Cerebral palsy Flashcards
What is cerebral palsy?
Permanent neurological problems resulting from bran damage at birth
Not progressive but changes due to growth and development
Huge range of severity
Antenatal causes of cerebral palsy
Maternal infections
Trauma during pregnancy
Perinatal causes of cerebral palsy
Birth asphyxia
Pre term birth
Post natal causes of cerebral palsy
Meningitis
Severe neonatal jaundice
Head injury
Type sof cerebral palsy
Spastic/pyramidal
Dyskinetic/athetoid/extrapyramidal
Ataxic
Mixed
What is spastic CP?
Hypertonia (increased tone) and reduced function due to UMN damage
Symptoms of dyskinetic CP
Problems controlling muscle tone
Hyper/otonia both
Causes atheotid movements and oro=motor problems
What part of brain is damages in dyskinetic CP
Basal ganglia
What is damaged in spastic CP
UMNs
Sympotms of ataxic CP + where damaged
Coordinated movement problems
Cerbellum
Patterns of CP
Monoplegia, hemiplegia, diplegia quadriplegia
What is differnece between diplegia and quadraplegia
Four limbs affected in both
Diplegia - four limbs are affected but mostly legs
Quadraplegia - four limbs are affected more severely often with seizures, speech disturbacnes and other impairments
Monoplegia vs hemiplegia
ONe limb affected -mono
Hemi - one side of body affected
What is hypoxic ischaemic encephalopathy
Perinatal asphyxia causing acute brain injury due to systemic hypoxia and decerased cerebral blood flow
Signs and sympotms of cerebral palsy during development
Failure to meet milestones
Increased or decreased tone, generally or in specific limbs
Hand prefernece below 18 months
Problems with coordination speech or wlaking
Feeding or swallowing problems
Learning difficulties
What does a high stepping gait suggest is damaged?
Foot drop or LMN lesion
What does a waddling gait suggest?
Indicates pelvic muscle weakness due to myopathy
Anatalgic gait (limp) suggests?
Localised pain
What lesion does a broad based gait/ ataxic gait suggest?
Cerebellar lesion
Muscle bulk LMN vs UMN
Bulk preserved in UMN
Reduced bulk with fasciculations
What causes hypertonia?
UMN lesion
What causes hypotonia?
LMN lesion
LMN vs UMN which more dramatically reduces power?
LMN
Reflexes UMN vs LMN
UMN - brisj
LMN - reduced
What causes hemiplegic/diplegic gait
Increased muscle tone and spasticity in the lefs
What happens in a hemiplegic/diplegic gait?
Leg extended with plantar flexion of feet and toes -> swing leg large semicircle when moving leg behind to front
What will people with CP typically have>
UMN lesion signs, good muscle bulk, increased tone, brisk reflexes and slightly reduced or normal power
Complications and ass conditions in CP
Learning disability
Epilepsy
Kyphoscoliosis
Muscle contractures
Hearing and visula impariment
Gastro-oeophageal reflux
What should first response be when asked how to manage cerebral palsy?
Management will involve a multidisciplinary team approach
What healthcare workers are involved in the care of someone with cerbral palsy>
Physio
Occupational therapy
Speech and language therapy
Dieticians
Orthopaedic surgeons
Paediatricians
Social workers
Charities and support grouos
What is physiotheraoy used for in cerebral palsy?
Stretch and strengthen muscles
Maximise function
Prevent muscle contractures
Occupational therapy how help cerebral palsy
Manage ADLs eg dressed, bathrom
Techniques to perform takss
ADAPTATIONS AND SUPPLY EQUIPMENT eg rails for assistance, hoist if wheelchair bound
What can do if patient cant reach nutritional requirements due to swallowing difficulties
NG
PEG tube
What can orthopaedic surgeons do for people with cerebral pasly?
Tenotomy to release contractures or lengthen tendons
What medications may people with cerebral palsy be on?
Muscle relaxants
Anti-epileptic drugs
Glycopyrronium bromide
What is baclofen used for?
Muscle spasticity and contractures
What is glycopyrronium bromide usedd for>
Excessive drooling
Support organisations for cerebral palsy
Action Cerebral Palsy
Association of Paediatric Chartered Physiotherapists
Royal College of General Practitioners (RCGP)
Royal College of Nursing (RCN)
Royal College of Paediatrics and Child Health
Antenatal risk factors for cerebral palsy
Preterm birth
Chorioamnionitis
Maternal respiratory tract or GU infection treated in hospital
Perinatal risk factors for cerbreal pasly
Low birth weigh t
Chorioamnionitis
Neonatal encephalopathy
Neonatal sepsis
Maternal resp tract or GU tract infeciton
What parts of brain cause CP most often?
white matter damage: 45%
* basal ganglia or deep grey matter damage: 13%
* congenital malformation: 10%
* focal infarcts: 7%.
What is Chorioamnionitis?
What is periventricular leukomalacia?
a softening of white brain tissue near the ventricles.
trouble with vision and with eye movements
trouble with movement, and tight muscles
developmental delay that is increasingly apparent over time
Ventricels not enough blood, PROM, infection
What condition is white matter damage most likey to occur in?
More common in spastic than dyskinetic CP
Can be of any functional level or motor subtype
What damage is most ass with dyskinetic CP?
Grey matter/basal ganglia
What type of CP is most likely to be related to perinatal hypoxic-ischaemic injury?
dyskinetic
What is the extent of long term functional impact determined by when CP caused by perinatal hypoxic-ischaemic injury?
The severity of the initial encephalopathy
When offer MRI to investigate CP?
To explore aetiology of sus or known CP if not clear form
* antenatal, perinatal and postnatal history
* their developmental progress
* findings on clinical examination
* results of cranial ultrasound examinations
How assess children 0-3 months who are at increased risk fo CP?
General movement assessment during routine neonatal follow ups
What are early motor features of CP?
Unusual fidgety movements or other abnormalities of movement incl asymmetry or paucity of movement
Abnormalities of tone incl hypotonia, spasticity or dytonia (fluctuating tone)
Abnormal motor development incl late head control, roll and crawling
Feeding difficulties
What are the most common delayed milestones in children with CP?
Not sitting by 8 months
Not walking by 18 months
Early asymmetry of hand function before 1 year
Red flags for other neurological disorders?
absence of known risk factors
* family history of a progressive neurological disorder
* loss of already attained cognitive or developmental abilities
* development of unexpected focal neurological signs
* MRI findings suggestive of a progressive neurological disorder
* MRI findings not in keeping with clinical signs of cerebral palsy
What are the determinants at 2 years old of how well they’ll be able ot walk?
If a child can sit at 2 years of age it is likely, but not certain, that they will be
able to walk unaided by age 6.
* If a child cannot sit but can roll at 2 years of age, there is a possibility that they
may be able to walk unaided by age 6.
Cerebral palsy in under 25s: assessment and management
* If a child cannot sit or roll at 2 years of age, they are unlikely to be able to walk
unaided.
What children are more likely to have speech and language problmes with CP?
bilateral spastic, dyskinetic or ataxic cerebral palsy
Unilateral spastic CP
What children are more likely to have speech and language problmes with CP?
bilateral spastic, dyskinetic or ataxic cerebral palsy
Unilateral spastic CP
What can you use as treatment for drooling after anitcholinergics if ineffective>
Botulinum toxin A injections
What should monitor for in children with CP bone wise?
Low bone mineral density
How to prevent low bone mineral density?
an active movement programme
* active weight bearing
* dietetic interventions as appropriate, including nutritional support and calcium
and vitamin D supplementation
* minimising risks associated with movement and handling.
What can cause oain in CP?
MSK - scoliosis, hip subluxation, dislocation
Increased muscle tone
Muscle fatigue and immobility
Constipation
Vommitting
GORD
What can cause sleep disturbances in children with CP?
sleep-induced breathing disorders, such as obstructive sleep apnoea
* seizures
* pain and discomfort
* need for repositioning because of immobility
* poor sleep hygiene (poor night-time routine and environment)
* night-time interventions, including overnight tube feeding or the use of
orthoses
* comorbidities, including adverse effects of medication.
What extra qs should you ask about in a CP consultation?
Pain
Sleep
Distress
What mental health related conditions are more common in children with CP?
Mental health and psychological problmes
Behaviours that challenge - may be triggered by pain, discomfort or sleep disturbances
Neurodevelopmental disorders - ASD, ADHD
What eye conditions are related to CP?
Problems controlling eye movements
Strabismus
Refractive errors
Problems of eye function incl retinopathy of prematurity
IMpaired cerebral visual info processing
Visual field defects
What other areas can children with CP have problems in?
Behavioural difficulties
LD
Hearing impairment
Visual impairment
Vommitting, regurgitation and reflux
Constipation
Epilepsy
What is athetoid movements
low, involuntary, writhing muscle movements
random and unpredictable changes in muscle movement
worsening symptoms with attempts at controlled movement
worsening symptoms with attempts at improved posture
inability to stand
