Cerebral Palsy Flashcards
What is the definition of CP?
group of disorders of the development of movement and posture, causing activity limitation
What is important to remember about etiology of CP?
its attributed to non progressive disturbances that occurred in infant brain
Besides motor disturbances what usually accompanies CP?
disturbances of sensation, cognition, communication, perception, seizure disorder
What does the term non-progressive mean in regards to CP?
the disease will not get worse but it’s a chronic issue
What is the etiology of CP?
disruption of blood and oxygen supply to developing brain
ex: hemmorrhage, hypoxia/anoxia, malformation, hyperbillirubin
What is the timing of the disruption of blood flow?
prenatal, perinatal, postnatal
What are risk factors for CP?
low birth weight and prematurity, disruption of blood flow, maternal blood infection
What is the diagnosis of CP?
developmental monitoring- growth and development over time
can use imaging or EEG as well
What are 4 types of CP classification?
hemi- half of body, usually UE
Diplegia- symetrical impairment usually both LE
triplegia- combination of both
quad- total body
What are movement characteristics of spastic CP?
abnormal movt patterns, abnormal posture, poor control, trunk and neck hypotonic
What areas of brain are likely affected with spastic CP?
motor cortex, white matter projections to/from sensorimotor areas of brain
What is 2 types dyskinetic CP?
uncontrolled fluctuating tone
- dystonia- abnormal posture, 1 part or throughout
- atheosis- slow, writhing type mov’t, involuntary
What areas of brain are involved is dyskinetic CP?
basal ganglia
What area of brain is involved in ataxic CP?
cerebellum
timing of controlled movt impaired
What is hypotonic CP?
usually transient but can be permanent, congenital abnormality
low tone in trunk and neck in kids with quad
What are the 5 levels on the GMFCS?
- walks w/o limitations
- walks with limitations
- walks with hand held device
- self mobility with limitations, may use power w/c
- transported in manual w/c
What are examples of primary impairments for CP?
abnormal ms tone, impaired strength, poor selective control of ms activity, poor postural control, impaired motor learning, retention of primitive reflexes
What is the reason for impaired strength in CP?
insuffiicient force generating capacity, decreased neuronal drive, inappropriate antagonisitc ms groups
What areas of postural control are most affected?
anticipatory, fine tuning
What areas of impaired motor learning are most affected?
using intrinsic feedback is difficult for them
PT must use extrinsic feedback and practice
What type of cognitive issues are associated with CP?
30-50% of pts will be impaired
attention, decision making, learning, memory, problem solving
What are primary sensory impairments for CP?
vision and hearing
What are secondary impairments of CP?
abnormal bone growth, ROM limitations, joint instability, disuse atrophy, impaired AC, pain
What is lever arm dysfunction?
spasticity/loss of selective motor control leads to inability to stretch ms through normal play leads to muscles contractures leads to abnormal skeletal forces leads to bony deformity
What is the effect of excessive femoral anteversion?
causes hip IR, which compromises level arm of abductors, causing tibial ER causing planovalgus foot pronation which leads to poor lever arm at push off
What is a positive prognosis for ambulation?
head control in prone by 9 months and Ind. sitting by 24 months
What is negative prognosis for ambulation?
retention of primitive reflexes at age 18-24 months , lack of indpt sitting by 3 years
What are main issues facing adults with CP?
decrease in number of supports, lack of continuing care, lack of medical professionals with experience
suffer from pain, physical function, obesity and social functioning
What are main areas of medical management for CP?
tone management, MS alignment, co morbidities
with primary goal of improving function and decreasing pain
What are goals of tone management?
improve voluntary control, improve acquisiton of skill, prevent secondary complications, facilitate hygiene
What are two types of meds used for ms tone?
- baclofen- inhibits reflex activity, pump used for GMFCS IV or V
- dantrolene sodium (dantrium)- impairs release of CA from sarcoplasmic reticulum which reduces intensity of ms contraction
What is the neuromuscular block used for tone?
Botulinum toxin which blocks Acetylcholine at NM junction for temporary ms paralysis
What is indications for botox?
improve function, prevent ms complications, decrease pain, improve ease of care
What is most important thing to remember about botox?
therapy is vital, using stretching, bracing, functional exercise
What are complications for surgery with CP?
- neurosurgery- taking away muscle tone could take away ability to walk with level 3 or 4
- orthopedic- lengthening ms = weakening, no adequate rehab after, too little surgery
What are 3 scales used to measure development of CP patient?
PDMS-2- peabody developmental motor scale
AIMS- alberta infant motor scale
TIMP- test of infant motor performance
What is important to remember about gait with CP?
children will have slower walking speed and its causes high strain as much as running on a treadmill at 75% of max capacity
What are gait abnormalities caused by?
weakness, spasticity, abnormal alignment, contractures
What are common gait analysis findings with CP?
abnormal timing, lower force, limited DF (put brakes on), impaired hip motions
What muscle is biggest influence on CP gait?
Gastroc. leads to atypical firing
What are 5 typical gait patterns in CP??
- crouched
- equinus
- stiff knee
- gait with genu recuvartum
- hemiplegic
What are contributing factors in crouched gait?
knee and hip flexion contracture, weak extensors and PF, planovalgus feet
What does contributing factors of crouched gait lead to?
decreased step length, knee ext at terminal swing, APT, increased HF/KF/DF instance, continuous quad firing to prevent knee collapse
What are contributing factors in stiff knee gait?
increased activity of rectus femoris in swing phase, poor ankle power in late stance leads to:
decreased KF causing poor foot clearance
What are contributing factors in equine gait?
HS spasticity, hyperactive stretch reflex of PF, PF contractures leads to:
toe walking
What are contributing factors of hemiplegic gait?
asymmetry, increased tone, weakness, bony deformaties leads to:
poorly aligned trunk, decreased Hip ext, knee hyperextension, lack of toe clearance, no UE swing on hemi side, short step length
What are general goals of PT intervention?
promote MS integrity, prevent secondary impairment, enhance functional movement
What is goal of LE orthoses?
limit inappropriate jt movement, prevent contractures, enhance postural control and balance, reduce energy of walking
What are strengthening examples?
treadmill use, transitional movt AG, bike riding, physioball, stairs
