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Pediatrics > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

What is the International Workshop of Definition and Classification’s definition of cerebral palsy?

A

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

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2
Q

What are some comorbidities that are associated with CP?

A
  • sensation/sensory processing involvement
  • perception
  • cognition
  • communication/speech issues
  • behavior/emotional disorders
  • mental retardation
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3
Q

What is the incidence for CP in single births in 1,000? Twins? Triplets? Quadruplets?

A 
single = 2-3
twins = 15
triplets = 80
quadruplets = 43
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4
Q

What is the main etiology of CP? What percent is related to the main cause?

A

changes in prenatal brain development, accounts for 75%

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5
Q

What are the other etiologies of CP?

A
  • congenital brain anomalies
  • prenatal events
  • perinatal events
  • post/neonatal events (10-18%)
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6
Q

When is the definitive diagnosis for CP made?

A

After 12 months of age (some doctors wait until after age 2, delayed diagnosis due to neuroplasticity)

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7
Q

What studies are available for the diagnosis of CP?

A

MRI, Cranial Ultrasound

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8
Q

What is the presentation for CP in infants?

A
  • abnormal muscle tone
  • atypical posture
  • movement with persistent reflexes
  • non-progressive
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9
Q

What other diagnoses can mimc CP?

A
  • metabolic disorders

- mitochondrial disorders

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10
Q

Intraventricular Hemorrhage

A

bleeding into the ventricles

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11
Q

Germinal Matrix Hemorrhage

A

bleeding into the tissue around the ventricles

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12
Q

Periventricular Intraventricular Hemorrhage

A

bleeding into both areas (tissue around ventricles and ventricles)

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13
Q

Periventricular Cyst

A

may form in the area where the bleed occurred once the acuteness has resolved

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14
Q

What are the grades for hemorrhages? Which is most severe?

A

I through IV, IV most severe

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15
Q

Is neuroimaging singly predictive for the development of CP?

A

No

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16
Q

What are the risk factors for CP?

A
  • mechanical ventilation

- injury during critical periods of brain development

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17
Q

What area of the brain is most sensitive to insult and at what time is it most sensitive?

A
  • periventricular white matter

- 24-34 weeks gestation

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18
Q

What are the antenatal risk factors for CP?

A
  • prematurity and low birth weight
  • intrauterine infections
  • multiple gestation
  • pregnancy complications
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19
Q

What are the perinatal risk factors for CP?

A
  • birth asphyxia

- complicated labor and delivery

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20
Q

What are the postnatal risk factors for CP?

A
  • non-accidental injury
  • head trauma
  • meningitis/enchaphalitis
  • cardiopulmonary arrest
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21
Q

What are the protective factors against CP?

A
  • magnesium sulfate
  • antibiotics
  • corticosteroids
22
Q

Spastic

A
  • most common

- increased resistance to passive movement which increases with increased velocity of movement

23
Q

Hypotonic

A

-some infants present with hypotonia with transition to spasticity or ataxia

24
Q

Dyskinetic

A

uncontrolled movement

25
Q

Athetoid

A

slow, writhing movement

26
Q

Ataxic

A

balance and control disorder

27
Q

Diplegic? Hemiplegic? Quad/Tetraplegic?

A 
Di = legs more affected
Hemi = one side
Quad = all 4 limbs
28
Q

What are of the brain has been insulted to cause spasticity?

A

Cortex

29
Q

What are of the brain has been insulted to cause athetosis?

A

Basal Ganglia

30
Q

What are of the brain has been insulted to cause ataxia?

A

Cerebellum

31
Q

What test is used to measure the severity of movement disability in CP?

A

Gross Motor Functional Measure (GMFM)

32
Q

Describe the 5 levels in the GMFM

A 
I = independent
II = walks w/o AD; limited in outdoor and community level ambulation
III = walk w/ AD; limited in outdoor and community level ambulation
IV = self mobility w/ limitations; children are transported or use power mobility outdoors and in community
V = difficulty controlling all movements, self mobility is severely limited even with the use of assistive technology
33
Q

What is a hyperactive stretch reflex?

A
  • decreased longitudinal growth of muscle fibers
  • decreased volume of muscle
  • change in muscle unit size and fiber type
34
Q

Spasticity is seen in ___% of children with CP. The _____ Scale is used to assess spasticity, it ranges from ___ to ___.

A

75%
Modified Ashworth
00-4

35
Q

What items should be included in a comprehensive assessment for a child with CP?

A
  • motor attainments
  • neurologic signs
  • primitive reflexes
  • postural reactions
36
Q

What is the most common form of spastic CP?

A

Diplegia

37
Q

What area of the brain is affected in diplegia? How is the infarct caused?

A

infarct in white matter of periventricular area, caused by hypoxia

38
Q

What is the common presentation for diplegia? What Ads may be needed?

A

Crouched gait, usually normal cognition

Lofstrand crutches

39
Q

What areas of the brain cause hemiplegia? What can cause hemiplegia?

A
  • periventricular white matter abnormalities
  • cervical-subcortical lesions
  • brain malformations
  • nonprogressive postnatal injuries
40
Q

What is the UE/LE positioning of hemiplegia?

A

UE: flexed
LE: plantarflexion

41
Q

What is the cognitive/social/emotional presentation for hemiplegia? ADs?

A 
Cognitive = normal
Social/Emotional = deficits present
AD = min equipment requirements
42
Q

What areas of the brain are affected in quadriplegia?

A

Periventricular white matter lesions

  • may affect basal ganglia
  • occipital area (leads to ataxia)
43
Q

What are the cognitive effects in quadriplegia? ADs?

A
  • variable cognitive effects

- requires significant equipment throughout lifespan

44
Q

What terms are associated with dyskinetic CP?

A
  • athetosis
  • rigidity
  • tremor
  • dystonia
  • ballismus
  • choreoathetosis
45
Q

Where do lesions occur to cause dyskinetic CP?

A

deep gray matter lesions; sometimes periventricular white matter lesions

46
Q

What are the effects to the c-spine in dyskinetic CP?

A

leads movements with jaw

C5-C6 hypermobile

47
Q

What is the intelligence and medical needs for dyskinetic CP?

A
  • normal to above normal intelligence

- more medical management than other forms of CP

48
Q

What is the presentation of ataxic CP?

A
  • difficulty w/ balance, control in the timing of coordinated movements
  • weakness
  • incoordination
  • wide based gait
  • noted tremor
49
Q

Where are deficits located to cause ataxia?

A

cerebellum

50
Q

What are some ways to treat patients with ataxic CP?

A

-making task specific activities, often have difficulty with transference of skills

51
Q

Describe diplegic gait

A
  • equinovarus
  • planovarus
  • crouch
  • jump knee
  • stiff knee
  • recurvatum
  • idiopathic toe walking

Pediatrics (7 decks)

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