Cerebral Palsy Flashcards
What is cerebral palsy?
A chronic disorder or movement and/or posture that presents early and continues throughout life
When does cerebral palsy present?
Before 2 years old
What is cerebral palsy characterised by?
Abnormal muscle tone, reflexes, or motor development
What is the incidence of cerebral palsy?
It occurs in about 2.1 per 1000 live births
What are the sub-types of cerebral palsy classified on the basis of?
The specific problems present
What are the sub-types of cerebral palsy?
- Spastic cerebral palsy
- Ataxic cerebral palsy
- Athetoid cerebral palsy
What is spastic cerebral palsy?
Those with stiff muscles
What is ataxic cerebral palsy?
Those with poor co-ordination
What is athetoid cerebral palsy?
Those with writhing movement
Do the sub-types of cerebral palsy occur on their own or together?
Most children have a mixed disorder
What is the underlying mechanism of spastic cerebral palsy
Damage to the upper motor neurone (pyramidal or corticospinal tract) pathway
What is unilateral spastic cerebral palsy most commonly caused by?
Neonatal stroke
What is bilateral (quadriplegic) spastic cerebral palsy most commonly caused by?
Perinatal hypoxic-ischaemic encephalopathy
What is bilateral (diplegic) spastic cerebral palsy most commonly caused by?
Preterm birth, due to periventricular brain damage
What is the underlying mechanism of dyskinetic cerebral palsy?
Damage or dysfunction to the basal ganglia, or their associated pathway
What is dyskinetic cerebral palsy most commonly caused by?
Hypoxic-ischaemic encepahlopathy at term
What is the underlying mechanism of ataxic cerebral palsy?
Most cases are genetically determined
What is the underlying mechanism of cerebral palsy?
Caused by abnormal development or damage to parts of the brain that control movement, balance, and posture
When does damage to the brain causing cerebral palsy occur?
Most often, problems occur during pregnancy, however they may occur during childbirth or shortly after birth
What % of cases of cerebral palsy are thought to have an inherited genetic cause?
About 2%
Is there always an identifiable cause in cerebral palsy?
No
Give some typical causes of cerebral palsy?
- Problems with intra-uterine development
- Hypoxia of the brain
- Birth trauma during labour and delivery
- Complications around birth or during childhood
Give 3 examples of problems with intrauterine development that can cause cerebral palsy
- Exposure to radiation
- Infection
- Fetal growth restriction
Give 2 examples of causes of hypoxia to the brain that can cause cerebral palsy
- Thrombotic events
- Placental conditions
What are the risk factors for cerebral palsy?
- Pre-term birth
- Being a twin
- Certain infections during pregnancy, e.g. toxoplasmosis, rubella
- Exposure to methylmercury during pregnancy
- Difficult delivery
- Head trauma during first few years of life
When will many children who develop CP be identified as being at risk?
In the neonatal period
What are the early features of CP?
- Abnormal limb and/or trunk posture and tone in infancy, with delayed motor milestones
- Feeding difficulties, with oromotor incoordination, slow feeding, gagging, and vomiting
- Abnormal gait once walking is achieved
- Asymmetric hand function before 12 months of age
How is CP now categorised?
According to neurological features
What are the different categories of CP?
- Spastic
- Dyskinetic
- Ataxic
What are the main features of spastic cerebral palsy?
- Persistently increased limb tone
- Brisk deep tendon reflexes and extensor plantar responses
What are the types of spastic CP?
- Unilateral
- Bilateral (quadriplegia)
- Bilateral (diplegia)
What is affected in unilateral spastic cerebral palsy?
Arm or leg (arm usually more than leg)
When do children with unilateral spastic cerebral palsy present?
4-12 months
How do children with unilateral spastic cerebral palsy present?
- Fisting of affected hand
- Flexed arm and pronated forearm
- Asymmetrical reaching
- Tip-toe walk on affected side
What is affected in bilateral (quadriplegic) spastic cerebral palsy?
All 4 limbs, often severely, as well as the trunk
What results from the trunk being involved in bilateral (quadriplegic) spastic cerebral palsy?
- Extensor posturing
- Poor head control
- Low central tone
What is opisthosomas? (if its not a spider just in case the word in an exam if its real)
Extensor posturing
What is bilateral (quadriplegic) spastic cerebral palsy associated with?
- Seizures
- Microcephaly
- Moderate or severe intellectual impairment
What is bilateral (diplegic) spastic cerebral palsy?
When all 4 limbs are affected, but legs are affected to a much greater degree than arms, so hand function may appear to be relatively normal
What does dyskinesia refer to?
Movements that are involuntary, uncontrolled, occasionally stereotyped, and often more evident with active movement or stress
Describe the muscle tone in dyskinetic cerebral palsy
Variable
Describe the motor reflexes in dyskinetic cerebral palsy
Primitive motor reflex patterns predominate
What may dyskinesia be described as?
- Chorea
- Athtosis
- Dystonia
What is chorea?
Irregular, sudden, and brief non-repetitive movements
What is athetosis?
Slow writing movements occurring more distally
What is dystonia?
Simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles, often given twisted appearance
How do children with dyskinetic cerebral present?
- Floppiness
- Poor trunk control
- Delayed motor development
When do abnormal movements appear in dyskinetic cerebral palsy?
Towards the end of the first year of life
How does ataxic cerebral palsy present initially?
- Early trunk and limb hypotonia
- Poor balance
- Delayed motor development
What features may be present later in ataxic cerebral palsy?
- Incoordinate movements
- Intention tremor
- Ataxic gait
What is the diagnosis of cerebral palsy based on?
Mainly history and physical examination, including general movements assessment
What does a general movements assessment involve?
Measuring movements that occur spontaneously
When is a general movements assessment most accurate?
At less than 4 months of age
What tests are done once a person has been diagnosed with CP?
Further diagnostic tests are optional, and may include CT/MRI
What is the purpose of a CT/MRI in CP?
- Determine cause of CP
- Suggest timing of initial damage
- Reveal treatable conditions, e.g. hydrocephalus, AV malformation
What are the differential diagnoses for CP?
- Temporary problems with muscle tone or control
- Metabolic disorders
- Fragile X syndrome
- Tumours of conus and cauda equina
- Vascular malformations of spinal cord
Give 2 metabolic disorders that are differentials for CP
- Metabolic myopathies
- Metabolic neuropathies
Is there a cure for cerebral palsy?
No
What are the types of management for CP?
- Supportive treatments
- Medications
- Surgery
What can some children achieve with appropriate management?
Near normal adult life
What are the management options for CP?
- Physical therapy
- Occupational therapy
- Speech therapy
- Medications to help relax stiff muscles
- Surgery
- External braces
- Assistive technology
What medications can be used to help relax stiff muscles in CP?
- Diazepam
- Baclofen
- Botulinum toxin
What are the surgical options in CP?
- Lengthening muscles
- Cutting overly active nerves
What impairments are children with CP at increased risk of?
- Vision
- Difficulty communicating
- Learning disabilities
- Epilepsy
- Nutrition
- Psychiatric
