Cerebral Palsy

Question 1

Cerebral palsy

Answer 1

• damage to one or more areas of the brain which leads to paralysis, spasticity, or abnormal control of movements or posture
• even though the damage is static, it might impact how the rest of the body develops
• muscles are activities in inefficient ways
• most prevalent of persistent motor dysfunction
• 1 in 345 children
• more common in males
• incidence is higher among African American children and children from low-middle income families

Question 2

What is Cerebral Palsy video

Answer 2

• variations in muscle tones
• can impact speech and articulation because of all the muscles involved
• CPs have a hard time with midrange movements

Question 3

Types of cerebral palsy

Answer 3

• spastic cerebral palsy (80%)
• dyskinesia cerebral palsy
• ataxia cerebral palsy
• mixed = more than one type (most common mix is spastic and dyskinetic)

Question 4

Spastic cerebral palsy

Answer 4

• hypertonic in muscles and resistance to stretch (fully flexed or fully extended)
• hypertonicity = more muscle tone
• excessive stiffness when the child attempts to move or maintain a posture
• poor control/gradation of voluntary movement
• limited ability to regulate force
• damage to motor cortex and pyramidal tracts of brain
• classified by location of impairment

Question 5

Spastic diplegia

Answer 5

• impacts lower extremities (impacts standing, walking, crawling)
• upper extremities less affected or not affected
• tight hip and leg muscles cause legs to pull together, turn inward, and cross at the kneed (also called scissoring)
• difficulties with walking
• commonly linked to prematurity

Question 6

Spastic hemiplegia

Answer 6

• involvement of upper/lower extremities on one side of the body
• arm is generally more impacted than leg
• commonly linked to prenatal brain bleed (a stroke) = bleed on the left side of the brain causes impairment on the right side of the body and vice versa

Question 7

Freddy Video

Answer 7

• right spastic hemiplegia CP
• posture with hemiplegia and CP is rotation
• impacts shoulder flexion, elbow flexion, pronation of forearm, wrist flexion, and its thumb has tendency to get in between the index finger and the long fingers

Question 8

Spastic quadriplegia

Answer 8

• involvement of all limbs, neck, and face
• most significant impairments = impacting most muscles of the body
• caused by widespread damage to the motor cortex
• generally utilize a wheelchair (and uses AAC)
• comborbidity of many secondary issues

Question 9

Dyskinetic cerebral palsy

Answer 9

• impacts the entire body
• fluctuation of tone from low to high
• excessive of tone from low to high
• excessive abnormal movement = initiating movement in one extremity causes atypical, abnormal movement in another
• damage to basal ganglia

Question 10

Ataxic cerebral palsy

Answer 10

• problems with balance and coordination
• difficulties with walking and fine motor coordination
• shakey movements, wide gait, difficulty with fine motor skills
• damage to cerebellum

Question 11

Secondary impairments associated with CP

Answer 11

• chronic pain
• intellectual impairment
• unable to walk
• experience hip displacement
• unable to verbally speak
• epilepsy
• behavior disorder
• incontinence
• sleep disorder
• vision impairment
• unable to eat orally (will eat via G-tube)
• hearing impairment

Question 12

Causes of cerebral palsy

Answer 12

• congenital cerebral palsy
• acquired cerebral palsy

Question 13

Congenital cerebral palsy

Answer 13

• related to events before or during birth
• low birth weight
• premature birth = prior to 32nd and 37th weeks
• multiple births = twins and triplets
• assisted reproductive technology (infertility treatments) = generally explained by preterm birth of multiples
• infection during pregnancy
• jaundice
• medical conditions of the mother
• birth complications = detachment of placenta, umbilical cord (stuck around the neck = traumatic birth)

Question 14

Acquired cerebral palsy

Answer 14

• occurs during the first 2 years of life
• due to infection or injury (ex: meningitis, abuse, accident, skaken baby)

Question 15

Diagnosing cerebral palsy

Answer 15

• generally diagnosed the first year of life
• child is not meeting age appropriate motor milestones
• diagnosed by developmental pediatrician or pediatric neurologist
• diagnosed via physical exam and brain imaging (MRI)

Question 16

Lincoln Video

Answer 16

• hand preference under age 3 is not typical
• cognition is not generally impacted

Question 17

Many individuals with CP will be seen across the lifespan

Answer 17

• NICU (may or may not have diagnosis)
• 0-3 = early intervention programs at home
• 3-5 = early childhood settings
• 5-21 = school based settings
• transitional and adult programming
• may be seen in homes, clinics, hospitals, school or community based setting
• hippotherapy or aquatic therapy

Question 18

Things to consider

Answer 18

• treatment is individualized and based upon the age an skills of the child
• the goal is always to help the child and family participate in meaningful activities to the fullest extent possible

Question 19

Sensorimotor problems to consider

Answer 19

• abnormal muscle tone
• spasticity = increase muscle tone with AROM/PROM
• hypotonicity
• fluctuating
• atypical or abnormal reflexes (are integrated in a delayed manner)
• poor sensory processing
• hypertonicity = increase in resting state
• joint hypermobility or stiffness

Question 20

Medical based treatment

Answer 20

Medication to manage tone:
- Baclofen = by mouth or pump (administered to the whole body), it relaxes the muscle tone throughout the body (good option for quadriplegic BUT not hemiplegic)
- Botox = injections to specific muscles (helps relax muscles; great option but for only short period of time)
Orthopedic surgery:
- muscle releases = incisions in muscle or tendon (helps loosen the muscles)
- tendon transfer = green transfer is flexor carpi ulnaris transferred to extensor carpi radialis brevis to correct wrist flexion deformity
- hip displacement (hip surgeries)
- spinal surgeries
- selective dorsal rhizotomy = neurological surgery of lower spine

Question 21

Dr. Zimmerman’s go to model

Answer 21

• PEO model
  *how can we modify the environment?

Question 22

Impact on ADLs

Answer 22

• its goal = to increase independence in self-care, dressing, ADLs
• utilize adaptive equipment

Question 23

Impact on participation in school/work

Answer 23

• person = how can we improve child’s ability to perform task?
• environment = can it be modified for success?

Question 24

Participation in leisure

Answer 24

• access to toys (such as Switched Adapted Toy Program)
• access to social
• access to playgrounds
• access to extracurricular activities

Question 25

Out of My Mind movie

Answer 25

• Phoebe Rae Taylor = an authentic actress with CP