franjoine 7

  8. 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 Prim Haynes & Franjoine

  9. Cognition Functions: • Motivated to Move - Fearless • Sociable (enjoys being with people) • Intelligence - very bright Impairments • Emotional swings Prim Haynes & Franjoine

  10. 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 Prim Haynes & Franjoine

  11. 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 Prim Haynes & Franjoine

  12. Neuromuscular System Impairment of Timing and Sequencing • Lack of coordination between agonist and antagonist muscles Prim Haynes & Franjoine

  13. Neuromuscular System Insufficient Force Generation (muscle strength) • Postural Muscles • Movement Muscles Prim Haynes & Franjoine

  14. Sensory System • Sensory Processing Impairment: fluctuates • Visually and auditory aware of environment (fluctuates) Prim Haynes & Franjoine

  15. Musculoskeletal System Secondary Impairments • High risk for scoliosis and hip dislocation • Repeative over use of jaw my led to TMJ problems Prim Haynes & Franjoine

  16. Musculoskeletal System Secondary Impairments • Repetitive asymmetrical movements stress the following joints: • Occiput on C1 • C6 - C7 • T12 - L1 Prim Haynes & Franjoine

  17. NDT Enablement Classification Model of Health and Disability + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82 2009 Prim Haynes & Franjoine 17

  18. 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 Prim Haynes & Franjoine

  19. 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 Prim Haynes & Franjoine

  20. 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) Prim Haynes & Franjoine

  21. Posture and Movement General Movement Characteristics • Balance insufficient to prevent from falling • Prefers to move in sagittal plane for added stability Prim Haynes & Franjoine

  22. Prone Postures: • Difficult position for function because of pull of gravity Movement • Equally difficult to initiate movement Prim Haynes & Franjoine

  23. Pictures Prim Haynes & Franjoine

  24. 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 Prim Haynes & Franjoine

  25. Pictures Prim Haynes & Franjoine

  26. Sitting Position • Sitting is an easier position • Independent in W sit – wide BOS Movement • Stabilize with upper body to get lower body mobile Prim Haynes & Franjoine

  27. Pictures Prim Haynes & Franjoine

  28. Mobility in Quadruped Posture: • Alignment: arms internally rotated elbows hyperextend, weight bearing on dorsum of hand Movement: • Bunny hop = pelvis behind knees Prim Haynes & Franjoine

  29. Pictures Prim Haynes & Franjoine

  30. Kneeling Posture • Hips in increased flexion and abduction supporting the wide BOS (pelvis posterior) Movement • Stabilize with upper body to move Prim Haynes & Franjoine

  31. 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 Prim Haynes & Franjoine

  32. Pictures Prim Haynes & Franjoine

  33. Oral-Motor Skills • Mouth used for stability • “Fixes” with the jaw, severely limiting articulation • May grind the teeth • Drooling Prim Haynes & Franjoine

  34. Video Prim Haynes & Franjoine

  35. NDT Enablement Classification Model of Health and Disability + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82 2009 Prim Haynes & Franjoine 35

  36. Activities & Activities Limitation Prim Haynes & Franjoine

  37. NDT Enablement Classification Model of Health and Disability + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82 2009 Prim Haynes & Franjoine 37

  38. Participation • Due to cognitive ability have potential to go to college and hold down a job. • Our role “dream big” • Think Mobility Equipment & AC Prim Haynes & Franjoine

  39. 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 Prim Haynes & Franjoine

  40. Treatment Comments • Treat up against gravity • Creative play allows for smoother transitions and action • Be careful with mobile surfaces but make sure that they move Prim Haynes & Franjoine

  41. Children with Athetosis Prim Haynes & Franjoine

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