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Cerebral Palsy (2) Flashcards

1
Q

What is cerebral palsy?

A

Abnormal motor control and tone in the absence of underlying progressive disease

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2
Q

What are some secondary impairments in cerebral palsy?

A

MSK changes (contractures, scoliosis, hip subluxation)

Arthritis

Fractures

Pain

Fatigue

Sensory impairments

Osteoporosis

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3
Q

What is the most common childhood motor disability?

A

Cerebral palsy

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4
Q

What increases the risk of a child developing cerebral palsy?

A

Low birth weight, pre-term, and multiple births

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5
Q

What are the pre natal risk fractures of cerebral palsy?

A

Pregnancy induced hypertension

Multiple gestation

Placenta insufficiency or abruption

Teratogenic drugs

Infections

Chromosomal abnormalities genetics

Maternal nutrition or malnutrition

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6
Q

What are perinatal risk factors of cerebral palsy?

A

Multiple gestation

Hypoxic ischemic encephalopathy

20 minute APGAR score < 3

Intraventricular hemorrhage

Jaundice

Infection

Stroke

Placental inflammation

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7
Q

What are common things that happen with pre-mature babies?

A

Low birth weight and Periventricular Leukomalicia

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8
Q

What are postnatal risk factors of cerebral palsy?

A

Head trauma

Intracranial infections

Toxic encephalopathies

Cerebral and intraventricular hemorrhages

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9
Q

What does having twins have a greater incidence of?

A

Low birth weight, pre term deliveries, and congenital malformations

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10
Q

What does the death of one twin do to the other in the placenta?

A

Increases the risk of cerebral palsy in surviving twin

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11
Q

What percentage of twins have cerebral palsy?

A

10%

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12
Q

What is the best predictor that a pre-term child will develop cerebral palsy?

A

Periventricular Leukomalacia

Grade 3 or 4 intraventricular hemorrhage

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13
Q

What makes it so it is a 90-95% chance of developing spastic diplegic cerebral palsy?

A

Periventricular cyst > 3mm

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14
Q

What is Periventricular Leukomalacia?

A

Loss of white matter in an infants brain

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15
Q

Are ischemic strokes in newborns usually unilateral or bilateral?

A

Unilateral

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16
Q

What does hypoxic ischemic encephalopathy effect in a newborns brain?

A

White and gray matter (often bilateral)

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17
Q

What are the types of brain malformations at birth?

A

Polymicrogyria

Microcephaly

Schizencephaly

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18
Q

What are some signs that can help make the diagnosis of cerebral palsy?

A

Failure to meet early developmental milestones

Differences in posture and movement patterns

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19
Q

What are some tools that can help diagnose cerebral palsy?

A

Prechtl qualitative assessment for general movements (GMA)

Hammersmith infant neurological exam (HINE)

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20
Q

What are the different types of cerebral palsy?

A

Hemiplegia

Diplegia

Quadriplegia

Athetoid (cerebellum)

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21
Q

What percentage of children have hemiplegia cerebral palsy?

A

25-40%

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22
Q

What is effected in hemiplegia cerebral palsy?

A

Unilateral with UE > LE

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23
Q

What are some symptoms that go along with hemiplegic cerebral palsy?

A

Cognitive concerns, seizures, and vision deficits

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24
Q

What is an early sign of hemiplegic cerebral palsy?

A

Palmar grasp and decreased reach at midline

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25
What percentage of children have diplegic cerebral palsy?
35% (80% in preemies)
26
What is effected in diplegic cerebral palsy?
LE > UE
27
What are other symptoms that happen with diplegic cerebral palsy?
Seizures, mental challenges, and strabismus
28
What percentage of children present with quadriplegic cerebral palsy?
20%
29
What are symptoms that come with quadriplegic cerebral palsy?
Dysphagia, speech disorders, cognitive impairments, and cortical vision impairment
30
What are examples of extrapyramidal cerebral palsy?
Involuntary movements such as athetosis, dystonia, and ataxia from damage to basal ganglia or cerebellum
31
What is mixed type cerebral palsy?
Includes both spastic and extrapyramidal types (9-22%)
32
What are the postural control deficits of cerebral palsy?
Impaired reactive and anticipatory postural adjustments Disorganization of muscle recruitment (timing, direction, force) Excessive antagonistic co-activation
33
What form of cerebral palsy shows the most cognitive impairment?
Quadriplegic
34
When do seizures usually begin in those with cerebral palsy?
First two years of life or with puberty
35
What is the most common visual impairment in cerebral palsy?
Strabismus (misalignment of eyes)
36
What is cortical visual impairment?
Caused by cerebral disorder (damage to visual pathways and centers)
37
What percentage of cerebral palsy children have auditory impairments?
15-25% (common with TORCH infections)
38
What percentage of children with cerebral palsy have tactile sensory impairments?
45-50%
39
What type of speech impairments may come with cerebral palsy?
Dysphasia or dysarthria
40
Why may newborns with cerebral palsy need a gastrostomy tube?
It allows them to get nutrition through an alternate route since they have poor motor control for swallowing
41
What are the reasons a child with cerebral palsy may experience constipation?
Inability to hydrate Loss of appetite Growth impairments
42
Which two positions would an infant with reflux uncomfortable?
Supine and prone
43
What are some respiratory issues a child with cerebral palsy may experience?
Weak respiratory muscles Abnormal chest wall compliance Infections (GERD)
44
Why does hip dysplasia commonly occur in children with cerebral palsy?
They have a lack of normal weight bearing forces through the developing acetabulum which leads to a muscle imbalance at the hip joint
45
Why does hip dysplasia occur?
Due to hip adductors and flexors overpowering the abductors and extensors
46
What type of cerebral palsy is most likely to have scoliosis?
Quadriplegic
47
What can scoliosis effect?
Positioning, respiratory status, pain, and skin integrity
48
Why do children with cerebral palsy have low bone mineral density?
Due to delayed or absent weight bearing
49
What is the strongest predictor of a gross motor impairment?
Selective voluntary motor control
50
What is the selective control assessment of the lower extremity (SCALE) used for?
To measure selective voluntary motor control in the LEs of children with cerebral palsy
51
What parts of the LE does the SCALE measure?
Hip, knee, subtalar joint, ankle, and toes
52
At what age will a child with cerebral palsy reach their peak prognosis?
Age 6-8
53
What happens if a child with cerebral palsy is ranked a level 1 or 2 on the gross motor function classification system?
They plateau
54
What happens if a child with cerebral palsy is ranked a level 3, 4, or 5 on the gross motor function classification system?
They continue to decline
55
What are the the F words in childhood disability that we need to remember when treating?
Function Family Fitness Fun Friends Future
56
What are some treatments to help children with cerebral palsy?
Orthopedic surgeries Spasticity management
57
What are the different types of spasticity management?
Oral Intramuscular (Botox) Intrathecal (Baclofen) Surgical (selective dorsal rhizotomy)
58
When does Botox reach its peak effect and how long is it effective?
Peak effect at 2 weeks and lasts 4 months
59
What are the common sites where Botox is used for cerebral palsy?
Gastroc/soleus Hip adductors Hamstrings UEs
60
What is intrathecal baclofen most effective for?
LEs
61
What type of lesion do children often have with cerebral palsy?
UMN

Pediatrics (16 decks)

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