Cerebral Palsy Flashcards
“A group of ________ disorders of the development of _________ and ________, causing ________ ________ that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”
“A group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”
Cerebral Palsy is an _________ term for a ________ developmental disorder caused by an __________ to the ________ ________. It is non-________ and involves _________ and ________ impairments
Cerebral Palsy is an umbrella term for a developmental disorder caused by an insult to the developing brain. It is non-nonprogressive and involves motor and sensory impairments
Co-morbidities (6)
- Sensation and sensory processing involvement
- Perception
- Cognition
- Communication and speech issues
- Behavioral and emotional disorders
- Mental retardation
Incidence: single births = ___ per 1,000 live births
2 and 3
Incidence: twins = ___ per 1,000 live births
15
Incidence: triplets = ___ per 1,000 live births
80
Incidence: quadruplets = ___ per 1,000 live births
43
75% of CP cases related to this
changes in prenatal brain development
10-18% of CP cases related to this
post/neonatal events (after birth with no upper age limit)
Other causes of CP (3)
- Congenital Brain abnormalities
- Prenatal Events (prior to birth)
- Perinatal Events (during birth)
What studies are available to diagnose CP?
- MRI
- Cranial US
Definitive diagnosis can be made after ___ months
12
most pediatricians will not diagnose until age 2
Presentation of CP (infants)
- Abnormal muscle tone
- Atypical posture
- Movement with persistent reflexes
- Non-progressive
Other diagnoses that can mimic CP…. What is the difference between these diseases and CP?
- Metabolic Disorders
- Mitochondrial Disorders
- These disorders will look like progressive disease (child will become weaker and lose abilities)
What is an Intraventricular hemorrhages (IVH)?
Bleeding into the ventricles
What is Germinal matrix hemorrhages (GMH)?
Bleeding into the tissue around the ventricles
What is Periventricular intraventricular hemorrhages (PIVH)
Bleeding into both the ventricles and the tissue surrounding the ventricles
What is Periventricular cyst (PVC)
May form in the area where the bleed occurred once the acuteness has resolved
How are the neuroimaging findings graded? (IVH, GMH, PIVH, PVC)
- Graded I through IV — IV being the most severe
- Not singly predictive for the development of CP
What are the known risk factors for development of CP?
- Mechanical Ventilation
- Injury during critical periods of brain development
When is the periventricular white matter most sensitive to insult and injury?
24-34 weeks
- most prevalent in mothers that use drugs
What are the risk factors in the Antenatal period? (prenatal)
- prematurity and low birth weight
- intrauterine infections
- multiple gestation
- pregnancy complications
What percentage of CP cases are attributed to the Antenatal period
70-80%
What are the risk factors associated with the Perintal period?
- Birth asphyxia
- Complicated Labour and Delivery
What percentage of CP cases are attributed to the Perinatal period
10%
What are the risk factors associated with the Postnatal period?
- Non-accidental injury
- Head trauma
- Meningitis/Encephalitis
- Cardiopulmonary Arrest
What are some protective factors against CP?
- Magnesium Sulfate
- Antibiotics
- Corticosteroids
What is the most common CP movement disorder?
Spastic
Increased resistance to passive movement which increases with increased velocity of movement describes what movement disorder classification?
Spastic
What type of movement often preceeds spasticity?
Hypotonia
What are the types of movement disorders? (5)
- Spastic
- Hypotonic
- Dyskinetic
- Athetoid
- Ataxic
Describe Dyskinetic movement disorder
Uncontrolled movement
Describe Athetoid movement disorder
Slow, writhing movement
- Continuous
Describe Ataxic movement disorder
Balance and control disorder
- Cerebellar Area Lesion
What type of lesion affects balance much more than dyskinetic
- Cerebellar area lesion – affects balance much more than dyskinetic*
What classifications - according to body part - are often affected if the lesion is pyramidal?
- Hemiplegia
- Diplegia
- Quadriplegia
What classifications - according to body part - are often affected if the lesion is extrapyramidal?
- Athetoid
- Dystonic
- Ataxic
What two classifications - according to the body parts affected - have regional involvement
- Hemiplegia
- Diplegia
What four classifications - according to the body parts affected - have global (total body) involvement?
- Quadriplegia
- Athetoid
- Dystonic
- Ataxic
What are the 3 areas of involvement associated with spastic movement?
- Hemiplegia
- Diplegia
- Quadriplegia
What are the 2 areas of involvement associated with dyskinetic movement?
- Athetoid
- Dystonic
What is the area of involvement associated with Ataxia movement?
- Ataxic/cerebellum
Spasticity is associated with lesions in what area of the brain?
Cerebral Cortex
Athetosis is associated with lesions in what area of the brain?
Basal Ganglia
Ataxic is associated with lesions in what area of the brain?
Cerebellum
Spasticity is present in ___% of people with CP
86%
What assessment is used to measure the severity of movement disability in CP?
Gross Motor Functional Measure (GMFM)
Level I
Independent
Level II
Walks WITHOUT assistive devices; limited in outdoor and community level ambulation.
Level III
Walks WITH assistive devices; limited in outdoor and community level ambulation
Level IV
Self-mobility with limitations; children are transported or use power mobility outdoors and in community.
Level V
Difficulty controlling all movements; self mobility is severely limited even with use of assistive technology.
Physical impairments restricts voluntary control of movement and the ability to maintain antigravity head and trunk postures. All areas of motor function are limited. Children have no means of independent mobility and are transported.
What level on GMFM would this describe?
Level V
Children may continue to walk for short distances on a walker or rely more on wheeled mobility at home and school in the community.
What level on GMFM would this describe?
Level IV
Children walk indoors and outdoors and climb stairs without limitation. Children perform gross motor skills including running and jumping. Speed, Balance, and Coordination are impaired.
What level on GMFM would this describe?
Level I
Children walk indoors or outdoors on a level surface with an assistive mobility device. Children may climb stairs holding onto railing. Children may propel a wheelchair manually or are transported when traveling for long distances or outdoors on uneven terrian.
What level on GMFM would this describe?
Level III
Children walk indoors and outdoors and climb stairs holding onto railing. Limitations walking on uneven surfaces and inclines and walking in crowded or confined spaces.
What level on GMFM would this describe?
Level II
What is an assessment is often used for assessing spasticity?
Modified Ashworth Scale
What is the cause of the hyperactive stretch reflex?
- Decreased longitudinal growth of muscle fibers
- Decreased volume of muscle
- Change in muscle unit size and fiber type
Where do the pyramidal and extrapyramidal tracts originate? Where do they synapse?
- Motor Cortex
- Basal Ganglia
- Brain Stem
- Spinal Cord
- Synapse onto the anterior horn in the spinal cord
What do the extrapyramidal and pyramidal tracts help to maintain? How do they accomplish this?
Maintain segmental muscle tone by modulating the stretch reflex arc
What do the corticospinal tracts do?
Carry movement order to the LMN
The Basal Ganglia correct what?
The timing of movement
What does the extrapyramidal system do? Where do they end?
Corrects the force of contraction of the muscles involved. End at the interneuron
What does the cerebellum do?
Coordinates the speed and direction of movement
The _______ _______ _______ sends contraction impulse to the muscle through the peripheral nerve. This is the final common pathway from the nervous system to the muscle
Lower Motor Neuron
What 3 brain centers modify the motor response as it goes to the medulla spinalis?
- Cerebellum
- Basal Ganglia
- Extrapyramidal System
What does a comprehensive assessment of the infant and child with CP include?
- Motor attainments
- Neurologic Signs
- Primitive Reflexes
- Postural Reactions
What is the most common form of spastic CP?
Diplegia
What area of the body does diplegia typically affect?
Lower Extremities
What type of gait is associated with diplegia
Crouched gait
What assistive devices usually seen in patient with diplegia?
Lofstand Crutches for life
Is cognition typically affected in cases of diplegia?
cognition usually normal
What is the cause of diplegia?
Infarct in white matter of periventricular area – caused by hypoxia
What are the positions of the UE and LE in hemiplegia?
Upper Extremities: Flexed, ADDucted, Internal Rotation
Lower Extremities: Plantarflexed foot… ?
What type of disorders are common with hemiplegia? Is cognition affected?
Behavioral Disorders common. Social and Emotional Deficits prevalent… Cognitive function normal
What are the 4 causes of Hemiplegia?
- Periventricular white matter abnormalities
- Cervical-subcortical lesions
- Brain malformations
- Nonprogressive postnatal injuries
If there is a lesion in the periventricular white matter that affects the occipital area - what movement disorder usually develops?
Ataxia
What is the cause of Quadriplegia?
Periventricular white matter lesions that may affect the basal ganglia or the occipital area
Which Movement disorder has the highest equipments need of all CP types?
Quadriplegia
What does the cognition look like in a person with Quadriplegia CP?
Variable cognitive effects
- Super genius below normal IQ
What type of lesions are associated with Dyskinetic movement?
Deep gray matter lesions; sometimes periventricular white matter lesions
What movement disorder requires the highest medication doses?
Dyskinetic
What is the cognition level of a person with Dyskinetic movement?
Normal to above normal
What types of movement are associated with Dyskinetic?
Athetosis, rigidity, tremor, dystonia, ballismus, and choreoathetosis
What is Athetosis?
slow, involuntary, convoluted, writhing movements
What is Ballismus?
uncoordinated swinging of the limbs and jerky movements
What is Dystonia?
neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.
What is choreoathetosis?
occurrence of involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing).
What is the definition of Ataxic?
Disorder of balance and control in the timing of coordinated movements
Ataxic signs
- Weakness
- Incoordination
- Wide based gait
- Noted tremor
A deficit in the ______ is associated with Ataxic
Cerebellum
If a person has Ataxic CP, What type of therapy is going to be the most effective and why?
Task- Specific… because they have difficulty with transference skills
(If this person has difficulty reaching for a cup with control – you cannot mimic the activity and expect them to carry through with it in their every day activity)
