Case 6: CP Flashcards
What can be worn at the ankle for children with CP?
Ankle foot orthosis: AFO
custom/prefabricated brace for ankle and WB support for stance and ambulation
What categories are in the Apgar score?
- breathing effort
- heart rate
- mm tone
- reflexes
- skin color
(scored 0-2)
What is a normal Apgar score, and what is an abnormal Apgar score?
normal: 7+
abnormal: 6 and below
Low Apgar scores (6 and below) at __ and __ minutes is associated with CP
1 and 5 minutes
Name the 5 level classification system based on self-initiated mobility for kids with CP
*Grade A evidence: this system is a valid and reliable tool to measure gross motor function and evaluate change over time in children w/ CP
Gross motor Function Classification System (GMFCS)
*sitting, walking, wheeled mobility are primary forms of mobility in GMFCS
Why would a knee immobilizer be worn for this patient?
for external support during stance
for hamstring stretching
Name the federal legislation that establishes school-aged services for students (3-21 years) with disabilities
Individuals with disabilities education improvement act PART B (IDEA)
Name the federal legislation that establishes EARLY INTERVENTION services for infants and toddlers (0-3 years) with disabilities and their families
Individuals with disabilities education improvement act PART C (IDEA)
For infants/toddlers who receive IDEA PART C services…what is NAME of the multidisciplinary assessment of family resources, priorities, concerns, strengths/needs of child, services needed, and individualized service plan to meet these needs?
IFSP: individualized family service plan
How often is IFSP plan evaluated and reviewed?
evaluated: at least 1x/year
reviewed: at least every 6 months
Why would someone use a posterior wheeled walker?
It is designed to promote upright posture, decrease forward lean during walking, and UE support for walking balance
*wraps behind user, open in front of user so they can lean back for support to promote EXTENSION
What is preeclampsia?
pregnancy complication (usually after 20 weeks) where mom has HYPERTENSION and protein in urine leading to big time complications including morbidity/mortality of mom and unborn child
What is the positioning device called that enables supported standing in supine for individuals unable to maintain independent standing?
supine stander
The prevalence of CP is significantly higher in babies born before _____ weeks gestation
before 28 (extreme premature)
What are the three systems classifying kids with CP based on functional abilities?
GMFCS (walking, wheeled mobility)
MACS (hand, ADLs)
CFCS (communication abilities)
all scored 1-5, 5 is most limited ability
What are the 4 categories for classification of CP based on motor involvement/clinical presentation?
- hemiplegia
- diplegia (LEs)
- triplegia (usually BLE, 1 UE)
- quadriplegia/tetraplegia
What are the 4 classifications of CP based on muscle tone?
- spastic: can lead to contractures
- dyskinetic: (athetoid, choreoathetoid, dystonic)
- ataxic: uncoordinated, abnormal, unstable movement not due to weakness or involuntary mm activity
- mixed: most common is spastic-dyskinetic CP
What are the precautions during PT interventions with this patient with CP?
- monitor skin integrity with AFOs (heels)
- be close to child during gait and transfer training
- safe guarding due to potential impulsivity of child
What is the term used to describe a group of permanent disorders of movement and posture attributed to non-progressive disturbances that occurred in the developing fetal or infant brain?
cerebral palsy
Although the brain lesion in static in children with CP, the MSK impairments are ______
progressive
primary impairments of CP include ___, reduced ___ control, reduced selective ____ ______ control, and impaired ____ processing.
primary impairments of CP include spasticity, reduced postural control, reduced selective voluntary motor control, and impaired sensory processing.
primary impairments may lead to secondary impairments such as….
- contractures
- skeletal deformities
- decreased strength
- limited endurance
- over time, at risk for osteopenia and osteoporosis
T or F: individuals with CP may also have cognitive delays, seizure disorders, urinary incontinence, constipation
true (more prevalent in people with CP)
For children with CP who are non-ambulatory, _________ reduce spasticity and improve bone density, hip stability, social interaction, and alertness.
*grade B evidence
supported standing programs
What grade is this evidence-based clinical recommendation? PT interventions structured within family’s daily routine facilitate increased adherence and practice while minimizing burden on family
GRADE B
The _____ (17-59 months of age) is a valid and reliable tool to assess participation for young kids with CP
The ____ (18-60 months of age) is a valid and reliable tool for assessing difficulty of caregiving for young children with CP
- Child Engagement in Daily Life (CEDL)
- Ease of Caregiving for Children measures
A child with CP’s mother asks a PT if her child’s brain damage will get worse over time. The most appropriate response to the mother’s concern would be:
A. CP is an inherited genetic disorder that directly affects muscle
B. CP results from brain damage that will not change, and signs that child demonstrates no will not change over time
C. Children with CP have non-progressive damage to the brain although secondary changes in MSK system may progress over time
D. Children with CP have progressive brain damage worsening over time, resulting in increased MSK changes over time.
C. Children with CP have non-progressive damage to the brain although secondary changes in MSK system may progress over time
26 month old child with CP:
-independent sitting
-does not pull to stand independently
-plays with toys and blocks
-log rolls on floor to get different toys
-when held in standing, legs stiff, scissored with hips ADD and IR
-legs much more involved than arms
-uses arms for functional tasks with greater ease than legs
What type of CP is most likely?
Diplegia
*spasticity in LE scissoring
*extensor tone –> stiffness in standing and walking
*minor involvement in UEs with much more involvement in LEs
What intervention is most important to initiate first with this 26 month old child who has diplegia spastic CP?
A. daily PROM for 20 min morning and evening
B. passive standing in prone stander daily
C. body weight supported treadmill
D. patterning done 6 hours a day
B. passive standing in prone stander daily
*LE WB through supported standing program is important to initiate to promote physiologic and psychosocial benefits
What is athetoid CP?
classification: dyskinetic CP
athetoid: slow, continuous, writhing movements that prevent maintenance of stable posture
What is dystonic CP?
classification: dyskinetic CP
dystonia: involuntary sustained or intermittent mm contraction with repetitive movements and abnormal postures
What is ataxic CP?
ataxic: uncoordinated ,abnormal, unstable movement NOT due to weakness/involuntary mm activity
review GMFCS levels 1-5
