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Y4 Paediatrics: Community > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

What is cerebral palsy (CP)?

A

Cerebral palsy (CP) is the name given to the permanent neurological problems resulting from damage to the brain around the time of birth.

It is not a progressive condition, however the nature of the symptoms and problems may change over time during growth and development.

There is huge variation in the severity and type of symptoms, ranging from completely wheelchair bound and dependent on others for all activities of daily living, to para-olympic athletes with only subtle problems with coordination or mobility.

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2
Q

What are the causes of CP?

Note: antenatal, perinatal and postnatal

A

Antenatal:

  • Maternal infections
  • Trauma during pregnancy

Perinatal:

  • Birth asphyxia
  • Pre-term birth

Postnatal:

  • Meningitis
  • Severe neonatal jaundice
  • Head injury
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3
Q

What are the 4 different types of CP?

A
  1. Spastic
  2. Dyskinetic
  3. Ataxic
  4. Mixed
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4
Q

Briefly describe spastic CP

A

Hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones.

Spastic CP is also known as pyramidal CP.

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5
Q

Briefly describe dyskinetic CP

A

Problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.

Dyskinetic CP is also known as athetoid CP and extrapyramidal CP.

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6
Q

Briefly describe ataxic CP

A

Problems with coordinated movement resulting from damage to the cerebellum.

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7
Q

Briefly describe mixed CP

A

A mix of spastic, dyskinetic and/or ataxic features.

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8
Q

Briefly describe the 4 patterns of spastic CP

A

Monoplegia: one limb affected.

Hemiplegia: one side of the body affected.

Diplegia: four limbs are affects, but mostly the legs.

Quadriplegia: four limbs are affected more severely, often with seizures, speech disturbance and other impairments.

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9
Q

Which type of CP is the most common?

A

Spastic CP accounts for 90%.

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10
Q

How does CP present?

A

Signs and symptoms of cerebral palsy will become more evident during development:

  • Failure to meet milestones
  • Increased or decreased tone, generally or in specific limbs
  • Hand preference below 18 months is a key sign to remember for exams
  • Problems with coordination, speech or walking
  • Feeding or swallowing problems
  • Learning difficulties
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11
Q

What does a hemiplagic/ diplegic gait indicate?

A

Indicates an upper motor neurone lesion.

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12
Q

What does a broad based gait/ ataxic gait indicate?

A

Indicates a cerebellar lesion.

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13
Q

What does a high stepping gait indicate?

A

Indicates foot drop or a lower motor neurone lesion.

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14
Q

What does a waddling gait indicate?

A

Indicates pelvic muscle weakness due to myopathy.

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15
Q

What does an antalgic gait (limp) indicate?

A

Indicates localised pain.

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16
Q

Briefly differentiate between upper and lower motor neurone injuries

Note: inspection, tone, power and reflexes

A
17
Q

What is the differntial diagnosis of an upper motor neurone lesion?

A

The differential diagnosis of an upper motor neurone lesion is acquired brain injury or a tumour.

18
Q

Briefly describe the presentation of a hemiplegic or diplegic gait

A

Patients with cerebral palsy may have a hemiplegic or diplegic gait. This gait is caused by increased muscle tone and spasticity in the legs. The leg will be extended with plantar flexion of the feet and toes. This means they have to swing the leg around in a large semicircle when moving their leg from behind them to in front. There is not enough space to swing the extended leg in a straight line below them.

They will have signs of an upper motor neurone lesion, with good muscle bulk, increased tone, brisk reflexes and slightly reduced power. Power may be normal. Look for athetoid movements that indicate extrapyramidal (basal ganglia) involvement. Test for coordination to look for cerebellar involvement.

19
Q

What complications and conditions are associated with CP?

A
  • Learning disability
  • Epilepsy
  • Kyphoscoliosis
  • Muscle contractures
  • Hearing and visual impairment
  • Gastro-oesophageal reflux
20
Q

Who is involved in the management of CP?

A

Management will involve a multi-disciplinary team approach:

  • Physiotherapy
  • Occupational therapy
  • Speech and language therapy
  • Dieticians
  • Orthopeadic surgeons
  • Paediatricians
  • Social workers
  • Charities and support groups
21
Q

What is the role of physiotherapy in CP?

A

Physiotherapy is used to stretch and strengthen muscles, maximise function and prevent muscle contractures.

22
Q

What is the role of occupational therapy in CP?

A

Occupational therapy is used to help patients manage their everyday activities, such as getting dressed and using the bathroom. That can involve techniques to perform tasks despite disability. They can also make adaptations and supply equipment, such as rails for assistance or fitting a hoist for a patient who is entirely wheelchair bound.

23
Q

What is the role of speech and language therapy in CP?

A

Speech and language therapy can help with speech and swallowing. When swallowing difficultly prevents them meeting their nutritional requirements they may require an NG tube or PEG tube to be fitted.

24
Q

What is the role of dieticians in CP?

A

Dieticians can help ensure they meet nutritional requirements. Some children may require PEG feeding through a port on their abdomen that gives direct access to the stomach.

25
Q

What is the role of orthopaedic surgeons in CP?

A

Orthopaedic surgeons can perform procedures to release contractures or lengthen tendons (tenotomy).

26
Q

What is the role of paediatricians in CP?

A

Paediatricians will regularly see the child to optimise their medications. This may involve:

  • Muscle relaxants (e.g. baclofen) for muscle spasticity and contractures
  • Anti-epileptic drugs for seizures
  • Glycopyrronium bromide for excessive drooling

Y4 Paediatrics: Community (7 decks)

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