Cerebral Palsy

Question 1

What is CP?

Answer 1

static lesion in the immature brain that leaves children with a permanent motor impairment

Question 2

How does a lesion occur to cause CP?

Answer 2

developmental defect, MCA occlusion causing an infarction, trauma during or after delivery

Question 3

What is the etiology breakdown for CP?

Answer 3

Prenatal (genetic syndroms, teratogenic (alcohol), viral infection, twin pregnancies= 40%

Perinatal (pre-exclampsia, birth asphyxia, cerebral artery infarction)= 55%

Postnatal (hypoxic ischemic injury, anoxia, cerebral traumatic injury, meningitis)= 5%

Question 4

What are associated disorders with CP?

Answer 4

seizures
cognitive/behavioral challenges
persistence of primitive reflexes
feeding disorders

Question 5

what are the topographical classifications of CP

Answer 5

monoplegic
hemiplegic (all 1 side)
diplegic (both UE and LE)
triplegic (both feet and 1 UE)
quadriplegic

Question 6

What are the two physiologic classifications of CP?

Answer 6

pyramidal or spastic type

Question 7

What is spasticity?

Answer 7

disorder of muscle tone characterized by an initial increased resistance to stretch (75% of CP cases)

Question 8

Extrapyramidal CP is damage to what brain structures and causes what

Answer 8

damage to the basal ganglia or cerebellum which results in movement disorders

Question 9

Athetoid CP effects what part of the brain

Answer 9

extrapyramidal CP
involuntary movements
intelligence normal

Question 10

Atonic CP

Answer 10

extrapyramidal CP
damage to motor area of cerebral cortex
flaccid muscle tone, "floppy"
no DTRs
clumsy/uncoordinated 
child will over or under-reach for objects (dysmetria)
gait is ataxic and wide-based

Question 11

spastic hemiplegia

Answer 11

involvement of one side of body
arm more affected than leg
definite hand preference in children less than 12 months
sitting and crawling at normal age, but walking is delayed

Question 12

spastic diplegia

Answer 12

lower limbs more involved than upper limbs
DTRs exaggerated
shuffling gait, w/flexion/adduction of hips and flexion of knees
growth of lower limbs suffers, but upper limbs grow normally.
can use a WALKER

Question 13

spastic quadriplegia

Answer 13

severely disabled
microcephaly
severe mental retardation
epilepsy
visual and hearing deficits
hip subluxation
hypertonicity leads to arching of the back
scissoring of legs
arms internally rotated

Question 14

athetosis

Answer 14

purposeless movements which are uncontrollable. These movements may be slow or fast, writhing, jerky, swiping, tremor, or rotary patterns

fluctuates with emotional state. fatigue decreases athetosis

Question 15

Patterns that show increase in tone

Answer 15

arm adducted 
shoulder internal rotation
elbow flexed
forearm pronated
wrist flexed
thumb adducted

Question 16

Medical Management of CP

Answer 16

Baclofen: muscle relaxer and antispastic agent

Botox: reduces spasticity by blocking neurmuscular transmissions by binding to receptors sites and inhibits release of acetycholine.

CITM: forced use of involved extremity by using a splint/cast and doing repetitive adaptive tasks with involved extremity

Question 17

What is the widely used intervention for CP?

Answer 17

Neurodevelopmental Treatment (NDT): key points are the places of physical contact b/w therapist’s parts of the body/equipment and client’s body

Question 18

Athetoid effects on movement and intelligence

Answer 18

Causes involuntary movements

And usually intelligence is normal