Cerebral Palsy Flashcards
Cerebral Palsy definition
Definition
●not a disease, but a neurological impairment of the immature brain
●vague diagnosis (“an artificial concept”), covering a variety of conditions with common management
●non-progressive – this is not a disease, it is an injury
Incidence of CP
2/1000 infants in the US
55% of children diagnosed at 2 yo were deemed not to have CP at 5 yo, why?
Neural reorganization
When is CP diagnosed?
Severe: 6 months
Normally: 1 year
Causes of CP
●Prenatal malnutrition ●genetic factors ●maternal/infant infection ●anoxia (small percentage!!!!) ●Inter cerebral hemorrhage ●Many cases are due to unknown causes
What percent of children with CP have mental retardation/ learning disability?
25-75%
What percent of children with CP have speech disorders?
25%
What percent of children with CP have auditory impairments ?
25%
What percent of children with CP have seizure disorders?
25%
What percent of children with CP have vision problems?
50%
Which part of the brain is affected in Spastic CP?
Involvement of the motor cortex or projections into the brain
Which part of the brain is affected in dyskinetic or athetoid CP?
Basal ganglia
Which part of the brain is affected in ataxic CP?
Cerebellum
Which part of the brain is affected in hypotonic CP?
No area specifically
Monoplegia CP
One limb affected
Hemiplegia CP
Looks like CVA
Diplegia CP
Both LE or both UE
Usually LE
Quadriplegia CP
All four limbs are affected but it may not be equally
True or false: It is impossible to walk with Hemiplegic CP
False: most children with hemiplegic CP will walk
Studies show that most children that can sit independently by _____ months will walk (regardless of diagnosis)
24 months
nearly all children with CP who walk, will do so prior to ____ yrs
8 years
What occurs in CP in regard to tone?
Decreased reciprocal inhibition
Decreased muscle activation without pathological reflexes
Decreased force production
In CP, Force length curve shows peak torque is realized later in the curve for plantarflexors, therefore…
Force length tension curve shows peak torque is moved later for patients
In gastroc,
- Critical length is moved closer to plantar flexion (contracture)
- Decreased plantar flexion force
- Change in where you produce force, the resting length is closer to plantar flexion
Muscular control in CP
●Poor isolated movement
●co-contraction around many joints (decrease of reciprocal inhibition)
●poor anticipatory postural adjustments
●“overflow” phenomena with an excessive amount of synergistic movements
What are some things to keep in mind regarding infants with CP?
●Experience with the world is different right from the start
●parental stimulation and care
●self directed movement is absent
Infant needs to see they can impact their environment
What is serial casting?
A cast that brings them into stretch a little more each time
What is inhibitive casting?
There is a bump in the cast to add extra stretch and pressure to the tendon
When would you use an AFO? SMO?
AFO- severe spasticity
Super malleolar orthotic (SMO)- mild to moderate
What is a crouch gait pattern?
Seen in quadriplegic CP
Hip flexion
Knee flexion
Toe-in feet
On met heads
Hard to advance in gait secondary to hip extensor absence
What would you expect to see with a knee extended gait pattern?
Quadriceps spasticity
Upright position on met heads
Stiff, small steps
What are the 3 stereotypical gait patterns of CP?
Crouch gait
Knee extended gait
Hemiplegic gait
What occurs with Spastic diplegia CP gait pattern?
●Lack of mobility in lumbar area, pelvis and hips
●therefore use head and shoulders for balance adjustments, weight shift, anticipatory postural adjustments (APA’s)
●hip flexion maintained during stance, full extension is never achieved
●excessive hip adduction and internal rotation is common- knees may touch
●knees may be flexed or hyperextended
●feet either in valgus or maintained in pf
What would you expect to see in a Hemiplegic CP gait pattern?
Looks like CVA with either knee flexion or knee hyper extension
