Cerebral Palsy Flashcards
CP Definition
Static encephalopathy
- Non-progressive brain injury causing posture and movement disorders
What is CP often a/w? (4)
- Epilepsy
- Speech problems
- Vision compromise
- Cognitive dysfunction
Associated Conditions (9)
- Sensorineural and conductive hearing loss
- Visual acuity impairement
- Somatosensory impairments
- Cognitive/development disability
- Language/learning disabilities
- M/S impairments
- Cardiorespiratory impairments
- GI/Nutritional impairments
- Skin- decubitus ulcers
Prenatal Causes of CP (13)
- Exposure to toxins/drugs
- Infections or fever
- HIV/STDrisk
- Vaginal bleeding
- Abnormal fetal movement
- Preeclampsia (especially proteinuria)
- Breech position
- Poor maternal weight gain
- Premature labor
- Fetal distress
- Intrauterine Growth Retardation (IUGR)
- Prenatal testing
- Placental disorders
Perinatal Causes of CP (6)
- Premature delivery
- Neonatal resuscitation
- Low Apgar scores
- Traumatic birth
- Neonatal encephalopathy (seizures, lethargy, hypotonia)
- Complicated neonatal course
(2)Postnatal Causes of CP
- Severe infection
- Trauma
T or F it is a red flag if a baby favors one hand over the other before they are 1 year old.
True
Growth and Development (4)
- Significant delay of motor mile stones
- Persistent primitive reflexes
- Delayed or absent development of protective reflexes
- Delays in language, play, social, and adaptive behavior
CP Presentation
- Hx of motor development delay in 1st yr
- Decreased tone followed by spasticity
- Definite hand preference before age 1
- Asymetric crawling or failure to crawl
- Growth disturbances, underweight
Pyramidal (5)
• Two groups of nerve fibers responsible for voluntary movements.
• Communicate the brain’s movement intent to the nerves in the spinal cord to stimulate the act of moving.
• Results in increased muscle tone.
• Referred to as upper motor neuron damage
- Spasticity
Extrapyramidal (4)
• Injury occurred outside the tract in areas such as the basal ganglia, thalamus, and cerebellum.
• Main characteristic is involuntary movement
• Divided into ataxic and dyskinetic
- Flaccid
Hemiplegia
Upper and lower extremity on one side of the body
Diplegia
Four extremities, legs more affected than the arms
Quadriplegia
Four extremities plus the trunk, neck and face
Triplegia
Both lower extremities and one upper extremity
Monoplegia
One extremity (rare)
Gross Motor Function Classification System (GMFCS)
- ambulate w/no limitations
- ambulates w/out devices, limitations
- ambulates w/assistive devices
- self mobility limited, technology helps
- self mobility severe limited even with technology
Spastic CP
- Most common type
Spastic CP Hypertonia (2)
- increased muscle resistance to passive motion
* Inability of some spinal nerve receptors to properly receive GABA
3 Anatomical Types of Spastic CP
Hemiplegia
Diplegia
Quadriplegia
Spastic CP Hemiplegia (10)
• Seizure disorders
• Affected limbs may be thinner and shorter
• Intelligence
• Average intelligence decreased
• Left hemiplegia is lower then right hemiplegia
• May have unexplained aggressiveness and hyperactivity
• Homonymous hemianopsia (affecting the field of vision on the side of the affected limb)
• Strabismus
• Astereognosis
• Proprioceptic loss
Spastic CP Diplegia (6)
- Most common form of the spastic forms
- Most are fully ambulatory with scissor’s gate
- May have dysarthria
- May be affected if neonatal asphyxia or jaundice of pre-maturity
- Epilepsy
- Intelligence (many have normal range and some have had above average ability
Spastic CP Quadriplegia (8)
• All four limbs relatively equally affected
• Can have Triplegia
• Speech
• Hearing
• Often myopia and cataracts of prematurity (vision)
• Perception
• Epileptic fit once or twice in their childhood, often associated with an infective illness
• The level of intelligence has some relationship to the severity of the
handicap (intelligence)
Non-Spastic CP Dyskinetic (6)
• Hypertonia and hypotonia
• Slow, wriggly, or sudden quick movements of the feet, arms, hands, or face muscles
• Constantly changing muscle tone – poor balance
• Dysarthria, dysphagia, and drooling accompany the movement problem
• Mental status: generally normal (severe dysarthria makes communication difficult and leads the observer to think that
the child has intellectual impairment)
• Sensorineural hearing dysfunction
Non-Spastic CP Ataxic (6)
- Hypotonia during first 2 years of life
- Muscle tone becomes normal; ataxia becomes apparent toward the age of 2-3 years
- Dysmetria
- Visual or auditory processing difficulty
- Hypotonia and tremors
- Impairment of motor skills like writing, typing, or using scissors
Mixed CP
- It is possible to have both spastic and non-spastic
* Often certain limbs will be effected by spasm while others by athetosis
Prenatal Hx from Mother (10)
- Prenatal exposure to illicit drugs, toxins or infections
- Maternal diabetes
- Acute maternal illness
- Trauma - Radiation exposure
- Prenatal care
- Fetal movements
- Hx of early frequent spontaneous abortions - – Parental consanguinity (incest)
- Family history of neurologic disease
Perinatal Hx (11)
- Child’s gestational age at birth
- Presentation of the child and delivery type
- Birth weight
- Apgar score
Complications in the neonatal period: - Intubation time
- Presence of intracranial hemorrhage on neonatal ultrasound
- Feeding difficulties
- Apnea
- Bradycardia
- Infections
- Hyperbiliruninemia
CP Developmental Hx
Review gross motor, fine motor, language, and social milestone from birth until time of evaluation
What Gross motor milestones are we concerned with? (4)
- Head control at 2 months
- Rolling at 4 months
- Sitting at 6 months
- Walking at 1 year
CP- PE
- Microcephaly
- Limb length discrepancies
- Cataracts
- Retinopathy
- Congenital heart defects
- Hypotonia/hypertonia
- Hyperreflexia
CP Diagnostic Testing (5)
- Rule out other neurologic disorders
- Depending on presentation
- MRI
- EEG
- Genetic Testing
Supportive Tx (2)
Team Approach!!
• Primary care provider, dentist, social worker, OT, PT, neurology, pulmonology, gastroenterology
• Family centered: Goal of obtaining maximum function and potential in physical, occupational and speech ability
CP Differential Diagnosis (7)
- Genetic Disease (e.g. Rett syndrome)
- Degenerative nervous disorders
- Muscle diseases
- Metabolism disorders (e.g. glutaric aciduria type 1)
- Nervous System Tumors
- Brachial Plexus injury
- Transient toe-walking
Overal Treatments of CP
• Nutrition
• Safety
• Exercise
• Glasses
• Hearingaids
• Muscle and bone braces
• Walkingaids/Wheelchairs
• Anticonvulsants to prevent or reduce the frequency of seizures
• Botulin toxin to help with spasticity and drooling
• Muscle relaxants (baclofen) to reduce tremors and spasticity
• Assistive technology
• Spinal cord stimulation
• Feeding tubes
• Release joint contractures
• Surgery for GERD
• Physical therapy & Occupational therapy
• Speech therapy
• Monitor burnout of parents and other care providers
• Stem Cell in the future?
