Scribd Logo
Upload

Welcome to Scribd!

  • 94 views

    Motor Disturbance in Children

    Uploaded by

    Yuri Brosgol
    The document discusses common patterns seen in pediatric motor disturbances, including clumsiness, stumbling, tripping, toe walking, imbalance, hypotonia, peculiar movements, weakness, and deformities. It covers the localization and etiology of motor disturbances, which can be due to static dysfunction from conditions like cerebral palsy or trauma, or progressive conditions like genetic or metabolic disorders. Specific conditions discussed include cerebral and peripheral hypotonia, cerebral syndromes, genetic syndromes like Down syndrome and Prader-Willi syndrome, and the workup for identifying the cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Motor Disturbance in Children

    Uploaded by

    Yuri Brosgol
    94 views84 pages
    The document discusses common patterns seen in pediatric motor disturbances, including clumsiness, stumbling, tripping, toe walking, imbalance, hypotonia, peculiar movements, weakness, and deformities. It covers the localization and etiology of motor disturbances, which can be due to static dysfunction from conditions like cerebral palsy or trauma, or progressive conditions like genetic or metabolic disorders. Specific conditions discussed include cerebral and peripheral hypotonia, cerebral syndromes, genetic syndromes like Down syndrome and Prader-Willi syndrome, and the workup for identifying the cause.

    Original Title

    Motor Disturbance in Children.ppt

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses common patterns seen in pediatric motor disturbances, including clumsiness, stumbling, tripping, toe walking, imbalance, hypotonia, peculiar movements, weakness, and deformities. It covers the localization and etiology of motor disturbances, which can be due to static dysfunction from conditions like cerebral palsy or trauma, or progressive conditions like genetic or metabolic disorders. Specific conditions discussed include cerebral and peripheral hypotonia, cerebral syndromes, genetic syndromes like Down syndrome and Prader-Willi syndrome, and the workup for identifying the cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    94 views84 pages

    Motor Disturbance in Children

    Uploaded by

    Yuri Brosgol
    The document discusses common patterns seen in pediatric motor disturbances, including clumsiness, stumbling, tripping, toe walking, imbalance, hypotonia, peculiar movements, weakness, and deformities. It covers the localization and etiology of motor disturbances, which can be due to static dysfunction from conditions like cerebral palsy or trauma, or progressive conditions like genetic or metabolic disorders. Specific conditions discussed include cerebral and peripheral hypotonia, cerebral syndromes, genetic syndromes like Down syndrome and Prader-Willi syndrome, and the workup for identifying the cause.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 84

    Pediatric Motor

    disturbance
    About Children who trip and
    stumble . . .

    Common Patterns
    Toe walking

    Common Patterns
    Toe Walking
    Clumsiness, Stumbling and Tripping

    Common Patterns
    Hypotonia

    Common Patterns
    Clumsiness, Stumbling and Tripping
    Toe walking
    Hypotonia

    Imbalance

    Common Patterns
    Clumsiness, Stumbling and Tripping
    Toe walking
    Imbalance
    Hypotonia
    Peculiar walking patterns

    Common Patterns
    Clumsiness, Stumbling and Tripping
    Toe walking
    Imbalance
    Hypotonia
    Peculiar movements
    Weakness

    Common Patterns
    Clumsiness, Stumbling and Tripping
    Toe walking
    Imbalance
    Peculiar movements
    Weakness
    Deformities

    Common Patterns
    Clumsiness, Stumbling and Tripping
    Toe walking
    Imbalance
    Peculiar movements
    Weakness
    Deformities
    Very Peculiar Signs

    Motor Development

    Newborn

    5 months

    7 months

    10-11 mo

    Newborn

    6 weeks

    3 months
    (12 weeks)

    5 months

    6 months

    5 months

    6 months

    7 months

    4 months

    6 months

    5 months
    7 months

    5 months
    4 months

    6 months

    7 mo

    8 mo

    9 mo

    10 mo

    Verticalization

    11 mo

    7 months

    8 months

    9th months

    Verticalization stepping forward


    upright posture, first loading
    predominantly the medial edges of the feet

    9 10 months

    10-11 months

    PHENOMENOLOGY
    Gross motor clumsiness
    Fine motor clumsiness
    Abnormal movements
    Abnormal posture and gait
    Muscular weakness
    Hypotonia or Spasticity

    LOCALIZATION
    CENTRAL MOTOR NEURON
    CORTEX
    CORTICO-SPINAL

    TRACTS

    PERIPHERAL Motor Neuron


    ANTERIOR-HORN

    Cells
    Motor Roots and Peripheral Nerves
    Neuro-Muscular Junction
    Muscles

    ETIOLOGY
    Static Dysfunction
    cerebral

    palsy

    Trauma
    Acute

    Infection , Toxicity

    CVA

    Progressive Condition
    Metabolic,

    Genetic
    Autoimmine
    Chronic Infection

    Hypotonia

    CENTRAL
    PERIPHERAL

    CEREBRAL HYPOTONIA
    Encephalopathy present !
    Change in Alertness and Activity
    Seizures *Cognitive Delay
    Signs of Upper Motor Neuron Disease:
    Reflexes Increased
    Pathologic reflexes
    Persistence of Primitive Reflexes
    Motor Delay
    Functional Asymmetry
    Progression to Spasticity

    PERIPHERAL HYPOTONIA
    Normal Brain Functions
    Signs of Lower Motor Neuron Disease:
    Reflexes Depressed (Myopathy) of Absent
    Signs of Denervation of Muscles: Amyotrophy,
    Fasciculations
    Low Tone in Extremities
    No Spasticity
    Pathologic reflexes Absent
    Decreased Movements and Postural Reactions
    NO Functional Asymmetry
    Electrophysiologic Findings
    Fibrillation Potentials
    Abnormal Nerve Conduction

    CEREBRAL SYNDROMES
    Benign Hypotonia of Infancy
    (Common, Self-limited)
    Hypotonia of the Prematurity
    Hypoxic Ischemic Encephalopathy
    Encephalopathic Syndromes

    GENETIC SYNDROMES
    Downs Syndrome
    21 translocation, deletion, mosaicism
    Prader-Willi Syndrome 5 (q11-13) deletion
    HHHH: -Hypotonia,
    -Hypogonadism,
    -Hypomentia;
    Hypo Hyperphagia
    Small Hands and Feet
    Microcephaly, Short Stature
    Congenital Hip Dislocation

    Work Up:
    Imaging studies
    Nerve Conduction Studies and EMG
    EEG
    Laboratory Studies: CPK; SGOT/SGPT
    Screening Tests; Amino Acids and Organic
    Acids; Long Chain Fatty Acids; Lactate and
    Pyruvate; Chromosomal DNA testing
    Muscle and/or Nerve Biopsy

    Right Tibi

    Ankle 100.0mA
    O

    P
    R
    O

    Right Perone

    Poplit 100.0mA

    0.53 mV [>3.0]
    43.75 m/s [>41.0]

    Amp:
    Vel:

    Ankle 100.0mA

    
    P
    R

    Fib Hed 100.0mA

    O
    T

    Amp:
    Vel:

    0.18 mV [>2.5]
    43.0 m/s [>40]

    EMG - Left

    EMG - Left Gas

     100

    2

    Mental Deficiency (improved after


    change in custodial caretakers)

    Dysmorphic Features
    Hypotonia, H/o clubbed feet
    Posture and Gait Abnormality
    Distal Legs Wasting:

    Work Up:
    Brain Imaging
    Cervical Imaging (r/o syrinx)
    EMG and Nerve Conduction
    Studies:

    rule out congenital neuropathy,


    muscular dystrophy,
    myopathy.

    Normal Cognitive
    Development
    Chronic Presentation
    Subcompensated course
    Gowers Sign
    Toe Walking
    car accident

    BILATERAL Toe Walking


    Idiopathic Toe Walking (Achilles Shortening)
    Spastic Diplegia
    Peripheral Neuropathy (CMT)
    Myscular Dystrophy (Duchenne)
    Cutaneous calcinosis (in dermatomyositis)
    Spinal Cord Anomaly
    Juvenile MS
    Dystonia
    Mannerism, as one of the autistic traits

    UNILATERAL Toe Walking


    Dystonia
    Spastic Hemiparesis
    Local Conditions:
    Achilles

    Tendonitis, Calf Hemangioma


    Linear Scleroderma

    Conversion reaction

    Work Up for Toe Walking


    Gait Analysis
    Measurement of Ankle Dorsiflexion
    Brain Imaging
    Thoraco-lumbar Spine Imaging
    Nerve Conduction Studies, EMG

    Ataxia

    Ataxia Differential:
    Brain Abnormalities:
    Leukodystrophies (Krabbe)
    Cerebellar
    Frontal

    Posterior Columns
    Spino-Cerebellar Ataxias
    Ataxia-Telangiectasia
    Neuropathies
    Postinfectious (Varicella Cerebellitis)
    Autoimmune (Miller-Fisher Variant of GBS)

    Ataxia Work Up:


    Brain Imaging
    Metabolic Studies
    Genetic Studies
    Spinal Tap
    Nerve Conduction Studies

    MUSCLE
    DISEASE

    Muscle Weakness
    Gowers Sign:

    Muscle Weakness
    Gowers Sign:
    Paretic Gait:

    Muscle Weakness
    Gowers Sign
    Reflex abnormalities
    Tone Abnormalities:

    Muscle Weakness
    Gowers Sign
    Reflex abnormalities
    Tone Abnormalities
    Muscle Deformities:

    Muscle Phenomena
    Myotonia:

    Muscle Phenomena
    Myotonia:

    Differential Muscle Disease


    Anterior Horn Disease (Spinal Muscular
    Atrophy)
    Polyradiculoneuropathies
    Acute (Guillain-Barre)
    Chronic (CIDP)

    Neuropathies
    Myopathy
    Muscular Dystrophies
    Myasthenia

    Muscle Disease Evaluation


    History, presentation
    Clinical Appearance
    Examination
    Nerve Conduction Studies, EMG
    Muscle / Nerve Biopsy
    Genetic Testing (Duchenne, Myotonic
    Dystrophy, CMT, SCD..)
    Labs: electrolytes, CPK, SGOT/SGPT;
    TFT; carnitine levels, antibodies analysis

    EMG, Nerve Conduction Data


    Low amplitudes
    Slowing of conduction velocities
    Prolonged Latencies
    Fibrillation potentials, positive waves
    Decreased recruitment
    Pathological patterns

    Myotonic Dystrophy

    Dystonia Differential:
    Degenerative Encephalopathies:

    Pelizaeus-Merzbacher
    Lesch-Nyhan
    Infantile seroid lipofuscinosis
    Niemann-Pick
    Mitochondrial diseases

    Genetic Syndromes

    Idiopathic generalized dystonia


    Dystonia-Plus: DOPA-responsive

    Metabolic Syndromes

    Biotinidase deficiency,
    Methylmalonic aciduria, Glutaric aciduria
    Pediatric neurotransmitters deficiencies

    Bilirubin Encephalopathy
    Potentially Treatable
    -Glucose transporter deficiency; Biotin Deficiency;
    DOPA-responsive, Homocystinuria; Wilson's D-se;

    You might also like