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4.3.11 – Neuromusculoskeletal and movement-related functions

A number of important and unique issues are involved when caring for children with impairments related to movement and coordination. The rehabilitation provider needs to consider:

  • Presence of encephalopathy and developmental delay
  • Spinal and corticospinal tract degeneration in children
  • Peripheral neuropathy in children
  • Muscle weakness due to atrophy
  • Joint pain due to infection (e.g., septic arthritis)

Red Flag: Any acute loss of previously mastered skills or fluctuations in levels of consciousness require urgent medical assessment.

Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 4.3.11: Clinical Aspects of Movement and Coordination Impairments

Impairment Possible etiologies Rehabilitation interventions
Generalized Hypotonia (low tone) and Delayed Achievement of Motor Milestones

Cerebral vascular disease

Vasculitis

  • Promote motor activity through play, positioning, and handling (e.g. neurodevelopmental therapy)
  • Develop muscle strength and transitional movements
  • Use infant seats or chair inserts or a cardboard box (to promote sitting)
  • Have infant in a variety of physical positions with only enough support to provide appropriate positioning (e.g. sitting, supine, lying prone, on side, supported standing)
Hypertonicity

Cerebral vascular disease

Vasculitis

HIV-related spinal or corticospinal tract degeneration

Wallerian degeneration from white matter disease

Stroke

Spinal cord infections (e.g., CMV, HSV)

Malignancies (e.g., lymphoma)

  • Use tone-inhibiting positioning and handling
  • Use splints or ankle foot orthoses
  • Promote motor activity through play, positioning, and handling (e.g. neuro-developmental therapy)
  • Develop muscle strength and transitional movements
  • Refer to a specialist for specific appropriate therapies, e.g. Botulinum toxin A, oral anti-tone treatments, surgical interventions

 Problems of Limited Mobility

  • Use of a wheelchair (with seating insert if required)
  • Practice selective muscle strengthening, maintaining range of motion
  • Practice gait re-training
  • Practice balance re-education
  • Practice transfers and transitional movements
  • Assess for walking aids, splints, orthoses
  • Use hot packs/ice packs as indicated for stiff painful joints (use with caution with children)

Loss of Independence in Self-Care

  • Install adaptations to home or school (e.g. bath seat, ramps, handrails)
  • Use diapers or special toilet seat
Weakness

Myopathy

AZT-related

HIV infection-related

Peripheral neuropathy

Drug-induced (e.g., AZT, ddl, d4T)

  • All children should be screened for peripheral neuropathy. Do not wait for complaints about altered sensation.
  • Assess children’s balance and proprioception
  • Monitor children’s gait pattern
  • A programme consisting of deep pressure and/or vibration, balance and gait re-education as well as proprioceptive training is advised.

Legend: AZT: zidovudine; CMV: cytomegalovirus; CNS: central nervous system; ddI: didanosine; HSV: herpes simplex virus