(8) Cerebral Palsy Flashcards
1
Q
What is cerebral palsy?
A
- involves a disorder of mvmt and posture
- permanent but not unchanging
- due to non progressive interference
- interference in developing brain
2
Q
What are the risk factors for CP (6)?
A
- prematurity
- low birth rate
- TBI
- infection
- placenta complications
- complications @ birth
3
Q
What are causes of CP?
A
- Periventricular Leukomalacia (PVL)
- Intraventricular Haemorrhage (IVH)
- Hypoxic-Ischaemic Encephalopathy (HIE)
4
Q
What is Periventricular Leukomalacia?
A
- damage to the white matter
- damage to myelin, slowing and impeding nerve transmission
5
Q
What are the major factors in periventricular leukomalacia?
A
- decreased blood (ischaemia) or O2 (hyoxia) flow to PV region
- Hypoxic-ischaemic incidents damage to the blood brain barrier (BBB)
6
Q
What does the blood brain barrier do?
A
- regulates flow of nutrients to brain
- supports neurons throughout nervous sysetm
7
Q
What are the risk factors for PVL (7)?
A
- premature birth 26 weeks
- low birth weight (1500g)
- intrauterine infection
- infection around time delivery
- placental blood vessel conditions
- vaginal bleeding
- hypotension, hypoxaemia
8
Q
When may an intraventricular haemorrhage occur?
A
PVL may be accompanied by a haemorrhage or bleeding in the periventricular-intraventricular area
9
Q
What happens in the brain in a PVL?
A
- enlarged ventricles
- loss white matter
10
Q
What happens in the brain in an IVH?
A
- bleeding in ventricles
- injury white matter
- cell damage
11
Q
How does an intraventricular haemorrhage occur?
A
- most common 48hrs birth
- changes BP cause delicate blood vessels rupture
- results loss O2 to tissue
- swelling & obstruction can lead to hydrocephalus
12
Q
What are risk factors for IVH (6)?
A
- premature birth
- low birth weight
- placental blood clots
- weak blood vessels brain
- maternal high BP or infection
- shaken baby syndrome
13
Q
What causes hypoxic-ischemic encephalopathy?
A
- O2 deprivation to the brain
- if lasts too long, brain tissue destroyed
14
Q
What are impairments that can be seen as a result of hypoxic-ischemic encephalopathy (5)?
A
- epilepsy
- developmental delay
- motor impairment
- neurodevelopmental delay
- cognitive impairment
15
Q
What areas of the brain will mild hypoxia affect?
A
parasagittal white matter
16
Q
What areas of the brain will severe hypoxia affect?
A
- putamen
- thalamus
- paracentral white matter
17
Q
What are the risk factors for hypoxic-ischemic encephalopathy?
A
- acute maternal hypotension
- blood containing less O2
- cardiac complications
- pressure to cranium changing its shape
- impaired blood flow to brain
- injury from umbilical cord complications
18
Q
How is CP diagnosed?
A
- MRI
- Medical Hx
- Reflexes
- Motor skills Ax
- Differential diagnosis
19
Q
What are the two types of spastic CP?
A
- Bilateral spastic CP
- Unilateral spastic (hemiplegia) CP
20
Q
What are features of Spastic CP?
A
- increased tone
- increased reflexes
- pyramidal signs (Babinski)
- abnormal pattern movement & posture
21
Q
What are the two types of Dyskinetic CP?
A
- Dystonic
- Choreo-athetotic
22
Q
What are features of dyskinetic CP?
A
- involuntary, uncontrolled, recurring movements
- primitive reflex patterns
- muscle tone varying
23
Q
What are features of ataxic CP?
A
- loss ordinal muscular coordination
- movements performed with abnormal force, rhythm & accuracy
24
Q
What is the GMFCS used for?
A
Classification tool for predicting outcomes in people with CP
25
What are the 5 different grades of GMFCS?
I - walk & climb stairs w/o limitations
II - walk & climb stairs using handrails w some limitations
III - assistive mobility device
IV - walker or wheeled mobility
V - restricted voluntary control of movement
26
What is the Manual Ability Classification System?
highlights the child's ability to handle objects in important daily activities
27
What is the Communication Function Classification System (CFCS)?
- used to assess everyday communication and focuses on how info is expressed and received
- can be used assess all methods of comms
28
What are the 5 grades of CFCS?
I - effective sender & receiver with familiar & unfamiliar
II - effective sender & receiver but slower paced
III - effective sender & receiver with familiar
IV - inconsistent sender/receiver w familiar
V - seldom effective sender/receiver w familiar
29
What are some characteristics of hypertonia (6)?
- stiffness
- restricted movement
- associated reactions
- unreliable balance
- abnormal co-contraction
- poor alignment
30
What are some characteristics of hypotonia?
- difficulty moving against gravity
- poor head & trunk control
- ligamentous laxity
- hypermobile joints
- spasticity, ataxia & athetosis
31
What are some characteristics of Ataxia (7)?
- tone low to normal
- poor grading & coordination
- excessive small movements
- poor selectivity
- poor proximal stability
- unreliable balance reactions
- speech difficulties
32
What are some characteristics of dyskinetic CP athetosis (4)?
- involuntary movements
- fluctuating tone
- poor muscle control
- unreliable balance reactions
33
What are some characteristics of dyskinetic CP dystonia? (4)
- fluctuating tone from high to low
- fast movements
- torsional element
- wide range of movements
34
What are the subtypes of dyskinetic CP (4)?
- Pure athetosis
- choreo
- athetosis with spasticity
- dystonic athetosis
35
What are factors that impact muscle tone in CP (6)?
- lack movement
- repetition abnormal movements
- type of stimulation
- effort
- illness
- height/weight gain
36
What are additional impairments of CP?
- intellectual
- speech and language
- visual & hearing
- sleep
- epilepsy
- perceptual & motor planning
37
What are secondary musculoskeletal deformities of CP?
- muscle/tendon contractures
- bony torsion
- hip displacement
- spinal deformity
38
What are the secondary musculoskeletal deformities of CP related to (6)?
- physical growth
- muscle tone
- ageing
- motor activity
- distribution
- types of CP
39
What are activity limitations that patients with CP have?
difficulties an individual may have when executing a task or action
40
What are participation limitations that patients with CP have?
problems an individual may have in involvement in life situations
41
What according to the ICF are some body functions and structures that may be affected in an individual with CP?
- muscle tone, power, length
- reflexes
- postural control
- joint ROM
42
What during assessment according to the ICF are some Activities that may be affected in an individual with CP?
- gait observation
- gross and fine motor development
- sports
43
What during assessment according to the ICF is participation that may be affected in an individual with CP?
- community and social events
- school and life after school
- home life
- learning and applying knowledge
44
During assessment, what are some environmental and personal factors that may be investigated in a patient with CP?
- environmental mods
- family dynamics/considerations
- family disability journey
45
What is involved in an objective Ax for an individual with a GMFCS score of 1-3?
- developmental infant Ax
- GMFM 66
- functional walk test
- 6MWT
- orthopaedic Ax
- postural Ax in lying, sitting & standing
- gait Ax
46
What is the gross motor function measure (GMFM)?
- standardised test used to assess gross motor skill development
- 88/66 items examine
- lying, sitting, crawling, kneeling, standing, walking etc
47
What is involved in an objective Ax for an individual with a GMFCS score of 4-5?
- developmental infant Ax
- GMFM 66/88
- Orthopaedic Ax
- Postural Ax in lying, sitting & standing
48
What is meant by the term postural management?
used to describe everything that has an impact on a childs postural ability
49
What is 24 hour postural management?
should consist of a program which is incorporated into the lifestyle/activities of the individual and is applied throughout 24 hours
50
What is involved in 24 hour postural management?
- postural management equipment
- individual therapy sessions
- active exercise
- orthotics
- medication
- surgery
51
What are important things for individuals with CP to avoid when sleeping?
- sleeping curled
- lying with knees together
52
What is the Bobath Concept Framework?
- based on clinical observation & analysis
- holistic
- a way of thinking, observing, & interpreting what a client is doing, then adjusting what we do in the form of techniques
- Dont teach them how to move, facilitate them to move
53
What does an intervention for an individual with CP involve (6)?
- handling to promote function
- hands on when child learning activity, hands off when they can do it
- start generally then move more specific treatment
- Developmental function in early years
- muscle strength training
- orthosis
54
What are the integral parts of an intervention for an individual with CP?
- Parent, family, child involvement
- education
- self management
- needs and goals
55
What are additional services for individuals with CP?
- Spasticity management clinic
- hip surveillance programme
- spinal surveillance programme
- orthopaedic conditions
- orthotics clinic
56
