Cerebral Palsy Flashcards
What is the International Workshop of Definition and Classification’s definition of cerebral palsy?
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
What are some comorbidities that are associated with CP?
- sensation/sensory processing involvement
- perception
- cognition
- communication/speech issues
- behavior/emotional disorders
- mental retardation
What is the incidence for CP in single births in 1,000? Twins? Triplets? Quadruplets?
single = 2-3 twins = 15 triplets = 80 quadruplets = 43
What is the main etiology of CP? What percent is related to the main cause?
changes in prenatal brain development, accounts for 75%
What are the other etiologies of CP?
- congenital brain anomalies
- prenatal events
- perinatal events
- post/neonatal events (10-18%)
When is the definitive diagnosis for CP made?
After 12 months of age (some doctors wait until after age 2, delayed diagnosis due to neuroplasticity)
What studies are available for the diagnosis of CP?
MRI, Cranial Ultrasound
What is the presentation for CP in infants?
- abnormal muscle tone
- atypical posture
- movement with persistent reflexes
- non-progressive
What other diagnoses can mimc CP?
- metabolic disorders
- mitochondrial disorders
Intraventricular Hemorrhage
bleeding into the ventricles
Germinal Matrix Hemorrhage
bleeding into the tissue around the ventricles
Periventricular Intraventricular Hemorrhage
bleeding into both areas (tissue around ventricles and ventricles)
Periventricular Cyst
may form in the area where the bleed occurred once the acuteness has resolved
What are the grades for hemorrhages? Which is most severe?
I through IV, IV most severe
Is neuroimaging singly predictive for the development of CP?
No
What are the risk factors for CP?
- mechanical ventilation
- injury during critical periods of brain development
What area of the brain is most sensitive to insult and at what time is it most sensitive?
- periventricular white matter
- 24-34 weeks gestation
What are the antenatal risk factors for CP?
- prematurity and low birth weight
- intrauterine infections
- multiple gestation
- pregnancy complications
What are the perinatal risk factors for CP?
- birth asphyxia
- complicated labor and delivery
What are the postnatal risk factors for CP?
- non-accidental injury
- head trauma
- meningitis/enchaphalitis
- cardiopulmonary arrest
What are the protective factors against CP?
- magnesium sulfate
- antibiotics
- corticosteroids
Spastic
- most common
- increased resistance to passive movement which increases with increased velocity of movement
Hypotonic
-some infants present with hypotonia with transition to spasticity or ataxia
Dyskinetic
uncontrolled movement
Athetoid
slow, writhing movement
Ataxic
balance and control disorder
Diplegic? Hemiplegic? Quad/Tetraplegic?
Di = legs more affected Hemi = one side Quad = all 4 limbs
What are of the brain has been insulted to cause spasticity?
Cortex
What are of the brain has been insulted to cause athetosis?
Basal Ganglia
What are of the brain has been insulted to cause ataxia?
Cerebellum
What test is used to measure the severity of movement disability in CP?
Gross Motor Functional Measure (GMFM)
Describe the 5 levels in the GMFM
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
What is a hyperactive stretch reflex?
- decreased longitudinal growth of muscle fibers
- decreased volume of muscle
- change in muscle unit size and fiber type
Spasticity is seen in ___% of children with CP. The _____ Scale is used to assess spasticity, it ranges from ___ to ___.
75%
Modified Ashworth
00-4
What items should be included in a comprehensive assessment for a child with CP?
- motor attainments
- neurologic signs
- primitive reflexes
- postural reactions
What is the most common form of spastic CP?
Diplegia
What area of the brain is affected in diplegia? How is the infarct caused?
infarct in white matter of periventricular area, caused by hypoxia
What is the common presentation for diplegia? What Ads may be needed?
Crouched gait, usually normal cognition
Lofstrand crutches
What areas of the brain cause hemiplegia? What can cause hemiplegia?
- periventricular white matter abnormalities
- cervical-subcortical lesions
- brain malformations
- nonprogressive postnatal injuries
What is the UE/LE positioning of hemiplegia?
UE: flexed
LE: plantarflexion
What is the cognitive/social/emotional presentation for hemiplegia? ADs?
Cognitive = normal Social/Emotional = deficits present AD = min equipment requirements
What areas of the brain are affected in quadriplegia?
Periventricular white matter lesions
- may affect basal ganglia
- occipital area (leads to ataxia)
What are the cognitive effects in quadriplegia? ADs?
- variable cognitive effects
- requires significant equipment throughout lifespan
What terms are associated with dyskinetic CP?
- athetosis
- rigidity
- tremor
- dystonia
- ballismus
- choreoathetosis
Where do lesions occur to cause dyskinetic CP?
deep gray matter lesions; sometimes periventricular white matter lesions
What are the effects to the c-spine in dyskinetic CP?
leads movements with jaw
C5-C6 hypermobile
What is the intelligence and medical needs for dyskinetic CP?
- normal to above normal intelligence
- more medical management than other forms of CP
What is the presentation of ataxic CP?
- difficulty w/ balance, control in the timing of coordinated movements
- weakness
- incoordination
- wide based gait
- noted tremor
Where are deficits located to cause ataxia?
cerebellum
What are some ways to treat patients with ataxic CP?
-making task specific activities, often have difficulty with transference of skills
Describe diplegic gait
- equinovarus
- planovarus
- crouch
- jump knee
- stiff knee
- recurvatum
- idiopathic toe walking
