Cerebral Palsy Flashcards
What is cerebral palsy?
Cerebral palsy is a persistent but not unchanging disorder of movement and posture, causing activity limitations, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. It is not technically a single disorder and more a group of disorders with diverse implciations for children and their families.
What are some of the disturbances associated with cerebral palsy?
The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder, and by orthopaedic complications
What is the cause of cerebral palsy?
RFs: low birthweight and prematurity
Perinatal asphyxia – less than 10% and post natal illnesses – 10%
Explain the criteria determining the classification of CP. (3 points)
Type of motor disorder (e.g. spasticity, dyskinesia (includes dystonia and athetosis), ataxia, mixed)
Distribution of the motor disorder (e.g. hemiplegia, diplegia and quadriplegia)
Severity of the motor disorder on gross motor function and mobility
How would a child with CP initially present? How would you identify cases of CP? (there are 5)
Follow up of “at risk” infants, such as those that are premature
Delayed MOTOR milestones, particularly learning to sit, stand and walk
Asymmetric movement patterns (e.g strong hand preference early in life)
Abnormalities of muscle tone (spasticity or hypotonia)
Management problems (e.g severe feeding difficulties and unexplained irritability)
What are 5 disorders associated with CP?
Visual problems (approx 40%): strabismus, refractive errors, visual field defects and cortical visual impairment
Hearing deficits (approx 3 - 10%)
Speech and language problems
Epilepsy (approx 50%)
Cognitive impairments. Intellectual disability, learning problems and perceptual difficulties are common.
What are the 4 main bands of management that are important in the context of a child with cerebral palsy?
- Accurate Diagnosis and genetic counselling
- Management of associated disabilities, health problems and consequences of motor disorder
- Assessment of the child’s capabilities and referral to appropriate services for the child and family
- Common presentations to the ED
How do you establish diagnose cerebral palsy?
It depends on if the cause is clear or not.
If the cause is clear, for example in the case that there was a massive APH with neonatal encephalopathy then no further investigation is required and the diagnosis can be made.
If cause is not clear then, it is important to investigate to find the cause of the cerebral palsy. Investigations include: Urine / plasma metabolic screen Consider congenital infections Chromosomal analysis Radiological investigation – MRI
What are the 3 different aspects of a child with cerebral palsy that need management?
Associated disabilities
Health Problems
Consequences of Motor Disorder
Based on the associated disabilities for cerebral palsy, what 3 things needs to be done to manage these?
Hearing and visual assessments
Epilepsy: review and assess need to anti-convulsants
Cognitive Impairment: help with the child’s educational program
What are 4 health problems which need management in a child with cerebral palsy? There are 8.
Growth – need dietary advice to prevent FTT. Consider NG or gastrostomy feeding if not good enough weight gain
GOR – can result in oeophagitis or gastritis which causes pain, poor appetite and aspiration
Constipation
Chronic Lung Disease – aspiration from oromotor dysfunction OR severe GOR. If child is choking or coughing a lot during meal times then maybe consider aspiration as a more likely cause.
Monitor ventriculo-peritoneal shunts
Osteoporosis and pathological fractures
Dental health
Emotional Issues
There are 4 categories for the motor problems which a child with cerebral palsy experiences. What are they and describe briefly some of the management strategies for each.
- Drooling – speech pathologist. Medication or surgery can be helpful
- Incontinence – CP kids will be late in achieving bowel and bladder control OR will have less access to toilet facilities because of physical disabilities. Can also have detrusor overactivity
- Orthopaedic Problems – contractures may develop at the knee and ankle with hop sublux and dislocation more common in CP kids. May require multiple surgeries to correct these
- Spasticity – management aims to improve function, comfort and care. Options: oral medications, inhibitory casts (increase joint range), Botox (reduce localised spasticity)
Once the diagnosis has been established and medical support has been given, what else is important to consider in the management of a child with CP?
Involvement of a multidisciplinary team is important.
• Physio for practical advice with positioning and minimising the effects of abnormal muscle tone and encourage movement.
• Occupational Therapists – child’s upper limb and self-care skills etc.
• Speech pathologists – development of communication skills and advice about augmentative communication skills.
• Social workers etc.
Ensure that all the adequate services including education are being offered to the parents of a child with CP.
Ensure that there is someone working with the families too in terms of providing a supportive environment for them and their child.
This is the final part of the Mx of a child with cerebral palsy but they do present to the ED. What are the three main categories of presentations to the ED?
- Respiratory problems (pneumonia) – RFs: Pseudobulbar palsy (aspiration of saliva or food/fluid), gastro-oesophageal reflux, poor cough, increased secretions (eg secondary to benzodiazepines), immobility, severe scoliosis
- Uncontrolled Seizures/Status Epilipticus
- Unexplained irritability – consider acute infections, oesophagitis, dental disease, hip subluxation, pathological fracture
