Cerebral Palsy Flashcards by Jared winston

What is the definition of CP?

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

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What is important to remember about etiology of CP?

its attributed to non progressive disturbances that occurred in infant brain

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Besides motor disturbances what usually accompanies CP?

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

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

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

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What is the etiology of CP?

disruption of blood and oxygen supply to developing brain

ex: hemmorrhage, hypoxia/anoxia, malformation, hyperbillirubin

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What is the timing of the disruption of blood flow?

prenatal, perinatal, postnatal

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What are risk factors for CP?

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

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What is the diagnosis of CP?

developmental monitoring- growth and development over time

can use imaging or EEG as well

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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

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What are movement characteristics of spastic CP?

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

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What areas of brain are likely affected with spastic CP?

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

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What is 2 types dyskinetic CP?

uncontrolled fluctuating tone

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

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What areas of brain are involved is dyskinetic CP?

basal ganglia

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What area of brain is involved in ataxic CP?

cerebellum

timing of controlled movt impaired

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What is hypotonic CP?

usually transient but can be permanent, congenital abnormality

low tone in trunk and neck in kids with quad

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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

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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

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What is the reason for impaired strength in CP?

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

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What areas of postural control are most affected?

anticipatory, fine tuning

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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?

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

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?

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

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??

1. crouched 2. equinus 3. stiff knee 4. gait with genu recuvartum 5. 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