hypoxic ischaemic encephalopathy

[anagha]

hi physios
I have a patient ,7yr old boy presently with a spastic upper and lower limb.upper limb in flexion and lower in extention . He was healthy before.he had undergone a surgery for supracondylar fracture and in between he got a cardiac arrest..then later he was stable later secondery massive brain edema developed.Now he cries as response to pain .nothing else.
So i want all physios advice whohad done similar case.What can we do for the child?
thanxs for ur all who read this!

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[anagha]

thanxs for all those u read this case.

[Canuck Physio]

hi physios
I have a patient ,7yr old boy presently with a spastic upper and lower limb.upper limb in flexion and lower in extention . He was healthy before.he had undergone a surgery for supracondylar fracture and in between he got a cardiac arrest..then later he was stable later secondery massive brain edema developed.Now he cries as response to pain .nothing else.
So i want all physios advice whohad done similar case.What can we do for the child?
thanxs for ur all who read this!

Hello,

My regards for your patient, is he not being medically managed?

Post cardiac arrest is there a risk of infection? Is he being provided respiratory care? Cardiac care?

Regards

[anagha]

yes canuck,the boy is medically stabilised.But only response to painthr cry.So how cn i help him,just passive movements ,stretching!
or any special care in pt?

[hari priya]

you mentioned that the upper limb is in flexion and lower limb in extension which could be decorticate rigidity.the things i suggest are do neurologic examination especially and other things.concentrate on respiratory care. if the patient is lethargic you can improve his alertness by using the stimuli.when is he crying while doing stretching or to minor touch stimuli?if you can provide somemore information then may be some more suggestions.

[Canuck Physio]

yes canuck,the boy is medically stabilised.But only response to painthr cry.So how cn i help him,just passive movements ,stretching!
or any special care in pt?

Hello again,

Considering the young boys age (7), have you made any attempt to first alleviate his obvious problem of crying?

Will just provide a case in point:
~
Pt with neurological problem would vomit when Physio touched him in any way.

Solution: Physiotherapist asked patient to view what physio was doing visually, and guided pt through therapy. Vomiting stopped subsequently.
~

Although this case may not apply to you directly, I hope you can infer some of this information in your own treatment.

If we were to analogize this strategy with your patient, is there some way that you can distract your patient to a level high enough so that the pain experience is lessened?
Examples include;
- providing a soft furry toy to hold on to while you treat (touch stimulus may interfere with pain signals via pain gate)
- providing visual stimuli to distract pt from treatment (television is usually a good one, how about something funny - as laughter is also a significant distraction from the subjective pain experience)

AS well is there any way in which you could include play into the therapy. Performing the therapy without the pt even realising it is perhaps the best option for pediatric pts, IMO.

As there is little detail to what is being done with pt, and what brings on the pain, I can only say thinking out of the box is something you may want to try.

Regards

[anagha]

hi again
yes ,am trying all the way to relax first.then am doing treatment.You know some times even a minor stimuli makes him cry.thanxs again

[anagha]

hi
he cries when doing stretching and even to minor stimuli.
he doesnt track.
he did speak.I mean not obeys command.

[aziznavii]

hi guys ...
i think u have to give him a streching any way what ever he is crying and try to drow his attention to other things while u give him streching if u didnt do it i think it,ll take a loooooooong tearm of treatment.thats my opinion and that what i,m doing and as i see it working with me,,,i wish i,m ryt ,,,