Cerebral Palsy Flashcards
1
Q
Cerebral palsy is…
A
- Umbrella term
- Nonprogressive developmental disorder
- Caused by insult to the developing brain
- Motor and sensory impairments
2
Q
What are some comorbidities of cerebral palsy?
A
Sensation and sensory processing involvement, perception, cognition, communication/speech issues, behavioral and emotional disorders, mental retardation
3
Q
There has been a steady prevalence of CP in the last _____ years. Why?
A
40 years
increase in survival rate of preterm babies
4
Q
Incidence of CP in single births?
A
2-3/1000
5
Q
Incidence of CP in twin births?
A
15/1000
6
Q
Incidence of CP in triplet births?
A
80/1000
7
Q
Incidence of CP in quadruplets?
A
43/1000
8
Q
What is the main etiology behind CP?
A
Changes in prenatal brain development (75% of all cases)
9
Q
What are some other etiologies behind CP?
A
congenital brain anomalies, prenatal events, perinatal events, post/neonatal events (10-18%)
10
Q
Why can a definitive diagnosis only be made after 12 months?
A
neuroplasticity
11
Q
What studies are available to diagnose CP?
A
MRI, cranial ultrasound
12
Q
What is the typical presentation of an infant/child with CP?
A
Abnormal muscle tone, atypical posture, movement with persistent reflexes, non-progressive
13
Q
What other diagnoses can mimic CP?
A
metabolic and mitochondrial disorders (they are progressive however)
14
Q
What is bleeding into the ventricles called?
A
Intraventricular hemorrhage (IVH)
15
Q
What is bleeding into tissues around the ventricles?
A
Germinal matrix hemorrhage (GMH)
16
Q
What is bleeding into the ventricles and around the venrticles called?
A
Periventricular intraventicular hemorrhage (PIVH)
17
Q
What is a periventricular cyst (PVC)?
A
a cyst that may form in the area where the bleed occurred once the acuteness has resolved
18
Q
What are some known risk factors for CP?
A
Mechanical ventilation (can cause IV bleeding) Injury during critical periods of brain development
19
Q
When is periventricular white matter most sensitive to insult and injury?
A
between 24-34 weeks gestation
20
Q
What are some antenatal risk factors for CP?
A
- prematurity and LBW
- intrauterine injections
- multiple gestation
- pregnancy complications
21
Q
What are some perinatal risk factors for CP?
A
- birth asphyxia
- complicated labor and delivery
22
Q
What are some postnatal risk factors for CP?
A
- non-accidental injury
- head trauma
- meningitis/enchephalitis
- cardio-pulmonary arrest
23
Q
What are some strategies for preventing CP?
A
Obstetrical care (magnesium sulfate for preeclampsia, antibiotics for infection, corticosteroids for preterm labor)
24
Q
What is the most common movement disorder associated with cerebral palsy?
A
spasticity
25
What is spasticity?
increased resistance to passive movement which increases with increased velocity
26
What are the movement disorders associated with CP?
Spastic, hypotonic, dyskinetic, athetoid, ataxic
27
What is dyskinesia?
uncontrolled movement
28
What is athetoid?
slow, writhing movement
29
What ataxia?
balance and control disorder
30
What is affected in diplegia?
legs
31
What is affected in hemiplegia?
one side of the body
32
What is affected in quadriplegia/tetraplegia?
all four limbs
33
Which type of plegia is most common in CP?
diplegia
34
What are the levels of the GMFM?
Level I- independent
Level II- walk w/o AD, limited community amb
Level III- walk with AD, limited community amb
Level IV- self mobility with limitation, transported in comm
Level V- difficulty controlling all movement, severely limited
35
What is the other name for the GMFM
Gross Motor Functional Classification
36
What changes in the muscle changes does the hyperactive stretch reflex cause?
decreased longitudinal growth of muscle fibers
decreased volume of muscle
change in muscle unit size and fiber type
37
How is the Modified Ashworth Scale for spasticity score?
00-4
38
What is involved in a comprehensive assessment of children with CP?
motor attainment, neurologic signs, primitive reflexes, postural reactions
39
What is diplegia often caused by?
infarct in white matter of periventricular area caused by hypoxia
40
What type of gait and AD do children with diplegic CP have?
crouched gait, Lofstrand crutches
41
How is the cognition in children with diplegic CP?
normal
42
What is hemiplegia often caused by?
periventricular white matter abnormalities, cervical subcortical lesions, brain malformations, nonprogressive postnatal injuries
43
How are the UE and LE often positioned in children with CP?
elbow flexed, shoulder adducted, wrist flexed, foot plantarflexed
44
How is the cognition in children with hemiplegic CP?
social and emotional deficits present (resemble adult stroke patients with impulsivity and forgetfulness)
45
What are the equipment requirements for children with hemiplegic CP?
AFOs and splinting, sometimes crutch or cane
46
What is quadriplegia often caused by?
periventricular white matter lesions (basal gangia, occipital area)
47
How is the cognition in children with quadriplegic CP?
variable (supergenius to below normal IQ)
48
What are the equipment requirements for children with quadriplegic CP?
significant requirement throughout lifespan
49
What is dykinesia often caused by?
deep gray matter lesions (sometimes periventricular white matter)
50
Where is one of the typical places of excess movement in patients with dyskinesia?
C5-C6
51
How is the cognition in patients with dyskinesia?
normal to above normal intelligence
52
Which type of movement disorder requires the most medication?
dykinesia
53
What does ataxia cause?
weakness, incoordination, wide based gait, noted tremor
54
What is ataxia often caused by?
deficit in cerebellum
55
What do patients with ataxia have particular difficult with?
transference of skills (therapy should be task specific)
56
What is important to assess in children with CP?
- motor attainments
- neurologic signs
- primitive reflexes
- postural reactions
57
_____ is a sign of increased tone.
distal fixing (toe curling or fisting)
58
_____ is a sign of decreased or fluctuating tone.
collapsing with postural alignment
59
What is normal femoral anteversion at birth? When fully developed as an adult?
40 degrees at birth
| 15 degrees once fully developed
60
How is tibial torsion measured?
thigh - foot angle (using transmalleolar axis and femur as landmarks)
61
What is one of the most important goals for PT for CP?
preventing surgery.... become as independent as possible
62
What kind of static positioning and dynamic patterns of movement do you want to facilitate?
Static positioning and symmetry in postures, facilitate postural control when able
Dynamic patterns of movement opposite to habitual abnormal spastic patterns
63
How do you want to provide external support?
proximally --> distally
64
What is the mature mechanism of the foot and knee?
knee extension before heel strike, knee flexion at mid-stance, knee extension at heel-off
65
What are some common gait deviations in patients with spastic hemiplegic CP?
```
toe walking (tight gastroc)
Asymmetrical weight shift to involved side
```
66
What are some common gait deviations in patients with spastic diplegic CP?
equinovarus, planovalgus, crouch, jump knee, stiff knee, recurvatum, idiopathic toe walking
67
What are some common gait deviations in spastic quadriplegic CP patients?
not usually community ambulators, encourage gait/standing, long term means of mobility = power
68
What are some common gait deviations in patients with athetotic CP?
difficult to make improvements with CP, weighted vest and ankle weights can sometimes help
69
What are some common gait deviations in patients with ataxic CP?
widened BOS, increased double-limb support time, balance is primary goal of PT
70
What other kinds of deficits can patients with spastic CP have?
possible visual, auditory, cognitive, and oral motor
71
Where are contractures and deformities present in spastic CP patients?
hip flexors, adductors, internal rotators, knee flexors, ankle plantarflexors, scapular retractors, glenohumeral extensors and adductors, elbow flexors, forearm pronators
72
What do ataxic cerebral palsy patients present with?
low postural tone, wide-based stance and gait, intention tremor of hands, uncoordinated movement, poor visual tracking and nystagmus, speech articulation problems
73
How do patients with athetoid CP present?
decreased muscle tone, poor functional stability in proximal joints, poor visual tracking, speech delay, and oral motor problems, persistent reflexes
74
Which reflexes tend to persist in patients with athetoid CP?
ATNR, STNR, TLR
75
When can CP patients begin strength training?
7 yrs and older
76
What is the warm up dimenstions for strength training?
5-10 min
77
What is the type of strength training for CP patients?
single and multi-joint; concentric and eccentric
78
What is the intensity/volume of strength training for CP?
1-3 sets of 6-15 reps 50-80% of 1 RM
79
What is the rest interval for strength training for CP?
1-3 min
80
What is the frequency of strength training for CP?
2-4 x / wk
81
What is the duration of strength training for CP?
8-20 weeks
82
What is the progression for strength training for CP?
increase resistance gradually (5-10%)
83
What ROM measurements should be taken when evaluating a patient with CP?
Hip IR, hip abduction, popliteal angle
84
What type of spine deformities can accompany CP?
neuromuscular scoliosis, posterior spinal fusion
85
What types of hip deformities can accompany CP?
subluxation/dislocation...can also migrate because of muscle imbalance
86
Windswept deformity
Windswept deformity
87
What are some hip surgical procedures that can be done?
soft tissue transfer and/or release of adductors, iliopsoas, proximal hamstring
femoral osteotomy
pelvic osteotomy (iliac, Chiari, Salter, Steel, Pemberton)
combined femoral and pelvic osteotomy
resection of the femoral head and neck
arthrodesis and arthroplasty
88
What happens at the knee in patients with CP?
flexion deformity (spastic hamstrings)
stiff knee gait
tibial torsion
89
What happens at the ankle in patients with CP?
```
equinus deformity (shortened achilles)
pes valgus (eversion, plantarflexion, inclination of calcaneus... abduction of forefoot)
varus deformity
```
90
What is used conservatively to treat foot deformities in patients with CP?
AFOs
