cerebral palsey Flashcards
what is Cerebral Palsy (CP)
A heterogeneous group of motor disorders
A syndrome of motor impairment
Results from brain abnormalities early in life
Non-progressive
Often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, epilepsy, and secondary musculoskeletal problems
Five Main Features of CP
- Onset before, during, or after birth (usually before 5 years)
- Damage to the brain, or an abnormality of the developing brain
- Motor difficulties that are secondary to brain damage or abnormal development
- Decreased control of movements with poor motor co-ordination, balance, or abnormal movements
- A condition that is non-progressive, but permanent
Early Signs of CP
Hypotonia/floppy baby syndrome or hypertonia
Failure to thrive syndrome- babies not gaining weight
Delayed motor milestones or abnormalities in movements
Identification of CP
Pediatricians conduct physical and neurological examination
May use an CT scan or MRI of the brain
Diagnosis often not made until 2 years old- usually diagnosed by age 4
Prevalence of 2.5 of 1000 children
what is the cause of CP?
Combination of genetic vulnerability and environmental stressors
what are the risk factors associated with CP?
Risk factors
Prenatal
Perinatal
Postnatal (10-25%)
Prenatal Risk Factors
Congenital malformations of the brain Congenital infections Exposure to teratogens Twin/multiple births Prematurity/low birth weight Inflammation of the placenta or amniotic fluidamniotic fluid Stroke Toxemia (maternal high blood pressure) Severe jaundice
Perinatal Risk Factors
Premature separation of the placenta from the uterus
Neonatal encephalopathy (birth asphyxia)
Hypoxic ischemic injury- lack of oxygen causes damage to brain and spinal cord (13%)
Not as common as originally thought
Cord prolapse
Brain hemorrhage or stroke
Use of forceps and squeezing the skull
Postnatal Risk Factors
Asphyxia (secondary to choking or near drowning)
Head injury/shaken baby syndrome
Brain infections (e.g. meningitis)
Strokes
Spastic CP
Scissor gait
Most common form of CP (70-80%)
spasticity
hypertonicity
Spasticity
extra stiffness in the muscles associated with increased reflexes
Hypertonicity
muscles are stiff and permanently contracted in a state of continual high muscle tone”
bilateral
limbs on both sides of the body are involved
Spastic diplegia
both legs
Spastic quadriplegia
ll four limbs
Unilateral
limbs on one side of the body are involved
AKA spastic hemiplegia
Dyskinetic CP
Uncontrolled, slow, writhing movements
10-20% of people with CP
Dystonic
fluctuation in tone and stiffness of movements
Might get stuck in abnormal postures
Choreoathetotic
hyperkinetic/increased activity involuntary movements
Ataxic CP
Poor balance and decreased muscle co-ordination
Difficulty with depth perception, fine motor coordination, and sudden movements
Wide based gait
Rare- 5-10% of people with CP
Impact of CP on Movement
Difficulty controlling and planning motor movements
Wide variability in movement function
Most individuals with hemiplegia and diplegia are able to walk
Individuals with quadriplegia or dyskinetic CP usually need a wheelchair
Contracture
shortened muscles/tendons, resulting in muscles being rigidly fixed in abnormal positions
Level I
walks without restrictions; limitations in more advanced motor skills
Level II
walks without assistive devices; limitations walking outdoors and in the community
Level III
walks with assistive mobility devices; limitations walking outdoors and in the community
Level IV
self-mobility with limitations; children are transported or use power mobility outdoors and in the community
Level V
self-mobility is extremely limited even with the use of assistive technology
Impact of CP on Learning
Not always associated with intellectual disability
Can have average intelligence (1/3)
However, learning disabilities are common
At a greater risk for developmental disability
30-60% of individuals with CP also have a DD
Cognitive deficits due to lack of exploration of the environment
Impact of CP on Speech and Language
Some difficulty with articulation
Some may be unable to speak because of motor problems (more likely in dyskinetic CP)
Medical Problems Associated with CP
Seizures (20-30%) Visual impairment or strabismus (25%) Hearing or speech impairment (50%) Feeding and swallowing difficulties Aspiration pneumonia Poor nutrition and growth Incontinence Orthopedic complications Drooling
treatment of CP
Surgery
E.g. lengthening tendons to increase flexibility
Physiotherapy
Stretching for flexibility
Work on muscle strength and movements
Orthotist
Special equipment such as walkers and wheelchairs
Use of braces
Occupational Therapists
Improving hand control and fine motor function
Equipment and home renovations to promote independence
Speech and Language Pathologists
Improve articulation and language development
Augmentative communication systems
Other
Vocational training
Special education
Recreation and leisure
Botox and CP
Boulinum toxin injections
Causes temporary paralysis of the muscle and decreases muscle tone
Can improve range of motion, function of opposing muscles, and relieve muscle spasms
Prevention of CP
Magnesium sulphate
Given to pregnant women at risk of having a preterm baby
May reduce the amount and severity of CP
Cooling beds
Newborns suspected of having CP go in a cooling bed for 72 hours after birth
May reduce the severity of CP
Vaccination of mothers
Prevents potential for infections such as rubella and meningitis
