Cerebral Palsy

Question 1

Cerebral Palsy definition

Answer 1

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

Question 2

Incidence of CP

Answer 2

2/1000 infants in the US

Question 3

55% of children diagnosed at 2 yo were deemed not to have CP at 5 yo, why?

Answer 3

Neural reorganization

Question 4

When is CP diagnosed?

Answer 4

Severe: 6 months
Normally: 1 year

Question 5

Causes of CP

Answer 5

●Prenatal malnutrition
●genetic factors
●maternal/infant infection
●anoxia (small percentage!!!!)
●Inter cerebral hemorrhage 
●Many cases are due to unknown causes

Question 6

What percent of children with CP have mental retardation/ learning disability?

Answer 6

25-75%

Question 7

What percent of children with CP have speech disorders?

Answer 7

25%

Question 8

What percent of children with CP have auditory impairments ?

Answer 8

25%

Question 9

What percent of children with CP have seizure disorders?

Answer 9

25%

Question 10

What percent of children with CP have vision problems?

Answer 10

50%

Question 11

Which part of the brain is affected in Spastic CP?

Answer 11

Involvement of the motor cortex or projections into the brain

Question 12

Which part of the brain is affected in dyskinetic or athetoid CP?

Answer 12

Basal ganglia

Question 13

Which part of the brain is affected in ataxic CP?

Answer 13

Cerebellum

Question 14

Which part of the brain is affected in hypotonic CP?

Answer 14

No area specifically

Question 15

Monoplegia CP

Answer 15

One limb affected

Question 16

Hemiplegia CP

Answer 16

Looks like CVA

Question 17

Diplegia CP

Answer 17

Both LE or both UE

Usually LE

Question 18

Quadriplegia CP

Answer 18

All four limbs are affected but it may not be equally

Question 19

True or false: It is impossible to walk with Hemiplegic CP

Answer 19

False: most children with hemiplegic CP will walk

Question 20

Studies show that most children that can sit independently by _____ months will walk (regardless of diagnosis)

Answer 20

24 months

Question 21

nearly all children with CP who walk, will do so prior to ____ yrs

Answer 21

8 years

Question 22

What occurs in CP in regard to tone?

Answer 22

Decreased reciprocal inhibition

Decreased muscle activation without pathological reflexes

Decreased force production

Question 23

In CP, Force length curve shows peak torque is realized later in the curve for plantarflexors, therefore…

Answer 23

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

Question 24

Muscular control in CP

Answer 24

●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

Question 25

What are some things to keep in mind regarding infants with CP?

Answer 25

●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

Question 26

What is serial casting?

Answer 26

A cast that brings them into stretch a little more each time

Question 27

What is inhibitive casting?

Answer 27

There is a bump in the cast to add extra stretch and pressure to the tendon

Question 28

When would you use an AFO? SMO?

Answer 28

AFO- severe spasticity

Super malleolar orthotic (SMO)- mild to moderate

Question 29

What is a crouch gait pattern?

Answer 29

Seen in quadriplegic CP

Hip flexion
Knee flexion
Toe-in feet
On met heads

Hard to advance in gait secondary to hip extensor absence

Question 30

What would you expect to see with a knee extended gait pattern?

Answer 30

Quadriceps spasticity
Upright position on met heads
Stiff, small steps

Question 31

What are the 3 stereotypical gait patterns of CP?

Answer 31

Crouch gait
Knee extended gait
Hemiplegic gait

Question 32

What occurs with Spastic diplegia CP gait pattern?

Answer 32

●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

Question 33

What would you expect to see in a Hemiplegic CP gait pattern?

Answer 33

Looks like CVA with either knee flexion or knee hyper extension