Cerebral Palsy Flashcards
Whic is the 2nd most common neurological
impairment in children
CP
2nd most common neurological nonprogressive lesion of the brain occuring prior to 2 yrs of age:
CP
Incidence of CP
1.5 to 4 cases per 1000 live births estimated
Causes of CP:
- unknown
- multifactorial
- Any prenatal, perinatal or postnatal condition resulting in:
- Cerebral anoxia
- Cerebral hemorrhage
- Other damage to brain
Pathogenesis of CP:
No consistent or uniform pathology
- Hemorrhage: stroke
- Hypoxic-Ischemic injury/encephalopathy: decreased perfusion
- CNS malformation: genetics
Classification of Cerebral Palsy
- Type of muscle tone: spastic, ataxic, dyskinetic, hypotonic
- Distribution of limb involvement: monoplegia, hemiplegia, diplegia, triplegia, quadriplegia (tetraplegia)
- Functional skills: Functional status, Need for assistive technology & wheeled mobility
What is Periventricular leukomalacia (PVL)?
- Bilateral necrosis of white matter of brain adjacent to the lateral ventricles (cystic lesions)
- Primary hypoxic-ischemic lesion in premature infants
- Occurs with CP
Motor impairments in CP:
- Impact changes with child maturation
- persistence of primitive reflexes
Percentage of mental retardation in CP cases:
50-70%
Neuromuscular impariments in CP:
- Altered muscle tone
- Muscle weakness
Common Musculoskeletal Deformities in CP:
- scoliosis
- hip
- knee
- ankle and foot
Diagnosis of CP:
- Observation
- Hx
- Neurologic Exam
- Diagnosis studies (MRI, CT scan)
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When are the moderate and severe forms of CP diagnosed?
At or before 2 years (6 – 18 months)
When are ataxia and hemiplegia diagnosed in CP?
10-20 months
When is the mild form of CP diagnosed?
Varies
What is the medical mgmt of CP?
-
Pharmacological intervention
- muscle relaxants
- Neurosurgical intervention
-
Orthopedic surgery:
- muscle lengthening or releases
- muscle tendon transfers
- bony procedures
- Orthotics
Medical Management Spasticity in CP:
- Injection Therapy
- Neurolytic Nerve blocks/Motor point blocks
- Phenol
- Botulism toxin
- BOTOX
- Neurolytic Nerve blocks/Motor point blocks
Neurosurgical Interventions in CP:
- Neurectomy
- Myelotomy
-
Selective Dorsal Rhizotomy:
- Dorsal sensory nerve roots are selectively severed
- Usually performed at L2 – L5 levels for spastic diplegia
- Often performed on children ages 7 to 10 yrs
- Irreversible
What is Selective Dorsal Rhizotomy:
- Neurosurgical Interventions in CP
- Dorsal sensory nerve roots are selectively severed
- Usually performed at L2 – L5 levels for spastic diplegia
- Often performed on children ages 7 to 10 yrs
- Irreversible
Prognosis in mild to moderate CP:
- normal lifespan
- predictors for amb based on achievements of motor milestones or by type of CP
- usually able to amb by 8 y/o
Common causes of death in CP population:
◦ Infection
◦ Aspiration
◦ Respiratory compromise
◦ Heart disease
predictors for amb in CP based on type of CP:
-
Type of CP
- Monoplegia 100%
- Hemiplegia 100%
- Ataxia 100%
- Diplegia 60% -90%
- Spastic quadriplegia 0% - 70%
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predictors for amb in CP based on motor function milestones:
- Sit indep by age 2: Good
- Indep crawling by age 2.5: Good
- Primitive reflexes persist > age 2: Poor
- Absence of postural reactions beyond age 2: Poor
Rehabilitation Considerations in CP:
-
PT goals:
- Maximize function
- Increase variety of movements available to the child
- Prevent secondary complications, especially orthopedic deformities
- Tenets of motor learning and neuroplasticity apply
- PT should be fun and interactive
- Family-centered
- School-aged children: include teachers in therapy program
- Rehab needs change as child grows/ages continued need across the lifespan
