Cerebral Palsy

Question 1

What is cerebral palsy?

Answer 1

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, to para-olympic athletes with only subtle problems with coordination or mobility

Question 2

Causes of Cerebral palsy can be divided into which categories?

Answer 2

Atenatal

Perinatal

Postnatal

Question 3

Antenatal causes of cerebral palsy?

Answer 3

Maternal infections

Trauma during pregnancy

Question 4

Perinatal causes of cerebral palsy?

Answer 4

Birth asphyxia

Pre-term birth

Question 5

Postnatal causes of cerebral palsy?

Answer 5

Meningitis

Severe neonatal jaundice

Head injury

Question 6

Types of cerebral palsy include?

Answer 6

Spastic: hypertonia (incrased tone) and reduced function resulting from damage to upper motor neurones

Dyskinetic: problems controlling muscle, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. this is the result of damage to the basal ganglia

Ataxic: problems with coordinated movement resulting from damage to the cerebellum

Mixed: a mix of spastic, dyskinetic and/or ataxic features

Question 7

Patterns of spastic cerebral palsy

Answer 7

Monoplegia: one limb affected

Hemiplegia: one side of the body affected

Diplegia: four limbs are affected, but mostly the legs

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

Question 8

Children particularly at risk of developing cerebral palsy include ?

Answer 8

those with hypoxic-ischaemic encephalopathy

Question 9

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

Answer 9

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

Question 10

Different types of gaits during neurological exam?

Answer 10

Hemiplegic / diplegic gait: indicates an upper motor neurone lesion

Broad based gait / ataxic gait: indicates a cerebellar lesion

High stepping gait: indicates foot drop or a lower motor neurone lesion

Waddling gait: indicates pelvic muscle weakness due to myopathy

Antalgic gait (limp): indicates localised pain

Question 11

Upper motor neurone affected findings:

Answer 11

Inspection: muscle bulk preserved

Tone: hypertonia

Power: slightly reduced

Reflexes: brisk

Question 12

Lower motor neurone affected findings:

Answer 12

Inspection: reduced muscle bulk with fasciculations

Tone: Hypotonia

Power: Dramatically reduced

Reflexes: Reduced

Question 13

Patients with cerebral palsy may have which types of gait?

Answer 13

Hemiplegic or Diplegit

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.

Question 14

Patients with cerebral palsy will have signs of upper or lower motor neurone lesions?

Answer 14

Upper motor neurone lesion

with good muscle bulk, increased tone, brisk reflexes and slightly reduced power

Question 15

Complications and associated conditions of cerebral palsy?

Answer 15

Learning disability
Epilepsy
Kyphoscoliosis
Muscle contractures
Hearing and visual impairment
Gastro-oesophageal reflux

Question 16

Management of cerebral palsy may include?

Answer 16

an MDT appraoch

physiotherapy is used to stretch + strengthen muscles

Occupational therapy: help patients manage their everyday activities

Speech and language therapy: can help with speech and swallowing

Dieticians: some children may require PEG feeding through a port on their abdomen that gives direct access to the stomach

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

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
  Social workers to help with benefits and support.