23. Cerebral Palsy Flashcards
Outline the aetiology and pathophysiology of CP
Prenatal = acute progressive hypoxia (APH), x-ray, alcohol, CMV, HIV, rubella, toxoplasmosis, Rh disease
Perinatal = birth trauma, fetal distress, hypoglycaemia, hyperbilirubinemia
Postnatal = trauma, hypoxia, meningoencephalitis, cerebral vein thrombosis
Chronic disorder of posture and movement caused by non-progressive CNS lesions sustained before 2y - resulting in delayed motor devel, evolving CNS signs, LD (35%), epilepsy
How does CP present?
4 types = spastic, dyskinetic, ataxic, mixed
Spastic (70-80%) (damage to motor cortex)
- Hypertonia
- Awkward reflexes
- Stiffness in one part of the body
- Contractures (permanently tightened muscles or joints)
- Abnormal gait
Dyskinetic (10%) (damage to basal ganglia/cerebellum)
- Mixture of hypotonia and hypertonia
- Involuntary movement in the face, torso and limbs
- Issues feeding
Ataxic (damage to cerebellum)
- Reduction in muscle tone
- Difficulty speaking
- Problems with depth perception
- Shakiness and tremors
- Spreading feet apart when walking
Mixed (<10%) (damage to multiple locations)
- Sx of more than one type
How is CP diagnosed?
Observational = posture, reflexes and muscle tone
- Holding his/her head up
- Rolling over
- Visual alertness
- Sitting
- Crawling
- Walking
- Picking up small objects
Imaging = cranial USS, CT, MRI
EEG
Outline the ideal management for CP
Physio = strength, mobility, posture, balance, flexibility
Orthotics = devices used to train major muscle groups
OT = improve fine motor skills
SALT = pronounce certain words and communicate more effectively
Meds =
- Baclofen - muscle stiffness
- Botulinum toxin injections
- Melatonin - sleep diff
- Anti-epileptics
- Laxative
- Analgesia
- Anticholinergics - reduce drooling
Surgery = muscle/tendon lengthening, tendon transfer, tenotomy/myotomy, neurectomy, osteotomy, arthrodesis, selective dorsal rhizotomy
How can the location of the movement disorder in CP be described?
Monoplegia = one limb
Diplegia = both limbs
Hemiplegia = one side of the body
Triplegia = 3 limbs
Quadriplegia = all limbs
Double hemiplegia = all limbs but arms more than legs
