The neuromuscular system plays a critical role in the body. The system comprises nerves and muscles. Infants and toddlers have a neuromuscular system that is still developing. In some, some diseases can adversely affect the neuromuscular system.
A weak or dysfunctional neuromuscular system can lead to serious abnormal effects in an infant’s body. These conditions can also have long-term – sometimes even life-long – complications. Early treatment and appropriate rehabilitation can help to improve the quality of life in the infant.
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These therapeutic services also help to equip the pediatric patient with the knowledge and skills to cope with any disabilities caused by neuromuscular conditions.
Realizing the importance of rehabilitation in neuromuscular conditions among pediatric patients should be a priority. Early treatment of these conditions, with the implementation of a long-term rehabilitation program, can make a significant difference.
Neuromuscular Conditions in Pediatric Patients
A paper in the Journal of Neuromuscular Disorders found that pediatric cases of neuromuscular conditions are more common than previously reported. Several epidemiology studies have been conducted to determine the potential prevalence of these conditions among infants and young children.
A study that looked at the occurrence of neuromuscular disorders among adults and pediatric patients also confirmed an increase in these conditions. The study considered data collected between 2003 and 2014. It was confirmed that an increase in diagnosis for neuromuscular conditions among children occurred in this timeframe.
Certain neuromuscular disorders are more common in pediatric patients than others. Identifying the common types help parents understand what symptoms to look for. This also ensures pediatricians can detect the potential presence of a condition during an early developmental stage of an infant.
One study found that dystrophin-related muscle disease is a particularly common type of neuromuscular disorder in the younger population. Other conditions affecting the neuromuscular system have been identified too – with some conditions causing long-term disabilities.
Cerebral Palsy
Cerebral palsy is one of the more common conditions that cause a motor disability among children in the modern world. The condition affects the brain. Researchers have found that an estimated 500,000 children younger than 18 are affected by cerebral palsy4. Each year, up to 12,000 newborn babies in the United States are diagnosed with cerebral palsy. The condition goes on to affect the individual in adulthood too.
The presence of cerebral palsy causes problems with these three areas:
- The ability to move around
- The ability to maintain a proper balance
- The ability to maintain a good posture
Among infants with cerebral palsy, damage to the brain is a potential cause. In some cases, developmental abnormalities in the brain can lead to the development of cerebral palsy as well. The condition primarily affects the parts of the brain that control muscle movements in the body.
In the majority of cases, the condition does not tend to worsen over time. Throughout a lifespan, some changes may occur in symptoms and effects, however.
There are four types of this condition. Healthcare providers use these types to help them identify the severity of the condition, as well as how the pediatric patient will be affected.
- Spasmic Cerebral Palsy
- Athetoid Cerebral Palsy
- Ataxic Cerebral Palsy
- Mixed Cerebral Palsy
Recognizing the early signs of cerebral palsy plays an important role in providing treatment during a younger age. There are sometimes signs that start to develop before the age of six months.
While a baby is picked up, they may feel unusually stiff. The legs may become stiff when it is crossed. Babies may also experience a lagging of their heads when they are picked up. Some parents report that it feels like their baby is pushing away due to an arch of the neck and back.
As the baby ages, other symptoms may start to develop. This may include the inability to place their hands together or not being able to roll over. The child may find it hard to bring their hands toward the mouth. Some parents report a lopsided crawling among babies with cerebral palsy.
Spasticity Management
Spasticity is one of the most common concerns among pediatric care settings where an infant or child is diagnosed with cerebral palsy. The management and treatment of pediatric spasticity can be challenging.
The major challenge is providing medicated treatment to these patients. Medication used in the treatment of spasticity among adult patients may pose a health risk to infants. Toxicity is a common issue with these medications, as an infant’s body may not respond well to certain chemicals in the drugs.
A long-term rehabilitation and treatment program are advised for infants. Spasticity management can form part of the rehabilitation system. This allows a more personalized program to be developed, consisting of therapies and medication that are appropriate for both the age of the child, as well as the severity of the cerebral palsy.
Spasticity among infants with cerebral palsy may cause several complications, including:
- Contractures
- Joint subluxation
- Joint dislocation
- Movement difficulties
- Posture problems
- Muscle pain
- Reduced muscle growth
- Soft tissues may become stiff
Rehabilitation will generally include a treatment approach to assist in the management of spasticity. Several medications have shown potential among infants, toddlers, and kids with this complication.
Some of the current treatments used in spasticity management include:
- Botulinum toxin injection may assist in the management of focal spasticity. This chemical causes dysfunction in acetylcholine release – particularly at the neuromuscular junction. It helps to reduce the contraction of muscles in targeted areas.
- Oral medications provide a systemic approach to the treatment of spasticity. Baclofen, clonazepam, tizanidine, dantrolene, and clonazepam are sometimes provided.
- Intrathecal baclofen is an FDA approved treatment for spasticity among children with cerebral palsy. This is a system that is implanted into the patient’s body through a surgical procedure. The implant infused the baclofen content into the patient’s spinal cord. This may assist in reducing spasticity symptoms. The side-effects are usually milder compared to the use of an oral baclofen drug.
- A selective dorsal rhizotomy is another optional procedure that has shown potential in the management of spasticity. This is a neurosurgical option. Deafferentation at L1 to S2 nerve roots is performed during the surgical procedure. Rehabilitation is a critical part of the recovery process following the performance of this surgery.
Rehabilitation programs will generally also include therapeutic services. These therapies will be required over a long period. Both physical therapy and occupational therapy may be useful in infants with cerebral palsy.
Parents may be shown how to apply certain therapies at home too. These therapies may form part of the rehabilitation program and should be applied as instructed.
Hot and cold therapies may be advised frequently, especially when there is an episode of severe symptoms.
Therapies in a rehabilitation system also introduce the pediatric patient to stretching exercises that help to reduce muscle contractions.
Cognitive Impairment
Cerebral palsy can affect more than just the physical functions of the human body. Up to 50% of children who are diagnosed with cerebral palsy will also experience cognitive impairment. The impairment in cognitive function can range from mild to severe. Pediatric patients who are diagnosed with a severe form of cerebral palsy have a higher chance of experiencing impairment in their cognitive function.
Specific cognitive functions that may be adversely affected by cerebral palsy, as well as other neuromuscular conditions, among infants and pediatric patients, include:
- Behavior
- Communication
- Learning
- Literacy
- Sensory
- Memory
These cognitive impairments can make it harder for the child to learn how to speak properly. They may have trouble learning a language. Parents may find that the child struggles to perform in terms of education.
Rehabilitation programs will consider if cognitive impairments are present in the pediatric patient. The healthcare professional needs to understand exactly how the cognitive functions of the child are affected. This ensures appropriate measures can be taken. Access to certain therapists will be provided as part of rehabilitation, to reduce the effects that the cognitive impairments may have on the child’s development.
Therapists will often utilize visual cards to help children understand basic words. Continuous exposure to facts and lessons may also assist in improving the chances that a child can retain information presented to them. Audio programs may be provided to the parent, which should be played back to the child as part of the rehabilitation.
Among children who experience sensory dysfunctions, aids can be provided. During therapy sessions, clear acoustics can be played to the child, provided at an ideal volume. Glasses can help with vision-related problems, along with a more abundant range of lighting equipment.
Myopathy & Hypotonia
Additional conditions have also been identified, with some causing long-term disability and adverse effects. Myopathies are often congenital conditions that affect muscle groups. These conditions are considered genetic. It can lead to the development of muscle weakness and cause hypotonia as a complication.
A neuromuscular specialist is advised to form part of the rehabilitation process for infants with congenital myopathies.
A new follow-up is advised every quarter in infants under one year of age. In children older than one-year, two follow-ups each year are highly advised. With congenital myopathies, the specialist will look for signs of swallowing difficulties, respiratory problems, and issues related to the infant’s ability to start talking.
Parents play a vital role in ensuring rehabilitation is a smooth and efficient process. The parents are expected to provide reports on the performance of the infant, along with notes on any notable issues experienced. It is also important for parents to realize when an immediate follow-up is needed, instead of waiting for the scheduled appointment.
Neuromuscular disorders among pediatric patients can have long-term complications on the growing child. Cognitive impairment can lead to learning difficulties and general problems with performance in an educational environment. Cerebral Palsy may cause mobility issues. Taking note of potential neuromuscular conditions at an early age is critical.
Long-term rehabilitation programs have been shown to yield positive effects among infants, toddlers, and young kids with these disorders.
Why Cambridge?
Cambridge Medical & Rehabilitation Center is the specialized provider for Long-term Care and rehabilitation services in the United Arab Emirates. With 2 main facilities in Abu Dhabi & Al Ain, which are designed in a hospital setup with a capacity of 90 beds each.
Cambridge provides an interdisciplinary clinical approach for Pediatric Rehabilitation. The best rehabilitation services are not only our goal but our ultimate objective is to customize the care plan for each patient and make sure that the patient’s family and their members are integrated into the treatment plan.
Either you joined Abu Dhabi hospital or Al Ain hospital for any kind of our rehabilitation services or even for long-term care you will feel as if you are at #Your Second Home.
