THE STRATEGIES FOR CONNECTION IN CHILDREN WITH CP

Transcription

1 2015 한국보바스소아학술대회 THE STRATEGIES FOR CONNECTION IN CHILDREN WITH CP KYOUNG SOOK PARK INSTRUCTOR

2 THE BOBATH CONCEPT The NDT/Bobath Concept offers a forward looking interdisciplinary problem solving approach to the assessment, treatment and management of any individuals with limited ability to fully participate in daily life due to impairment of motor (including tone and patterns of movement), sensory, perceptual and cognitive function resulting from a CNS disorder (From the Berlin Workshop, EBITA, 2004) Treatment is an interaction between therapist and patient where facilitation leads to improved function (IBITA 2005)

3 Bobath in 1990 s-based on Clinical Practice and Emerging Theory/Knowledge Preparation TEAMWORK Normal Postural Control Mechanism 1.Normal Postural tone 2.All degrees of reciprocal innervation 3.All patterns of movement (automatic reactions) For Function Aims of management 1.Increase skill repertoire 2.Maintain functional level 3.General Management THEORY 1.Tone = neural & non-neural 2.Dynamic interacting systems 3.Motor control theories: Feedback & feedforward 4.Central & peripheral mechanisms 5.Changed clinical picture T.I.Ps Tone reduction: neural And non-neural factors Inhibition Facilitation Stimulation Balance reactions as Part of task goal Essential elements for Function: problem solving Sensation Perception Cognition

4 MIDLINE / AXIS All kind of muscles of human act 100% their own movements when they are on correct alignment. (chain reaction)

5 POSTURAL CONTROL CONNECTION MIDLINE (ALIGNMENT, AXIS) KINEMATIC CHAIN (CHAIN REACTION) ENERGY CONSUMPTION

6 WHOLE BODY CONNECTION HEAD / EYE NECK DYNAMIC STABILITY SCAPULA & THORACIC SPINE PROXIMAL DYNAMIC STABILITY 3-DIMENSION PELVIC MOVEMENT WITHOUT or WITH BOS THE PELVIS MOVES onto THE HIP JOINT FOOT/ANKLE, TOE as a BOS HAND MOVEMENT POSTURAL TONE

7 THE STRATEGIES for NECK CONNECTION

8 CAPITAL FLEXION (Chin tuck)

9 Stabilizing the Neck Flexor group - Longus capitis - Longus colli Vertical Oblique superior /inferior

10 Longus colli Deep neck flexor Stabilizing the neck Make sure other muscles do their jobs ;UT, SCM, LS etc.

11 A1: Muscle Spindle in the Neck Autopsy from 16 individuals (C5~C7) Age from 4 to 77years Distribution, Morphology, and Density <Results> Longus colli has a high density of M.S. No change in spindle distribution, morphology, and density with aging

12 Proprioception in the Neck Longus colli: small tissue volume with many spindles Multifidus: large tissue volume with few spindles Upper cervical afferents the inferior olive& Cbll

13 Neck straightening Extensor group -Semispinalis capitis/cervicis -Splenius capitis /cervicis

14 Rectus capitis Posterior minor Obliquus Capitis superior Rectus capitis Posterior major Obliquus Capitis inferior Suboccipital stretching to help inhibit hamstring tightness and improve hip flexion range of motion. The suboccipital muscles play an important role in movement of the head, posture, and function of the entire body.

15 A2: Muscle spindle in Sub-occipital Muscles From stillborn human fetus within 24 to 48 <Results> Deep cervical muscles have high spindle content The oblique muscles have significantly higher spindle density Muscle belly > polar regions No tendon organs were found in any suboccipital muscles

16 Density of muscle spindle in the Sub-occipital muscles Sub-occipital m. proprioceptive (with vestibular&oculomotor afferent Thalamus Cortex

17 Proprioceptive inputs from dorsal cervical musculature play Important role in head-eye coordination and postural control Small flexion of upper cervical joints cause major changes in firing rate of spindle afferents from peri-vertebral muscles As sensors and monitors of joint position and movements of craniovertebral joints The neck is regarded as an important proprioceptive organ for postural processes

18 Capital flexion

19 CLINICAL PICTURE

20 NECK FLEXION VS CHIN TUCK

21

22 WHOLE BODY CONNECTION HEAD / EYE NECK DYNAMIC STABILITY SCAPULA & THORACIC SPINE PROXIMAL DYNAMIC STABILITY 3-DIMENSION PELVIC MOVEMENT WITHOUT or WITH BOS THE PELVIS MOVES onto THE HIP JOINT POOT/ANKLE, TOE as a BOS HAND MOVEMENT POSTURAL TONE

23 PROXIMAL DYNAMIC STABILITY OPTIMAL NECK AXIS CORE MUSCLES :Transverse, rectus abdominis, Obilique abdominis 3-DIMENSIONAL MOVEMENT OF THE PELVIS :Gluteal group PELVIS MOVES ON BOTH THE HIP JOINTS :It requires adequate angle of both hip joint :Adductors, Quadriceps, TFL, Hamstrings BASIS OF CONNECTION TO LEGS

24 THE STRATEGIES for HIP CONNECTION

25 RECRUITMENT of MOTOR UNIT

26 ROLE OF GLUTEAL GROUP The gluteal muscles (gluteus maximus, gluteus medius and gluteus minimus) stabilize the hip by counteracting gravity s hip Weak glutes plus short/tight quadriceps/psoas and resulting back pain The gluteus maximus plays an important role in maintaining an upright standing position the gluteal muscles will re-establish correct muscle recruitment patterns

27 CLINICAL PICTURE I

28 CLINICAL PICTURE II

29 CLINICAL PICTURE III

30

31

32

33

34

35 THE STRATEGIES for ANKLE CONNECTION

36

37 POSTURAL CONTROL in CHILDREN CORE STABILIZATION NECK STABILIZATION & GUIDE CONNECTION FROM HEAD TO FEET CHANGE OF MUSCLE DIRECTION :proximal distal DISTAL STABILIZATION (ESP. ANKLE & FOOT) APA

38 Development of anticipatory postural adjustments Top-down (neck-trunk-l/e) When starts APAs? -independent sitting Reactive rather than prospective adjustments Gradually establish prospective control

39 1) Reaching in independent sitting - Neck extensor- trunk extensor-deltoid 2) Standing(4groups) :Reactive postural control pulling to stand(10m) standing alone(11m) walking onset(12m) Anticipatory postural control-walking mastery 3) Independent walking -Anticipatory lateral weight shifts before initiation gait

40 Development of Muscle synergies

41

42 실험 Participants Task 34명의 infants - healthy, full-term infants(>38weeks) 6명 : 10m 6명 : 11m 6명 : 13m 4명 : 14m 6명 : 15m 6명 : 16-17m

43 Results 1. Age changes in Anticipatory activity of postural muscles

44 THE ANKLE Connection for bipedal Guides L/E & proximal part in sitting, stand up, standing and walking Dynamic ankle stability (Distal stabilization) Ankle works for increasing stability just same as chin tuck Ankle strategy works for maintain posture dynamically

45 ANKLE AND FOOT The complete somato-sensation generates 100% ankle movements in standing The ankle is the most strongest posture keeper Outstanding of tendons on anterior part of the ankle Outstanding of interosseus of the foot Tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.

46

47 CLINICAL PICTURE

48

49

50