Cerebral Palsy

Question 1

BSF: strength/force/power

Answer 1

Decreased ability for strength-force generation

Lateral step up test
Sit to stand test
Half kneel to stand test
1 RM

Question 2

BSF: motor control and fractionated movement

Answer 2

Impaired motor control and difficulty controlling fractionated movement

SCALE (selective control assessment for the LE)

Question 3

BSF: coordination/neurological

Answer 3

decreased muscle tone
increased muscle spasticity
^ both: ashworth and tardieu
Abnormal reflex patterns (primitive, righting, equilibrium)

Question 4

BSF: sensation/pain

Answer 4

impaired sensation
decreased tactile sensation and proprioception
impaired vestibular system reactions
pain
- faces pain scale
- FLACC (faces, legs, activity, crying, consolability)

Question 5

BSF: endurance/fatigue

Answer 5

impaired cardiopulmonary endurance
- HR, BP, RR
- 6 MWT or 2 MWT
- muscle power sprint test
- 10 M shuttle test

Question 6

BSF: ROM, joint mobility, soft tissue flexibility

Answer 6

Muscle tension is disproportionate to muscle activity

Increased muscle stiffness (stiffer fiber bundles, overstretched sarcomeres, fewer sarcomeres in series, higher collagen content, muscle fibers w/ lower cross section area)

Contractures

Issues w/ bony alignment/osteopenia (GMFCS IV and V)

Fractures

Degenerative joint disease

Scoliosis

Overuse syndromes

Test w/: muscle length, ROM, manual therapy mobility

Question 7

BSF: cognition, perception, communication

Answer 7

impaired cognition
basic screens for communication and understanding of commands

Question 8

Spastic CP

Answer 8

Motor cortex or white matter
Positive UMN
Hyperreflexia
Hypertonicity
Most common

Question 9

Dyskinetic CP

Answer 9

Athetosis/dystonic
Basal ganglia
Variable muscle tone
Primitive reflexes
Quadriplegic distribution

Question 10

Ataxic CP

Answer 10

rarest form
Cerebellar lesion
Intention tremor, slurred speech
incoordination

Question 11

Atonic/hypotonic

Answer 11

early infancy only
low muscle tone
may improve over time or become spastic

Question 12

Hemiplegia or hemiparesis CP

Answer 12

small hemorrhagic unilateral focal lesion
pediatric stroke

Question 13

diplegia

Answer 13

lower limbs > upper
bilateral hemorrhagic lesion

Question 14

tetraplegia or quadriplegia

Answer 14

basically everything, including above the neck
large HIE

Question 15

Key points of CP

Answer 15

non-progressive lesion
immature brain (prior to 3-4 years)
disorder of posture and mvmt
2.2/1000

Question 16

Prenatal risk factors

Answer 16

TORCH
genetics
placental insufficiency
prematurity

Question 17

Perinatal risk factors

Answer 17

TORCH
birth asphyxia
prematurity

Question 18

Postnatal risk factors

Answer 18

head trauma
near-drowning
stroke
infection

Question 19

GMFCS I

Answer 19

walks w/o restrictions
limitations in more advanced gross motor skills

Question 20

GMFCS II

Answer 20

walks w/o devices
limitations in walking outdoors and in community

Question 21

GMFCS III

Answer 21

walks w/ mobility devices
limitations in walking outdoors and in community

Question 22

GMFCS IV

Answer 22

self-mobility w/ limitations
transported or use power mobility outdoors and in community

Question 23

GMFCS V

Answer 23

self-mobility is severely limited even w/ use of supporting tech

Question 24

Potential for future independent walking with or without support

Answer 24

Head control by 9 mo
Rolling supine to prone by 18 mo
Sitting w/o arm support by 24 mo
Reciprocal creeping by 30 mo
Integration of primitive reflexes by age 2

Question 25

Tests for participation

Answer 25

Patient specific functional scale (PSFS)
- patient selected activities

Goal attainment scale (GAS)
- goal identification and importance scoring

Children’s assessment of participation and enjoyment and preferences for activities of children (CAPE-PAC)

Question 26

Tests for activity

Answer 26

Gross motor function measure (GMFM 66)
- evaluate change in gross motor in children w/ CP

Pediatric evaluation of disability inventory (PEDI)

Question 27

Tests for impairment

Answer 27

10 M shuttle test (vo2max)
- agility, speed, aerobic capacity

Functional strength test (verschuren)
- lateral step up
- STS
- 1/2 kneel to stand

Selective control assessment of the LE (SCALE)
- motor control

Faces, legs, activity, crying, consolability (FLACC)
- sensation

Question 28

Green light interventions

Answer 28

Context-focused functional therapy
Fitness training (I-III)
CIMT
Bimanual training
Serial casting
Home programs for improving motor performance or self-care
Strength/muscle power training

Question 29

Strength/muscle power training

Answer 29

Hip ABD, KF, DF highly correlated w/ function

Strength:
2-3x/wk, 6-8 wks
5-8 reps, 3 sets, 80% 1RM

Power:
2-3x/wk, 6-8 wks
6 x 6, 60-80% 1RM

Question 30

Yellow light interventions

Answer 30

Assistive tech
Early intervention for motor outcomes
E-stim
Hippotherapy
Hydrotherapy
Orthoses
Therasuits
Treadmill training
stretching

Question 31

Intraventricular hemorrhage (IVH)

Answer 31

Large region of necrosis in periventricular white matter
Unilateral or bilateral neurologic effects

Question 32

Hypoxic ischemic encephalopathy (HIE)

Answer 32

Lack of O2 delivery to brain due to decrease BF
Spastic quadriparesis
Diffuse –> bilateral

Question 33

Hemorrhage

Answer 33

Focal –> unilateral
Can affect multiple areas of primary motor cortex and myelination of tracts

Question 34

Balance and CP key takeaways

Answer 34

Postural control develops in cephalocaudal pattern
Children incorporate new postural strategies as they learn new motor skills
Children w/ CP frequently have postural control challenges which interferes w/ self-care