Cerebral Palsy Flashcards
Corrected Age for Development
- Use: plot growth parameters (don’t use past 2 years) and developmental parameters
- Calculate: (40 weeks - gestational age) = result
- take Age - result = corrected age
What patient wants to get out of interview?
make sure the patient gets what they want out of the interview
Common questions about walking in toddlers
When should they walk? –> 9-17 months
Pigeon-toed normal? –> YES
Flat feet? –> NORMAL
Use walker? –> NO
Developmental categories
Gross motor Fine motor Social/communication Cognitive/language \+/- problem solving *USE A QUESTIONNAIRE (bright futures)
Developmental screening timeline
9 months 18 months 30 months - document stuff and make sure to ID risks *tons of questionnaires out there
Developmental delays
Autism - primarily social interactions
CP - motor dysfunction and other domains
Genetic/metabolic - global delays
*Psychostressors can cause delays too
Autism Spectrum Disorder
- 6% prevalence - mean age of diagnosis is 48 months
- recommended screening at 12 & 24 months
- use M-CHAT to screen for it
- early intervention = best prognosis
Risks of developmental delay in preterms?
and severity of delays correlates with decreasing gestational age
- Bronchopulmonary dysplasia
- Retinopathy of newborn
- Hyperbilirubinemia
- Periventricular leukomalacia
Bronchopulmonary dysplasia
poor growth due to increased caloric requirements, recurrent infections, or CHF
Retinopathy of newborn
all premies at risk for this
- extraretinal fibrovascular proliferation = can cause retinal detachment
Hyperbilirubinemia
Bilirubin is potential neurotoxin = can lead to kernicterus
- abnormal motor development and sensorineural hearing loss
Periventricular leukomalacia
damage of white matter around ventricles –> hypoxia, ischemia, inflammation
- correlated with intraventricular hemorrhage
Family pedigree
Determine if there are conditions that run in families and which members have been affected
Stressors on kids
can act as regression of milestones, tantrums, sleep problems, eating problems
Measuring head circumference
measure around most prominent parts of frontal and occiput
- may need to measure more than once
Toddler neuro exam
OBSERVATION IS MOST IMPORTANT
- Mental Status - interaction, sleepy, arousable
- CN exam - flashlight, facial symmetry, hearing, voice
- Muscle tone and strength - watch them walk, feel extremities, note any weakness
- DTR - note any hyperreflexia or asymmetry
- Babinski - thumb on bottom of foot (L5-S1)
- Cerebellar - balance, smooth movements
Cerebral Palsy
hetergeneous disorders characterized by motor and postural dysfunction (wide range of severity)
- 2/1000 kids
- need therapy with speech, mobility, and self-care
Spastic Quadriplegia
- entire body involved
2. Global brain abnormalities
Spastic diplegia
- Legs greater than arms
2. periventricular white matter abnormalities
Dyskinetic cerebral palsy
- variable, often entire body
2. basal ganglia, cerebellum, thalamus
Spastic hemiplegia
- arm and leg on one side
2. unilateral UMN abnormalities
Ataxic cerebral palsy
- entire body
2. cerebellar abnormalities
Learning 2 languages at once
Probably causes a slight delay in expressive language in kids –> but helps them with language acquisition later in life
Risks for CP
- Prematurity
- IUGR
- Perinatal asphyxia
- Intrauterine infections
Assessment of CP
- Complete H&P
- Screening for hearing, vision, or speech problems
- Neuroimaging - MRI for baseline
- Referral for formal developmental testing
MRI findings consistent with CP
- irregularly shaped ventricles and periventricular leukomalacia
- thinned corpus callosum
Therapy for CP
The more = the better, earlier = better
PT, OT, speech and language
