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neuro rehab final > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

What is the definition of CP?

A

group of disorders of the development of movement and posture, causing activity limitation

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2
Q

What is important to remember about etiology of CP?

A

its attributed to non progressive disturbances that occurred in infant brain

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3
Q

Besides motor disturbances what usually accompanies CP?

A

disturbances of sensation, cognition, communication, perception, seizure disorder

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4
Q

What does the term non-progressive mean in regards to CP?

A

the disease will not get worse but it’s a chronic issue

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5
Q

What is the etiology of CP?

A

disruption of blood and oxygen supply to developing brain

ex: hemmorrhage, hypoxia/anoxia, malformation, hyperbillirubin

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6
Q

What is the timing of the disruption of blood flow?

A

prenatal, perinatal, postnatal

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7
Q

What are risk factors for CP?

A

low birth weight and prematurity, disruption of blood flow, maternal blood infection

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8
Q

What is the diagnosis of CP?

A

developmental monitoring- growth and development over time

can use imaging or EEG as well

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9
Q

What are 4 types of CP classification?

A

hemi- half of body, usually UE
Diplegia- symetrical impairment usually both LE
triplegia- combination of both
quad- total body

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10
Q

What are movement characteristics of spastic CP?

A

abnormal movt patterns, abnormal posture, poor control, trunk and neck hypotonic

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11
Q

What areas of brain are likely affected with spastic CP?

A

motor cortex, white matter projections to/from sensorimotor areas of brain

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12
Q

What is 2 types dyskinetic CP?

A

uncontrolled fluctuating tone

  1. dystonia- abnormal posture, 1 part or throughout
  2. atheosis- slow, writhing type mov’t, involuntary
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13
Q

What areas of brain are involved is dyskinetic CP?

A

basal ganglia

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14
Q

What area of brain is involved in ataxic CP?

A

cerebellum

timing of controlled movt impaired

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15
Q

What is hypotonic CP?

A

usually transient but can be permanent, congenital abnormality

low tone in trunk and neck in kids with quad

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16
Q

What are the 5 levels on the GMFCS?

A
  1. walks w/o limitations
  2. walks with limitations
  3. walks with hand held device
  4. self mobility with limitations, may use power w/c
  5. transported in manual w/c
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17
Q

What are examples of primary impairments for CP?

A

abnormal ms tone, impaired strength, poor selective control of ms activity, poor postural control, impaired motor learning, retention of primitive reflexes

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18
Q

What is the reason for impaired strength in CP?

A

insuffiicient force generating capacity, decreased neuronal drive, inappropriate antagonisitc ms groups

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19
Q

What areas of postural control are most affected?

A

anticipatory, fine tuning

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20
Q

What areas of impaired motor learning are most affected?

A

using intrinsic feedback is difficult for them

PT must use extrinsic feedback and practice

21
Q

What type of cognitive issues are associated with CP?

A

30-50% of pts will be impaired

attention, decision making, learning, memory, problem solving

22
Q

What are primary sensory impairments for CP?

A

vision and hearing

23
Q

What are secondary impairments of CP?

A

abnormal bone growth, ROM limitations, joint instability, disuse atrophy, impaired AC, pain

24
Q

What is lever arm dysfunction?

A

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

25
Q

What is the effect of excessive femoral anteversion?

A

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

26
Q

What is a positive prognosis for ambulation?

A

head control in prone by 9 months and Ind. sitting by 24 months

27
Q

What is negative prognosis for ambulation?

A

retention of primitive reflexes at age 18-24 months , lack of indpt sitting by 3 years

28
Q

What are main issues facing adults with CP?

A

decrease in number of supports, lack of continuing care, lack of medical professionals with experience

suffer from pain, physical function, obesity and social functioning

29
Q

What are main areas of medical management for CP?

A

tone management, MS alignment, co morbidities

with primary goal of improving function and decreasing pain

30
Q

What are goals of tone management?

A

improve voluntary control, improve acquisiton of skill, prevent secondary complications, facilitate hygiene

31
Q

What are two types of meds used for ms tone?

A
  1. baclofen- inhibits reflex activity, pump used for GMFCS IV or V
  2. dantrolene sodium (dantrium)- impairs release of CA from sarcoplasmic reticulum which reduces intensity of ms contraction
32
Q

What is the neuromuscular block used for tone?

A

Botulinum toxin which blocks Acetylcholine at NM junction for temporary ms paralysis

33
Q

What is indications for botox?

A

improve function, prevent ms complications, decrease pain, improve ease of care

34
Q

What is most important thing to remember about botox?

A

therapy is vital, using stretching, bracing, functional exercise

35
Q

What are complications for surgery with CP?

A
  1. neurosurgery- taking away muscle tone could take away ability to walk with level 3 or 4
  2. orthopedic- lengthening ms = weakening, no adequate rehab after, too little surgery
36
Q

What are 3 scales used to measure development of CP patient?

A

PDMS-2- peabody developmental motor scale
AIMS- alberta infant motor scale
TIMP- test of infant motor performance

37
Q

What is important to remember about gait with CP?

A

children will have slower walking speed and its causes high strain as much as running on a treadmill at 75% of max capacity

38
Q

What are gait abnormalities caused by?

A

weakness, spasticity, abnormal alignment, contractures

39
Q

What are common gait analysis findings with CP?

A

abnormal timing, lower force, limited DF (put brakes on), impaired hip motions

40
Q

What muscle is biggest influence on CP gait?

A

Gastroc. leads to atypical firing

41
Q

What are 5 typical gait patterns in CP??

A
  1. crouched
  2. equinus
  3. stiff knee
  4. gait with genu recuvartum
  5. hemiplegic
42
Q

What are contributing factors in crouched gait?

A

knee and hip flexion contracture, weak extensors and PF, planovalgus feet

43
Q

What does contributing factors of crouched gait lead to?

A

decreased step length, knee ext at terminal swing, APT, increased HF/KF/DF instance, continuous quad firing to prevent knee collapse

44
Q

What are contributing factors in stiff knee gait?

A

increased activity of rectus femoris in swing phase, poor ankle power in late stance leads to:

decreased KF causing poor foot clearance

45
Q

What are contributing factors in equine gait?

A

HS spasticity, hyperactive stretch reflex of PF, PF contractures leads to:

toe walking

46
Q

What are contributing factors of hemiplegic gait?

A

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

47
Q

What are general goals of PT intervention?

A

promote MS integrity, prevent secondary impairment, enhance functional movement

48
Q

What is goal of LE orthoses?

A

limit inappropriate jt movement, prevent contractures, enhance postural control and balance, reduce energy of walking

49
Q

What are strengthening examples?

A

treadmill use, transitional movt AG, bike riding, physioball, stairs

neuro rehab final (10 decks)

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