Cerebral Palsy

Question 1

Etiology

Answer 1

• non-progressive motor disorder
• abnormal motor actions and postural mechanisms
• localized to CNS
• cause: brain damage
  
  • anoxia > brain damage > immature brain
  • STI
  • stroke
  • virus
  • labor
  • brain bleed
  • decreased HR
  • car accident
  • near drowning

Question 2

Prenatal Factors 75%

Answer 2

• 2+ previous abortions
• hereditary or genetic conditions
• infections
• anoxia
• Rh-incompatibility
• bleeding during pregnancy
• pre-eclampsia signs
• SGA
• metabolic deficiencies
• placental malnutrition
• developmental defecits
• multiple births
• maternal ingestion of toxins

Question 3

Perinatal Factors 6-8%

Answer 3

• cerebal hemorrhage
• compression of brain
• asphyxia producing encephalopathy
• separation of placenta
• premature
• infection
• hypoxia
• CNS infection
• hyperbilirubinemia-Kernicterus

Question 4

Postnatal Factors 10-18%

Answer 4

• vascular accidents
• anoxia
• siezures
• ICH
• tumors
• head injury/MVA
• shaken baby syndrome
• metabolix encephalopathy
• near drowning
• surgical complications
• toxic conditions
• brain infections

Question 5

Spastic Diplegia

Answer 5

LE more involved than UE

• hard to dissociate LE
• high incidence in premies
• risk factors: necrosis of white matter, vascular anomalies, drugs, hemmorhage
• high functioning
• like to go with the flow

Question 6

Spastic Quadriplegia

Answer 6

• entire body involved
• begins with low tone and increases over first year
• total patterns of movement are seen
• associated problems with vision, hearing, seizures, MR, oral motor etc
• hate change
• full term
• prenatal insult
• LBW - full term
• cortical and subcortical insults
• bulbar involvement
• fetal toxin etc

Question 7

Spastic Hemiplegia

Answer 7

• stroke in utero or during birth or after
• one side of body or trunk
• motor delay depends on severity
• neglect often seen with non use phenomena
• seizures are common
• learning disabilities, perceptual problems and speech/language depending on brain lesion
• full term pregnancy
• neonatal stroke MCA
• cortical lesion
• common in 3rd trimester
• cognitive involvement due to synaptic production/elimination up to 5yo

Question 8

Spastic/Low Tone CP

Athetoid-dyskinetic = fluctuating tone

>>Never normal

Answer 8

• involuntary movements
• postural instability with fluctuating tone
• speech and feeding problems
• associated hearing loss
• high incidence of normal cog functioning
• full term most common
• caused by kernituris - increased bili
• never have midline
• dominated by pathologic primitive reflexes
• function in end range
• can have joint laxity
• risk takers
• mood may flucuate with tone

Question 9

Spastic/Low Tone CP

Ataxia = dx of exclusion

Answer 9

• greater in full term
• incoordination and disturbance of posture and widespread motor dysfucntion
• low postural tone
• intention tremors
• associated nystagmus, poor eye tracking, delayed poorly articulated speech
• cerebellum involved- rule out tumor

Question 10

Low Tone - Hypotonia

Answer 10

• increased invidence in full term
• may mask undiagnosed degenerative condition
• precursor of dyskinetic syndrome
• develops abnormal patterns to create point of stability
• poor recruitment and difficulty initiating movement - slow development

Question 11

Mixed - CP

Answer 11

combination of 2 types

triplegia, monoplegia

Question 12

General Characteristics

Answer 12

• communication issues
• delayed motor milestones
• visual deficits
• swallowing or feeding problems
• neglect
• respiration issues
• sensory deficits
• emotional problems
• language
• scar tissue = seizures
• social
• self help
• persistent primitive reflexes
• predictable personality characteristics