DOCSLIB.ORG

Cerebral-Palsy-Feeding Executive

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cerebral-Palsy-Feeding Executive Comparative Effectiveness Review Number 94 Effective Health Care Program Interventions for Feeding and Nutrition in Cerebral Palsy Executive Summary Background Effective Health Care Program Cerebral palsy (CP) is a “group of disorders of the development of The Effective Health Care Program movement and posture, causing was initiated in 2005 to provide activity limitation, that is attributed to valid evidence about the comparative non-progressive disturbances that effectiveness of different medical occurred in the developing fetal or interventions. The object is to help infant brain. The motor disorders of consumers, health care providers, cerebral palsy are often accompanied and others in making informed by disturbances of sensation, cognition, choices among treatment alternatives. communication, perception, and/or Through its Comparative Effectiveness behaviour, and/or by a seizure disorder.”1 Reviews, the program supports This group of syndromes ranges in systematic appraisals of existing severity and is the result of a variety scientific evidence regarding of etiologies occurring in the prenatal, treatments for high-priority health perinatal, or postnatal period. Though conditions. It also promotes and the disorder is nonprogressive, the generates new scientific evidence by clinical manifestations may change over identifying gaps in existing scientific time as the brain develops, with other evidence and supporting new research. neurologic impairments frequently The program puts special emphasis co-occurring.1,2 on translating findings into a variety of useful formats for different More than 100,000 children are estimated stakeholders, including consumers. to be affected with CP in the United States. Due to advances in supportive The full report and this summary are medical care, approximately 90 percent available at www.effectivehealthcare. of children with CP survive into ahrq.gov/reports/final.cfm. adulthood, resulting in an additional estimated 400,000 adults living with CP in the United States.3-8 Lifetime costs are estimated to be nearly $1 million per person.9 Effective Health Care 1 Classification and Spectrum of Disorder feeding process may require considerable time and may be associated with stress and caregiver fatigue16; stress and CP includes a spectrum of disorders of movement, posture, fatigue may in turn affect the feeding process.17 A number and coordination with heterogeneous etiologies. The of feeding and oral-motor intervention strategies have been diversity of the clinical features is reflected in multiple developed to address difficulties with sucking, chewing, classification systems that include reference to type of swallowing, and improve oral-motor skills. Strategies motor dysfunction, body parts affected, severity, and include oral sensorimotor management, positioning, oral functional abilities. Further classification is by severity appliances, food thickeners, specialized formulas, and level (mild, moderate, severe), and gross motor function, neuromuscular stimulation. These interventions address which reflects the functional capabilities of the affected.10,11 different aspects of feeding difficulties, reflecting the range Developed in the late 1990s, the Gross Motor Function in specific problems associated with feeding and nutrition Classification System (GMFCS) outlines a standardized in CP. Sensorimotor techniques seek to strengthen oral- system for classifying motor function based on constructs motor control and counteract abnormal tone and reflexes of disability and functional limitation.12 The GMFCS to improve oral feedings, and typically require months includes levels that reflect abilities ranging from walking of daily application. Positioning techniques address poor without limitations (level I) to severe head and trunk postural alignment and control that exacerbates swallowing control limitations requiring extensive use of assisted difficulties, and include stabilizing the neck and trunk. technology, physical assistance, and a wheelchair Positioning interventions are individualized and often (level V). Table A summarizes criteria used in widely guided by video-fluoroscopy to optimize swallowing. Oral accepted classification systems. appliances have been used to stabilize the jaw, improve The epidemiologic Oxford Feeding Study reported sucking, tongue coordination, lip control, and chewing. significant correlations between severity of motor Multiple approaches may be used in children with growth impairment and feeding problems including choking, failure. For children with moderate to severe aspiration underweight, prolonged feeding times, vomiting, and need or malnutrition related to oral-pharyngeal dysphagia 13 for gastrostomy feeding (p values typically <0.005). and GER, surgical interventions with gastrostomy (tube Although CP is a motor disorder, many children and feeding directly into the stomach) or jejunostomy tubes adults with CP are affected by other developmental (tube feeding into the middle portion of the small intestine, disabilities, including intellectual disability, impaired the jejunum) and antireflux procedures are often deemed vision and hearing, language and behavioral disorders, and necessary to improve nutritional status and reduce risk of 11,14,15 epilepsy. Survival and quality of life vary across the chronic aspiration.16,18 spectrum of CP, but both are associated with severity and functional disabilities, as well as comorbid conditions.15 No uniform decision pathway exists for deciding when a child should move from oral feeding to enteral Feeding Difficulties and Interventions tube feedings, but there is general consensus.19 If oral Individuals with CP frequently have feeding and calorie intake is insufficient to maintain growth, there is swallowing problems that may lead to poor nutritional increased risk or occurrence of aspiration into the lungs, status, growth failure, chronic aspiration, esophagitis, and or the level of work necessary to maintain adequate respiratory infections. Across the cerebral palsy spectrum, caloric intake orally by the individual and the caregiver poor nutritional status is caused by distinct pathways is excessive, then a medical provider may recommend ranging from inadequate intake, oral dysphagia, oral- enteral tube feedings (see Glossary). The method of pharyngeal dysphagia, gastroesophageal reflux, chronic tube feeding is based on the likely time span needed for aspiration, and behavioral etiologies. Some patients with tube supplementation, the availability of an experienced oral-pharyngeal dysphagia and gastroesophageal reflux surgeon, and specific symptoms of the child. For example, (GER), particularly those with severe CP, are also at a child may be considered too medically fragile for risk for recurrent aspiration, which can lead to chronic surgery, so a nasal tube may be used for a time, which pulmonary disease. Patients with feeding difficulties range may be advanced beyond the stomach into the jejunum to from those with self-feeding skills to populations with reduce gastroesophageal reflux, then later replaced with severe disability (GMFCS V) who require extensive use a surgically placed tube. A gastric fundoplication may be of assisted technology and are dependent on others to feed included to reduce GER, if needed in the judgment of the them. Caregiver burden is a significant concern as the surgeon. 2 Table A. CP classification systems used and understood by qualified medical practitioners* Gross Motor Function Severity Level Topographical Distribution Motor Function Classification System • Mild: Child can move without • Monoplegia/monoparesis means only • Spastic: Implies increased muscle The GMFCS uses head control, movement assistance; his or her daily one limb is affected. It is believed tone. Muscles continually contract, transition, walking, and gross motor skills activities are not limited. this may be a form of hemiplegia/ making limbs stiff, rigid, and resistant such as running, jumping, and navigating hemiparesis where one limb is to flexing or relaxing. Reflexes can inclined or uneven surfaces to define a child’s • Moderate: Child will need significantly impaired. be exaggerated, while movements accomplishment level. The goal is to present braces, medications, and tend to be jerky and awkward. Arms an idea of how self-sufficient a child can be adaptive technology to • Diplegia/diparesis usually indicates and legs often affected. Tongue, at home, at school, and at outdoor and indoor accomplish daily activities. the legs are affected more than the mouth, and pharynx can be affected, venues. arms; primarily affects the lower body. • Severe: Child will require as well, impairing speech, eating, • GMFCS Level I: Walks without limitations. a wheelchair and will have • Hemiplegia/hemiparesis indicates the breathing, and swallowing. Spastic CP significant challenges in arm and leg on one side of the body is is hypertonic and accounts for 70% • GMFCS Level II: Walks with limitations. accomplishing daily activities. affected. to 80% of CP cases. The injury to the Limitations include walking long distances and balancing, but not as able as Level I to run • No CP: Child has CP signs, • Paraplegia/paraparesis means the brain occurs in the pyramidal tract and or jump; may require use of mobility devices but the disorder was acquired lower half of the body, including both is referred to as upper motor neuron when first learning to walk, usually prior to after completion of brain legs, are affected. damage. age 4; and
Load more

Recommended publications
  • Influence of Gestational Age on the Type of Brain Injury and Neuromotor Outcome in High-Risk Neonates
    Eur J Pediatr DOI 10.1007/s00431-007-0629-2 ORIGINAL PAPER Influence of gestational age on the type of brain injury and neuromotor outcome in high-risk neonates Christine Van den Broeck & Eveline Himpens & Piet Vanhaesebrouck & Patrick Calders & Ann Oostra Received: 16 July 2007 /Accepted: 4 October 2007 # Springer-Verlag 2007 Abstract This study was an investigation of a possible periventricular leukomalacia, 24% intraventricular hemor- correlation between either the gestational age (GA) and rhage and 18% persistent flares. There was a significant type of brain injury or between the gestational age and type, correlation between the GA and type of brain injury (P< distribution and severity of cerebral palsy (CP). Four 0.001; Cramer’s V=0.76) and between the GA and type (P= hundred sixty-one children with a birthweight ≥1250 g 0.004; Cramer’s V=0.47) and distribution (P<0.001; and GA ≥30 weeks with a complicated neonatal period and/ Cramer’s V=0.55) of CP. There was no significant correla- or brain injury on serial cerebral ultrasound were selectively tion between the GA and severity of CP. The type of brain followed at the regional Center for Developmental Disor- injury detected by serial ultrasound during the neonatal ders. The children were divided into a preterm and term period, as well as the type and location of CP detected group. There were 40 children with cerebral palsy in the during later childhood, are all GA-dependent in at-risk preterm group and 38 children with cerebral palsy in the newborn infants with a birthweight of ≥1,250 g and term group.
    [Show full text]
  • WCN19 Journal Posters Part 2 Revised V1
    JNS-0000116542; No. of Pages 131 ARTICLE IN PRESS Journal of the Neurological Sciences (2019) xxx–xxx Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns WCN19 Journal Posters Part 2 revised_V1 WCN19-2260 WCN19-2269 Poster shift 01 - Channelopathies /neuroethics /neurooncology / Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Part I /stroke /training in neurology - Part I and traumatic brain injury injury Numb chin syndrome- The first finding in metastatic malignancy Results of surgical treatment in patients with moyamoya disease considering CT-perfusion imaging study N. Mustafayev, A. Bayrakoglu, F. Ilgen Uslu, M. Kolukısa Bezmialem University, Neurology, Istanbul, Turkey O. Harmatinaa, V. Morozb, I. Skorokhodab, I. Tyshb, N. Shahinb,R. Hanemb, U. Maliarb a Numb chin syndrome (NCS) is a sensory neuropathy of the SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», mental nerve, which is accompanied by hypoesthesia and paresthe- Neuroradiology Department, Kyiv, Ukraine b sia of the jaw and lower lip. Although being well known in neurology SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», practice, most of the physicians who have not experienced this Emergency Department of Vascular Neurosurgery, Kyiv, Ukraine phenomenon are unaware of this phenomenon since it is rare and can be confused with somatic complaints. This case report aims to Aim point out that NCS may be the first sign and symptom of metastatic To improve the results of surgical treatment of patients with cancers in patients who are not diagnosed.
    [Show full text]
  • Hepatic Myelopathy: Case Report And
    LIVER RESEARCH ISSN 2379-4038 http://dx.doi.org/10.17140/LROJ-1-108 Open Journal Case Report Hepatic Myelopathy: Case Report and *Corresponding author Review of the Literature Hua Hong Department of Neurology First Affiliated Hospital Huanquan Liao1#, Zhichao Yan2#, Wei Peng3# and Hua Hong1* Sun Yat-Sen University No. 58 Zhongshan Road 2 #These authors contributed equally. Guangzhou 510080, P.R. China Tel. +008615920500906 1 Fax: +00862087331989 Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou E-mail: [email protected] 510080, P.R. China 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen Univer- Volume 1 : Issue 2 sity, Guangzhou 510060, Guangdong, P.R. China 3 Article Ref. #: 1000LROJ1108 Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, P.R. China Article History Received: August 5th, 2015 ABSTRACT Accepted: August 12th, 2015 Published: August 12th, 2015 Background: Hepatic Myelopathy (HM) is a rare complication of chronic liver disease usually associated with extensive portosystemic shunt of blood, which has been created surgically or has occurred spontaneously, causing progressive spastic paraparesis. Some single cases or short Citation clinical reports describing patients suffering from HM have been published worldwide, but are Liao H, Yan Z, Peng W, Hong H. He- patic myelopathy: case report and re- often scattered. view of the literature. Liver Res Open Material and method: One additional case of HM with typical symptoms was presented, and J. 2015; 1(2): 45-55. doi: 10.17140/ a retrospective survey of the literature in a manner of comprehensive review was undertaken.
    [Show full text]
  • A Dictionary of Neurological Signs
    FM.qxd 9/28/05 11:10 PM Page i A DICTIONARY OF NEUROLOGICAL SIGNS SECOND EDITION FM.qxd 9/28/05 11:10 PM Page iii A DICTIONARY OF NEUROLOGICAL SIGNS SECOND EDITION A.J. LARNER MA, MD, MRCP(UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. FM.qxd 9/28/05 11:10 PM Page iv A.J. Larner, MA, MD, MRCP(UK), DHMSA Walton Centre for Neurology and Neurosurgery Liverpool, UK Library of Congress Control Number: 2005927413 ISBN-10: 0-387-26214-8 ISBN-13: 978-0387-26214-7 Printed on acid-free paper. © 2006, 2001 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dis- similar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to propri- etary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omis- sions that may be made.
    [Show full text]
  • Spectrum of Nontraumatic Myelopathies in Ethiopian Patients: Hospital-Based Retrospective Study
    Spinal Cord (2016) 54, 604–608 & 2016 International Spinal Cord Society All rights reserved 1362-4393/16 www.nature.com/sc ORIGINAL ARTICLE Spectrum of nontraumatic myelopathies in Ethiopian patients: hospital-based retrospective study NJ Fidèle1 and A Amanuel2 Study design: This is a retrospective hospital-based study. Objectives: The study aimed at a better understanding of the etiology, clinical presentation and treatment outcome of nontraumatic myelopathies in Ethiopian patients. Setting: Etiologies of nontraumatic myelopathies have not been evaluated extensively in most sub-Saharan African countries. The available studies in this region were conducted before the widespread clinical use of modern neuroimaging modalities. This study was conducted in Addis Abba, Ethiopia. Methods: We retrospectively analyzed medical files of patients with a diagnosis of myelopathy (age ⩾ 13 years) admitted or followed up at Tikur Anbesa Hospital between 1 January 2010 and 30 June 2013. Results: Records of 105 patients were analyzed. The male to female ratio was 1.7. The mean age was 38.5 years. Weakness, sensory symptoms (including sensory level), back pain and sphincter dysfunction were the dominant features. Etiologies were dominated by spinal tuberculosis (23.8%) followed by spinal cord neoplastic lesions (primary (10.5%) and secondary neoplasms 8.6%). Other important etiological causes were transverse myelitis (16.2%), degenerative cervical spondylotic myelopathy (15.2%), amyotrophic lateral sclerosis (4.8%) and neuromyelitis optica/multiple sclerosis (3.8%). The mortality rate was 9.5%. Among the patients who died, 40% had chest infection as a complication and 70% presented with complete weakness. Conclusion: Infections remain a major cause of spinal cord disease, and tuberculosis constitutes public health target for reducing the incidence of myelopathies.
    [Show full text]
  • A Dictionary of Neurological Signs.Pdf
    A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A.J. LARNER MA, MD, MRCP (UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. 123 Andrew J. Larner MA MD MRCP (UK) DHMSA Walton Centre for Neurology & Neurosurgery Lower Lane L9 7LJ Liverpool, UK ISBN 978-1-4419-7094-7 e-ISBN 978-1-4419-7095-4 DOI 10.1007/978-1-4419-7095-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010937226 © Springer Science+Business Media, LLC 2001, 2006, 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Pediatric Orthopedics in Practice, DOI 10.1007/978-3-662-46810-4, © Springer-Verlag Berlin Heidelberg 2015 880 Backmatter
    879 Backmatter Subject Index – 880 F. Hefti, Pediatric Orthopedics in Practice, DOI 10.1007/978-3-662-46810-4, © Springer-Verlag Berlin Heidelberg 2015 880 Backmatter Subject index Bold letters: Principal article Italics: Illustrations A Acetylsalicylic acid 303, 335 Adolescent scoliosis Amyloidosis 663 Acheiropodia 804 7 Scoliosis Amyoplasia 813–814 Abducent nerve paresis 752, Achievement by proxy 10, 11 AFO 7 Ankle Foot Orthosis Anaerobes 649, 652, 657 816 Achilles tendon Aggrecan 336, 367, 762 ANA 7 antinuclear antibodies Abducted pes planovalgus – lengthening 371, 426, 431, aggressive osteomyelitis Analysis, gait 488, 490–497 433, 434, 436, 439, 443, 464, 7 osteomyelitis, aggressive 7 Gait analysis Abduction contracture 468, 475, 485, 487–490, 493, Agonist 281, 487, 492, 493, Anchor 169, 312, 550, 734 7 contracture 496, 816, 838, 840 495, 498, 664, 832, 835, 840, Andersen classification abduction pants 219–221 – shortening 358, 418, 431, 868 7 classification, Andersen Abduction splint 212, 218–221, 433, 464, 465, 467, 468, 475, Ahn classification 366 Andry, Nicolas 21, 22 248, 850 489, 496, 838 Aitken classification (congenital Anesthesia 26, 38, 135, 154, Abduction Achondrogenesis 750, 751, femoral deficiency ) 7 classi- 162, 174, 221, 243, 247, 248, – hip 195, 198, 199, 212, 213, 756, 758–760, 769 fication, femoral deficiency 255, 281, 303, 385, 386, 400, 214, 218, 219, 220, 221, Achondroplasia 56, 163, 166, Akin osteotomy 477, 479 500, 506, 559, 568, 582–585, 241–245, 247, 248, 251, 255, 242, 270, 271, 353, 409, 628, Albers-Schönberg
    [Show full text]
  • Brainstem and Multiple Cranial Nerve Syndromes
    CHAPTER 21 Brainstem and Multiple Cranial Nerve Syndromes he brainstem is a compact structure, with cra- the lower motor neurons of the CN nuclei. With a nial nerve (CN) nuclei, nerve fascicles, and few exceptions, CNs innervate structures of the head T long ascending and descending tracts all and neck ipsilaterally. A process affecting the brain- closely juxtaposed. Structures and centers in the reticu- stem long tracts on one side causes clinical abnormal- lar formation control many vital functions. Brainstem ities on the opposite side of the body. For this reason, diseases are serious and often life threatening. focal brainstem lesions are characterized by “crossed” Involvement of the intricate network of neural struc- syndromes of ipsilateral CN dysfunction and contra- tures often causes a plethora of clinical findings. lateral long motor or sensory tract dysfunction. For Brainstem syndromes typically involve dysfunction of instance, in the right side of the pons, the nuclei for one or more CNs. Deficits due to dysfunction of indi- CNs VI and VII lie in proximity to the right corti- vidual nerves are covered in the preceding chapters. cospinal tract, which is destined to decussate in the This chapter discusses conditions that cause dysfunc- medulla to innervate the left side of the body. The tion beyond the distribution of a single CN, involving patient with a lesion in the right pons will have CN more than one CN, or conditions that involve brain- findings on the right, such as a sixth or seventh nerve stem structures in addition to the CN nucleus or fasci- palsy, and a hemiparesis on the left.
    [Show full text]
  • Module 2 Neurology and Instrumentation Motor Paralysis The
    Module 2 Neurology and Instrumentation Motor paralysis The term paralysis is derived from the Greek words para, “beside,off, amiss,” and lysis, a “loosening” or “breaking up.” In medicine it has come to refer to an abolition of function, either sensory or motor. When applied to motor function, paralysis means loss of voluntary movement due to interruption of one of the motor pathways at any point from the cerebrum to the muscle fiber. Patterns of paralysis and their diagnosis: The following subdivision, based on the location and distribution of the muscle weakness: 1. Monoplegia : refers to weakness or paralysis of all the muscles of one leg or arm. This term should not be applied to paralysis of isolated muscles or groups of muscles supplied by a single nerve or motor root. 2. Hemiplegia: It is the commonest form of paralysis, involves the arm, the leg, and sometimes the face on one side of the body. With rare exceptions, mentioned further on, hemiplegia is attributable to a lesion of the corticospinal system on the side opposite to the paralysis. 3. Paraplegia: indicates weakness or paralysis of both legs. It is most often the result of diseases of the thoracic spinal cord, caudal equina, or peripheral nerves, and rarely, both medial frontal cortices. 4. Quadriplegia (tetraplegia) :denotes weakness or paralysis of all four extremities. It may result from disease of the peripheral nerves, muscles, or myoneural junctions; gray matter of the spinal cord; or the upper motor neurons bilaterally in the cervical cord, brainstem, or cerebrum. Diplegia is a special form of quadriplegia in which the legs are affected more than the arms.
    [Show full text]
  • Rehabilitation Principles for Motor Dysfunctions According to the Kozyavkin Method
    Kozyavkin V. I. Sak N. N. Kachmar O. O. Babadahly M. O. Rehabilitation principles for motor dysfunctions according to the Kozyavkin Method International Clinic of Rehabilitation www.reha.lviv.ua 2009 1 Universal Decimal classification УДК 616.831 - 009.11 - 053.2 - 085.838 Library and descriptive classifier ББК 57.336.1 Kozyavkin V. I., Sak N. N., Kachmar O. O., Babadagly M. A. Principles of rehabilitation of motor dysfunctions according to Kozyavkin Method. – Lviv: scientific production company ”Ukrayinska tekhnolohiya” (Ukrainian technology), 2007.- 192p. The proposed book is devoted to theoretical principles of motor dysfunction rehabilitation according to Prof. Kozyavkin’s Method and reflects 17 years of experience by the staff at the Institute of Medical Rehabilitation and the International Clinic of Rehabilitation. Readers will be informed about fundamentals related to the organization of human movement systems and rehabilitation principles for disorders of function caused by brain lesions and, in particular, cerebral palsy. They will come to understand how this idea evolved into a fundamentally new tendency in medical treatments and will learn about the effectiveness and application of the given system of rehabilitation. The book will be useful to child neurologists, pediatricians, specialists in medical and physical rehabilitation and students attending related academic institutions. ISBN 978-966-345-118-3 © International Clinic of Rehabilitation 2 Introduction Introduction Motor dysfunctions are one of the main causes of child disabilities and rank the problem of cerebral palsies together with the most important tasks which social pediatrics, child neurology and medical rehabilitation face. For many years, the history of the development of medical treatments for CP was based on attempts to eliminate the most obvious disorders of movement and posture.
    [Show full text]
  • Medical Assistance Eligibility Policy Manual (Archive) - Part 3 of 3
    THIS DOCUMENT IS FOR ARCHIVE PURPOSES ONLY AND MAY NOT REFLECT CURRENT POLICY. Medical Assistance Eligibility Policy Manual (Archive) - Part 3 of 3 Effective until 2021-08-06 THIS DOCUMENT IS FOR ARCHIVE PURPOSES ONLY AND MAY NOT REFLECT CURRENT POLICY. Table of Contents Introduction ................................................................................................................... 11 Getting Started .......................................................................................................... 12 Getting Started ....................................................................................................... 12 Cash Assistance and Nutrition Assistance Policy ...................................................... 18 Example ........................................................................................................................ 19 Examples ................................................................................................................... 19 Introduction ................................................................................................................ 20 E508 Community Spouse Example ........................................................................... 21 E602 Budget Group Examples .................................................................................. 22 E602 Budget Group Examples ............................................................................... 22 A MAGI Budget Group Examples ..........................................................................
    [Show full text]
  • A Dictionary of Neurological Signs
    A Dictionary of Neurological Signs A.J. Larner A Dictionary of Neurological Signs Fourth Edition A.J. Larner, MA, MD, MRCP(UK), DHMSA, PhD Walton Centre for Neurology and Neurosurgery Liverpool UK ISBN 978-3-319-29819-1 ISBN 978-3-319-29821-4 (eBook) DOI 10.1007/978-3-319-29821-4 Library of Congress Control Number: 2016938226 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To Sue Nil satis nisi optimum The dictionary is the only place where success comes before work Arthur Brisbane Foreword to the First Edition (2001) Neurology has always been a discipline in which careful physical examination is paramount.
    [Show full text]