Cerebral Palsy

Question 1

Components of muscle tone

Answer 1

Neural = innervation component
Mechanical = elastic component

Question 2

Hypotonia

Answer 2

“Low muscle tone”

Decreased ability to generate voluntary muscle force

Question 3

Hypotonia symptoms

Answer 3

Decreased strength, hypermobile joints, increased flexibility, rounded shoulders, delayed motor skills, leans on supports, poor attention and motivation, decreased activity tolerance, improvement with therapy

Question 4

Hypertonia

Answer 4

“High muscle tone”

“Greater than normal resistance found with passive ROM of a limb”

Question 5

Hypertonia symptoms

Answer 5

Neurally mediated stiffness (active and passive), increased resistance of muscle to stretch, tends to increase in age until 4 and then decreases till 12 and stabilizes

Question 6

Spastic catch (R1/R2)

Answer 6

R1 = first point of resistance
R2 = last point you can reach (end of ROM)

Question 7

Spasticity and reflexes

Answer 7

Absence of automatic postural reflexes

Persistence of primitive reflexes

Question 8

Modified Tardieu Scale

Answer 8

Spasticity. ID’s the neural component.
Relationship of R2-R1:
- Large difference = neural component
- Small difference = mostly musculoskeletal component

Question 9

APGAR acronyms

Answer 9

A = activity
P = pulse
G = grimace
A = appearance
R = respiration
*Scores range = 0-2

Question 10

Before 2nd birthday Level I GMFCS

Answer 10

Minor amount of difficulty

Question 11

Before 2nd birthday Level II GMFCS

Answer 11

Might need hands for support

Question 12

Before 2nd birthday Level III GMFCS

Answer 12

Need for AD in later years

Question 13

Before 2nd birthday Level IV GMFCS

Answer 13

Head control but needs trunk support

Question 14

Before 2nd birthday Level V GMFCS

Answer 14

Difficulty holding head upright in anti-gravity position; assistance needed for rolling

Question 15

Between 2nd and 4th birthday Level I GMFCS

Answer 15

Often walk as preferred mobility

Question 16

Between 2nd and 4th birthday Level II GMFCS

Answer 16

Use AD or cruise

Question 17

Between 2nd and 4th birthday Level III GMFCS

Answer 17

Still walking indoors with AD

Question 18

Between 2nd and 4th birthday Level IV GMFCS

Answer 18

Less ambulatory capability. Still creeping, non-reciprocal hands and knees crawling

Question 19

Between 2nd and 4th birthday Level V GMFCS

Answer 19

No means of independent mobility. May use power mobility option

Question 20

Manual Ability Classification System

Answer 20

Same as GFMCS only for fine motor

Question 21

Motor milestones in children with CP

Answer 21

Sidelying with hands in midline > head and hands in midline while in seat > prone on elbows with head up > lifts feet off floor in supine and rolls over > plays in prone/belly crawls > sits propped up on both arms > attains quadruped > squat to stand > heel sits holding stable object > heel sits holding stable object with one hand free > heel sits with both hands free > creeps on hands and knees reciprocally > sits erect on bench > cruises > walks with reverse walker > walks with forearm crutches > stands without support > walks alone

Question 22

Other domains affected by CP

Answer 22

Cognitive delays/learning disabilities, speech delays, auditory impairments, seizure disorders, vision problems

Question 23

CP classification according to body area affected

Answer 23

Monoplegia (one limb) - rare
Diplegia (lower extremities)
Hemiplegia (unilateral)
Quadriplegia (entire body)

Question 24

CP classification according to movement abnormality

Answer 24

Spastic - abnormally increased tone
Athetoid (dyskinesia) - fluctuating tone
Ataxic - cerebellar lesion causing wild, uncontrolled movements
Hypotonic - low tone (no lesion found, just gross motor hypotonia)

Question 25

CP classification according to severity

Answer 25

GMFCS

Question 26

How common types of CP are

Answer 26

Spastic diplegia = most common (41.5%)
Spastic hemiplegia = second most common (36.4%)
Athetoid (dyskinesia) = 10%
Spastic quadriplegia = 7.3%
Ataxic = least common (5%)

Question 27

CP causes

Answer 27

Coagulation disorders, intrauterine exposure to infection or inflammation, asphyxiating birth complications, intracranial hemorrhage

Question 28

Types of CP neuropathic lesions ID’d

Answer 28

Neuropathy due to subdural hemorrhage (IVH)
Encephalopathy caused by anoxia or hypoxia (HIE)
Neuropathy due to malformation of the CNS
Periventricular Leukomalacia (PVL)

Question 29

CP is diagnosed when

Answer 29

Child does not meet gross motor milestones, exhibits abnormal muscle tone, or movement patterns with asymmetry. It should be diagnosed in all but the mildest cases by 6 mo
AIMS, TIMP, GMA