Cerebral Palsy Flashcards
BSF: strength/force/power
Decreased ability for strength-force generation
Lateral step up test
Sit to stand test
Half kneel to stand test
1 RM
BSF: motor control and fractionated movement
Impaired motor control and difficulty controlling fractionated movement
SCALE (selective control assessment for the LE)
BSF: coordination/neurological
decreased muscle tone
increased muscle spasticity
^ both: ashworth and tardieu
Abnormal reflex patterns (primitive, righting, equilibrium)
BSF: sensation/pain
impaired sensation
decreased tactile sensation and proprioception
impaired vestibular system reactions
pain
- faces pain scale
- FLACC (faces, legs, activity, crying, consolability)
BSF: endurance/fatigue
impaired cardiopulmonary endurance
- HR, BP, RR
- 6 MWT or 2 MWT
- muscle power sprint test
- 10 M shuttle test
BSF: ROM, joint mobility, soft tissue flexibility
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
BSF: cognition, perception, communication
impaired cognition
basic screens for communication and understanding of commands
Spastic CP
Motor cortex or white matter
Positive UMN
Hyperreflexia
Hypertonicity
Most common
Dyskinetic CP
Athetosis/dystonic
Basal ganglia
Variable muscle tone
Primitive reflexes
Quadriplegic distribution
Ataxic CP
rarest form
Cerebellar lesion
Intention tremor, slurred speech
incoordination
Atonic/hypotonic
early infancy only
low muscle tone
may improve over time or become spastic
Hemiplegia or hemiparesis CP
small hemorrhagic unilateral focal lesion
pediatric stroke
diplegia
lower limbs > upper
bilateral hemorrhagic lesion
tetraplegia or quadriplegia
basically everything, including above the neck
large HIE
Key points of CP
non-progressive lesion
immature brain (prior to 3-4 years)
disorder of posture and mvmt
2.2/1000
Prenatal risk factors
TORCH
genetics
placental insufficiency
prematurity
Perinatal risk factors
TORCH
birth asphyxia
prematurity
Postnatal risk factors
head trauma
near-drowning
stroke
infection
GMFCS I
walks w/o restrictions
limitations in more advanced gross motor skills
GMFCS II
walks w/o devices
limitations in walking outdoors and in community
GMFCS III
walks w/ mobility devices
limitations in walking outdoors and in community
GMFCS IV
self-mobility w/ limitations
transported or use power mobility outdoors and in community
GMFCS V
self-mobility is severely limited even w/ use of supporting tech
Potential for future independent walking with or without support
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
Tests for participation
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)
Tests for activity
Gross motor function measure (GMFM 66)
- evaluate change in gross motor in children w/ CP
Pediatric evaluation of disability inventory (PEDI)
Tests for impairment
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
Green light interventions
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
Strength/muscle power training
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
Yellow light interventions
Assistive tech
Early intervention for motor outcomes
E-stim
Hippotherapy
Hydrotherapy
Orthoses
Therasuits
Treadmill training
stretching
Intraventricular hemorrhage (IVH)
Large region of necrosis in periventricular white matter
Unilateral or bilateral neurologic effects
Hypoxic ischemic encephalopathy (HIE)
Lack of O2 delivery to brain due to decrease BF
Spastic quadriparesis
Diffuse –> bilateral
Hemorrhage
Focal –> unilateral
Can affect multiple areas of primary motor cortex and myelination of tracts
Balance and CP key takeaways
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
