understanding the child with athetosis

UNDERSTANDING THE CHILD WITH ATHETOSIS

Robyn SmithDepartment of Physiotherapy

University of Free State2012

Athetoid groupNB!!! Characterised by: •Fluctuating postural/•muscle tone

•Involuntary movements

Do not confuse with ATAXIA = in co-ordinated movements

Athetoid group

Classified according to type of involuntary movement into 4 groups

• Pure athetosis

• Choreoathetosis

• Athetosis with dystonic spasms

• Athetosis with spasticity

A look at muscle tone in the athetoid group

Low tone Normal tone High tone

Pure athetosischoreoathetosisAthetoid with dystonic spasms

Athetoid with spasticity

Etiology

• Kericterus hyperbilirubinaemia (severe jaundice)

• Rh- incompatability• Prematurity • Asphyxia• Metabolic disorders• Encephalitis/ meningitis• Heavy metal poisoning• Rheumatic fever• Degenerative disorders brain

Management of jaundice

Etiology

NB!!!!! = damage to the basal ganglia

Basal ganglia are NB for:• Control of movement• Scale and amplitude determination of

movement• Important in the control of eye movements

Characteristics• High IQ –cortex not involved

However usually severely disabledEmotionally volatileOften frustrated –temper tantrums

• Lack of proximal stabilityPoor grading movementPoor balance

• Muscle contractures usually not a concernDue to constantly changing muscle tone and

movementRepetitive asymmetrical movement patterns may

lead to deformities

Characteristics

• Muscle tone fluctuates constantly– Inconsistent motor responses, child unsure of

outcome of an action

• General underlying hypotoniaLigament laxity Hypermobile

Athetoid

• Most are wheelchair bound• Need lap and/or cross straps in the case of

dystonic spasms to prevent the spasm from throwing them out of chair

• Adequate trunk and foot support is critical to their stability

Seating : Shona Madiba buggy

• Custom made to fit patient and meet specific support needs

• Cost extremely expensive R 8000

Associated problems

Speech & hearing

• Vocalisation & speech problem –speech poor and indistinct

• Often hearing loss • Can hear but does

not listen due constant movement head

Feeding

• Difficulty in swallowing due to muscle incoordination

• Battle especially with liquids and runny consistencies

• Extreme difficulty in feeding safely

Associated problemsVision• Battle to focus• May have nystagmus

= rapid, rhythmic, involuntary eye movements caused by damage brain

• Eyes unable move independently head

• Lack of stability of head affects vision

Development

• Fluctuating tone present sometimes birth

• Initially seem hypotonic• Develop extension

pattern head, neck, retraction shoulders

• Persistent ATNR• Due to involuntary

movements fail to develop adequate head and trunk control

Athetoid very intelligent and quickly learn to use pathological reflexes for function !!!!

Habitual patterns

Development

Prone

• ATNR get up on one arm

• TLR and STNR to get into M-sitting

Sitting

• Like to M-sit as is stable position

• Uses ATNR for hand function

• Chair –stabilises using arm around backrest or hooks foot around leg chair

• Promotes further asymmetry resulting postural deformity

Development

Gait

• Struggle to learn to walk due to fluctuating tone, poor central control and involuntary movement

• Asymmetry may be noted• Lumbar lordosis and anterior tilt due

to poor central control• Knees locked together for stability• Arm held together or against leg for

stability• Often appears in-coordinated

Treatment Principles

References

• Brown, E. 2001. NDT basic course material (unpublished)

• Smith, R. 2009. Paediatric dictate, UFS (unpublished)

• Smith, R. 2008. role of physiotherapy in vestibular rehabilitation, PowerPoint presentation

• Images courtesy of Google images (2009)