Cerebral Palsy

Question 1

Description

Answer 1

Disorder of movement, muscle tone, and postureCaused by lesion that affects the immature brainNon-progressiveunderlying neurological lesion is static, process that led to brain dysfunction is no longer active

Question 2

Incidence

Answer 2

2-3/1000 live births

Question 3

When does the damage occur

Answer 3

CNS damage can occur prenatally, perinatally (period around childbirth), postnatally

Question 4

Risk Factors

Answer 4

Maternal/Intraueterine infectionsPrematurity&raquo_space; peri or intra ventricular hemorrhageLow birth weight, SGA, IUGRMultiple births, congenital malformationsNeonatal infection, hyperbilrubinemiaCVA, encephalopathy, anoxia

Question 5

Clinical Exam

Answer 5

Early hypotoniaAfter 3-4 months, increased tonePersistent and pervasive primitive reflexesDelayed motor developmentAsymmetrical upper limb use or hand preference in 1st year

Question 6

Cerebral Palsy Clinical Types

Answer 6

Spastic HemiparesisSpastic DiplegiaSpastic QuadriparesisDyskineticHypotonic

Question 7

Spastic Hemiparesis

Answer 7

Gross motor delayMost walk by age 3Hemiparetic gait, upper > lower limbCortical sensory deficitHemiparetic limbs remain underdevelopedMay develop mild scoliosis

Question 8

Spastic Diplegia

Answer 8

Predominant extensor posture with scissoring in lower limbsCrouched gait secondary to hip flexor weaknessLater, internal rotation of 1 or both legs, pes planovagus, pelvic obliquity, hip subluxation/dislocation commonScoliosisMay have mild upper limb dysfunction

Question 9

Spastic Quadriparesis

Answer 9

More extensive cortical damage, severe disabilityMore frequent musculoskeletal complications and pseudobulbar palsy signs1/3 never ambulate1/3 ambulate with assistive devices1/3 ambulate independently

Question 10

Dyskinetic

Answer 10

AthetoidChreiformBallisticAtaxicAthetosis may become dystoniaDrooling, dysarthric speechUpper limbs may be more involved than lowerEquinovarus, scoliosis75% ambulate, 50% by age 3

Question 11

Hypotonic

Answer 11

Persistent hypotonia/atonia with hip adduction, external rotation, and hip flexion contracturesSevere neuromuscular dysfunctionIntellectual deficitPoorest overall prognosis for ambulation and independence

Question 12

Associated Disabilities

Answer 12

Mental retardation 50%Communication disorderHearing ImpairmentLanguage delayPerceptual problemsApraxiaADHD, PDDSeizure disordersVisual and Extraocular motor deficitsFeeding difficultiesPulmonary diseaseUsually Maximal level of motor function by age 7

Question 13

CP Treatment

Answer 13

PT, OT, SLPTraining gross and fine motor skill, ADLOrthoses and adaptive equipmentOrthopedic surgeryTendon Lengthening or transfer, osteotomy, arthrodesisNeurosurgical procedures: posterior rhizotomyMedical management: medications, monitoring