Escolar Documentos
Profissional Documentos
Cultura Documentos
FOR
CEREBRAL PALSY Deborah Gaebler-Spira
XIII International ORITEL Conference
Foundational and First General Assembly
of the Latin American Academy on Child
Development and Disability
9/2/11
2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
2
OBJECTIVES
CP - descriptors
The context of the ICF
Classifications and relationships
How this moves us forward together
LETS START
What do parents ask about?
Diagnosis - what does my child have?
Function - what can my child do?
CEREBRAL PALSYDEFINITION-BAX-2001
Disorder of movement and posture resulting from a
condition of non-progressive brain damage that
occurred in infancy
Abnormality of tone
Inclusive-many etiologies
Brain lesion is static-musculoskeletal system changes
9/2/11
2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
Cerebral
Palsy
Spastic
Dyskinetic
Ataxic
Bilateral
Unilateral
Hypokinetic
Hyperkinetic
Diplegic
Quadriplegic
Triplegic
Hemiplegic
Dystonic
Choreoathetosis
TOPOGRAPHY
Hemiplegia
Diplegia
Quadraplegia
Triplegia
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
NEW/WHO/ICF
Health Condition
(disorder or
disease)
Body Functions
& Structures
Environmental
Factors
Activities
Participation
Personal Factors
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
GMFCS
The Gross Motor Classification System
Developed to classify severity of functional
limitation/disability in children with cerebral palsy.
Ages birth to 12 years
Not to be used as a diagnostic tool- describes gross motor
function with an emphasis on movement initiation, sitting
control and walking.
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
GMFCS
Reliable method of classifying based on function
Inherent meaning to families-therapists-physicans
Usual performance
FUNCTIONAL CLASSIFICATION OF CP
GMFCS
Stratification according to functional level
Observed at ages 2-12
GMFCS E&R
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
GMFCS LEVELS
GMFCS LEVELS
GMFCS LEVELS
GMFCS LEVELS
GMFCS LEVELS
ARM PLACEMENT
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
MACS
I.
II.
Handles most objects but with somewhat reduced quality and/or speed of
achievement
III.
Handles objects with difficulty; needs help to prepare and/or modify activities. The
performance is slow and achieved with limited success regarding quality and quantity.
Activities are performed independently if they have been set up or adapted.
IV.
V.
Does not handle objects and has severely limited ability to perform even simple actions.
Requires total assistance
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
Conversation. Voice may be breathy or harsh sounding but does not impair intelligibility.
Articulation is imprecise; most consonants are produced, but deterioration is noticeable in longer
utterances. Although difficulties are noticeable, speech is usually understandable to unfamiliar
listeners out of context.
Speech is unclear and not usually understandable to unfamiliar listeners out of context.
Difficulties controlling breathing for speech can produce one word per utterance and/or speech
is sometimes too loud or too quiet to be understood. Voice may be harsh sounding; pitch may
change suddenly. Speech may be markedly hyper nasal. A very small range of consonants are
produced. The severity of the difficulties makes the speech difficult to understand out of context.
No understandable speech.
EDACS
I - Eats safely and efficiently
II - Eats and drinks safely but have limitations to efficiency
III - Eats and drinks safely but have limitations to efficiency
and safety
IV - Eats and drinks with significant safety issues
V - Unable to eat safely-G tube
E a tin g a n d D r in k in g A b ility C la s s if ic a t io n S y s te m - A lg o r it h m
Is th e in d iv id u a l
a b le t o s w a llo w
f o o d a n d d r in k
w ith o u t r is k o f
a s p ir a tio n ?
Is th e in d iv id u a l a b le
Yes
to b ite a n d c h e w o n
h a rd lu m p s o f fo o d
w ith o u t a ris k o f
c h o k in g ?
Is th e in d iv id u a l
a b le to e a t a m e a l
in th e s a m e tim e
as p eers?
Yes
L evel I
E a ts a n d d rin k s
s a f e ly a n d
e f f ic ie n t ly
Yes
No
Yes
No
No
L e v e l III
E a ts a n d d r in k s
w it h s o m e
lim it a t io n s t o
sa fe ty ; th e re m a y b e
lim it a t io n s t o
e f f ic ie n c y.
L e v e l IV
E a ts a n d d rin k s w ith
s ig n ific a n t
lim ita t io n s to s a f e t y.
C a n r is k s o f
a s p ir a t io n b e
m a n a g e d to
e lim in a te h a r m t o
th e in d iv id u a l?
No
L evel V
U n a b le to e a t o r
d r in k s a fe ly t u b e
f e e d in g m a y b e
c o n s id e r e d to
p r o v id e n u tr it io n .
L e v e l II
E a t s a n d d r in k s
s a fe ly b u t w ith
s o m e lim it a t io n s
t o e f fic ie n c y.
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2 A Neural Interface for Artificial Limbs: Targeted Muscle Reinnervation
ICF
Activity
(Limitatio
n)
GMFCS,FM
S
MACS
,
CFCS,EADS
C,.
Environmental Factors
Participatio
n
(Restriction
)
Daily Living
activities,
Social roles in
community
(children, student,
friends,etc.)
WeeFIM
Personal Factors
PEDI etc.
OPTIMIZES MANAGEMENT
Sharpens aligns focus on function versus impairments
More useful than severity, type and distribution
INTERVENTION PLANNING
Assists with realistic goal therapy setting
Children with GMFCS 3 community wheelchair
GMFCS 3,4-use walker part time
GMFCS 5 limited self mobility
90%offinalGMFachieved
THERAPY INTERVENTIONS
Secondary impairments vary with GMFCS level
Endurance, fatigue, weakness can target better
interventions for groups
Supports evidence based research
IN A VARIABLE DISORDER-ALLOWS-CLINICIANSPARENTS
Common language
Common groupings
Common Goals