Homeworks academic service


A training program for bob an eleven year old with cerebral palsy

In these situations, they can be part of normal infantile development. Stereotypies can also be secondary when they occur in the setting of a neurodevelopmental disorder such as autism spectrum disorder. A definitive cause of stereotypies has not been determined. Both a psychogenic and neuro-biologic basis of this movement disorder have been proposed.

Dystonia Dystonia can be primary where dystonia is the only or predominant symptom or secondary where dystonia is due to another identified cause. Primary dystonia is typically caused by a single gene mutation. An example of this is DYT-1 dystonia which is a generalized dystonia that can present in childhood.

In this disease, dystonia is the only symptom. In DYT-1 dystonia, children typically present with dystonia in a limb that then spreads and can involve their entire body. Secondary dystonia has varied causes. Dystonia can be a symptom of cerebral palsy. An example of how this occurs is in the setting of hypoxic-ischemic brain injury. The brain does not get enough oxygen and blood during delivery.

This causes an injury to the basal ganglia which are the primary structures of the brain that control movement. Sometimes this injury can be seen on brain imaging with an MRI. Dystonia has many other causes. These include neurodegenerative diseases, brain infections, structural brain lesions, and medications.

  • Bent-knee leg lifts and reverse leg lifts could be replaced by walking and using the wheelchair as a walker — to provide balance and support some weight;
  • Other movement disorders are disruptive to a child, impact their quality of life, and necessitate treatment;
  • Children with essential tremor typically have an action tremor involving the hands;
  • These children have a dramatic and sustained response to low-dose levodopa;
  • Primary dystonia is typically caused by a single gene mutation;
  • Quadriceps extensions and hamstring curls may be done with ankle weights or on a weight machine designed for these and toe raises and pulls could be replaced with step aerobics in the water as the pool has the equipment for this.

Dopamine-blocking medications can cause a specific type of dystonia called an acute dystonic reaction. In this case, dystonia presents abruptly after the medication is administered. Tremor There are many causes of tremor.

On the least severe end of the spectrum, tremor can be physiologic and occur in otherwise healthy children. When tremor is more notable than the average healthy child, it is called an enhanced physiologic tremor. These tremors are exacerbated by stress and anxiety.

Tremor can be hereditary as in the case with essential tremor. Children with essential tremor typically have an action tremor involving the hands. In some children, the head, voice, trunk, or legs can also be involved. Tremor can be caused by strokes or brain lesion which most commonly cause a unilateral tremor. Tremor can be caused by metabolic derangements such as low calcium, endocrine disorders such as hyperthyroidism, neurodegenerative diseases, medications, or toxins.

Chorea Chorea can be seen in normal, healthy infants until they are about 6 month of age. After this age, chorea is typically pathologic. Chorea is rarely a primary disorder. Secondary chorea has numerous causes. In these cases, chorea is accompanied by additional neurologic symptoms and non-neurologic symptoms. Chorea can be acquired in childhood. On average 1-2 months after the infection, children develop chorea.

This is thought to happen when antibodies that formed to fight off the strep infection incorrectly attack and injure the basal ganglia. Chorea can be caused by metabolic derangements such as hypoglycemia or hyperglycemia low or high sugarhyponatremia or hypernatremia low or high sodiumhypocalcemia low calcium and hyperthyroidism. Chorea can be seen after heart surgery when children have cardiopulmonary bypass post-pump chorea.

Additional causes of chorea include infections, systemic lupus erythematosus, toxins, and neurodegenerative disorders. Chorea can be chronic as seen in a subtype of cerebral palsy. In this setting, chorea often co-exists with dystonia due to injury to the basal ganglia. Myoclonus Myoclonus can arise from multiple areas in the nervous system including the cortex, basal ganglia, brainstem, and spinal cord.

Movement Disorders

In fact, myoclonus can be normal, as with sleep myoclonus. Most people have experienced this phenomenon where the body jerks as they are falling asleep, sometimes waking the person up while they are dozing off. There are numerous causes of pathologic myoclonus.

Epileptic myoclonus must be differentiated from non-epileptic myoclonus. Sometimes this requires an electroencephalogram EEG to differentiate.

Once myoclonus is confirmed as a movement disorder, the location and the appearance of the myoclonus can be helpful in determining the cause. Myoclonus can be seen in numerous inherited genetic diseases. It can also be acquired by exposure to toxins, infections, metabolic derangement, and hypoxic events. Parkinsonism Primary parkinsonism is typically caused be a single gene mutation. Secondary parkinsonism has a wide variety of causes.

It can present as a symptom of a larger neurodegenerative disorder as in mitochondrial diseases. It can be caused by a brain infection encephalitis or an autoimmune inflammatory process autoimmune encephalitis.

Parkinsonism can also be an adverse reaction to a medication. This can be seen with a class of medications called dopamine-blocking medications. For example, in an otherwise healthy 5-yold with eye blinking and sniffing, a tic disorder can be diagnosed without laboratory evaluation. When additional diagnostic testing is indicated, it may include the following: In some cases, the movement disorder can be observed during the clinic visits.

If the movement disorder is intermittent, the physician must rely on the description of the movement from the parents; this can be challenging. Parents and children can also attempt to mimic the abnormal movement during the visit. If the abnormal movement in questions is intermittent, home videos are very helpful in identifying the phenomenology.

In these cases, a short video from a cell phone may be all that is needed to arrive at the correct diagnosis. Movement disorders may need to be distinguished from other conditions which lead to the appearance of abnormal movements. The most common distinction that needs to be made is between a movement disorder and a seizure. This can often be done by simple observation but in more challenging cases, may require addition diagnostic testing to make this important distinction.

The standard for diagnosis of a seizure disorder is an electroencephalogram EEG.

  • Chorea can be chronic as seen in a subtype of cerebral palsy;
  • Ten consecutive jumps form a set;
  • This is a perfect location for the training sessions as it provides a fun environment to exercise in, he can walk with less than normal body weight and Bob is able to swim;
  • In both cases, the treatment of choice is anti-epileptic medication;
  • Let him decide how fast to go; if you move to fast he is light enough that he will just start to float in the deep end and fall in the shallow end.

In some cases, the identification of the type of movement disorder is all that is needed to come to a diagnosis. For example, a primary tic disorder may be diagnosed on history, examination, and observation alone. In other cases, additional diagnostic testing may be needed. Additional testing may include blood and urine testing, imaging studies, and testing of the cerebrospinal fluid. Diagnostic testing starts with attempting to identify the most common causes of the movement disorder as well as treatable forms of the movement disorder.

Increasingly, more extensive genetic testing has enhanced the ability to diagnose movement disorders as well as lead to the discovery on new genetic movement disorders diagnoses. Some movement disorders are considered benign and do not require treatment.

Other movement disorders are disruptive to a child, impact their quality of life, and necessitate treatment. Rarely, a pediatric movement disorder can be life-threatening and requires emergent treatment in a hospital. With some movement disorders, the goal of treatment is to lessen the severity of the involuntary movement. In other cases, the goal of treatment is to eliminate the abnormal involuntary movement.

Many movement disorders can be difficult to eliminate even with our current best treatments. The benefit of the medication also must be weighed against the risk of potential side effects. For example, a slight decrease in tics might not be worth the sedation caused by a medication used to reduce tics.

In cases of acquired movement disorders, it is important to treat the underlying cause. Treatment of the underlying cause may eliminate the movement disorder and obviate the need to treat the movement disorder itself. Tics Regardless of treatment, one-third of children will outgrow tics in adolescence or early adulthood, one-third will have improvement of tics in adolescence or early adulthood, and one- third will have tics that continue to be disruptive in adulthood.

The decision to treat tics is based on whether the tics are bothersome or disruptive in day to day life. Often counseling the family to show that the tics are not the sign of an underlying serious neurologic condition provides enough reassurance that medications are not pursued. Providing information to teachers, classmates, and other family members can also reduce the stress caused by tics therefore minimizing the need for medication.

A training program for bob an eleven year old with cerebral palsy

In older children, tics may be embarrassing or the children may be teased about their tics. There are medications that can be used to treat tics. These include alpha agonists e. Medications decrease tics on average by one-third to one- half at best.

Medication choices can be based on whether the child has tics alone or tics in combination with comorbid conditions. For example, if a child has tics and ADHD, the alpha agonists may be chosen as this medication can be helpful for both conditions.

  • Tremor can be caused by strokes or brain lesion which most commonly cause a unilateral tremor;
  • As of now he can only do them in the middle of the pool however as his strength gains he could slowly move towards to shallow end thereby putting more of his body above the water and increasing the weight;
  • On average 1-2 months after the infection, children develop chorea;
  • When additional diagnostic testing is indicated, it may include the following;
  • Often counseling the family to show that the tics are not the sign of an underlying serious neurologic condition provides enough reassurance that medications are not pursued;
  • For example, adequate treatment of ADHD may decrease stress at school and at home, secondarily decreasing tics.

In some children with tics, the associated psychiatric symptoms are more disruptive than the tics themselves. For example, adequate treatment of ADHD may decrease stress at school and at home, secondarily decreasing tics. An alternative to oral medication is a cognitive-based behavioral therapy training program called the comprehensive behavioral intervention for tics.

A training program for bob an eleven year old with cerebral palsy

A key component of this behavioral approach is habit reversal therapy. This process teaches tic awareness and the development of a competing response which is an action that replaces the current tic.

The child learns to stop the urge to have their tic with no movement at all.