Cerebral Palsy Flashcards
what is CP?
a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occured in the developing fetal and infant brain
T/F: CP is a static brain lesion?
TRUE
this means a non-progressing injury, but since it occurs in a growing child we can see regression in these children despite CP being a “fixed injury”
pathophysiology of CP
- When does the injury occur?
- prenatal
- perinatal
- postnasal
- Types of injury resulting in CP
- hypoxic
- ischemic
- infectious
- congential
- trauamtic
Risk factors assocaited with CP
- preterm birth
- uterine abnormalities
- multiple births
- genetics
what is required for a diagnosis of CP?
- neuroimagining findings
- clinical findings
- not reaching milestones
- demonstrates abnormal muscle tone
- qualitative differences in movement patterns
- risk factor assessment
how can CP impact various outcome measures?
- Prechtl’s Assessment of General Movements
- best combo of sensitivity and specificity for predicting CP in early months
- AIMS and NSMDA
- better as infants age
how is CP classified?
- Body part involved
- hemi, di, tri, quad
- Type of movement disoder
- spastic
- ataxic
- athetoid
- hypotonic
- mixed dyskinetic
- Severity of movement disoder
- GMFCS helps determine this
Characteristics of Spastic or Hypertonic CP
- stiffness → usually greater distally
- velocity dependent resistance
- abnormal and limited movement synergies
- excessive co-activation and/or reciprocal inhibition → results in limited ROM
- abnormal timing and grading of muscle activation
- abnormal posture responses
- difficulty maintaining activity of certain muscle groups
Implications for MSK system in Spastic CP
- limited ROM
- weakness
- deformities
Implications for Sensory/Perceptual System in Spastic CP
- decreased tactile, kinesthetic, vestibular, and proprioceptive awareness
- difficulty discriminating
- upward visual gaze
- may be due to increased cervical ext
Implications for Cardiovascular and Respiratory System in Spastic CP
- poor cardiovascular fitness due to decreased mobility
- reduced breath support with flared ribs and tight rectus abdominus
Implications for Oral Motor in Spastic CP
- drooling
- poor articulation
- difficulty feeding
Charactertistics of Dyskinetic CP
includes athetosis, rigidity and tremor
- movement that appears uncontrolled and involuntary
- athetosis
- abnormal timing
- direction and spatial characteristics
- impaired postural stability
- abnormal coordination in reversal of movement and latency of onset movement
- oral-motor dysfunction
Implications for MSK system in Athetosis
- significant asymmetry
- joints may be hypermobile
- frequent TMJ problems
4.
Characteristics of Rigidity CP
resistance to both active and passive movement throughout the range in both agonist and antagonist
Characteristics of Ataxic CP
- primarly a disorder of balance and control in the timing of coordinated movement
- often occurs in combo with spasticity and/or athetosis
- ineffective postural alignment
- ineffective anticipatory adjustments
- abnormal postural stability
- often hypotonic with impaired force during active movement and tremor
Implications for MSK system in Ataxia CP
- tend to rely on ligaments for stability
- relies on vision for balance
- postural insecurity
Characteristics of Hypotonic CP
- may be permanent or a transient condition in the evolution of athetosis or spasticity
- diminished resting muscle tension
- decreased ability to generate voluntary muscle force
- excessive joint flexibility
- postural instability
- extension usually favored over flexion
Implications for MSK system in Hypotonic CP
- stability gained through end-range positioning
- contractures develop secondary to position of the arms and legs
- rib cage at risk to become flat due to gravity
Describe the Diplegic classification of CP
- legs involved more than arms
- Half are preterm deliveries
- injury to perinatal white matter common
- great ambulation potential
Describe the Triplegic classification of CP
- combo of diplegia and hemiplegia
- hemiplegia → one side of body more involved
- half are prenatal in origin
Describe the quadriplegia classification of CP
sign involvment of all 4 limbs
what are primary impairments in CP?
impairments in body systems that are directly attributed to the brain pathology
what are positive signs?
behaviors that are present and not expected in the typical population
what are negative signs?
behaviors that are absent because of the pathophysiology
Give some examples of primary impairments
- problems detecting, registering, modulating, and optimizing sensory info
- selecting, activating, sequencing, and executing coordinated movement synergies
- regulating anticipatory postural strategies
- producing appropriate levels of coactivation and force production
what are secondary impairments?
impairments that do not result directly from the original pathophysiology and generally develop over time due to the effects of the brain lesion interaction with other body systems and in various contexts
list some examples of secondary impariments
- weakness
- muscle atrophy
- epilepsy
- visual system impairments
- decreased endurance
- limited selection of patterns of activation due to limited practice
- inability to allocate attention to multiple motor tasks due to cognitive system impairments
- joint or muscle pain from abnormal mechanics
