Cerebral Palsy Flashcards
Pathophysiology
group of permanent but not unchanging disorders that cause disorders of muscle tone, movement and posture, and which are the result of non progressive impact on the developing brain
Areas affected
secondary MSK problems sensation perception cognition communication behaviour epilepsy pain
Associated Impairments
1/3 unable to walk 1/4 unable to talk 3/4 have pain 1/4 have epilepsy 1/2 have an intellectual impairment 1/10 have severe visual impairments 1/4 have bladder control problems 1/5 have a sleep disorder
Aetiological Risk Factors
brain malformation kernicterus maternal iodine deficiency preterm brith twin birth maternal genital tract infections perinatal adversity
Classification - Type
spasticity - damage to the cerebral cortex
dyskinesia - dystonia/athetosis - damage to the basal ganglia
ataxia - damage to the cerebellum
mixed - multiple areas affected
Classification - Distribution
hemiplegia - one sided
diplegia - LL+UL, LL>UL
Quadriplegia - LL+UL equal, trunk
Classification - Gross Motor Function Classification System
standard tool for describing child’s functional ability
have to include GMFCS classification number on all documentation
Level 1 - children able to walk in all settings, able to ambulate stairs without a railing, can perform gross motor tasks such as running and jumping, but balance and coordination is limited
Level 2 - children walk in most settings, climb chairs using a railing, may struggle walking long distances and may use a mobility device, minimal ability to perform gross motor skills such as running and jumping
Level 3 - use handheld mobility device to walk in most indoor settings, may climb stairs using a railing with assistance or supervision, use wheeled mobility devices for longer distances
Level 4 - use mobility methods that requires assistance or are powered for most distances, may walk short distances at home with hand held mobility
Level 5 - transported in manual wheelchair in all settings, limited in ability to maintain head position, and control trunk and limb movement
Classification - Manual Abilities Classification System (MACS)
measure ability to handle objects in everyday activities
also needs to be included on all documentation
Level 1 - objects handled easily and successfully
Level 2 - handles most objects but with reduced control and success
Level 3 - handles objects with difficulty, requires some assitance to prepare
Level 4 - handles limited number of objects, always requires assistance
Level 5 - unable to handle objects or complete simple tasks with their hands
Classification - Functional Mobility Scale
describes how child normally moves around, not their best effort
over 5m, 50m, or 500m
Types of cerebral palsy
Spastic - motor cortex injury - muscles appear to be stiff and tight Dyskinetic - basal ganglia damage - involuntary movements - dystonia and choreoathetosis Ataxic - cerebellum damage - shaky movements Mixed - combination of damage
Assessment - general overview
General observation Neurological Assessment - mainly tone Functional assessment Refer to early identification and intervention centre Not our role to diagnose
Assessment - measures of function
Prechtl’s General Movements
- requires specific training
Observation at 6-9 weeks
- writhing stage, is it normal, poor or abnormal?
Observation at 9-20 weeks
- fidgety stage, normal, absent or abnormal?
Hammersmith Infant Neurological Examination (HINE) assesses neuro function at 3-24 mths Section 1 - cranial nerve function Section 2 - motor milestones Section 3 - motor behaviour
Assessment - measures of activity
Alberta Infant Motor Scale
Test of infant motor performance
Neurosensory and motor development assessment
Development Assessment of Young children
Assessment - Muscle Tone
Australian Spasticity Assessment Scale
- start with muscle positioned in its shortest passive length
- determine ROM - R2
- determine whether the catch is present - x3 rapid, gentle movements through range
- record R1 where catch is in range
- determine whether there is any resistance after the catch
Assessment - Hip Status
need regular surveillance via imaging
GMFCS level determines likelihood of hip problems
- increased GMFCS level = increased likelihood of hip issues = increased frequency of screening
all children with CP have to be referred to hip surveillance service before 2yo, or at 2 if that is when they were diagnosed
Measures of Function - Gross Motor Function Measure
5 dimensions, 66 items lying and rolling sitting crawling and kneeling walking, running, jumping get x3 changes, no hands on assistance, set up environment for optimal success
Gait in CP - overall impact
poor postural control causes secondary compensation by other muscles
restricts their ability to act as prime movers of the extremities
different timing patterns for muscles globally
early onset and late cessation of muscle activity
increased postural muscle effort, increased fatigue and reduced endurance
Gait Classification - Spastic Hemiplegia
don't progress through the types Type 1 - drop foot Type 2a - true equinus Type 2b - true equinus/recurvatum knee Type 3 - true equines with jump knee Type 4 - true equinus, jump knee, pelvic rotation, hip flexion, adduction and IR
Interventions - Green Light
COPCA - coping and caring for infants with special needs
Learn2Move
BIM - bimanual intervention for hemiplegia
CIMT - constrain induced manual therapy
Why don’t interventions get a green light?
inadequate infant independent activity
inadequate initiation by the infant
reliant on passive handling
therapist handling dependent on skill/expertise
Gait Classification - Spastic Diplegia
can progress through the types
True Equinus
Jump Knee
Apparent Equinus - toe touch with ankle at 90 degrees
Crouch gait - excessive DF, hip and knee flexion
- should not reach this stage with appropriate intervention
Types of Hypertonia
Spasticity
Dystonia
Rigidity
Spasticity Definition
Increased resistance to stretch of a muscle that is velocity dependent
may or may not have a catch in range
Dystonia Definition
involuntary movement that is triggered by sensory input or movement of a different part of the body
- eg. tough to leg causes involuntary flexion of elbow
- movement normally very small
Rigidity Definition
increased resistance to passive movement of a muscle that is not velocity dependent - occurs all the time
