Cerebral palsy

Question 1

What is cerebral palsy?

Answer 1

Abnormality of movement and posture - limit activities - caused by non-progressive disturbances that occurred in developing fetal/infant brain.

Question 2

What accompanies motor disturbances in CP?

Answer 2

Disturbances of:
•	Cognition
•	Communication
•	Perception
•	Sensation
•	Behaviour

• Seizure disorder & secondary musculoskeletal problems

Question 3

What are the common causes of CP?

Answer 3

• 80% is antenatal due to vascular occlusion, cortical migration disorder or structural maldevelopment
• Roughly 10% due to hypoxic-ischaemic injury during delivery
• About 10% postnatal in origin

Question 4

What are the early features of CP? (4)

Answer 4

• Abnormal limb and/or trunk posture and tone in infancy with delayed motor milestones
• Feeding difficulties with oromotor incoordination, slow feeding, gagging and vomiting
• Abnormal gait once walking
• Aysmmetric hand function before 12 months of age

Question 5

What is the pathology in spastic CP?

Answer 5

Damage to UMN pathway - persisten increase in limb tone (brisk reflexes)

Question 6

What are the three types of spastic CP?

What does each entail?

Answer 6

• Hemiplegia: Unilateral involvement of arm and leg (arm > leg) with face spared. Presents at 4-12 months with fisting of affected hand, flexed arm and pronated forearm.
• Quadriplegia: All 4 limbs affected, often severely. Associated with seizures and intellectual impairment
• Diplegia: All 4 limbs, but legs much worse affected than arms – walking abnormal.

Question 7

What is dyskinetic cerebral palsy?

Answer 7

Involuntary, uncontrolled, sometimes stereotypes movements, often more evident with active movement/stress

Muscle tone variable and primitive reflexes may predominate.

Question 8

What are the 3 types of dyskinetic CP?

Answer 8

• Chorea: Irregular, sudden and brief non-repetitive actions
• Athetosis: Slow, writhing movements occurring more distally (fanning of fingers)
• Dystonia: Simultaneous contraction of agonist and antagonist muscles of trunk and proximal muscles give twisting appearance.

Question 9

How do children affected with dyskinetic CP present?

Answer 9

• Floppiness
• Poor trunk control
• Delayed motor development in infancy
• Abnormal movements may only appear after 1st year of life.

Signs due to damage/dysfunction in basal ganglia or associated pathways (extrapyramidal)

Question 10

What is pathology in ataxic (hypotonic) CP?

What are the signs?

Answer 10

Most ataxic CP = genetically determined

When due to acquired brain injury (cerebellum and its connections) signs occur on same side as lesion but are normally relatively symmetrical

Signs of ataxic CP:
•	Early trunk and limbs hypotonia
•	Poor balance
•	Delayed motor development
•	Incoordinate movements, intention tremor and ataxic gait may be evident later.