Cerebral palsy Flashcards
Define cerebral palsy (CP)
Abnormality in movement or posture because of a NON PROGRESSIVE brain damage that happened during development, birth or early life
Over 2y/o -not CP and instead aquired brain injury
1 in 400 and most common motor impairment
amazing paces case
Causes and risk factors of cerebral palsy (CP)
Causes are very varied-
Risk factors:
Antenatal - Premmie,, multiple babies, maternal infection like chorioamnimonitis (rubella, toxoplasmosis, CMV)
Natal -HIE, Low birth weight, trauma, tools used during delivery
Postnatal - Meningitis, neonate sepsis, jaundice, neonate seizures
80% of CP are antenatal -
vascular occlusions, structural maldevelopment, genetic syndromes, congenital infections
10% are perinatal -HIE during pregnancy (and all the causes of HIE)
10% are postnatal -esp in premature babies with periventricular leukomalacia 2nd to ischemia
Signs and Sx of cerebral palsy (CP)
Signs and Sx are usually seperated into categories-spastic (90%), ataxic (6%) and dyskinetic (4%) (they get own card)
General signs -
Development delay -missing milestones in gross motor skills +- persistance of primitive reflexes
NEVER LOSE ANY
abnormal posture/limb movement -depends on type of CP
Abnormal feeding/distrubance (slow, gagging, vomit, micro-aspiration)
abnormal gait
early hand preference
often associated with -learning disabilities, epilepsy, squints and hearing problems
Signs and Sx of Spastic cerebral palsy (CP)
Spastic–damage to UMN pathways/pyramidal tracts -leading to hypertonia, hyperreflexia,
“clasp knife reflex” -can resist with flexor until 1 point where it just gives -UMN sign
dynamic catch -faster the muscle used, stronger it is (velocity)
3 main types -
Hemiplegic Unilateral arm and/or leg, face spared 4-12 month 1st presentation fisting of affected hand, asymetric movements at birth walk on tip toes on affected side Scissor gait -knee looking inwards flaccid but increase tone on 1 side
PMh and BH can be clear -unclear cause/stroke
quadriplegic All 4 limbs affected, often severe hyperflexed back and neck -opisthotonos Trunk affected Poor head control Low central tone - associated with seizures, micocephaly, big learning disabilities
PMH-often HIE, severe
diaplegic-legs affected more than arms, but still all 4affected
abnormal walking -scissor gait or worse
difficulies with hand use
assocaited with LVP and preterm damage
Sign and Sx of Ataxic cerebral palsy (CP)
HYPOtonic CP -
damage to cerebellum
usually very genetic determined
hypotonia, ataxia, coordination issues
delay in development
intension tremors
Signs and Sx of dyskinetic cerebral palsy (CP)
Involuntary/uncontrolled abnomral movements
damage to basal ganglia
usually HIE or kernicterus caused
variable muscle tone determined by primitive reflexes -
Chorea- irregular, sudden, non rythmical
athetosis -slow, writhing distal movement -finger fanning
Dystonia -simultaneous flex/extensor action -twisted motion
Investigation of cerebral palsy (CP)
have high clinical suspicion with any child not walking by 18 months, not sitting by 8mo, early hand preference
or still tiptoeing walk
or any other sign previously discussed
MRI -will show where and what the lesion is
needed if PMH, BH and Hx not clear enough
if its progressive-not CP
if lose milestones
MDT investigation with paeds, Physio, SALT, Nurse, OT, ortho
Management of cerebral palsy (CP)
very MDT related because no treatment
and common in paces ;)
Educate parents about prognosis and what it is
prognosis -those that can sit before 2 probs can walk before 6
speech -50% trouble with talk, 33 with language
Life expect - worse with severe CP
Paeds-medical -epilepsy common (33%)
Physio -encourage movement, improve stengh, reduce loss of ROM
SALT -improve talking and communication capabilites
OT -identify tasks that could be hard and help with
Medication for Sx - anticonvusltants Stiffness-diazepam Constip -movicol drooling-antocholinergic sleeping-melatonin
PACES mx talk for cerebral palsy (CP)
explain diagnosis (damage to brain that accured early in develop)
Explain it wont progress/get worse, even if Sx might evolve
Refer to MDT, with Paeds/OT/SALT/PT which will all be involved in long term management
medication is available for sx control and help
Social services and support groups for parents