Introduction%20Questions%20and%20Answers - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Introduction%20Questions%20and%20Answers

Description:

A Paediatrician is a doctor who specialises in the care of children. ... Port wine stain on face (cutaneous angioma) Epilepsy in 80 ... – PowerPoint PPT presentation

Number of Views:21
Avg rating:3.0/5.0
Slides: 45
Provided by: jboth
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Introduction%20Questions%20and%20Answers


1
IntroductionQuestions and Answers
  • Dr Janice Bothwell
  • Consultant Paediatrician
  • Belfast HSCT

2
Objectives
  • Role of Paediatrician in management of children
    with hemiplegia
  • Multidisciplinary team
  • Some questions parents have when told their
    child has a hemiplegia
  • Other questions?

3
What is the role of the doctor ?
  • A Paediatrician is a doctor who specialises in
    the care of children.
  • Neurodevelopmental Paediatricians specialise in
    the care of children with developmental disorders
    and/or medical conditions such as hemiplegia
    which can affect the development of skills in a
    growing child
  • Neurologists specialise in children who present
    with neurological conditions such as hemiplegia

4
Assessment process
  • Unidisciplinary
  • Multidisciplinary

5
Medical Assessment
  • History of pregnancy, birth, family history,
    significant illnesses, any injuries sustained,
    medications taken, developmental progress,
    educational history
  • Physical examination
  • - examination of heart, lungs, abdomen, central
    and peripheral nervous system, hearing and vision
  • - height and weight

6
Developmental Assessment
  • Gross Motor Skills
  • Fine Motor Skills
  • Speech and Language ability to both speak and
    understand language
  • Personal and social skills
  • Cognitive ability

7
Child development team
Speech Language therapist
Dentist
Doctor
Child
Physiotherapist
Occupational therapist
Social Worker
8
Investigations
  • Neuroimaging
  • Blood investigations
  • EEG
  • Hearing tests
  • Vision tests

9
Diagnosis - Hemiplegia
  • Congential
  • Acquired

10
What questions do parents ask when their child is
diagnosed with hemiplegia?
11
What does hemiplegia mean?
  • Paralysis of one side of the body resulting from
    disease or injury to the motor centres of the
    brain.

12
My child has hemiplegia does this mean he/she has
cerebral palsy?
  • Cerebral palsy is an umbrella term covering a
    group of non-progressive but often changing
    motor-impairment syndromes secondary to anomalies
    or lesions in the brain
  • These anomalies or lesions can be
    prenatal/perinatal/postnatal in origin
  • Hemiplegic CP is classified as a unilateral motor
    disability

13
What is a Congenital Hemiplegia?
  • A congenital hemiplegia is one which occurs as a
    result of a prenatal/perinatal or early postnatal
    problem (lt28 days after birth).

14
What went wrong?
  • Three main processes can occur, each occur at
    different developmental stages during
    pregnancy/birth
  • - cerebral malformations originating early in
    the pregnancy
  • - periventricular lesions mainly arising during
    24 34 weeks (either during pregnancy or after a
    preterm birth)
  • - cortical infarctions occurring just before or
    around the time of a term birth

15
What does a normal brain look like?
16
What are cerebral malformations?
  • All malformations originate from early fetal life
  • Neuronal migration disorder
  • - agyria or lissencephaly at early stage
  • - schizencephaly and pachygyria at later stage
  • - heterotopias and polymicrogyria at later
    stages (up to 30 weeks gestation)

17
What do these conditions look like on MRI?
lissencephaly
schizencephaly
polymicrogyria
18
What are periventricular lesions?
  • During the period between 24th and 34th week of
    gestation the brain is very vulnerable to
    bleeding
  • As a result periventricular leukomalacia or
    periventricular haemorrhagic infarctions can
    develop which may result in a congenital
    hemiplegia

19
What does this look like on a scan?
20
How can this cause hemiplegia?
A simplified diagram to show how the corticspinal
tracts can be affected by PVL and hydrocephalus
21
What are cortical infarctions?
  • Cortical infarctions occur around term and are
    caused by ischaemia (lack of oxygen and/or blood
    flow to part/parts of brain tissue).
  • This is actually the least common type

22
What does this look like?
23
My child has a congenital hemiplegia why were
there no signs when he/she was born?
  • Clinical signs of a hemiplegia may not be evident
    until the child is old enough to use the affected
    limb.
  • The child may show signs such as being slower to
    crawl, pull to stand, walk or may develop hand
    dominance at a very early age.

24
What else can you tell me about congenital
hemiplegia?
  • This affects about 4 babies per 10,000
  • Its more common in males 1.41
  • R sided hemiplegia is more common

25
What is an acquired hemiplegia?
  • An acquired hemiplegia is a weakness which
    develops in a child who has previously been well
  • Acute
  • Chronic progressive

26
What is an acute hemiplegia?
  • This is a sudden onset of one sided weakness
    which can be associated with seizures

27
What causes an acute hemiplegia?
  • An acute hemiplegia can have a number of causes.
  • A brief outline of some of the causes will be
    given

28
What is an alternating hemiplegia?
  • This is a hemiplegia which appears and any time
    from birth to 54 months.
  • The initial signs are mild delay in your childs
    development
  • This may be followed by abnormal positioning of
    your childs limbs or weakness of one side and
    can be associated with jerking movements of the
    eyes

29
How long does the hemiplegia last for?
  • In alternating hemiplegia the duration varies
    from minutes to days and the seriousness of
    symptoms can vary.
  • The side affected with weakness can alternate and
    the arm is usually more affected than the leg.
  • Hemiplegia is also noted to disappear with sleep
    and reappear on wakening

30
Will a child recover from alternating hemiplegia?
  • After each episode the child may recover to a
    degree, but after multiple episodes the child may
    have learning difficulties and possibly lose some
    skills
  • Medications can be used with various degrees of
    success

31
My child has been diagnosed as having a stroke
why?
  • There are many reasons why a child will have a
    stroke which results in a hemiplegia.
  • These reasons can include clotting problems,
    heart disease, trauma, infections, vascular
    problems, tumours

32
What investigations will doctors do to identify
why?
  • Investigations include multiple blood
    investigations, urine sampling, heart scans,
    brain scans

33
What do strokes look like on a scan?
34
Can infection cause hemiplegia?
  • An acute hemiplegia can be caused by brain
    infections such as meningitis or encephalitis
  • Infection which causes hemiplegia is also usually
    associated with seizures

35
What causes progressive hemiplegias?
  • Progressive hemiplegias can be caused by
  • AV malformations
  • Brain abscesses
  • Tumours
  • Demyelinating disease
  • Sturge Weber syndrome

36
What is Sturge Weber syndrome?
37
What are the signs of Sturge Weber syndrome?
  • Port wine stain on face (cutaneous angioma)
  • Epilepsy in 80
  • Hemiplegia evident in 50 affecting limbs on side
    opposite to facial signs

38
We have a diagnosis of hemiplegia what other
problems may be present?
  • Children with hemiplegia may also have
  • Learning disability (1 in 5 children)
  • Epilepsy present in 25 to 33 of children
  • Vision significant problems rare but squints and
    refraction errors are common
  • Hearing most often normal
  • Speech is well preserved

39
Who should be involved with my child after
diagnosis?
Voluntary agencies
Paediatrician
Orthopaedic surgeon
Neurologist
Child
Occupational therapist
Physiotherapist
Educational Psychologist
40
How do we treat hemiplegia?
  • Main treatment aims are
  • Child will walk and aims of treatment are to
    maximise efficiency and look of walking
  • The arm can be very often ignored by the child so
    early awareness of its use and encourage use of
    this limb is important. This should be combined
    with improvement of efficiency and look
  • Monitor spine

41
Is early treatment important?
  • Yes to ensure
  • Greater symmetry of posture and movement
  • Develop an awareness of affected side
  • Prevention of fixed deformity
  • Provide support for families

42
Are there any surgical or medical treatment
available?
  • Yes surgical treatments are offered by the
    orthopaedic surgeons to correct deformities or to
    improve limb function
  • Medical treatment includes treatment for
    spasticity (tight muscles) this includes
    baclofen, diazepam
  • Botulinum toxin now used as injection form to
    help spastic limbs

43
What other therapeutic options are there?
  • Numerous need to look at evidence base for
    effectiveness

44
Any other questions ????
About PowerShow.com