Cerebral Palsy Flashcards
Cerebral palsy
Permanent disorders of the development and posture that are attributed to non-progressive disturbance occurring pre-natally or post natally
The disease doesn’t worsen with age but it gets more obvious as the child develops
Can also be accompanied by sesnsation, perception, cognition, communication and behavior
How does CP happen
Multi factorial due to a static lesion in the developing brain
Risk factors of CP
Prematurity
Low or high birth weight
Infection
Infarction
Developmental defect (lissencephaly- smooth brain)
Multiple gestation (twins, triplets etc)
Placental pathology (inflammation of placenta)
Trauma (prenatal, perinatal, early postnatal)
What’s the most prevalent type of CP
Spastic (M>F)
Classifications by impairment
Anatomical distribution
- hemiplegia (one side of body affected)
- diplegia (the legs are more affected than arms)
- quadriplegia (arms, legs, and trunk are affected)
Type of impairment
- spastic
- dyskinetic (Ataxic, athetoid, dystonic)
- mixed
Spastic
Velocity- dependent resistance to passive elongation
Damage to the cortex or white mater to and from sensorimotor cortex
Most common
UMN
Diplegia most common distribution of spastic CP
- scissor gait, toe walking
Dyskinetic
Ataxic
- intention tremor, lack of muscle control and poor coordination of voluntary mvmts
Athetosis
- slow, continuous, involuntary writhing movements
Dystonic
- invultnary sustained muscle contraction
Classification by function
Gross motor function classification system (GMFCS)
- aligned with the ICF model
- focused on what the child CAN do in regards to self-mobility
- 5level classification system with 5 age groups
- helps describe severity
GMFCS levels (ex of 6-12 years)
Level 1- walk without restriction
Level 2- walks without restriction but limitations outdoors and in community
Level 3- Walks with mobility devices
Level 4- Children transported or use power mobility outdoors
Level 5- Self mobility limited even with the use of supporting technology
Associated impairments
Cognitive
Sensory
Behavioral
Speech and language
Perceptual dysfunction
Problems with motor planning (apraxia)
Assessment
Motor
GMFM-88 and 66
Spasticity
Modified ashworth scale
Modified Tardieu sale
GMFM- 88 and 66
Observational instrument measuring gross motor function
Intervention goals
Address impairments and participation restrictions
What impairments do we address when providing interventions
Bone development/ deformity (hip dysplasia, scoliosis, torsion)
Balance
Coordination
Motor planning
ROM (flexbitily and contractures)
Strength
Tone (spasticity)
What participation restrictions
Transfers, gait, stairs
Sports
Play
PT interventions specifically
Education for families
Stretching
Exercise (strengthening, ROM, balance and coordination)
Splinting
Orthoses
Assistive/Adaptive device perscription and training (crutches, walkers, standers, wheelchairs)
Gait training
Transfer training
Functional Training
AFOs for CP
Solid- blocks talocrural and subtalar (decrease knee Hyperextension)
Hinged- allows for controlled ankle DF while still limiting PF (decrease knee Hyperextension)
Ground- Reaction- blocks mvmt at talocrural joint and limits mvmts at subtalar jt (increases knee extension)
Medical Interventions
Bony realignment
Botox injections (reduce spasticity)
Intrathecal Baclofen (reduce spasticity)
Selective dorsal rhizotomy (reduce spasticity)
Serial casting (increase ROM)
Soft tissue lengthening and tendon transfers (increase ROM)
Percutaneous muscle/tendon release (increase ROM)
Recontruction (hip)
GMFC Levels
l- walk independent on flat and stairs
2- walk independently, need handrail for stairs
3- handheld mobility indoor, manual wheelchair long distance
4- physical assistance or power chair
5- physical assistance
