AGALOOS, Althea Ninotschka B.

October 5, 2019
2015-03788 Instructional Design: Hydrocephalus & ADHD
HYDROCEPHALUS & ADHD

Participants: 6 Physical Therapy Interns

Time Frame: 20 – 30 mins

Goals:
● Recall and understand the medical background of Hydrocephalus and ADHD with emphasis on details relevant to PT
● Discuss the precautions and contraindications to PT Management
● Discuss the common PT interventions specific to hydrocephalus and ADHD

INSTRUCTIONAL DESIGN
LEARNING OUTCOMES CONTENT T-L STRATEGY T-L RESOURCES EVALUATION
Define Hydrocephalus ● Hydrocephalus
o The accumulation of excessive CSF within the ventricular system ● Lecture/ ● PPT ● Question
● Incidence Discussion and Answer
o 10 per 10,000 live births
o Most also present with macrocephaly
o May also happen during adulthood
● Types
o Non-communicating Hydrocephalus
▪ If there Is a localized obstacle to CSF flow within the ventricular system, then a portion of
the ventricles enlarges while the remainder does not
▪ It is commonly caused by masses obstructing the foramen of Monro or compressing the
cerebral aqueduct
o Communicating Hydrocephalus
▪ The entire ventricular system is enlarged
▪ It is usually caused by reduced CSF resorption
o Hydrocephalus Ex Vacuo
▪ A compensatory increase in CSF volume following the loss of brain parenchyma, as after
infarcts or with degenerative diseases
▪ Hydrocephalus without head enlargement but the brain may shrink
Discuss the clinical ● Accelerated enlargement of head (infants)
presentation of children o UMN lesions show up d/t affectation of the brain
with Hydrocephalus ▪ Irritability
▪ Lethargy
● Hyperreflexia
● Spasticity
● (+) Pathologic reflexes
● Poor appetite, vomiting
● Decreased Cognitive Functioning: Memory and Attention
Enumerate precautions & ● Avoid pressure on shunt as it can increase ICP
contraindications to PT ● Factors that may increase ICP
management o Maximal exercise
o Valsalva maneuver
o Supine position
o Trendelenburg positions
● WOF signs of increased ICP
o Increased sleeping time
o Vomiting
o Nausea
o Headache
o Decreased appetite
o Decreased LoC
Discuss common PT ● Promoting achievement of physical milestones
management to be done ● Maximizing independence in mobility
for children with ● Balance and coordination exercises
Hydrocephalus ● Stretching
● Endurance exercises
● Tone management
Define ADHD ● Attention Deficit Hyperactivity Disorder
o A brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity
that interferes with functioning or development (National Institute of Mental Health)
● Prevalence
o Boys are 2 to 3 times more likely to show signs and symptoms
o Average age of onset: 7 years old
o 12 month prevalence: 4.1% of U.S adult population
Enumerate characteristics ● Characteristics
and clinical presentation o Excessive daydreaming
of children with ADHD o Forgetfulness
o Squirming/fidgeting excessively
o Talking excessively
o Trouble getting along with peers
o Poor academic performance
o Trouble with organizing tasks and activities
o Easily distracted
● Systemic Involvement
o Cognitive/ Mental
▪ Concentrating problems: inattention to details as well as careless mistakes. Difficulties
sustaining attention with activities or games.
▪ Difficulty controlling impulses
▪ Executive function: difficulties in planning, organizing, and performing strategies.
▪ Memory function: forgetful, and difficulty recalling information, no matter how intense the
effort put forth.
 o Motor
▪ Difficulty remaining seated, when staying seated is expected, which can be seen in the
classroom.
▪ Difficulty awaiting turn or standing in line. The child tends to run about or climb excessively
when it’s inappropriate.
▪ Excessive talking: Blurting out answers or disrupting the classroom.
▪ Feelings of always being “in a hurry”
● ADHD usually presents in 3 different ways in children:
o Predominantly Inattentive:
▪ Wandering off task, difficulty sustaining focus, disorganized
o Predominantly Hyperactive-Impulsive:
▪ Hyperactivity means a person moves constantly, or is restless; impulsivity means a person
makes hasty actions that occur at the moment
o Combined
Enumerate precautions & ● Associated Comorbidities
contraindications to PT o There is a high rate of anxiety in those diagnosed with ADHD, along with the depressive
management disorder.
o Having the diagnosis of ADHD doubles the likelihood of having depression.
o Bipolar disease has a growing association as well, with 22% of those with ADHD having
bipolar disorder.
o There is data to indicate that youth with ADHD are at an increased risk for cigarette smoking
and substance abuse during their teenage years and are twice as likely as their non-ADHD
counterparts for this to occur. Those with this disorder also tend to maintain their addictions for
longer.
Discuss common PT ● Sensory techniques may be effective in addressing many of the problem behaviors characteristic
management to be done of children with ADHD, including inattention, disorganization and hyperactivity (Bhatara et al
for children with ADHD 1978, Kantner and Tacco 1980, Bhatara et al 1981).
● The ultimate goal of sensory integrative intervention is to facilitate a child’s development, self-
actualisation and occupational performance (Bundy et al 2002).
● Sensory Diet
o Deep pressure touch (Krauss 1987)
o Using latex-free rubber tubing as a ‘chewy’ (Scheerer 1992)
o Using a weighted vest (VandenBerg, 2001)
o Allowing the child to sit on a therapy ball chair while doing his or her schoolwork (Schilling et al
2003)
● Moderate to high-intensity exercise
o To reduce stress, anxiety, and depressive symptoms
o To improve cognitive function
o To improve motor performance
o To improve to social skills and behavior
o To improve ability to maintain attention
● Yoga
 o An eight-week yoga intervention improved both selective and sustained attention in children
with ADHD
o It can reduce impulsivity, anxiety, and social problems
● Executive Function (EF) Training Program
o This type of training with multiple EF focus and parent involving in real-life activities could be a
potentially promising intervention associated with significant EF and ADHD symptoms
improvements.
o Specifically, for children with ADHD, is important and useful to reduce the EF developmental
gap by teaching the children appropriate coping skills and strategies

REFERENCES
● Hydrocephalus—Paediatric physiotherapy—Manchester Physio—Leading Physiotherapy Provider in Manchester City Centre and Sale. (n.d.). Retrieved October 5, 2019, from
https://www.manchesterphysio.co.uk/what-we-treat/paediatric-physiotherapy/hydrocephalus.php
● Krauss KE (1987) The effects of deep pressure touch on anxiety. American Journal of Occupational Therapy, 41(6), 366-73.
● Bhatara V, Clark DL, Arnold LE (1978) Behavioural and nystagmus response of a hyperkinetic child to vestibular stimulation. American Journal of Occupational Therapy, 32, 311-16.
● Scheerer CR (1992) Perspectives on an oral motor activity: the use of rubber tubing as a ‘chewy’. American Journal of Occupational Therapy, 46(4), 344-52.
● VandenBerg NL (2001) The use of a weighted vest to increase on-task behaviour in children with attention difficulties. American Journal of Occupational Therapy, 55(6), 621-28.
● https://www.physio-pedia.com/Attention_Deficit_Disorders
● CDC: CDC. Facts about ADHD; 2016 Nov 16 [cited 2019 Oct]. Available from: https://www.cdc.gov/ncbddd/adhd/facts.html.
● Loe IM, Feldman HM. Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology. 2007 May 28;32(6):643–54.