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Neurology > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

CP Definition

A

Static encephalopathy

- Non-progressive brain injury causing posture and movement disorders

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2
Q

What is CP often a/w? (4)

A
  • Epilepsy
  • Speech problems
  • Vision compromise
  • Cognitive dysfunction
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3
Q

Associated Conditions (9)

A
  • 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
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4
Q

Prenatal Causes of CP (13)

A
  • 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
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5
Q

Perinatal Causes of CP (6)

A
  • Premature delivery
  • Neonatal resuscitation
  • Low Apgar scores
  • Traumatic birth
  • Neonatal encephalopathy (seizures, lethargy, hypotonia)
  • Complicated neonatal course
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6
Q

(2)Postnatal Causes of CP

A
  • Severe infection

- Trauma

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7
Q

T or F it is a red flag if a baby favors one hand over the other before they are 1 year old.

A

True

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8
Q

Growth and Development (4)

A
  • Significant delay of motor mile stones
  • Persistent primitive reflexes
  • Delayed or absent development of protective reflexes
  • Delays in language, play, social, and adaptive behavior
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9
Q

CP Presentation

A
  • 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
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10
Q

Pyramidal (5)

A

• 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

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11
Q

Extrapyramidal (4)

A

• 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

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12
Q

Hemiplegia

A

Upper and lower extremity on one side of the body

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13
Q

Diplegia

A

Four extremities, legs more affected than the arms

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14
Q

Quadriplegia

A

Four extremities plus the trunk, neck and face

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15
Q

Triplegia

A

Both lower extremities and one upper extremity

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16
Q

Monoplegia

A

One extremity (rare)

17
Q

Gross Motor Function Classification System (GMFCS)

A
  1. ambulate w/no limitations
  2. ambulates w/out devices, limitations
  3. ambulates w/assistive devices
  4. self mobility limited, technology helps
  5. self mobility severe limited even with technology
18
Q

Spastic CP

A
  • Most common type
19
Q

Spastic CP Hypertonia (2)

A
  • increased muscle resistance to passive motion

* Inability of some spinal nerve receptors to properly receive GABA

20
Q

3 Anatomical Types of Spastic CP

A

Hemiplegia
Diplegia
Quadriplegia

21
Q

Spastic CP Hemiplegia (10)

A

• 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

22
Q

Spastic CP Diplegia (6)

A
  • 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
23
Q

Spastic CP Quadriplegia (8)

A

• 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)

24
Q

Non-Spastic CP Dyskinetic (6)

A

• 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

25
Q

Non-Spastic CP Ataxic (6)

A
  • 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
26
Q

Mixed CP

A
  • It is possible to have both spastic and non-spastic

* Often certain limbs will be effected by spasm while others by athetosis

27
Q

Prenatal Hx from Mother (10)

A
  • 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
28
Q

Perinatal Hx (11)

A
  • 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
29
Q

CP Developmental Hx

A

Review gross motor, fine motor, language, and social milestone from birth until time of evaluation

30
Q

What Gross motor milestones are we concerned with? (4)

A
  • Head control at 2 months
  • Rolling at 4 months
  • Sitting at 6 months
  • Walking at 1 year
31
Q

CP- PE

A
  • Microcephaly
  • Limb length discrepancies
  • Cataracts
  • Retinopathy
  • Congenital heart defects
  • Hypotonia/hypertonia
  • Hyperreflexia
32
Q

CP Diagnostic Testing (5)

A
  • Rule out other neurologic disorders
  • Depending on presentation
  • MRI
  • EEG
  • Genetic Testing
33
Q

Supportive Tx (2)

A

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

34
Q

CP Differential Diagnosis (7)

A
  • 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
35
Q

Overal Treatments of CP

A

• 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?

Neurology (12 decks)

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