Cerebral palsy

Question 1

What is cerebral palsy?

Answer 1

This is a persisting qualitative motor disorder appearing before the age of three, caused by non-progressive damage to the brain, occurring before the growth of the central nervous system is complete

Question 2

What causes cerebral palsy?

Answer 2

Cerebral palsy is caused by an insult to the growing brain before, during or after birth

Question 3

What are some causes of antenatal insult to the CNS?

Answer 3

• Genetic conditions
• Intra-uterine infection in early pregnancy
• Trauma during pregnancy

Question 4

What are some causes of perinatal insult to the CNS?

Answer 4

• Birth asphyxia -> Hypoxia
• Prematurity

Question 5

What are some causes of post-natal insult to the CNS?

Answer 5

Meningitis
Severe neonatal jaundice
Intra-cranial haemorrhage

Question 6

What percentage of cerebral palsy cases are caused by problems during labour?

Answer 6

1 in 10

Question 7

Describe the progression of musculoskeletal disease in cerebral palsy

Answer 7

Injury to the brain ->
Increased muscular tone (Spasticity) ->
Abnormal posture ->
Muscular contracture ->
Bone deformity

Question 8

What are the 2 musculoskeletal pathways of disease presentation in cerebral palsy?

Answer 8

Loss of connections with the lower motor neurone
Loss of inhibition of the lower motor neurone

Question 9

What are some symptoms caused by loss of connections with the LMN?

Answer 9

Weakness
Fatiguability
Poor balance
Sensory deficits

Question 10

What are some symptoms caused by loss of inhibition of the LMN?

Answer 10

Spasticity
Hyperreflexia
Clonus
Co-contraction

Question 11

What is meant by co-contraction?

Answer 11

This is the contraction of both muscles in an antagonistic muscle pair simultaneously (e.g. biceps and triceps)

Question 12

What is meant by clonus?

Answer 12

This is involuntary and rhythmic muscle contractions

Question 13

What is meant by hyperreflexia?

Answer 13

This is an overreactive involuntary response to a stimulus

Question 15

What muscles are most likely to be affected by spasticity in cerebral palsy?

Answer 15

Iliopsoas
Adductor brevis
Adductor magnus

Question 16

What is caused by spasticity of the iliopsoas and thigh adductor muscles?

Answer 16

This increases the risk of hip dislocations as the femur is pulled out of the acetabulum

This causes hip asymmetry and thus can lead to scoliosis

Question 17

When will hip dislocation and scoliosis usually present in cerebral palsy?

Answer 17

During puberty, before the age of 18
After this age, the hips and spine are assumed stable if no problems have yet arisen

Question 18

What is the name given to the signature gait caused by cerebral palsy?

Answer 18

Diplegic gait - child will walk on their toes with in-scissoring of the knees

Question 19

What are some non-musculoskeletal symptoms of cerebral palsy?

Answer 19

• Learning difficulties
• Epilepsy
• Visual/hearing impairments
• Communication difficulties
• Behavioural problems
• Feeding difficulties

Question 20

How is mobility classified in cerebral palsy?

Answer 20

Via the GMFCS score

This is a scoring system between I and V, with I being high mobility and V being immobile and requiring a permanent wheelchair

Question 21

How is cerebral palsy usually managed?

Answer 21

Cerebral palsy is an incurable lifelong condition, however, there are treatment options to reduce pain, correct some spinal deformities and maximise the child’s independence

Social support may also be indicated as rates of divorce in families of children with cerebral palsy and much higher

Surgeries to correct the scoliosis such as fusion of the cervical spine to the pelvis can be used in some cases of class V immobility

Severe spasticity can sometimes be managed with an intrathecal baclofen pump, which delivers baclofen directly into the dura