Cerebral Palsy

Question 1

Whic is the 2nd most common neurological
impairment in children

Answer 1

CP

Question 2

2nd most common neurological nonprogressive lesion of the brain occuring prior to 2 yrs of age:

Answer 2

CP

Question 3

Incidence of CP

Answer 3

1.5 to 4 cases per 1000 live births estimated

Question 4

Causes of CP:

Answer 4

• unknown
• multifactorial
• Any prenatal, perinatal or postnatal condition resulting in:
  
  • Cerebral anoxia
  • Cerebral hemorrhage
  • Other damage to brain

Question 5

Pathogenesis of CP:

Answer 5

No consistent or uniform pathology

1. Hemorrhage: stroke
2. Hypoxic-Ischemic injury/encephalopathy: decreased perfusion
3. CNS malformation: genetics

Question 6

Classification of Cerebral Palsy

Answer 6

1. Type of muscle tone: spastic, ataxic, dyskinetic, hypotonic
2. Distribution of limb involvement: monoplegia, hemiplegia, diplegia, triplegia, quadriplegia (tetraplegia)
3. Functional skills: Functional status, Need for assistive technology & wheeled mobility

Question 7

What is Periventricular leukomalacia (PVL)?

Answer 7

• Bilateral necrosis of white matter of brain adjacent to the lateral ventricles (cystic lesions)
• Primary hypoxic-ischemic lesion in premature infants
• Occurs with CP

Question 8

Motor impairments in CP:

Answer 8

• Impact changes with child maturation
• persistence of primitive reflexes

Question 9

Percentage of mental retardation in CP cases:

Answer 9

50-70%

Question 10

Neuromuscular impariments in CP:

Answer 10

• Altered muscle tone
• Muscle weakness

Question 11

Common Musculoskeletal Deformities in CP:

Answer 11

• scoliosis
• hip
• knee
• ankle and foot

Question 12

Diagnosis of CP:

Answer 12

• Observation
• Hx
• Neurologic Exam
• Diagnosis studies (MRI, CT scan)
  *

Question 13

When are the moderate and severe forms of CP diagnosed?

Answer 13

At or before 2 years (6 – 18 months)

Question 14

When are ataxia and hemiplegia diagnosed in CP?

Answer 14

10-20 months

Question 15

When is the mild form of CP diagnosed?

Answer 15

Varies

Question 16

What is the medical mgmt of CP?

Answer 16

• Pharmacological intervention
  
  • muscle relaxants
• Neurosurgical intervention
• Orthopedic surgery:
  
  • muscle lengthening or releases
  • muscle tendon transfers
  • bony procedures
• Orthotics

Question 17

Medical Management Spasticity in CP:

Answer 17

• Injection Therapy
  
  • Neurolytic Nerve blocks/Motor point blocks
    
    • Phenol
    • Botulism toxin
    • BOTOX

Question 18

Neurosurgical Interventions in CP:

Answer 18

• 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

Question 19

What is Selective Dorsal Rhizotomy:

Answer 19

• 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

Question 20

Prognosis in mild to moderate CP:

Answer 20

• normal lifespan
• predictors for amb based on achievements of motor milestones or by type of CP
• usually able to amb by 8 y/o

Question 21

Common causes of death in CP population:

Answer 21

◦ Infection
◦ Aspiration
◦ Respiratory compromise
◦ Heart disease

Question 22

predictors for amb in CP based on type of CP:

Answer 22

• Type of CP
  
  • Monoplegia 100%
  • Hemiplegia 100%
  • Ataxia 100%
  • Diplegia 60% -90%
  • Spastic quadriplegia 0% - 70%

*

Question 23

predictors for amb in CP based on motor function milestones:

Answer 23

• 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

Question 24

Rehabilitation Considerations in CP:

Answer 24

• 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