2009Prim Haynes & Franjoine1 Children with Athetosis Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009

Prim Haynes & Franjoine2

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2009Prim Haynes & Franjoine4 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

2009Prim Haynes & Franjoine5 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

2009Prim Haynes & Franjoine6 Video of Kevin

2009Prim Haynes & Franjoine NDT Enablement Classification Model of Health and Disability DimensionFunctional DomainDisability Domain A. Body structure & functions Structural & functional integrity Impairments A. Primary B. Secondary B. Motor functionsEffective posture & movement Ineffective posture & movement C. Individual functions Functional activitiesFunctional activity limitations D. Social functionsParticipationParticipation restriction + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009Prim Haynes & Franjoine8 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

2009Prim Haynes & Franjoine9 Cognition Functions: Motivated to Move - Fearless Sociable (enjoys being with people) Intelligence - very bright Impairments Emotional swings

2009Prim Haynes & Franjoine10 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

2009Prim Haynes & Franjoine11 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

2009Prim Haynes & Franjoine12 Neuromuscular System Impairment of Timing and Sequencing Lack of coordination between agonist and antagonist muscles

2009Prim Haynes & Franjoine13 Neuromuscular System Insufficient Force Generation (muscle strength) Postural Muscles Movement Muscles

2009Prim Haynes & Franjoine14 Sensory System Sensory Processing Impairment: fluctuates Visually and auditory aware of environment (fluctuates)

2009Prim Haynes & Franjoine15 Musculoskeletal System Secondary Impairments High risk for scoliosis and hip dislocation Repeative over use of jaw my led to TMJ problems

2009Prim Haynes & Franjoine16 Musculoskeletal System Secondary Impairments Repetitive asymmetrical movements stress the following joints: –Occiput on C1 –C6 - C7 –T12 - L1

2009Prim Haynes & Franjoine NDT Enablement Classification Model of Health and Disability DimensionFunctional DomainDisability Domain A. Body structure & functions Structural & functional integrity Impairments A. Primary B. Secondary B. Motor functionsEffective posture & movement Ineffective posture & movement C. Individual functions Functional activitiesFunctional activity limitations D. Social functionsParticipationParticipation restriction + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009Prim Haynes & Franjoine18 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

2009Prim Haynes & Franjoine19 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

2009Prim Haynes & Franjoine20 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)

2009Prim Haynes & Franjoine21 Posture and Movement General Movement Characteristics Balance insufficient to prevent from falling Prefers to move in sagittal plane for added stability

2009Prim Haynes & Franjoine22 Prone Postures: Difficult position for function because of pull of gravity Movement Equally difficult to initiate movement

2009Prim Haynes & Franjoine23 Pictures

2009Prim Haynes & Franjoine24 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

2009Prim Haynes & Franjoine25 Pictures

2009Prim Haynes & Franjoine26 Sitting Position Sitting is an easier position Independent in W sit – wide BOS Movement Stabilize with upper body to get lower body mobile

2009Prim Haynes & Franjoine27 Pictures

2009Prim Haynes & Franjoine28 Mobility in Quadruped Posture: Alignment: arms internally rotated elbows hyperextend, weight bearing on dorsum of hand Movement: Bunny hop = pelvis behind knees

2009Prim Haynes & Franjoine29 Pictures

2009Prim Haynes & Franjoine30 Kneeling Posture Hips in increased flexion and abduction supporting the wide BOS (pelvis posterior) Movement Stabilize with upper body to move

2009Prim Haynes & Franjoine31 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

2009Prim Haynes & Franjoine32 Pictures

2009Prim Haynes & Franjoine33 Oral-Motor Skills Mouth used for stability “Fixes” with the jaw, severely limiting articulation May grind the teeth Drooling

2009Prim Haynes & Franjoine34 Video

2009Prim Haynes & Franjoine NDT Enablement Classification Model of Health and Disability DimensionFunctional DomainDisability Domain A. Body structure & functions Structural & functional integrity Impairments A. Primary B. Secondary B. Motor functionsEffective posture & movement Ineffective posture & movement C. Individual functions Functional activitiesFunctional activity limitations D. Social functionsParticipationParticipation restriction + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009Prim Haynes & Franjoine36 Activities & Activities Limitation Locomotor SkillsMay or May not require assistance & AT CommunicatesRequires AT Basic ADL’sFull time assistance & AT FeedingPossible feeding tube as transition to adult

2009Prim Haynes & Franjoine NDT Enablement Classification Model of Health and Disability DimensionFunctional DomainDisability Domain A. Body structure & functions Structural & functional integrity Impairments A.Primary B.Secondary B. Motor functionsEffective posture & movement Ineffective posture & movement C. Individual functions Functional activitiesFunctional activity limitations D. Social functionsParticipationParticipation restriction + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009Prim Haynes & Franjoine38 Participation Due to cognitive ability have potential to go to college and hold down a job. Our role “dream big” –Think Mobility Equipment & AC

2009Prim Haynes & Franjoine39 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

2009Prim Haynes & Franjoine40 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

2009Prim Haynes & Franjoine41 Children with Athetosis