what are some considerations to be mindful of for interventions with CP
- values/concepts
- collaborative goal setting
- intervention planning
- service delivery models
- how much how often
- roles of other disciplines
- equipment needs
- evidence-informed practice
what are parts of evidence-informed practice
- clinical expertise
- best evidence
- patient values
what is the F-words framework
- fitness
-functioning - friends
- fun
- future
-family
what are some neurological interventions related to CP
- oral baclofen
- baclofen pump
- botox injections
- selective dorsal rhizotomy
what is baclofen
- synthetic GABA
- decreased excitation of alpha motor neuron
what are usual indications for intrathecal baclofen pump
- GMFCS level 5
- overall tone or co-contraction
- simplify sitting and position posture
what are two required indications for selective dorsal rhizotomy
- velocity dependent spasticity
- overactive EMG
what are some contraindications for selective dorsal rhizotomy
- weakness
- poor motor control
- dyskinetic
-ataxic
when is hemi-epiphysiodesis indicated
- genu valgus
- varus knee recurvatum
what are some potential consequences for asymmetry from neuromuscular conditions
- scoliosis
- pelvic obliquity
- sitting balance deficit
- pulmonary function
- GI function
- pain
what are the 9 green light interventions for CP
- activity focused + goal oriented functional therapy
- fitness therapy
- constrain-induced
- bimanual
- casting for improved ROM
- home program to improve motor performance or self-care
- hippotherapy
- treadmill
- strength/power
how much change in degree ROM is usual after serial castin
10-15 degrees
what levels of GMFCS are hippotherapy possible for
1-4
dosage for hippotherapy
2x per week, 1 hr session, 8 weeks total
what are some precautions for strength/power exercising
- communication impairment
- heat sensitivity
- cardiac precautions
- recent or minor musculoskeletal injury
- joint contracture or skeletal malformation
- sensory impairment
contraindications for strength/power training
- recent orthopedic surgery
- unable to follow directions
- less than 3 yrs of age
- unhealed wound around moving joint
- specific neuromuscular diseases (muscular d\ystrophy)
what is usual time frame of resistance training intensive design (CHCO)
- 8-12 weeks
-2-3 sessions per week - 45-60 minutes
targeted dosage for power in pediatrics
- 6 sets of 6 reps
- 60-80% 1 RM
- fast concentric/ slow eccentric
strength training dosage for pediatrics
- 3 sets of 5-8 reps
- greater than 80% of 1 RM
- slow and controlled throughout movement
what are some “yellow” interventions for CP
- assistive technology
- electrical stimulation
- hydrotherapy/aquatic therapy
- suit therapy (theratogs)
- stretching
- orthoses
how often per day should a child be using standing/weight-bearing devices
60-90 minutes per day
guidelines for stretching and CP
-need a prolonged sustained stretch to have meaningful change in muscle length + joint ROM
- really think of as a warm up before activity
what is the general design of orthotics
- 3 point pressure system
- stability (more or less)
- growth
how much stability is given with solid afo
a large amount
