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

2009 Prim Haynes & Franjoine 1

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– Helps maintain posture and control

automatic movements– Organizes the antagonist & agonist

muscles to work together


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


Video of Kevin

2009 Prim Haynes & Franjoine 72009 7

NDT Enablement Classification Model of Health and Disability

Dimension Functional Domain

Disability Domain

A. Body structure & functions

Structural & functional integrity

ImpairmentsA.PrimaryB.Secondary

B. Motor functions Effective posture & movement

Ineffective posture & movement

C. Individual functions

Functional activities

Functional activity limitations

D. Social functions Participation Participation restriction

+ Domains -

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From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82


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


Cognition

Functions:

• Motivated to Move - Fearless

• Sociable (enjoys being with people)

• Intelligence - very bright

Impairments

• Emotional swings


Neuromuscular SystemImpaired 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


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



Impairment of Timing and Sequencing

• Lack of coordination between agonist and antagonist muscles



Insufficient Force Generation (muscle strength)

• Postural Muscles

• Movement Muscles


Sensory System

• Sensory Processing Impairment: fluctuates

• Visually and auditory aware of environment (fluctuates)


Musculoskeletal System

Secondary Impairments

• High risk for scoliosis and hip dislocation

• Repeative over use of jaw my led to TMJ problems


Musculoskeletal System

Secondary Impairments

• Repetitive asymmetrical movements stress the following joints:

– Occiput on C1

– C6 - C7

– T12 - L1




Disability Domain










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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



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



General Movement Characteristics

• Moves with asymmetrical phasic bursts

• Initiates movement with asymmetrical extension

• Prefer large amplitude wide range movement (characteristic of fluctuating tone)



General Movement Characteristics

• Balance insufficient to prevent from falling

• Prefers to move in sagittal plane for added stability

•


Prone

Postures:

• Difficult position for function because of pull of gravity

Movement

• Equally difficult to initiate movement


Pictures


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


Pictures


Sitting

Position

• Sitting is an easier position

• Independent in W sit – wide BOS

Movement

• Stabilize with upper body to get lower body mobile


Pictures


Mobility in Quadruped

Posture:

• Alignment: arms internally rotated elbows hyperextend, weight bearing on dorsum of hand

Movement:

• Bunny hop = pelvis behind knees


Pictures


Kneeling

Posture

• Hips in increased flexion and abduction supporting the wide BOS (pelvis posterior)

Movement

• Stabilize with upper body to move


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


Pictures


Oral-Motor Skills

• Mouth used for stability

• “Fixes” with the jaw, severely limiting articulation

• May grind the teeth

• Drooling


Video




Disability Domain










+ Domains -

Dim

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Activities & Activities Limitation

Locomotor Skills May or May not require assistance & AT

Communicates Requires AT

Basic ADL’s Full time assistance & AT

Feeding Possible feeding tube as transition to adult



Dimension Functional Domain Disability Domain



Impairments

A.Primary

B.Secondary




Functional activities Functional activity limitations


+ Domains -

Dim

ensi

ons



Participation

• Due to cognitive ability have potential to go to college and hold down a job.

• Our role “dream big”

– Think Mobility Equipment & AC


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


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


Children with Athetosis

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

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