Cerebral Palsy Flashcards
Components of muscle tone
Neural = innervation component Mechanical = elastic component
Hypotonia
“Low muscle tone”
Decreased ability to generate voluntary muscle force
Hypotonia symptoms
Decreased strength, hypermobile joints, increased flexibility, rounded shoulders, delayed motor skills, leans on supports, poor attention and motivation, decreased activity tolerance, improvement with therapy
Hypertonia
“High muscle tone”
“Greater than normal resistance found with passive ROM of a limb”
Hypertonia symptoms
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
Spastic catch (R1/R2)
R1 = first point of resistance R2 = last point you can reach (end of ROM)
Spasticity and reflexes
Absence of automatic postural reflexes
Persistence of primitive reflexes
Modified Tardieu Scale
Spasticity. ID’s the neural component.
Relationship of R2-R1:
- Large difference = neural component
- Small difference = mostly musculoskeletal component
APGAR acronyms
A = activity P = pulse G = grimace A = appearance R = respiration *Scores range = 0-2
Before 2nd birthday Level I GMFCS
Minor amount of difficulty
Before 2nd birthday Level II GMFCS
Might need hands for support
Before 2nd birthday Level III GMFCS
Need for AD in later years
Before 2nd birthday Level IV GMFCS
Head control but needs trunk support
Before 2nd birthday Level V GMFCS
Difficulty holding head upright in anti-gravity position; assistance needed for rolling
Between 2nd and 4th birthday Level I GMFCS
Often walk as preferred mobility
Between 2nd and 4th birthday Level II GMFCS
Use AD or cruise
Between 2nd and 4th birthday Level III GMFCS
Still walking indoors with AD
Between 2nd and 4th birthday Level IV GMFCS
Less ambulatory capability. Still creeping, non-reciprocal hands and knees crawling
Between 2nd and 4th birthday Level V GMFCS
No means of independent mobility. May use power mobility option
Manual Ability Classification System
Same as GFMCS only for fine motor
Motor milestones in children with CP
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
Other domains affected by CP
Cognitive delays/learning disabilities, speech delays, auditory impairments, seizure disorders, vision problems
CP classification according to body area affected
Monoplegia (one limb) - rare
Diplegia (lower extremities)
Hemiplegia (unilateral)
Quadriplegia (entire body)
CP classification according to movement abnormality
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)
CP classification according to severity
GMFCS
How common types of CP are
Spastic diplegia = most common (41.5%) Spastic hemiplegia = second most common (36.4%) Athetoid (dyskinesia) = 10% Spastic quadriplegia = 7.3% Ataxic = least common (5%)
CP causes
Coagulation disorders, intrauterine exposure to infection or inflammation, asphyxiating birth complications, intracranial hemorrhage
Types of CP neuropathic lesions ID’d
Neuropathy due to subdural hemorrhage (IVH)
Encephalopathy caused by anoxia or hypoxia (HIE)
Neuropathy due to malformation of the CNS
Periventricular Leukomalacia (PVL)
CP is diagnosed when
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
