Differential Diagnosis. Anamnesis. Examination: EWMM Nederland - cursus Kiss

Transcription

1 Differential Diagnosis Anamnesis Pregnancy and birth Neurophysiological development Vegetative development Slow c.q. disturbed development Extra information other disciplins, Growing book Examination: Examination manual therapist X-ray results acc. to Gutmann Examination physiotherapist for children Complimantery examination

2 Differential diagnosis Genetic symptoms Central neurological symptoms Functional symptoms Most of the children that we examine and/or treat, show a combination of symptoms Robby Sacher Examination tests acc. Biedermann Observation spontanious motor functions Examination primitive reflexes Vojta tests

3 Abnormal test results with multiple causes: Cerebellum intact but under-developed Cerebral trauma Perinatal lesion myelum Perinatal lesion spinal chord Lesion peripheral nerve Neuro-muscular pathology Endocrine pathology Functional vertebrogenic versus central/spinal (Biedermann 2004) A good diagnosis depends on good communication between neurologists, pediatritions and manual therapists different disciplines see and talk from different perspectives

4 Classification acc. to Biedermann Osteopathological asymmetry Neuropathological cerebral asymmetry Neuropathological spinal asymmetry Myopathological asymmetry Fibropathological asymmetry Osteopathological asymmetry Infections (e.g. m. Grisel) Tumors in corpus vertebrae Congenital asymmetry (curved spine, blocked vertebrae) Dysplastic asymmetry (Neurofibromatosis) Vertebrae fracture with laesion substantia compacta Position asymmetry in the spine (f.e. KISS) Congenital disorders in the upper cervical region Axis: Atlas: Occiput: Atlas Axis fusion Irregular Atlas Axis segmentation Ossilicum terminal persistence Os odontoideum Dysplasy, Hypoplasy en Aplasia of the dens Spina bifida axis C2-C3 fusion Atlas asymmilation Atlas arch aplasy Atlas ring stenosis Open atlas arch Presence of occipital vertebre Basilar Impression Condylar Hypoplasy Very Moonen&Maarten Schmitt Oktober 1994

5 Neuropathological asymmetry e.g. laesion cerebral motor neurons Infantile Cerebral Paresis Other Cerebral Paresis meningitis/ drowning) Congenital neurological pathology (eg. Friedreich-ataxie, Charcot-Marie-Tooth atrophy) Neuro degenerative pathology (bv. Leukodystrofy) (eg. after Neuropathological asymmetry e.g. laesion spinal motor neurons Poliomyelitis acquired Myelopathy Myelitis Myelum tumor Asymmetry with vascular cause (A. spinal-anterior-syndrome) Congenital Myelodysplasy (bv. Myelomeningozele, Syringomyely, Tethered-cordsyndrome etc.) Spinal muscle atrophy (bv. Werdnig-Hoffmann syndroom, Kugelberg-Welander syndrome) Myopathological asymmetry Progressieve muscle atrophy (eg. m. Duchenne, m. Becker-Emery-Dreifuss) Congenital muscle dystrophy Congenital myopathy Metabolic myopathy

6 Fibropathological asymmetry Marfan Syndrome Ehlers-Danlos Syndrome Chromosom anomaly (eg. Trisomy 21) Spinal Tumor: early diagnosis is important Incidents: 5/ of which 10-20% in children More investigation required by: Inadequate trauma Late showing of symptoms Lots of treatment before final presentation Crescendo development of symptoms Wrong palpatory findings ( Wrong feeling therapeut) H. Biedermann/L. Koch 1996 m. Grisel Chronic tonsillitis rare in first year of life, from 2nd year more relevant symptoms: *AARF (atlantis axial rotation fixation) and a fixed torticollis *medical history of great imporance: *a short period of symptoms *no KISS-related symptoms *tonsillites/ ENT- symptoms

7 Absolute contra indications: Tumors Inflammatory processes b.v. m. Grisel Extreme hypermobility Extreme ossal malformation Trauma and instability naar Heiner Biedermann Relatieve contra indications: *Syndroms related to hypermobility (e.g. Downsyndrome) *Cervical fusion syndroms (m. Klippel-Feil) *Actual infections especially in ENT-region *Therapy for the spine in the previous two weeks Heiner Biedermann Heiner Biedermann

8 Heiner Biedermann Heiner Biedermann Heiner Biedermann

9 Heiner Biedermann Some Number - Crunching.. Number of treated patients in our practice in 2001 (3 M.Ds) 0 2 years 3 14 years 15 x year total: baby s & infants children adults

10 Catamnestic Study: Follow up interviews with families & pediatricians of 0-24 month old babies treated between (584 babies treated, 300 randomly sampled, 263 data sets). H.Biedermann: KiSS-Kinder: eine katamnestischeuntersuchung in: Manualtherapie bei Kindern. Indikationen & Erfahrungen; Enke, Stuttgart 1999 Primary Reason for Presentation Torticollis Skull Asymmetry Retarded Develoment Fixed lateral Pos. Fixed Retroflexion Restless, Sleep Problems Muscular Dystonia Muscular Hypotonia ,3% 12,6% 11,4% 27,8% 7,2% 5,3% 6,8% 5,3% beginning of the reaction day 2-3 days 4-5 days 1 week 2 weeks 3 weeks later

11 Treatment: appraisal of the parents v e r y g o o d g o o d s a t i s f a c t o r y a c c e p t a b l e u n s a t i s f a c t o r y b a d Number of treatments & more total ,9% 15,6% 1,5% 1,5% 100%