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 occurred in the developing fetal or infant brain.
T/F: Cerebral palsy is a dynamic brain lesion.
FALSE
it’s a static one
What does CP cause in most children?
- progressive musculoskeletal impairments in most children
- Disturbances of
- Cognition
- Behavior
- Communication
- Sensation
- Perception
- Epilepsy
Onset, Etiology, other factors of CP
- Onset
- Prenatal
- Perinatal
- Postnatal
- Etiology
- Hypoxic
- Ischemic
- Infectious
- Congenital
- Traumatic
- Other factors
- Preterm birth
- Uterine abnormalities
- Multiple births
- Genetics
What is on the differential diagnosis list for CP?
- Brain tumors
- Metabolic abnormalities
Outcome measures and CP
- Prechtl’s Assessment of General Movements: best combination of sensitivity/specificity for predicting CP in the early months
- AIMS/NMSDA: better as the infants age
Other CP characteristics
- Child does not reach milestones
- Abnormal muscle tone
- Qualitative differences in movement patterns
How do we classify the severity of movement disorder with CP?
GMFCS
Body parts involved, type of movement
- Body parts involved
- Hemiplegia
- Diplegia
- Triplegia
- Quadriplegia
- Type of movement disorder
- Spastic
- Ataxia
- Athetoid
- Hypotonic
- Mixed
- Dyskinetic
Levels of GMFCS
Walks without limitations
Walks with limitations
Walks using a hand held mobility device
Self mobility with limitations: may use powered mobility
Transported in a manual wheelchair
Characteristics of Spastic/Hypertonic CP
- Stiffness (usually greater distally)
- Velocity dependent resistance
- May or may not be present
- Abnormal and limited movement synergies
- Excessive coactivation and/or reciprocal inhibition leading to limited ROM
- Abnormal timing and grading of muscle activation
- Abnormal postural responses
- Difficult maintaining activity of certain muscle groups
MSK implications and sensory perceptual system for spastic/hypertonic CP
- MSK Implications
- Limited ROM
- Weakness
- Deformities
- Sensory-Perceptual System
- Decreased tactile, kinesthetic, vestibular, and proprioceptive awareness
- Difficulty discriminating
- Upward visual gaze
Cerebral palsy spastic/hypertonic CV respiratory implications; oral motor complications
- CV/Respiratory Implications
- Poor cardiovascular fitness due to decreased mobility
- Reduced breath support with flared ribs and tight rectus abdominus
- Oral/motor Implications
- Drooling
- Poor articulation
- Difficulty feeding
dyskinetic CP
- Dyskinesia: movement that appears uncontrolled and involuntary
- Tremor
- Rigidity: resistance to both active and passive movement throughout the range in both agonist and antagonist
- Athetosis: abnormal timing, direction, and spatial characteristics, impaired postural stability, abnormal coordination in reversal of movement and latency of onset of movement, oral-motor dysfunction
MSK implications dyskinetic CP
- Significant asymmetry
- Joints may be hypermobile
- Frequent TMJ problems
Definition, characteristics of Ataxia CP
- Definition: primarily a disorder of balance and control in the timing of coordinated movement
- Characteristics
- May occur in combination with spasticity and/or athetosis
- Ineffective postural alignment, anticipatory postural adjustments, abnormal postural stability
- Often hypotonic with impaired force during active movement and tremor
MSK implications for 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 spasticity or athetosis
- Diminished resting muscle tension
- Decreased ability to generate voluntary muscle force
- Excessive joint flexibility
- Postural instability
- Extension usually favored over flexion
MSK implications hypotonic CP
- Stability gained through end range positioning
- Contractures develop secondary to the position of the arms/legs
- Rib cage at risk for becoming flat due to gravity
Define diplegia, triplegia, hemiplegia, quadriplegia
- Diplegia: legs more involved than arms
- 50% are preterm deliveries
- Injury to perinatal white matter common
- Great ambulation potential
- Triplegia: combination of diplegia and hemiplegia
- Hemiplegia: one side of the body more involved
- 50% are prenatal in origin
- Quadriplegia: significant involvement of all 4 limbs
What are primary impairments and positive/negative signs
- Primary impairments: impairments in body systems that are directly attributed to the brain pathology
- Positive signs: behaviors that are present and not expected in the typical population
- Negative signs: behaviors that are absent because of the pathophysiology
Examples of primary impairments
- Problems detecting, registering, modulating, and organizing sensory information
- 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 pathophysiology and generally develop over time due to the effects of the brain lesion interaction with other body systems and in various contexts
Examples of secondary impairments
- 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
single system impairments
- Primary: insufficient force generation, spasticity, abnormal extensibility, hyperactive reflexes
- Secondary: malalignments such as torsion or hip deformity
Multisystem impairments
- Poor selective control of muscle activity
- In CP: inappropriate sequencing, coactivation of synergists/antagonists
- Poor regulation of activity in muscle groups in anticipation of postural changes and body movement
- In CP: the contraction that is needed to produce stability is frequently interrupted by destabilizing synergistic or antagonistic muscle activity
- Decreased ability to learn unique movements
CP Prognosis
- Ambulation: nearly all who eventually walk do so by age 8
- Key predictors of reduced life expectancy
- Lack of mobility
- Feeding difficulty
- GMFCS Level V
- 90% of motor potential reached by age 3
- GMFCS Level I
- 90% of motor potential reached by age 5
- Poor prognosis for ambulation
- Rigidity
- Persistent tonic neck reflexes
- Adults
- 31% live independently
- 12% are married
- 28% are employed
