Cerebral Palsy Flashcards
Primary lesion is located in the:
CNS
Who gets CP?
50% of diagnoses in full-term infants
33% pre-term
How is CP diagnosed?
eval of mvmnt and ID of mvmnt dysfxn; generally followed by MRI for baseline assessment
CP incidence?
2/1000 live births
Define CP:
group of mvmnt disorders occurring as a result of lesion in motor areas of the developing, immature brain
What systems are involved in addition to CNS?
Cognitive Vision Hearing Seizures GI Orthopedic Oral motor Respiratory Endocrine Integumentary G-U
What factors are considered in CP classification?
- location
- type of mvmnt disorder
- functional level
Locations:
diplegia
hemiplegia
quadriplegia
Type of mvmnt disorders:
spastic dystoni athetotic ataxic mixed
How is CP classified based on function level?
GMFCS
5 levels: reflects child’s current abilities and limitations in gross motor function; focused on sitting/walking fxns
Goals for infants and toddlers with CP?
facilitate normal mvmnt for achievement of developmental milestones
Goals for older children with CP?
maintain and increase strength/flexibility to optimize fxn; develop habits for life long health and wellness
Intervention in infancy:
educate!
promote parents’ ease in handling/care
facilitate optimal sensorimotor development for motor skill achievement with well aligned postural stability
monitor for positioning (prevent deformities in children and more severely involved)
Intervention in toddler-preschool years:
Optimize mobility and access to environment. Assistive devices for ambulation Seating systems Consider power mobility Self care equipment
Intervention in adolescence:
Health Maintenance- contractures, cardiovascular
Continued access to school and community. Consider ways to foster independence including home modifications, adaptive equipment.
Participation continues to present challenges for high school aged children
Find Mechanisms for involvement in fitness activities to promote health
Intervention in school-aged children:
Allow for continued access to school, home and play.
Develop programs to prevent secondary deformities
Encourage participation by modification of environment or activity as needed.
What causes joint contracture in individuals with CP?
abnormal forces on bones that create bony deformity
capsular tightness due to abnormal mvmnt patterns and lack of normal joint excursion
tightness of muscle-tendon unit due to weakness, hypotonicity (which inhibits muscle growth)
Contracture tend to form in predictable patterns and joints. Describe both UE and LE:
Upper extremities: Shoulder flexors and adductors, pectoralis major, biceps, pronators, FCU, thumb adductors.
Lower extremities: Hip adductors, +/- anteversion, knee flexors, plantar flexors and everters
What causes limited flexibility/ in CP patients?
Limited movement of 2 joint muscles is common.
Weakness, and poor selective motor control also play a big part.
What motor control deficits are expected?
abnormal tone (hyper or hypotonicity) lack of selective control athetoid or ataxic mvmnts
What strength deficits are expected?
spastic muscles are week (antagonists not strong enough to overpower spastic muscles)
disturbances in length-tension relationships also impair force generation
What aerobic capacity factors need to be considered?
Ambulatory children have a much less efficient gait than their peers so to perform the same level of work, they need to work harder.
Many are sedentary
How would you assess aerobic capacity?
6 min or 3 min walk tests
can be done both walking and propelling manual wheel chair
What standardized tests are commonly performed?
PEDI COPM CAPE GMFM GMFCS
Describe the GMFM:
A standardized instrument designed to measure change in in motor function in children with cerebral palsy:
Has predictive value in determination of ultimate highest motor function
5 Domains for testing (Rolling, sitting, crawling and kneeling, standing and Walking running and jumping)
Why family centered intervention?
Best practice in pediatric PT bc takes into consideration the child and families needs, goals and priorities in the settings where children work, learn and play.
Collaboration since frequent practice which is done under a variety of environments which are part of the child’s daily routines enhances motor learning.
Whats the current consensus on stretching?
To maintain muscle length over time: prolonged stretching (>30min) consider position changes, standing, bracing, night splints etc
Whats the current consensus on strengthening?
functional utilization of strength > isolated muscle strength
