Cerebral Palsy

Question 1

Definition

Answer 1

an umbrella term for a group of non-progressive movement and posture disorder, caused by damage to the developing nervous system, before or during birth or in the early months of infancy. However, secondary impairments can be progressive. (i.e. musculoskeletal)

Question 2

Risk factors

Answer 2

-Multiple pregnancy
-Birth hypoxia (asphyxia) (10%)
-Low birth weight (50%) (30 fold increase in risk)
-Infection (Measles, Herpes simplex)
[Greater correlation between abnormalities during pregnancy than in labour]

Question 3

Epidemiology: ___ - ____ in 1000 live births in NZ; approximately _____ people have some degree of CP

Answer 3

2 - 2.5 , 7000

Question 4

Lesion location may be identified by ____, or by _______. List 3 areas that affects + clinical features

Answer 4

CT, clinical presentation

• Premotor - Motor cortex - Sensory cortex… Spastic (70-80%)
• Basal Ganglia - Dyskinetic (10-20%)
• Cerebellum - Ataxic (5-10%)

Question 5

Diplegia

Answer 5

paralysis of corresponding parts on both sides of the body

• increased tone in legs; little or no involvement in the arms
• Femoral anteversion (IR of the femoral shaft on the femoral neck)
• Crouching gait (spasticity in hip adductors, flexors, hamstrings and calf muscles)
• Tibial torsion (malleoli are parallel)

Question 6

Hemiplegia

Answer 6

paralysis of one side of the body

• Spasticity in the arm, leg and trunk on one side
• Underdevelopment of the affected side (smaller limbs and leg shortning)
• Equinus of foot, ankle, flexion of elbow, wrist and fingers

Question 7

Quadriplegia

Answer 7

paralysis of all four limbs

Question 8

Athetoid (dyskinesia) CP

Answer 8

basal ganglia (10-20%)

• uncontrolled, purposeless, slow, writhing movements
• Muscles change from floopy to tense
• May affect face or tongue (resulting in drooling)

Question 9

Ataxic CP

Answer 9

cerebellar (5-10%)

• low muscle tone and poor coordination of movements
• affects the sense of balance and depth perception

Question 10

Aims of PT

Answer 10

• increase/ improve motor skill repetore
• maintain gross motor function level
• general management and minimisation of contractures and deformities

Question 11

Diagnosis

Answer 11

• based on Px’s history and physical examination

- CT and MRI when aetiology of CP has not been established

Question 12

Medications

Answer 12

• Anticonvulsants … to prevent or stop seizures or convulsioins
• Antipasmotics … Baclofen, Botulinum toxin (Botox) for spastic CP

Question 13

Prognosis

Answer 13

reduced life expectancy - 90% survival into teens and 20s (immobility and sever learning difficulties main influencing factor)

Question 14

Gross Motor Function Classification System (GMFS)

Answer 14

Five levels based on the child’s ability to perfoem gross motor skills and assistance requird when mobilising in a variety of conditions (stairs, distances, altered terrain, inclines)

Question 15

Functional mobility scale (FMS)

Answer 15

Considers the assistance the person’s requires over 5, 50 and 500 meters, and it is a performance measure.
1. use wheel chair; 2. walker or frame; 3. crutches; 4. sticks; 5. independent on level surfaces; 6. independent on all surfaces

Question 16

other outcome measures

Answer 16

Paediatric Balance scale (PBS)
Manual Ability Classification system (MACS)
6MWT