Cerebral Palsy

Question 1

MSK

Answer 1

• joint contractures and scoliosis due to spasticity of muscles
• osteopenia lead to fracture

Question 2

GIT

Answer 2

• swallowing problems
• excessive salivation (sialorrhea) treated by hyoscine patch
• GERD (pseudo balbular palsy)
  constipation

Question 3

CNS

Answer 3

• convulsion
• hearing problem
• vision problem

Question 4

Respiratory

Answer 4

wheezy chest due to recurrent aspiration lead to recurrent infection

Question 5

G & D

Answer 5

• poor weight gain
• learning difficulties
• developmental delay
• speech problem - ariculation

Question 6

DDx Spastic CP

Answer 6

• Familial spastic paraparesis
• Intrauterine drug withdrawal
• Transient dystonia of prematurity
• Tethered cord
• Congenital tightness of heel cords
• Toe walkers (autism, us of walkers)
• Rule out neuro-degenerative diseases (primary and metabolic)

Question 7

DDx of CP-Athetosis/Ataxia

Answer 7

• Metabolic disorders e.g. Glutaric aciduria
• Dopamine responsive disorder
• Rett Syndrome
• Chromosomal disorders e.g. Angelman’s
• Intracranial lesions

Question 8

What to ask in CP History

Answer 8

• Concentrate on problems
• Neonatal history
• Developmental history
• Social history

Question 9

Developmental History (developmental delay)

Answer 9

• When mother notice her baby abnormal?
• What she noticed?
• What action taken?
• Any assessment done?
  Is it delay or regress milestones?
• start to gain skills and then lost - regress - metabolic
• not develop from start “delay-CP”

Question 10

Gross Motor

Answer 10

• Is he sitting? standing? walking? (when start to sitting? standing? walking?
• can he turn to side?
• Is he supporting his head? When patient support his head?
• Is he rolling on bed? When patient start rolling?

Question 11

Social History

Answer 11

• Is he toilet training? dry by day - 3 y/o; dry by night - 5 y/o
• Is he smiling? When start to smile? Look at faces? Stranger awareness?

Question 12

Fine Motor and Vision

Answer 12

• any concern regard vision? Does he follow side to side?
• Is he reaching out for objects?
• Is he grasping with palmar grip and brings things to mouth?

Question 13

Speech and hearing

Answer 13

• any concern regard speech?
• how many words know?
  any concern regarding hearing? screening test done or not?
• does he turn to sound….. mother sound/noise sound?

Question 14

Growth: FTT

Answer 14

• What about his weight?
• When noticed that he didn’t gain weight?
• Can you estimate how much reduction?
• You seek any medical advise? Who give advice “dietitian”?
• What action plan given? Is measure taken help him to gain weight?
• Did he had ff-up? Did he had growth chart for ff-up?

Question 15

Nutritional History - What

Answer 15

• What type of milk? Breast fed or bottle fed?
• What type of food? Any special formula?
  What route of feeding? through NGT, or gastrostomy tube

Question 16

Nutritional History - When

Answer 16

• frequency - “how many meals per day?”
• duration - diary of meal
• start solid food?

Question 17

Nutritional History - Who, where and any

Answer 17

• who give?
• where: away from distraction?
• any allergy to certain food?