cerebral palsy child with cast

merlee · Apr 25, 2011

I am not certain that there would be complications specific to CP, except for balance if the child is walking. But that might be for anyone.

Is he able to understand what is going on? That might be an issue.

Best wishes!

annabeap, MSN, APRN, NP · Apr 25, 2011

Well, is he wheelchair bound? What's his weight bearing status? Why did he get the casts in the first place? What kind of seizures does he have? Isn't he a fall risk? What could happen if he falls? Can he communicate with any pain? Can you see his toes? Check a pulse? What are basic concerns of having a cast? And what are you most concerned about in a patient that may not be able to communicate well?

Don't let these kids with a significant history scare you. :)

TJacob · Apr 25, 2011

He is wheelchair bound but the other information is not clear. This is a hypothetical patient. Here is the only information I have:

10-year-old has a history of cerebral palsy, spastic quadriplegia, neuromuscular scoliosis, seizures, and hydrocephalus with VP shunt. He is non-verbal and diapered. He is wheelchair bound. He was born at 27 weeks with complications from intraventricular hemorrhage and seizures. He has bilateral short leg casts.

This is what I wrote so far... but its not right (see below)

Increased risk for compartment syndrome due to altered sensation in their extremities.
Skin breakdown caused by altered sensation and inability to communicate well.

The next question asks:

What medication can help with one of these complications?

So now Im REALLY confused! Ive been researching this for two days reading everything I can on CP, casts, treatments etc.

annabeap, MSN, APRN, NP · Apr 25, 2011

So you need to find complications for a child with CP? And think of a med that could help with the complication?

Don't get distracted by the pt's history too much. He is non-verbal, in a cast. I don't know if he's really a risk for compartment syndrome just because he has altered sensation. But your second complication makes more sense.

Try looking at what a normal child in a cast might take as a medication. I don't know 100% what your prof is looking for either, but I think the significant history is a distraction.

Good luck on that homework :)

j621d · Apr 25, 2011

Think psychosocial development....

TJacob · Apr 25, 2011

I asked my instructor for further clarification, here is her reply.

A child with CP will not always have altered sensation. The child in the design has spastic CP. What happens to the muscles of a child with spastic CP? Why are you casting? What can the muscles not do if they are in a cast? What about the reflexes in a child w/ CP?

Ill research and think about this but nothing immediately comes to mind as far as one of the answers having a medication that will help. He is already on Dilantin, Diastat and Depakote for seizures and Baclofen which is an antispastic so his muscles are already being pharmacologicaly controlled.

Furthermore.. I need to decide which methold of oxygen to admimister for pneumonia. I choose nasal canula. Would that be right? I wonder about the lines interfering if he were to have a seizure but what other method would work for a 10 year old?

Thanks :) Im usually really good at figuring these out but this one really has me stummped!

tralalaRN · Apr 25, 2011

I'm a nurse as well as a mother to twins - both with CP - both of whom have had surgeries for CP. Your instructor was right - do not assume there is altered sensation because they have CP - they aren't "paralyzed" due to spinal cord injury, but have CP d/t neurological damage to the areas of the brain that control motor function. Both of my twins - one walking, one not - have normal pain sensation.

This is the main issue we have had with surgeries involving tendons - MUSCLE SPASMS causing severe pain! Pain meds, muscle relaxants would be excellent meds to have on board, especially for the first few weeks. Of course, along with this, stool softeners. Yes, skin breakdown is an issue for someone as you described. The only time my daughter ever ever had a pressure ulcer, was when she was in leg casts. Very important to move them with all that weight from the casts.

Any other ques- feel free to ask. I'm the CP post-surgery queen:)

tralalaRN · Apr 25, 2011

More answers to your above posts:

The instructor doesn't appear to actually be saying the child has had surgery. So, the casting may be happening to prevent contractures to joints and to regain range of motion. Also, lower leg casting is done to help with lengthening heel cords. The tendons in kids with spastic CP always are involved, and it is most reflected in the heel cords (if they are walking, they tend to walk on their toes and are unable to do a heel strike to the floor first). Casting sometimes helps lengthen heel cords without surgery.

Pain management would still be an issue even without surgery, as muscle spasms would be a problem here.

Also, when talking about kids with cerebral palsy, refer to them as "children with cerebral palsy" not "cerebral palsy child" . . they are always children first - this is a big issue in the disability field.

Spastic cerebral palsy means that the childs muscles are tighter than normal, legs are most commonly affected, as the nerve fibers leading to the legs are the longest, therefore most likely to be damaged, especially in preemies with IVHs.

tralalaRN · Apr 25, 2011

Babinski reflex is abnormal in children with spastic CP. When you hit the bottoms of their feet, there is a repeated jerking response.

TJacob · Apr 25, 2011

Thank you tralalaRN,

I thought about muscle relaxers and pain relievers since his current med list didnt include either. I thought if his muscles wanted to be spastic but he was confined to a cast it might hurt even more. Does that sound right? However, I thought the antispastic Baclofen would help with the muscles.

What do you think about the best way to administer O2? Mask or NC? He does have a history of seizures.

Thank you for your insight.. with all the research Im doing on this, Im starting to understand the complexity of the disorder!!!

tralalaRN · Apr 25, 2011

Good for you for researching this! Yeah. Happy to help.

Administering 02 - again - it's a personal thing. The child may be non-ambulatory, but have perfectly good use of upper extremities. If they are seriously involved cognitively, it is going to be nearly impossible to keep either a mask OR a nasal cannula on them, as they will be bothered by it and constantly be trying to pull it offl Sometimes if the child is on the small side and needs oxygen, they will put them in a large crib with an oxygen tent over it. Otherwise, probably I would choose a nasal cannula, as if he has a whopping seizure, he could vomit and aspirate. Having a mask would impede clearance of the airway more so than the NC.