4.5 Cerebral Palsy

Question 1

What is cerebral palsy

Answer 1

chronic nonprogressive motor disorder
–> damage to the areas of brain that control motor function

Question 2

When do symptoms of CP first start

Answer 2

within first 2 years of life

Question 3

Why is the early detection of CP important

Answer 3

allows for early dx and tx which helps long term outcomes

Question 4

What is a common cause of CP

Answer 4

global hypoxic insult to the brain

Question 5

What is the diagnostic criteria for CP

Answer 5

motor dysfunction and eitheir abnormal neuroimaging or risk factors for CP

Question 6

How does muscle tone change in infants with CP who are less than 6 months old and older than 6 months

Answer 6

when < 6 months tone is hypotonic then becomes hypertonic after 6 months

Question 7

What type of reflexes are common in those with CP

Answer 7

persistent primitive reflexes (moro, tonic neck)

Question 8

Hand preference before ___ year old is highly suspect for CP

Answer 8

1 year old

Question 9

Risk factors for CP part one

• maternal vaginal bleeding between ___ and ___ months of pregnancy
• severe proteinuria late in pregnancy; ___
• antepartal hemorrhage, maternal ___ or ___
• maternal/intrauterine ___

Answer 9

• maternal vaginal bleeding between 6 and 9 months of pregnancy
• severe proteinuria late in pregnancy; preeclampisa
• antepartal hemorrhage, maternal stroke or seizure
• maternal/intrauterine infection

Question 10

Risk factors for CP part two
* Complications during ___ and ___
* fetal ___
* small for ___
* intracranial ___

Answer 10

• Complications duringlabour and delivery
• fetal distress
• small for gestational age
• intracranial hemorrhage

Question 11

What are common findings of infants with CP on physical exam

Answer 11

• lack of reflexes
• low tone
• perferred handedness before 1-2 years old
• head size abnormal (large or small)

Question 12

What common visual issue is present in infants with CP

2

Answer 12

• visual refractive errors (like nearsighted, farsighted)
• strabismus

Question 13

What motor abnormalities are common in infants with CP

Answer 13

delayed motor function like grasping

Question 14

What feeding issues are noted in infants with CP

Answer 14

reversed swallow wave- uncoorindated suck and swallow that leads to reflux and resp issues

decreased tone of the lips, tongue, and cheeks; increased gag

reflex; involuntary tongue and lip movements; increased sensitivity to food stimuli; poor occlusion; and delayed inhibition of the suck reflex.

Question 15

Is CP a progressive disorder

Answer 15

no- but without intervention motor dysfunction may worsen

Question 16

Does the level of brain damage from the hypoxic injury that causes the CP corelate to the level of disability the patient will experience

Answer 16

no- no one can predict the level of disability

refer pts with suspected CP

Question 17

What is the Gross Motor Function Classification System (GMFCS)

Answer 17

5-level classifiction system for CP that describes motor performance in everyday life

validated as a predictive tool for future gross motor function, which is helpful for prognostic discussions with families, goal-setting, and intervention planning

Question 18

What are the 5 red flags for early dx of CP

Answer 18

• Hand preference before 1 year
• Stiffness or tightness in the legs before 12 months
• Inability to sit by 9 months
• Persistent fisting of hands beyond 4 months
• Delays or asymmetry in movement or posture

Question 19

How can you confirm CP

Answer 19

MRI to confirm brain injury or malformation

CP dx is clinical but MRI is helpful

some CP cases are from brain malformation not hypoxia

Question 20

What other neuro disorder do kids with CP typically have

Answer 20

seizures

Question 21

There are different types of CP including spastic unilateral or hemiplegic (more common types)

Which type is most associated with seizures

Answer 21

spastic unilateral CP due to stroke or cerebral malformation

Question 22

What device can be used to increase stability and stretch calf muscles in kids with CP

Answer 22

ankle-foot orthotics

Question 23

Do all kids with CP require active therapy throughout their lives

Answer 23

no- goal directed activity based therap is more appropriate and effective

Focusing on participation is more important than engaging in therapy to promote ‘normal’ function.

Question 24

What developmental disorder are kids with CP more likely to have

Answer 24

autism