Cerebral Palsy Flashcards
Cerebral Palsy
Definition
A group of permanent disorders of the development of movement & posture causing activity limitations that are attritbuted to non-progressive distrubances that occurred in the developing fetal or infant
The motor disorders of cerebral palsy are also accompanied by disturbances of sensation, perception, cognition, communication, and behaviour by epilepsy & by secondary MSK problems
- Can all occur b/c brain injury - depends on type & where in the brain
LESION = non-progressive BUT impairments progress & become more apparent
CP: Etiology & RF
(8)
Multifactorial d/t static lesion in the developing brain - also linked w/ PVL (Periventicular Leukomalacia) = form of white matter disorder
RF
1. Prematurity - INC risk d/t difficulty w/ ventilation - inadequate O2 & CO2 gas exchange
2. Atypical Intraurterine Growth (low/high birth weight)
3. Infection (in utero & post-natal)
4. Infarction - INC risk of stroke in utero (neonatal period) w/ mothers who are: obese, older, fmaily Hx of thembo/metabolic disease
5. Developmental defect (ie. lissencephaly - smooth brain - lacks folds & microcephaly (small brain))
6. Multiple Gestation - more babies in womb = INC risk for at least one or all
7. Placental Pathology - malfunction or inflammation fo placenta
8. Trauma (pernatal, perinatal - during birth, early post-natal - could be d/t shaken baby syndrome)
What is the most prevalent type of CP?
Spatic type CP
Types of Classifications
(2) + 2
Classification by Impairment
Anatomic Distribution - “where”
- Hemiplegia
- Diplegia
- Quadriplegia
Type of Impairment
- Spastic
- Dyskinetic
- Mixed
Classification by Function
- Gross Motor Function Classifciation System (GMFCS)
Classification by Impairment
(4)
Hemiplegia
- One side of the body is affected (similar to stroke)
Diplegia
- The legs are more affected than the arms
Quadriplegia
- Arms, legs, and trunk are affected
Asymmetrical diplegia
- The legs are more affected than the arms & one side of the body is more affected than the other
Type of Impairment: Spastic
Describe (5)
Spastic - specific type of HYPERtonia
- Velocity-dependent resistance to passive elongation
- Damage to cortex or white matter to & from sensorimotor cortex
- Most common type of CP
- DIPLEGIA most common distribution of spastic CP
** Scisooring gait - Adductor spasticity kicks in & they start crossing their legs over
** Toe walking - PF b/c of spasticity
POSTURAL INSTABILITY
Type of Impairment: Dyskinetic:
Ataxic
Describe (2) & Part Affected
Ataxic
- Movement disorder characterized by intention tremor, lack of mm control, and poor coordination of voluntary movements
- Most children with ataxis CP can walk without gait aid, but may have difficulty with balance
CEREBELLUM is affected
1 of 3 sub-categories of DYSKINETIC
Type of Impairment: Dyskinetic:
Athetosis
Describe (4) & Part Affected
Athetosis
- Movement disorder characterized by slow, continuous, involuntary writhing (contusion of body parts // continuous twisting & squirming mvmts) movments
- Commonly affects the distal extremities & mouth)
- Difficult to maintain a stable posture
Legs are also ER (valgus) & twisting which makes balancing difficult > torso rocks around in an attempt to compensate
- Significant limitations in gross motor function
2/3 sub-categories of DYSKINETIC
Type of Impairment: Dyskinetic:
Dystonic
Describe (2+3) & Part Affected
Dystonic
Dystonia (INVOLUNTARY mm contractions):
- A movement disorder that is characterized by involuntary sustained or intermittent mm contractions leading to repetitive mvmts, abnormal fixed postures, and disordered tone
Dystonic Posturing:
Co-contraction (involuntary) of muscles causing sustained abnormal posture
- Dystonic movements are typically patterned & may included twisting or tremulous movement (tremor)
- Often triggered by voluntary movement
- Significant limitations in gross motor function & fatigue due to high metabolic demand
*THALAMUS is damaged - relay center &/or BASAL GANGLIA (putament or caudate nucleus)
3/3 sub-cateogires of DYSKINETIC
Type of Impairment: Mixed
Describe
Mixed
- Combination of dyskinetic & spastic
- Diffuse brain injury to motor cortex & the basal ganglia
Classification by Function:
Gross Motor Function Classification System (GMFCS)
More objective measure - can be used to communicate the severtiy of the disease (clinically & for research)
Focused on what the child CAN do in regard to self-mobility
- 5-level (I-V) classification system that described gross motor functin (regardless of the type of CP - applied to all types)
- 5 Age Groups:
1. 0-2
2. 2-4
3. 4-6
4. 6-12-12-18 - Scale is considered stable after the age of 2
- Child is classified by the method of mobility
Gross Motor Function Classification System (GMFCS) - General Headings for each level
Level I - Walks without limitations
Level II - Walks with limitations
Level III - Walks Using a Hand-Held Mobility Device
Level IV - Self-mobility w/ Limitations; May Use Powered Mobility
Level V - Transported in a Manual W/C
Gross Motor Function Classification System (GMFCS):
Level I
(3)
- Walks w/o restrictions
- Limitations in more advanced gross motor skills (runing, jumping)
- DO NOT need a mobility aid
Gross Motor Function Classification System (GMFCS):
Level II
(2)
- Walks w/o devices
- Limitations in walking outdoors & in the community (inclines, crowds, uneven surfaces)
Gross Motor Function Classification System (GMFCS):
Level III
(2)
- Walks with mobility devices
- Limitations in walking outdoors and in the community
