Cerebral Palsy Flashcards
Description
Disorder of movement, muscle tone, and posture
Caused by lesion that affects the immature brain
Non-progressive
underlying neurological lesion is static, process that led to brain dysfunction is no longer active
Incidence
2-3/1000 live births
When does the damage occur
CNS damage can occur prenatally, perinatally (period around childbirth), postnatally
Risk Factors
Maternal/Intraueterine infections
Prematurity»_space; peri or intra ventricular hemorrhage
Low birth weight, SGA, IUGR
Multiple births, congenital malformations
Neonatal infection, hyperbilrubinemia
CVA, encephalopathy, anoxia
Clinical Exam
Early hypotonia
After 3-4 months, increased tone
Persistent and pervasive primitive reflexes
Delayed motor development
Asymmetrical upper limb use or hand preference in 1st year
Cerebral Palsy Clinical Types
Spastic Hemiparesis
Spastic Diplegia
Spastic Quadriparesis
Dyskinetic
Hypotonic
Spastic Hemiparesis
Gross motor delay
Most walk by age 3
Hemiparetic gait, upper > lower limb
Cortical sensory deficit
Hemiparetic limbs remain underdeveloped
May develop mild scoliosis
Spastic Diplegia
Predominant extensor posture with scissoring in lower limbs
Crouched gait secondary to hip flexor weakness
Later, internal rotation of 1 or both legs, pes planovagus, pelvic obliquity, hip subluxation/dislocation common
Scoliosis
May have mild upper limb dysfunction
Spastic Quadriparesis
More extensive cortical damage, severe disability
More frequent musculoskeletal complications and pseudobulbar palsy signs
1/3 never ambulate
1/3 ambulate with assistive devices
1/3 ambulate independently
Dyskinetic
Athetoid
Chreiform
Ballistic
Ataxic
Athetosis may become dystonia
Drooling, dysarthric speech
Upper limbs may be more involved than lower
Equinovarus, scoliosis
75% ambulate, 50% by age 3
Hypotonic
Persistent hypotonia/atonia with hip adduction, external rotation, and hip flexion contractures
Severe neuromuscular dysfunction
Intellectual deficit
Poorest overall prognosis for ambulation and independence
Associated Disabilities
Mental retardation 50%
Communication disorder
Hearing Impairment
Language delay
Perceptual problems
Apraxia
ADHD, PDD
Seizure disorders
Visual and Extraocular motor deficits
Feeding difficulties
Pulmonary disease
Usually Maximal level of motor function by age 7
CP Treatment
PT, OT, SLP
Training gross and fine motor skill, ADL
Orthoses and adaptive equipment
Orthopedic surgery
Tendon Lengthening or transfer, osteotomy, arthrodesis
Neurosurgical procedures: posterior rhizotomy
Medical management: medications, monitoring
