Cerebral Palsy Flashcards
a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.
CP
what is the most common motor disability in children
CP (1-4/1000)
what factors increase prevalence of CP in children
low birth weight and those born before 28 weeks gestation
common risk factors for prenatal CP (most common)
vascular events, congenital brain malformations, maternal infections, multiple gestations
common risk factors perinatal (during birth)
umbilical prolapse, obstructed labor, placental abruption
common risk factors postnatal
infections, blood disorders, injuries
are low or high APGAR scores associated with CP
Low (0-3)
what is the cutoff age to begin to worry about asymmetry
4 m/o
what are the key elements in diagnosing CP
Motor skills/development
Non-progressive sx
Neuroimaging
bleeding into the ventricles only
Intraventricular Hemorrhage (IVH)
bleeding into the tissue around the ventricles only
Germinal Matrix Hemorrhage (GMH)
bleeding into both the ventricles and tissues around the ventricles
Periventricular Intraventricular Hemorrhage (PIVH)
may develop in these areas as the hemorrhage resolves
Periventricular Cyst (PVC)
grading for hemorrhages
I-IV (least to most severe)
Ischemic lesion in areas adjacent to the lateral ventricles
Periventricular Leukomalacia (PVL)
major cause of CP in infants born preterm (<32 weeks)
Periventricular Leukomalacia (PVL)
Focal periventricular necrosis and more diffuse white matter cerebral injury
Periventricular Leukomalacia (PVL)
where is there damage to in PVL
cortical spinal tracts
are the LE or UE more affected in PVL and why
LE (spastic diplegia) because LE cortical tract is closest to the ventricles
what are the 3 ways to classify CP
type of movement abnormality related to tone
anatomical distribution of involved areas
functional abilities (GMFCS)
3 types of tone related to CP
spastic, ataxic, dyskinetic
one extremity involved
monoplegia
UE and LE on same side and trunk involved
hemiplegia
all extremities and trunk involved with LE more involved than UE
diplegia
equal involvement of all extremities and trunk
Quadriplegic
Classification based on gross motor function in kids with CP
Standardized system to measure severity of movement of the disability
gross motor function classification system (GMFCS)
what is the most prominent type of CP
spastic
velocity dependent hypertonicity characterized by resistance to passive stretch that increases with increased speed of movement; hyperactive stretch reflex
spasticity
how can spasticity lead to histological muscle tissue changes
Decreased longitudinal growth of muscle fibers
Decreased muscle volume
Change in muscle unit size
most common form of spastic CP
diplegia
White matter infarct in periventricular area caused by hypoxia
Primarily affects b/l LE
spastic diplegia
Increased lordosis
Anterior pelvic tilt
B/L hip IR
B/L knee flexion
Toe in
Equinovalgus foot position
spastic diplegia
Large range of motor function/gat abilities
Cognition is usually typical
May have social/emotional issues
diplegia
Periventricular white matter abnormalities most common cause
UE and LE on same side of the body are affected
(UE>LE )
Spastic Hemiplegia/Unilateral
Scapular protraction
Elbow flexion
Forearm pronation
Wrist flexion
Ulnar deviation
Posterior pelvic rotation
Hip IR and flexion
Knee flexion
Ankle plantar flexion
Spastic Hemiplegia/Unilateral
Usually able to achieve all developmental milestones but with delays
Delay of bimanual skills depending on severity of UE involvement
Usually have typical cognition/intelligence, may have social/emotional deficits
Spastic Hemiplegia/Unilateral
Impairment of voluntary muscle control of UE, LE, neck/trunk muscles
Wide range of cognitive abilities from typical to severe impairment
Gross and fine motor delays
Spastic Quadriplegia
PVL lesions most often seen, or lesion of basal ganglia or occipital region»_space; seizures, visual impairments
Function: Wide range from household ambulation or complete dependent care
Spastic Quadriplegia
movement is uncontrolled and involuntary
dyskinetic
dyskinetic typically has abnormalities in the deep gray matter such as
basal ganglia and thalamus
what is the hallmark sign of dyskinetic CP
hypotonia
Infants show little to no antigravity movements in first few months
Movement characterized by bursts of activity
dyskinetic
what are the 3 subtypes of dyskinetic CP
athetosis, dystonia, choreoathetosis
means without fixed posture (constant, slow movements)
athetosis
Involuntary movements that are slow and writhing, continuous and prevent sustaining of stable posture
Posture is asymmetric extension of trunk
Movements are abnormal in timing and direction
Often unable to produce speech due to unable to control breathing
Cognition is often normal to above-normal intelligence
athetosis
Global decrease in stiffness/tone proximal to distal
Inability to grade muscle activation
Muscle termination tends to be passive
athetosis
Asymmetry of spine and hips
Joint hypermobility
Poor ability to produce force (decreased strength)
athetosis
Fluctuations in respiration rate and rhythm
Poor breath support
athetosis
Movement disorder characterized by sustained muscle contraction with twisting, repetitive movements and abnormal postures
Sustained muscle contraction when trying to move
Low tone at rest
Often resembles spasticity due to co-contraction and overflow into extraneous muscles
Large variability in body position and movement
dystonia
means dance
Choreoathetosis
Involves brief, jerky, random movements
Differs from athetosis in duration and continuity of movements
In CP, almost never seen in isolation, will usually be classified along with another type of dyskinetic CP
Choreoathetosis
A disorder of balance and control in timing and coordination movements
ataxia
where due lesions occur with ataxia
cerebellum
Often in combination with spasticity and athetosis
Often use musculoskeletal system to extremes to support posture
Poor processing of sensory information
ataxia
common characteristics of ataxia
weakness, incoordination, wide based gait, tremor, dysmetria, hypotonia
Often correlated to congenital abnormalities
Wide range of functional abilities
Can be main form of motor dysfunction or as a precursor to athetosis or spasticity
hypotonia
Decreased stiffness/tone throughout trunk and extremities
Difficulty sustaining most muscle groups
Passive termination of muscle activity
hypotonia
Joint hypermobility
Muscle contractures
Poor force production
hypotonia
Decreased breath support
Poor cough
Decreased cardiovascular fitness
hypotonia
Origin in weakness in CNS dysfunction
Force Production Deficit
Inability to fractionate/isolate movement associated with moderate or greater hyperexcitability
Fractionated Movement Deficit
fractionated movement deficit is always associated with what type of deficit
CNS
Slowness in initiating and executing movement
hypokinesia
Inability to grade forces appropriately for the distance and speed aspects of a task
Associated with cerebellar dysfunction
Dysmetria
Systemic effect on muscle tone
Inhibit the release of excitatory neurotransmitters or increase release of inhibitory neurotransmitters
Oral anti-spasticity medications
Diazepam (Valium) and Baclofen effect the binding and transmission of GABA receptors at what level
spinal level
Dantrolen is an anti-spasticity medication that acts directly on
skeletal muscle
Regional effect on spasticity
Neurosurgical implantation of pump into abdomen with catheter inserted intrathecally
Intrathecal Baclofen Pump
ways to treat spasticity
oral medications, intramuscular injections, neurosurgical interventions, botox, selective dorsal rhizotomy (SDR)
increased resting muscle tension
hypertonia
Toe curling, fisting hands, difficulty moving a body part (actively or passively), asymmetric posture, arching
hypertonia
decreased resting muscle tension
hypotonia
Collapse of body segments, loss of postural alignment, inability to sustain a posture against gravity
hypotonia
resistance to passive movement at 2 speeds
tardieu scale
angle of muscle reaction, point of first catch, functional ROM
R1
full PROM
R2
17 parameters assessed on each LE at foot, knee, hip and trunk in sagittal, frontal, and transverse planes
Edinburgh Visual Gait Score (EVGS)
Assesses ability to perform isolated joint movement without using mass flexor/extensor patterns or undesired movement at other joints
Selective motor control is a predictive factor of functional ability in children with CP
Tests hip, ankle, knee, subtalar joint and toes
Selective Control Assessment of the LE (SCALE)
