cerebral palsy Flashcards
is ID more common among individuals w CP
yes about 50%
what does cerebral and palsy mean
cerebral = brain palsy = decrease in m control (paralysis in the brain)
CP what is it (5)
non-progressive but not unchanging (symptoms can change), disorder of mvt and/or posture, due to an insult to or an abnormality of the developing brain (elocution, hearing and vision difficulties may also accompany the problems of muscular control)
remember CP: (3)
not contagious
not hereditary (not transmitted)
not life-threatening (life expectancy is similar to able-bodied individuals)
incidence of CP
2 to 2.5 cases per 1000 births (incidence hasn’t declined over last 60 years despite med advances bc of increase in survival rate of pre-term babies)
15 000 people in Qc
50 000 in canada
males > females (1.33 males for 1 female)
sex and pathogenesis of CP
males born very preterm slso appear to be more vulnerable to white matter injury and intraventricular hemorrhage than females
sex hormones such as estrogens provide protection against hypoxic-ischemic injury, and the neonatal brain is also influenced by these hormones
CP causes
brain lesion
CP causes brain lesions subdivisions
90% before or during birth: maternal infections (aids, rubella, herpes), chemical toxins (alcohol, tobacco and drugs)
- injuries affecting fetal development
- damage to brain or O2 deprivation during deliveries (number 1)
- genetic disorders, chromosomal abnormality and faulty blood supply
10% after birth
- brain infections (meningitis)
- cranial traumas (accidents, shaken baby syndrome)
- oxygen deprivation (near drowning, >2min)
brain lesions other factors (3)
age of the mother (under 20; maternal infection and chemical toxins or over 34; genetic disorders, …)
premature + under birth weight babies
older moms is more physiological
early signs of CP (4)
- before 3 years of age
- motor skills not developing normally (coordination + balance)
- abnormal m tone (hypotonia; 1st, hypertonia; 2nd)
- favour one side of body
- toe walking, foot dragging, favour left when standing up)
types of CP; classification by # of limbs affected (6)
quadra: all 4 extremities
para: 2 lower ext affected
diplegia: lower ext more frequent than upper (2 limbs affected, either legs or arms)
hemiplegia: entire l or r side of body affected
triplegia: 3 ext (usually 2 legs and one arm)
monoplegia: one extremity
type of CP: classification by mvt disorder
spastic CP: tug-of-war or co-contraction
athetoid CP: mixed m tone, cte motion (harder to talk or feed themselves; most severe form)
ataxic CP: looks unsteady and shaky (go slow, walking like a child learning to walk)
what structures of the brain are affected by spastic, athetoid and ataxic
spastic; motor cortex, premotor cortex, spasticity
athetoid: basal ganglia, athetosis, tremors
ataxic: cerebellum, ataxia
characteristics of spasticity (5)
abnormal m tightness + stiffness
- most common (65% of people w CP)
- caused by damage to motor cortex + cortical tracts (basal ganglia + cerebellum) = exacerbate spasticity
- spastic m. interfere with voluntary mvts
- intervention: surgical lengthening of tendon (toe walking and knee flexion), dorsal rhizotomy
spastic CP; dorsal rhizotomy
the long tracts represent neurons that pass up and down the sc and modify the action of the reflex arc. injury to these tracts usually causes the reflex arc to become hyperactive (spastic)
characteristics of athetosis (5)
- constant, unpredictable, and purposeless mvt caused by fluctuating m tone (hyper/hypotonia)
- damage to basal ganglia
- (+ or -) 25% of people w CP
- problems w facial expressions, eating, speaking, head control, fingers + wrist control
- most people w athetosis are quadraplegic
characteristics of ataxia (3)
- disturbance of balance and coordination characterized by hypotonia + decrease in postural tone
- results from disorders of the cerebellum + vestibular system
- 10% of people with CP
abnormal gaits associated with spastic CP
scissors gait: leg = flexed +inwards rotated + toe walking
hemiplegic gait: hip circumduction +toe walking
abnormal gait in ataxic CP
ataxia or cerebellar gait: eyes down + wide base of support + arms away from body, absence of opposition of arms & legs (if they close their eyes they fall)
fitness and CP for same workload as able-bodied individuals (4)
higher HR, BP and [lactate]
decreased mechanical efficiency = increase energy
cause by spasticity + athetosis and poor exercise habits
support harness for balance and BW control
effects of exercise training (5)
limited info
improvement of:
- sense of wellness
- body image
- capacity to perform ADL
- less spasticity + athetosis (mild to moderate changes)
- resistance training = controversial
according to latest studies, resistance training increases spasticity (and in turn decrease __) by __ in participants with CP
ROM
0%
resistance training and walking in children with CP
effects of 12 weeks of progressive resistance training on walking ability
study summary:
- 3x / week for 60 min; 26 subjects /group, aged 6 to 13
- training group: leg press machine and 3 exercises (sit to stand)
- control group: conventional PT program
results of the study (4)
- increase in isometric m strength: (knee extensors, hip abductors and total increase)
- no improvement in walking ability in both groups (comfortable walking speed, cadans, step length and fast walking speed)
- no changes in m spasticity (m tone) and ROM in both groups
- possible reasons for lack of improvement in walking
