1
Q
Cerebrovascular Accident (CVA, Stroke)
What is it? Etiology, Prognosis, Orthotic Intervention
A
- What is it? - TIA - least traumatic, temporary and usually recoverable. Ischemic - Caused from a blood clot or embolism that impedes blood flow to a portion of the brain. 85% of srokes. Hemorrhagic - Breakage of artery leading to a brain bleed.
Accute neurologic dysfunction of vascular origin with sudden or at least rapid occurrence of symptoms and sign s corresponding the the involvement of focal areas in the brain. - Etiology - leading cause of death over 75. Smoking, diabetes, high blood pressure and cholesterol are risk factors.
- Prognosis - After stroke, gain of function for 6 months to a year, after that, functionality tends to plateau.
Signs and Symptoms - motor control and strength, hemiplegia, clonus, apraxia, ataxia, dysphasia, tone, contractures, flexor upper, extensor lower, balance, spasticity, reduced sensation, vision impairments, numbness, neglect, bowel and bladder, depression, pain. - Orthotic Intervention - Upper motor neuron, high tone. AFO and WHO most common. Manage Contractures, maintaining ROM, promote weight bearing and balance, encourage early ambulation.
2
Q
Cerebral Palsy
What is it, etiology, prognosis, types, orthotic intervention
A
- What is it? - A group of neurological disorders that is a result of damage to the cerebrum around the time of birth. A disorder of movement, muscle tone, and posture. Caused by a non progressive lesion in the immature brain. Most patients are walking by age 7. If they don’t walk by 10, they likely never will.
- Etiology - Pre, peri, postnatal. Hypoxia, hemorrhage, toxins in utero, head trauma, severe jaundice, infections, low birth weight (premature), multiple births.
- Prognosis - Non-progressive.
- Types (GMFC is a classification tool Levels 1-5 where 5 is most severe)
Spastic - damage to motor cells, cortex, and motor fibers. 75% of CP (typically hemi). Presents with hyperreflexia, exaggerated extensor patterns, contractures,
Athetoid - Basal Ganglia damage, 2nd most common 20%. hyper or hypotonic, large wide movements, overshooting of targets.
Ataxic - Cerebellar damage, lurching gait, “drunken” appearance. decreased fine motor skills. 1%
Mixture - Take a wild guess! - Orthotic Intervention - Manage contractures, aid in ambulation and balance, promote independence. Botox, tendon lengthening, serial casting, surgery
- Signs and Symptoms - spasticity, contractures, hyperactive, hyper-irritable, convulsions, scoli.
3
Q
Multiple Sclerosis
What is it?, Etiology, Types, Symptoms, Orthotic Intervention
A
- What is it? - Chronic neurological disease effecting CNS inflammation and degradation of myelin sheath. Damaged sheath impedes nervous function to and from the brain. Autoimmune
- Etiology - Unknown. Genetic, environmental, viral. Average age of onset - 30. More common in women then men.
- Types - Relapsing remitting - Most common: Flare up followed by partial to total recovery
Benign - Few attacks followed by long periods of remission
Secondary Progressive - May progress with or without relapse. Recovery after attack is usually not complete
Primary Progressive - Gradually worsening attacks with no relapsing or remission - Symptoms - Spasticity, speech, cognitive FX, bowel and bladder, paresis/plegia, sensory involvement, pain, fatigue, muscle weakness, contractures, ataxia, visual disturbance.
- Orthotic Intervention - Contractures, support weak muscles, improve balance and proprioception
4
Q
Spina Bifida (Myelomeningocele) What is it?, Etiology, types, Lesion levels, Orthotic Treatment, common co-morbidities
A
- What is it? - A congenital abnormality of the spine. Neural tube defect. Upper and lower motor neuron involvement. Varying degrees depending on level of abnormality. Non-progressive. Musculoskeletal, sensory, and neurological change. Folic acid used to prevent. Sensation is always effected.
- Etiology - Idiopathic, famillial, teratogens, maternal age, lack of folate (folic acid)
- Types - Occulta - Least severe, typically undiagnosed. A bifid vertibrebral arch, but spinal cord and meninges remain in colum
Systica meningocele - bifid vertibra with protruding cystic sack filled with spinal fluid and meninges. Spinal cord remains intact and in the column. This type is rare.
Cystical Myelomeningocele - Most severe, most common. Bifid vertibra with cystic sack protruding containing spinal cord and meninges. Lumbosacral area is most common. Most commonly effects musculoskeletal, kidneys, and bowels. - Lesion Levels - Anything below L4, patients can typically ambulate effectively.
- Orthotic Treatment - Reduce contractures, standing more improves bowel and bladder function, increase bone density, improve upper body strength and postural muscles. prevent deformity, correct existing deformity, ambulation and standing.
Other Complications - Hyrodephalis (shunt), osteomyelitis (bone infection), skin concerns (due to sensory loss), fractures, arnald Chiari malformation, seringomelia (collection of fluid in spinal canal), spinal tethering, lymphoma, decreased skeletal growth, hip dislocation
5
Q
Spinal Cord Injury (SCI)
What is it?, Etiology, Types, Special Considerations
A
- What is it? - 82% males, average age 31.7. Damage to spinal cord through
- Etiology - Motor vehicle accident, falls, sports, violence, farm accidents, etc.
- Types - Tetraplegia - injury in cervical segment.
Paraplegia in Thoracic, Lumbar, and Sacral. Loss of bowel, bladder, and sexual function. - Special Considerations - Spasticity is common, pain, osteoperosis, heterotrophic ossification, autonomic disreflexia, seringomylia,
6
Q
Poliomyelitis
What is it, prognosis, signs/symptoms, clinical signs, Orthotic intervention
A
- What is it? - Acute infectious disease charactarized by fever, permanent motor paralysis, and irriversable muscle atrophy. Lower motor only, resulting in asymetrical flaccid paralysis. No sensory deficits. Attacks anterior horn cells. Develops as a virus by oral or droplet infection.
- Prognosis - Infection/incubation, invasion, acute/paralytic, convalescence (recovery), post polio occurs 20-40 years after initial incident.
- Signs and Symptoms - Weakness, muscle waisting, hyporeflexia, affected limb is typically shorter, contractures, fatigue, weakness, pain.
- Clinical Signs - Flail ankle, foot complex. Pes cavus, hindfoot valgus, genu recurvatum or knee flexion contracture. genu valgum, atrophy, trendelenberg, hyperlordosis, internal femoral tortion, external tibial tortion.
Orthotic Intervention - No sensation, so must protect skin! Energy conservation
7
Q
Cauda Equina Syndrome
A
SCI that effects the Cauda Equina. Leads to flaccid paralysis of the legs and an areflexic bladder. Typically caused to trauma of an intervertebral disc.
8
Q
Muscular Distrophy (MD) What is it?, prognosis, types (6), symptoms/comorbidities
A
- What is it? - Genetic disorder caused by distrophin gene. Distrophin protein is absent or dysfunctional. With damaged distrophen complex, the contractile element of muscle fibers are non-functioning. Leads to damage and an inflamatory response leading to muscle atrophy as muscles go beyond repair. Sensation and Proprioception typically remain normal.
- Prognosis - Diagnosed age 3-5. Walking gone 12-13 Progressive, symmetrical muscle weakness, leads to death in late teens or early 20s when respiratory involvement occurs. Progresses proximal to distal, shoulder girdle and pelvis are first to go.
- 6 Types - Duchenne (most common), becker, Emery Dreyphuss, Limb Girdle, Facioscapulohumeral, occulophalangeal.
- Symptoms - Hip flexion, plantarflexion, and lordosis are common. Scoli. Fractures, arthritis, osterperosis. Gower’s sign (walking up legs with hands to rise from floor) weakness in glutes quads and p flex contracture. Trendelenberg is common. Clumsy walking, frequent falls, inversion of foot. Delayed reflexes
9
Q
Rheumatoid Arthritis (RA) What is it, diagnosis (4/7), typical presentation, orthotic intervention
A
- What is it? - Autoimmune disease characterized by inflamation of joints leading to hyperperfusion. Starts distal and moves proximal, symmetrically. Cartalege, ligament, and bone distruction leading to deformity of joints. Women 3x more common than males. Peak age 20-50.
- Diagnosis - 4/7 must be met. Morning stiffness, arthritis of 3 or more joint areas, hand joints effected, symmetrical arthritis, rheumatoid nodules, serum rheumatoid factor, x-ray changes.
- Typical Deformities - Swan neck, boutineer, Metacarpalphalangeal ulnar deviation, subluxation (MCPs), ruptured finger tendons, claw toes, hallux valgus, hammer toes, tarsal tunnel syndrome.
- Orthotic Intervention - FOs, rocker bottom shoes, WHOs. degrease pain and inflammation. Decrease weight through the joint, decreased range of motion, stabilization, prevent deformity
10
Q
Osteoarthritis (OA)
What is it?, Etiology, signs/symptoms, Orthotic Treatment
A
- What is it? - Cartilage degeneration, bony changes and sometimes inflammation.
- Etiology - Overuse/mechanical wear on cartilage. Insufficient self repair mechanisms. Can be caused by varum/valgum, obesity, etc. Increases with age
- Signs/Symptoms - Joint pain, stiffness, tenderness, locking, swelling, instability, crepitis, decreased Rom, osteophyte formation.
- Orthotic Intervention - Knee bracing, FOs, digital splints. Anything that can stabalize/unload/reduce bone on bone forces.
Orthotics
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