Cerebral Palsy

Question 1

In early development, which develops first between gross and fine motor functions?

Answer 1

Gross motor functions. The prerequisite for stable and balanced mobility after birth is achieving bilateral stability, first in the torso then in the limbs.

Question 2

What part of the brain controls locomotion?

Answer 2

Motor cortex.

Question 3

Strong deviations in cervical spine apart from positioning in gmfcs 3/4/5

Answer 3

Hight tone systemic presentations do get treated with Botox and perhaps systemic medication regiments but this may affect breathing and is risky.

Question 4

Do active extension devices work for all cases of spasticity?

Answer 4

No not at all. Some cp presentations will tolerate stretch and some will provoke spasticity.

Question 5

What can be used for helping to control hip subluxation during the night?

Answer 5

Keep hips in abducted position with orthotic device. Saw one of cp webinar, pneumatic pillow between thighs connected to kafo medial joint only and afo with ankles in functional position.

Question 6

What ia the most common seen deformity across gmfcs 1-5?

Answer 6

Foot and ankle deformities. Maybe not fixed, but deviations none the less.

Question 7

Name four types of cerebral palsy…

Answer 7

Unilateral and bilateral spastic CP (85%)

Dyskinetic CP (20%)

Ataxic CP (5%)

Question 8

How is spastic cp classified?

Answer 8

Unilateral SP (US-CP; Unilateral spastic CP) - Hemiparesis.

Bilateral SP (BS-CP; Bilateral spastic CP) - Diparesis and tetraparesis.

Question 9

How many levels are on the GMFCS scale?

Answer 9

5

Question 10

Explain GMFCS 1

Answer 10

Can run, jump and climb stairs without issue, but speed, balance or co-ordination
are impaired.

Question 11

Explain GMFCS 2

Answer 11

Can walk and climb stairs using a rail but issues with walking on uneven or inclined
surfaces or walking in crowds or confined spaces.

Question 12

Explain GMFCS 3

Answer 12

Can walk on level surfaces with assistive device
but a manual wheel chair used most of the time.

Question 13

Explain GMFCS 4

Answer 13

Capable of walking with a walking frame but mostly
relies on wheeled mobilty at home and when out.

Question 14

Explain GMFCS 5

Answer 14

Little or no voluntary control of movement. Maintaining anti- gravity head and trunk postures difficult. All areas of motor
function limited. Usually needs to be transported.

Question 15

Why is GMFCS after 6years of age so important?

Answer 15

Generally, a child or young person over the age of 5 years will not improve their GMFCS-E&R level so, if for example, a child is classified at a Level IV at the age of 6 then it is likely that they will need to use a mobility device throughout their life.

Question 16

What is Dyskinetic Cerebral Palsy (Dyskinesia)

Answer 16

People with dyskinetic forms of cerebral palsy have variable movement that is involuntary (outside of their control). These involuntary movements are especially noticeable when a person attempts to move.

Question 17

How many types of Spastic hemiplegia are there and can you describe each?

Answer 17

Type 1 – weak or paralysed/silent dorsiflexors (= dropfoot)
Type 2 – type 1 + triceps surae contracture
Type 3 – type 2 + hamstrings and/or Rectus Femoris spasticity
Type 4 – type 3 + spastic hip flexors and adductors

Question 18

Name Common Postural/Gait Patterns Bilateral Spastic Cerebral Palsy

Answer 18

Type 1. True Equinus.

Type 2. Jump Gait (With or Without Stiff Knee)

Type 3. Apparent Equinus (With or Without Stiff Knee)

Type 4. Crouch gait (With or Without Stiff Knee Gait)

Question 19

Types of treatment in spastic cp…

Answer 19

Ortho surgery

Botox

Baclofen pump

Question 20

List the 4 levels of the MACS classification system.

Answer 20

MACS level 1: Objects are handled easily and successfully.

MACS level 2: Handles most objects with reduced quality and speed.

MACS level 3: Handles objects with difficulty - will need help to prepare or modify activities.

MACS level 4: Handles a limited selection of easily managed objects in appropriate situations (continuos assistance required).

Question 21

Name the four signs of sensorimotor disorders:

Answer 21

Spasticity

Dystonia

Athetosis

Ataxia

Question 22

Describe symptoms of spastic hemiparetic cp

Answer 22

Hypertonia in arm and leg (unilateral).

Reduced growth of the affected limbs.

Walking upright possible but delayed.

Abnormal movement patterns.

Question 23

Describe symptoms of spastic cp diparesis

Answer 23

Hypertonia especially in the legs

Pelvis-leg and pelvis-torso as well as torso rotation impaired

No reciprocal (alternating) crawling

Difficulty moving upright against gravity (unstable stance)

Question 24

Describe symptoms of spastic cp tetraparesis

Answer 24

Impairment of the entire body - spasticity in upper and lower limbs

Insufficient head control

Balance problems

No voluntary movements

Questionable ability to stand

Primary reflexes preserved

Question 25

Describe symptoms of dystonia

Answer 25

Hypotonia (reduced muscle tension over torso and head)

Hypertonia (increased muscle tension in affected limbs. Cramping posture.)

Hypotonic torso (no control of torso/and or head. Newborns difficulty breastfeeding and movement problems).

Question 26

Symptoms of athetosis

Answer 26

Slow involuntary convoluted and twisting movements of :

Fingers
Toes
Limbs
Torso
Neck, face and tongue

Question 27

Symptoms of ataxia

Answer 27

Disharmonious, shaky movements

Impaired fine motor skills

Gait and stance problems

Difficulty controlling strength of movements

Hardly any rotational movements