Cerebral Palsy Flashcards
What is CP?
category of disability
chronic non progressive disorders of movement and posture
abnormality or injury to the developing brain
What are the grades of IVH?
Grade I: isolated without germinal matrix hemorrhage
Grade II: IVH without ventricular dilation
Grade III: IVH with ventricular dilation
Grade IV: IVH and parenchymal hemorrhage
What is GMFCS Level I?
walk inside and out without limitation
perform gross motor skills like running and jumping
speed, balance and coordination are impaired
What is GMFCS Level II?
walk indoors and out and climb stairs with railing
limitations walking on uneven surfaces and inclines and crowded or confined spaces
What is GMFCS Level III?
walk indoors or out on level surface with AD
may climb stairs with railing
may need wheelchair for long distances or on uneven terrain
What is GMFCS Level IV?
May walk short distances with walker
may be more reliant on wheeled devices at home/school/in community
What is GMFCS Level V?
restricted voluntary control of movement and ability to maintain anti gravity head and trunk postures
children have no means of independent mobility
What are the Age 90 Scores for each level?
Level I: 4.8 years
Level II: 4.5 years
Level III and IV: 3.5 years
Level V: 2.9 years
How are the Gross Motor Development Curves used?
aid prognosis
determine consistency of motor pattern with other children in level
evaluation of intervention
Hemiplegia is a _________ prognosis for ambulation.
good
diplegia is a ________ prognosis for ambulation.
When will they ambulate by?
fair
4 years old
Quadriplegia is a __________ prognosis for ambulation.
What percent and when will they ambulate by?
poor
10% are functional
ambulation by age 7 or 8
What does persistent tonic neck reflexes indicate?
decreased likelihood of walking
If a child with CP were to sit independently by 2 years, what would that indicate?
achieve walking by age 8
What are typical primary impairments of CP?
insufficient force generation
decreased selective control
abnormal muscle tone
abnormal muscle extensibility
persistent neonatal reflexes
decreased balance and/or reactions (righting, protective extension, equilibrium)
What are typical secondary impairments of CP?
orthopedic changes
pain
decreased cardiorespiratory endurance
skin breakdown
Which children with CP are most at risk for scoliosis?
children with hemiparesis and spasticity that are non ambulators
When should the therapist be thinking about scoliosis for a child with CP?
Before the child has it, ensure proper positioning and try to decrease asymmetrical patterns of movement
Why is hip dislocation a common complication of CP?
decreased weightbearing results in shallow acetabulum
spasticity/contracture of hip flexors, adductors, and IR
excessive femoral anteversion
Why would a child need to be in a stander if they have not yet started standing on their own by 1 year?
to begin weightbearing so that the hip anteversion is decreased
When might you see hip retroversion?
patients that are positioned in hip ER
would see more than normal ER and less than normal IR
What would you expect to see in tibial torsion in a child with CP?
excessive internal tibial torsion
lateral malleolus would be more anterior than medial malleolus
What is normal tibial torsion and when is it reached?
15 degrees of external (medial in front of lateral mal)
age 10
What is the clinical test for tibial torsion?
thigh foot angle
What is a common complication at the ankle for children with CP and why does it occur?
valgus deformity
plantar flexion with eversion
overpull of gastrocs and peroneals
What would you see in gait with a valgus deformity?
midfoot pronation (collapse through midfoot to touch the ground) and external foot progression angle
What is a varus deformity at the ankle?
dorsiflexion and inversion–anterior tib
plantarflexion and inversion–post tib
What would you expect to see in gait with a varus deformity?
land on lateral border of foot
internal foot progression angle
What is another common orthopedic complication for children with CP?
leg length discrepancy–especially with hemiplegia
What are some interventions for CP?
PROM
orthoses
alignment and weightbearing
AD
modalities
strengthening
functional activities
What are the goals of intervention for children with CP?
maximize function and participation
empower families and patients
prevent/predict/minimize orthopedic complications
improve muscle strength
