Cerebral Palsy Flashcards
DEFINITION
Cerebral palsy is a group of disorders that afect movement and muscle tone or
posture. It’s caused by damage that occurs to the immature, developing brain, most
ofen before birth.
Generally, signs and symptoms include problems with movement and coordinaton,
speech and eatng, development, and other problems such as seizures, hearing and
visual impairment ….
The brain disorder causing cerebral palsy doesn’t change with tme, so the symptoms
usually don’t worsen with age. However, as the child gets older, some symptoms
might become more or less apparent. And muscle shortening and muscle rigidity can
worsen if not treated aggressively
Inclusion and exclusion criteria
Inclusion criteria are evolving
- The tming of the insult to the developing brain conventonally under two years of
postnatal age.
- Timing up to 5 years
Exclusion
- Neurodegeneratve conditons,
- Neuromuscular conditons
- Tumors
- Neural Tube defect
PREVALENCE
The overall rate is 2- 2.5 per 1000
Prevalence of CP increases with decrease in gestatonal age at birth
Prevalence in extremely low gestatonal age < 28 weeks is 100 tmes
that of term infants.
Prevalence in term newborns has not changed much despite advances
in obstetric management.
EARLY SIGNS
In a Baby Younger Than 6 Months of Age
• His head lags when you pick him up while he’s lying on his back
• He feels stf
• He feels foppy
• When held cradled in your arms, he seems to overextend his back and
neck, constantly actng as if he is pushing away from you
• When you pick him up, his legs get stf and they cross or scissor
In a Baby Older Than 6 Months of Age
• She doesn’t roll over in either directon
• She cannot bring her hands together
• She has difculty bringing her hands to her mouth
• She reaches out with only one hand while keeping the other fsted
In a Baby Older Than 10 Months of Age
• He crawls in a lopsided manner, pushing of with one hand and leg
while dragging the opposite hand and leg
• He scoots around on his butocks or hops on his knees, but does not
crawl on all fours
CLINICAL PRESENTATION
Primary presentaton is the motor impairment
Type of motor or movement impairment
Distributon
Secondary impairments and difcultes that accompany the motor defcit
Cognitve
Behaviour
Feeding
Sleep
Constpaton
Respiratory
Musculo-skeletal
Seizures
Sensory
CLASSIFICATION
• Unilateral spastc – involves the pyramidal tract with increase tone and refexes
on one side of body – Hemiplegic
• Bilateral Spastc- as above but involving both side of body
Quadriplegia
Diplegia
• Dyskinetc- abnormal movements such as choreoathetosis involving all limbs with
facial grimacing and severe oromotor problems; dystonic posturing.
• Ataxic- broad-based gait with truncal ttubaton: unsteady on feet
• Hypotonia with Ataxia or Hypotonia without Ataxia)
• Mixed – can include any combinaton of the above
Functions Classifcation systems GMFCS, MACS, EDACS and CFCS are based on function in conjunction with motor impairment
- The Gross Motor Functonal Classifcaton System (GMFCS)
- The Manual Ability Classifcaton System (MACS)
- The Communicaton Functonal Classifcaton System (CFCS)
- The Eatng and Drinking Ability Classifcaton System ( EDACS)
- The Visual Ability Classifcaton System
RECENT APPROACH
- Motor abnormalites
Nature and typology – tone and movement disorder: spastc,
dyskinetc, ataxic. Unilateral or bilateral
Functonal motor abilites - Accompanying impairments
Sensory problems, seizures, behaviour, communicaton (CFCS),
cognitve defcit - Anatomical and neuroimaging fndings
- Causes and Timing
Part I: Motor Impairment
- Is there spastcity in one or more limbs
- Describe face/neck/trunk tone
- Is muscle tone varying ?
Dystonia
Athetosis/ Chorea - Is ataxia present
Part II: Function and associated impairments
Associated impairments
1. Nutriton – we use specifc CP growth chart
2. Intellectual Disability /Global Developmental Delay
3. Epilepsy
4. Visual Impairment
5. Hearing Impairment
6. Speech
7. Swallowing – Bulbar dysfuncton- GERD
8. Respiratory – silent aspiratons
9. Musculo-skeletal
Part III Anatomical and neuroimaging fndings
Brain imaging modalities: Cranial Ultrasound, CT-Scan
and MRI Scan
Part IV Cause and Timing
• Antenatal (80%)
Cerebral malformaton, cerebral dysgenesis, congenital infecton
• Intrapartum (10%)
Hypoxic–ischaemic encephalopathy (birth asphyxia)
• Postnatal (10%)
Cerebral ischaemia, intraventricular haemorrhage, head trauma,
Hydrocephalus, non-accidental injury, hyperbilirubinemia
(Kernicterus)
INVESTIGATIONS
Causes and Complications
- Neuroimaging: Brain MRI – CT Scan
- Genetcs testng
- Blood – FBC, Thyroid functon test, Lactate, Ammonia
- Metabolic screen
- Urine for metabolic screening
- X rays
- EEG
Management
Early diagnosis and Interventon
Multdisciplinary Management Team
Co-morbidites
Feeding
Epilepsy
Muscular skeletal –contracture – deformites
Improve functons
Improve communicaton
Prevent Complicatons
Educaton
Family support
