Cerebral Palsy

Question 1

What is Cerebral Palsy?

Answer 1

A disorder of movement and posture due a non-progressive lesion of the motor pathways in the developing brain.

Question 2

Presentations of Cerebral Palsy

Answer 2

Abnormal tone in early infancy
Delayed motor milestones
Abnormal Gait
Feeding difficulties

Question 3

Non-motor Symptoms of cerebral palsy

Answer 3

60% have learning difficulties
30% have epilepsy
30% will have a squint
20% will have hearing impairments

Question 4

Causes of Cerebral palsy

Answer 4

80% are antenatal - cerebral malformations or congenital infections (rubella, CMV, Toxoplasmosis)
10% intrapartum - birth asphyxia or trauma
10% postnatal - IVH, meningitis, hyperbilirubinaemia or head trauma
Also linked strongly to low birth weight and prematurity.

Question 5

Classification of Cerebral Palsy

Answer 5

70% spastic - pyramidal signs, hyperreflexia, increased tone and posture - can be hemiplegia, diplegia or quadriplagia
Also Dyskinetic (involuntary, uncontrolled recurring movements), ataxic (abnormal pattern of movement with loss of muscular co-ordination). Also dystonic (hypokineasia and hypertonia) or choreoathetotic (hyperkinesia and hypotonic)

Question 6

Management of Cerebral Palsy

Answer 6

Multidisiplinary approach is needed. Treat spasticity with oral diazepam, oral or intrathecal baclofen, botulinium toxin type A, orthopaedic surgery and selective dorsal rhizotomy (possibly DBS)
May also need analgesia and anticonvulsants as required

Question 7

Incidence of Cerebral Palsy

Answer 7

2/1000 live births. Increased in LBW babies (59/1000 2,500gs) and decreases with gestational age (111/1000 before 28wks, 1.35/1000 after 36wks)

Question 8

Secondary Impairments in Cerebral palsy

Answer 8

Feeding problems
Constipation
Asthma, reactive airways disease or upper airway obstruction
UTIs, skin breakdown or dental problems

Question 9

Gross motor function classification system (GMFCS)

Answer 9

I - walks fine but limited in more advanced motor skills
II - walks independently but difficulties with walking outdoors/in the community
III - walks with mobility devices
IV - Self mobilises with limitations (uses power mobilisers)
V - self mobility is severely limited even with the use of supporting technology.

Question 10

Long term motor consequences of Cerebral palsy

Answer 10

Spasticity and loss of motor control leading to muscle shortening, bony torsion and joint instability, degenerative arthritis