222 - CP + Autism Flashcards
What is a learning disability?
IQ
What can cause a learning disability?
Genetic (fragile X, down’s. Prader willi)
Antenatal (infections, intoxication, endocrine - hypothyroid)
Perinatal (birth asphyxia, kernicterus, haemorrhage)
Post-natal (injury, infection, intoxication, malnutrition, epilepsy
What is kernicterus?
Bilirubin toxcitiy
How common are associated symptoms with learning difficulties?
40% - sight issues 25% - hearing issues 20% - dental issues 12% - psychiatric 20% - epilepsy
When do you asses child development?
Oppertunistically
Whenever concerns expressed
At routine child health surveillance appointments
When well known factors exist (down’s, neglect..)
How to we judge child develpment?
Milestones - when an average child does X
Monitored over time
Correct for due date
What factors determine child development?
Genetic
Antenatal exposure (alcohol)
Diseases (meningitis, trauma)
Chronic health problems (congenital heart probs - put all energy into them)
Parenting (home structure and relationships important
Socioeconomic circumstances (need opportunities to learn and play)
What are the 4 domains child development is split into?
Gross motor
Social, emotional, behavioural
Speech and hearing
Fine motor + vision
What are some common milestones a child should meet in gross motor areas?
Sit - 6months Crawl - 8 months Walk - 12 months Kick - 2 years Steps - 2-3 years
What are some common milestones a child should meet in the social, emotional and behavioural area?
Social smile - 6 weeks
Waves - 10 months
Symbolic play - 18months
Play socially - 3 years
What are some common milestones a child should meet in speech and hearing areas?
‘aa aa’ - 3 months
Turns to sound - 3 months
Words - 12 months
Sentences - 3 years
What are some common milestones a child should meet in fine motor and vision areas?
Fix eyes on object - 6 weeks
Hold object - 3 months
Pincer grip - 9 months
Draw - 3 years
What are some red flags of child development?
Regression Special sense issues Discordance between domains Abnormal head growth Not meeting milestones Hand dominance under 1year No words by 18 months Only tip-toe walking at 2 years
what is cerebral palsy?
A disorder of movement and posture, or motor function.
Permanent but not unchanging
Due to a non-progressive lesion of the developing brain
Often accompanied by disturbances in sensation, cognition, communication, perception and behaviour
How common is cerebral palsy?
2/1000 live births
M:F, 1.33:1
20% of people with CP have profound disability
What types of motor impairment may someone with CP have?
Ataxia - abnormality in smooth approach to an object
Athetosis - slow writhing movements, usually distal
Chorea - rapid, high amplitude sudden + involuntary
Tone:
- Spasticity: velocity dependant, increase in resistance to passive stretch + hyperreflexia
- Dystonia: abnormal sustained contraction of agonists and antagonists resulting in abnormal posture
What are some common subtypes that CP is classified into?
Spastic CP - bilateral or unilateral
Dyskinetic CP - dystonic or choreo-athetotic
Ataxic CP
What associated impairments are seen in someone with CP?
Cognitive - 30% have global learning disability
Visual - 11% severe impairment, many have myopia, cortical VI, squint, field deficit, visuo-perceptual difficulties
Hearing 20-30% have impairment
Epilepsy - 20%
Sleep disturbances
Behavioural, attentional, communicative issues too.
Will you find abnormalities in radiological investigations in someone with CP?
83% have abnormal imaging
10% have maformations
When does CP occur / when is the cause?
80% pre-natal
10% peri-natal
How does a child with CP often present?
Delayed motor milestones Abnormal gait Early hand dominance Reduced movements Persistant of primitive reflexes Tone and posture abnormalities
How is CP managed?
Aim to maximise QoL, improve everyday function and increase independence and participation.
MDT key
need good respiratory care, ? gastrostomy feeding, epilepsy control, immunisations….
What is the 20yr survival expectation of someone with CP?
If 1 severe disability - 90%
if 2: 85%
if 3: 50%
What is autism?
A neurodevelopmental disorder
Characterised by difficulties in - social aspects, communication and restricted repetitive behaviour + interests.
Lifelong, typically noticed around 3 years old.
At any level of intellegance
