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PRM Board Exam > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

Three criteria for diagnosis of CP?

A

1) static brain lesion
2) lesion occurred before birth or first few years of life
3) neuromotor control deficit with altered movement or posture

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2
Q

Greatest risk factor for development of CP?

A

Prematurity

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3
Q

Are most children with CP born premature?

A

NO

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4
Q

What are 5 preconception/maternal risk factors for CP?

A

maternal seizures, maternal thyroid disease, advanced age (>40), obesity, use of reproductive technology, coagulopathy

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5
Q

Most common topographic form of CP?

A

Hemiplegia (39%)

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6
Q

Does hemiparetic CP typically demonstrate greater impairment in the upper or lower extremity?

A

upper

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7
Q

What are the 5 different movement patterns seen in CP?

A

spastic, dyskinetic, hypotonic, ataxic, and mixed

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8
Q

What are the two most common movement patterns seen in CP?

A

Spastic followed by dyskinetic

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9
Q

At what age can a child be classified with the GMFCS? Why?

A

Age 2, before this assessments are often inaccurate due to evolving myelination.

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10
Q

GMFCS II

A

ambulatory but limitation with uneven surfaces and inclines

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11
Q

GMFCS III

A

use of hand-held mobility device (Lofstrand crutches or rolling walker), may propel a manual wheelchair independently

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12
Q

GMFCS IV

A

rely mostly on wheeled mobility at home and in community.

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13
Q

GMFCS V

A

No independent mobility

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14
Q

What ages is the Manual Ability Classification used?

A

4 to 18

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15
Q

MACS II

A

slower with manual function but independent with daily activities

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16
Q

MACS III

A

can complete some activities independently with set-up or assistance

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17
Q

MACS IV

A

continuous support needed to complete a portion of activity

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18
Q

MACS V

A

No handling of objects

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19
Q

CFCS II

A

effective communicator but slower

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20
Q

CFCS III

A

effective communicator with familiar partners but not effective with unfamiliar partners

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21
Q

CFCS IV

A

inconsistent communication, even with familiar partners

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22
Q

CFCS V

A

ineffective communication

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23
Q

What ages is the Eating and Drinking Ability Classification System designed for?

A

3 and older

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24
Q

EDACS II

A

needs additional time

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25
Q

EDACS III

A

some limitation to safety

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26
Q

EDACS IV

A

significant limitations to safety

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27
Q

EDACS V

A

unable to eat or drink safely

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28
Q

Most common finding on MRI in children with CP?

A

PVL

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29
Q

When is a repeat MRI recommended if initial MRI is normal in a child with motor abnormalities?

A

2 years old

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30
Q

What are 4 primitive reflexes that can be used to evaluate for early CP?

A

moro, palmar grasp, ATNR, tonic labyrinthine reflex

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31
Q

What are three ways that the 4 primitive reflexes can be highly suspicious for CP?

A

1) persistence beyond 6 months
2) asymmetric response
3) obligatory response (unable to break out)

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32
Q

At what age do the parachute and lateral protection reactions emerge?

A

6 months

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33
Q

What ages is the HINE appropriate for?

A

2 months to 2 years

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34
Q

Optimal HINE scores at 3, 6 and 9 months (not at risk for CP)?

A

67, 70, 73

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35
Q

What portion of the HINE exam is most predictive?

A

movement quality and quantity

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36
Q

HINE score at 3-6 months indicating likely GMFCS III or IV

A

less than 40

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37
Q

HINE score at 3-6 months indicating likely GMFCS I or II

A

40 - 60

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38
Q

What HINE score at 3 months is highly sensitive and specific for development of CP?

A

56

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39
Q

Up to what age can the General Movement Assessment be used?

A

5 months

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40
Q

When is the infant “writhing period”

A

from preterm to 6-9 weeks

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41
Q

When is the infant “fidgety period”

A

9 to 20 weeks

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42
Q

How are abnormal fidgety movements characterized?

A

larger amplitude with moderately exaggerated speed and jerkiness

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43
Q

What assessment is the reference standard for early detection for CP?

A

GMA

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44
Q

What are three indications for genetic testing in suspected cases of CP?

A

1) neuroimaging is non-revealing
2) family history of childhood neurologic disorder
3) developmental deterioration

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45
Q

What should be suspected in a previous healthy child with acute encephalopathy without explanation?

A

metabolic disorder

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46
Q

What imaging findings are more common in children with intellectual disabilities?

A

gray matter injuries and malformations

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47
Q

What are 5 risk factors for recurrent admission due to respiratory illness in children with CP?

A

GMFCS IV, dysphagia, seizures, snoring, recent respiratory admission

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48
Q

What are three strategies to address frequent aspiration?

A

saliva control, g-tube placement with fundoplication, and thickening of feeds

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49
Q

Three treatments for impaired mucociliary clearance?

A

saline, bronchodialators, chest PT

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50
Q

What is the most common foot deformity in CP?

A

Equinovalgus

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51
Q

What degree spinal curves are likely to progress?

A

Greater than 40

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52
Q

What are five risk factors for progression of a spinal curve?

A

spasticity, quadriparesis, younger age, poor sitting balance, pelvic obliquity

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53
Q

What is the most common upper extremity contracture in CP?

A

thumb-in-palm

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54
Q

What is the most important outcome to predict satisfaction after surgical correction of an upper extremity contracture?

A

cosmesis

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55
Q

Most common type of pain in GMFCS I, II?

A

headaches

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56
Q

Most common type of pain in GMFCS IV, V?

A

back pain

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57
Q

External rotation of the leg is associated with what type of ankle deformity?

A

valgus

58
Q

What is the best type of therapy for patients with CP?

A

active, task-specific, and goal directed

59
Q

What benefits are seen when using NMES in children with CP?

A

short-term increase in muscle volume and strength

60
Q

What parameters improve with FES in CP?

A

strength, gait kinematics, and SMC

61
Q

What parameter has not been shown to improve with FES in CP?

A

walking speed

62
Q

What is a realistic speech therapy goal in CP?

A

Improved intelligibility in a child with dysarthria

63
Q

Children older than what age typically do not have recurrence of tightness after surgery for contracture?

A

6

64
Q

What causes neuromuscular scoliosis?

A

imbalance in control of trunk musculature

65
Q

When should spinal surgery for scoliosis be considered in a child with CP? (degree for skeletally immature and mature)

A
  • skeletally immature: over 40 degrees
  • skeletally mature: over 50 degrees
66
Q

What can we say about evidence in relation to using hyperbaric oxygen in children with CP?

A

There is inadequate evidence for benefits or risks

67
Q

What marijuana-derived product has shown improvement in spasticity and comfort in children?

A

dronabinol

68
Q

What percentage of patients with CP report a quality of life similar to typically developing children?

A

50%

69
Q

What are two predictors of reduced quality of life in children with CP?

A

pain, psychological challenges

70
Q

What are the three categories that best predict ambulation in the CP population?

A
  • primitive reflexes
  • gross motor development
  • topography of CP
71
Q

What topographic type of CP has best potential for ambulation?

A

hemiplegia

72
Q

What can be said about timing of gross motor development and prognosis for ambulation in the CP population?

A

Children are likely to functionally ambulate if sitting by 2 years old an unlikely to functionally ambulate if not sitting by 4 years old

73
Q

What can be said about primitive reflexes/postural responses and prognosis for ambulation?

A

persistence of primitive reflexes or absence of postural reactions at age 2 is associated with a poor prognosis for ambulation

74
Q

What is the life expectancy of most children with CP?

A

near-normal

75
Q

What are three reasons that a diagnosis of CP may be excluded?

A

Progressive nature, primary peripheral etiology, injury occurred after CNS fully developed (2 years)

76
Q

What can we say about prevalence rates of CP in the past 20 years?

A

Rates have stayed the same at around 1 per every 500 births

77
Q

What two factors are associated with increased prevalence of CP?

A

Very early gestation, very low birth weight

78
Q

Why are premature children more prone to CP?

A

The germinal matrix around the ventricles has immature vasculature and it prone to ischemia or hemorrhage

79
Q

What are the 5 categories of risk factors for CP?

A

Preconception, Antepartum (during pregnancy), Intrapartum (during labor), Neonatal (first 28 days), Postnatal

80
Q

What are 5 antepartum (during pregnancy) risk factors for CP?

A

intracranial hemorrhage, placental abnormalities, toxins, infections, maternal disease (seizures, hyperthyroidism)

81
Q

What are four intrapartum risk factors for CP?

A

Birth hypoxia, meconium aspiration/staining, hyperbilirubinemia, traumatic delivery

82
Q

What are 5 neonatal risk factors for CP?

A

Seizures, infection, hypoglycemia, respiratory distress, jaundice

83
Q

What are three postnatal risk factors for CP?

A

Head injury, stroke, infection

84
Q

What is hypertonia?

A

Examiner induced abnormally increased resistance to movement about a joint

85
Q

What is hyperkinesia?

A

Unwanted excess movement by the child

86
Q

What are the three subdivisions of hypertonia?

A

Spasticity, dystonia, rigidity

87
Q

Why are seizures more likely in spastic hemiplegia?

A

Cortical involvement of the lesion

88
Q

What is a grade 3 intraventrcular hemorrhage?

A

With ventricular dialation

89
Q

What is a grade one intraventricular hemorrhage?

A

Isolated to the germinal matrix

90
Q

What is a grade 4 intraventricular hemorrhage?

A

With parenchyma hemorrhage

91
Q

What are 4 negative motor signs in CP?

A

Ataxia, Apraxia, weakness, reduced selective motor control

92
Q

What should one suspect if there is persistent hypotonia in a CP patient?

A

Genetic or metabolic syndrome

93
Q

What GMFCS levels tend to require reclassification over time?

A

II, III, IV

94
Q

What medical comorbidity is more commonly seen in mild cases of CP?

A

Behavioral disorder

95
Q

Is pain limited to more severe forms of CP?

A

No, it is seen at all levels of disability

96
Q

What three things are malnourished patients with impairments at increased risk for?

A

Skin breakdown, osteopenia, infection

97
Q

What is the treatment for upper airway obstruction in CP?

A

CPAP

98
Q

What is the treatment for lower airway obstruction in CP?

A

Bronchodilators

99
Q

What is the risk of seizure in the CP population?

A

30%

100
Q

Injury to what part of the brain can present with severe dysarthria but preservation of intellectual abilities?

A

Basal ganglia

101
Q

Why is strabismus important to recognize early?

A

To avoid amblyopia

102
Q

When is CIC indicated in CP patients?

A

Chronic urinary retention

103
Q

What is a 504 plan?

A

Accommodation for children who do not qualify for special education

104
Q

What disability legislation has section 504?

A

The Vocational Rehabilitation act of 1973

105
Q

What legislation mandated IEPs?

A

The Education of All Handicapped Children Act of 1975

106
Q

What act provided funding for Early Intervention?

A

The Individuals with Disabilities Education Act (IDEA) of 1990

107
Q

At what age is it reasonable to consider power mobility?

A

Around 18 months

108
Q

What are some of the demonstrated benefits of AFOs in the CP population?

A

improved energy efficiency, stride length, and velcocity

109
Q

What are three positive preoperative functional predictions of a good SDR outcome?

A

Ability to crawl, tall kneel, and squat.

110
Q

Until what ages should orthopedic surgery in the CP population be delayed (unless hip subluxation) due to high risk of recurrence?

A

7 to 9 years old

111
Q

What two muscle groups are most responsible for hip subluxation in the CP population?

A

Iliopsoas and adductors

112
Q

What is guided growth?

A

A temporary medial hemiepiphysiodesis to increase femoral shaft angle

113
Q

What are the two most effective parameters to monitor when determining timing of surgery to prevent hip dislocation in the CP population?

A

Acetabular index and migration percentage

114
Q

When is surgical treatment indicated for a CP hip at risk of dislocation?

A

Acetabular index greater than 30 degrees or migration percentage greater than 33%

115
Q

What are 5 comorbidities related to a dislocated hip in the CP population?

A

Pain, skin breakdown, impaired sitting balance, worsening scoliosis, hygiene difficulty

116
Q

What type of muscles are most at risk for contracture in CP patients? Please give 4 examples

A

Biarticular (hamstrings, gastrocnemius, psoas, rectus femoris)

117
Q

When can scoliosis in a CP patient be treated with observation?

A

When the curve is less than 40 degrees, flexible, and not impairing sitting balance

118
Q

When does the insult responsible for a majority of CP cases occur?

A

during the prenatal period (in utero before delivery)

119
Q

When is the extensor Babinski response abnormal?

A

greater the 2 years old

120
Q

What is the most common type of CP seen in premature infants?

A

spastic diplegia

121
Q

What type of CP is associated with sensorineural deafness?

A

dyskinetic

122
Q

What is chorea?

A

abrupt, irregular jerky movements

123
Q

What is athetosis?

A

slow writhing movements

124
Q

What is the most frequent visual deficit in CP?

A

strabismus

125
Q

What gaze deviation is seen in kernicterus?

A

paralysis of upward gaze

126
Q

What is the characteristic hearing loss in CP?

A

sensory neural impairment

127
Q

What milestone is a indication of good intellectual potential in CP patients?

A

speaking in three word sentences by age 3

128
Q

What symptoms can be seen in pseudobulbar palsy in CP?

A

emotional lability, dysarthria, drooling

129
Q

Typical age range for SDR?

A

3 to 8 years old

130
Q

What are three predictors of successful employment in CP patients?

A

IQ level (> 80), hand function, and ambulation level

131
Q

Three main NMSK causes for scissoring gait?

A

femoral anteversion, medial hamstring spasticity, hip adductor spasticity

132
Q

How does jump gait present?

A

with excessive hip/knee flexion and ankle equinus

133
Q

What is the most common diplegia gait pattern in young CP children?

A

jump gait

134
Q

What is the goal in treating the CP hip?

A

Avoiding future hip pain due to OA

135
Q

Chance of hip displacement in GMFCS V?

A

90%

136
Q

Overall chance of hip displacement in CP population?

A

35%

137
Q

Main factor associated with hip displacement?

A

GMFCS level

138
Q

In which CP motor type is hip displacement NOT uniformly seen?

A

ataxic

139
Q

4 factors that are greater determinants of ambulation potential than spasticity in the CP population?

A

weakness, poor selective motor control, poor balance, and sensory deficits

140
Q

How may coxa valga contribute to hip dislocation in the CP population?

A

creating a longer lever arm for hip adductors

PRM Board Exam (17 decks)

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