26. CP Flashcards
Definition
Chronic, incurable, non-life threatening, non-progressive.
A disorder of movement affecting muscle tone and motor skills appearing early in life.
What parts of the brain does it affect?
Cerebral hemispheres, cerebellum, subcortical structures (basal ganglia). Where lesion is, different picture of CP.
Aetiology
Brain damage before, during or up to 5 years after birth. Not known in many cases. Infections, genetic disorders, toxins, hypoxia, foetal cardiac problems, ABI post natal, shaken baby syndrome, blood clotting
Prenatal, perinatal and post natal causes
Prenatal: Disturbance of cell migration, poor myelination of nerve cell fibres
Perinatal: Brain cell death (hypoxia) during birth
Post-natal: Non-functional or inappropriate synaptic connections
Risk factors
Males, premature and small babies, multiple births. Genetic links.
4 Classifications of CP
Classification by severity, topographical distribution, motor function, Gross motor functional classification system (GMFCS)
Classification by severity
Mild: Requires little assistance in moving, ADL not limited
Moderate: Needs some assistance, adaptive equipment
Severe: Wheelchair, significant changes to ADL
No CP: Has signs but impairment acquired after 5 years when brain is developed. Is an ABI.
Classification by topographical distribution
Paresis vs. paralysis?
Monoplegia, diplegia, hemiplegia, quadriplegia or tetraplegia
Paresis: meaning weakened
Classification by motor function
Spastic CP (high and low muscle tone) and non-spastic CP. Two terms to describe muscle tone are hypertonia and hypotonia. Hypertonia: Too much muscle tone. Rigid, stuck in postures, exaggerated reflexes, swallowing and eating all affected Hypotonia: Flaccid hypotonia means too little muscle tone. Involuntary movements, floppiness in some areas (20% of cases, rarer).
4 divisions of non-spastic CP
1: Ataxic CP: Less common, balance and posture, coordinated movements, cognition not affected. Can be mild.
2: Dyskinetic CP: Athetoid (involuntary movement, incoordination, mainly limbs) and dystonic (affects trunks more than limbs).
3: Mixed CP: Both spastic and non-spastic
4: Athetoid CP: Affects voluntary control of limbs and face. Sit in cross legged position to give stability because no trunk sttability.
Classification by GMFCS
Developed for universal understanding and WHO goals on strengths based approach. Level is determined by age and set of activities they can achieve by themselves (head control, walking, gross motor skills, reliance on adaptive equipment. 1-5, 1 being walks without limitations and 5 being severe limitations, maximum assistance etc.
8 clinical signs:
Muscle tone abnormalities, movement control and coordination delays, infantile/primitive reflexes remain, postural abnormalities/delays, balance delays/difficulties, fine motor and gross motor delays, oral motor dysfunction or delays.
Intellect is not always deficient.
Diagnosis:
Developmental screening, CT scans, MRI, full neurological screening, exclusion of other diagnoses. Lengthy and careful process.
Trajectory
Early intervention –> better outcome.
Generally normal life expectancy
Delays will vary depending on: Extent and severity and location of brain.
Treatments
Medications: Drugs (anticonvulsants to control seizures, anticholingerics to assist uncontrolled movement), antidepressants, muscle relaxants, pain management, botox injections.
Surgical interventions: Not necessary for all children, orthopaedic and gastroenterological, neurosurgery.
Non-medical interventions: Grading and adapting, assistive technologies and equipment, optimising function and mobility, controlling pain, reducing secondary complications and maximising independence.
