Cerebral Palsy Flashcards
Risk Factors for CP
Prematurity Low birth weight Low maternal education Poor prenatal care Maternal or fetal infection or inflammation Multiple pregnancy Perinatal asphyxia Brain malformation Genetic disorders
Diagnosis of CP
12-18 months History and physical Neuroimaging studies, e.g., MRI, CT scan Metabolic and genetic screening Coagulation studies Developmental surveillance, i.e., motor, speech and language, cognition, vision, hearing Nutritional and growth status
Clinical Signs of CP
Qualitative movement differences Muscle tone differences Hypertonia Hypotonia Failure to attain, or asymmetrical development of, motor milestones Decreased muscle strength for transitional movements Deficits in postural control development Deficits in voluntary motor control
Prenatal Causes of CP
Congenital problems causing defects in the developing brain
Maternal infections: rubella, cytomegalovirus, toxoplasmosis
Metabolic disorders
Rare genetic syndrome
Congenital problems causing defects in the developing brain
Microcephaly
Schizencephaly-cleft defect
Lissencephaly- smooth brain
Classification by Topography
Hemiplegia (33%) Diplegia (44%) Triplegia Quadriplegia (6%) Monoplegia
Diplegia
primary motor impairment of lower limbs, limited involvement of upper limbs
GMFCS Level I:
Walks without restrictions; limitations in more advanced gross motor skills
GMFCS Level II:
Walks without assistive devices; limitations walking outdoors and in the community
GMFCS Level III:
Walks with assistive mobility devices; limitations walking outdoors and in the community
GMFCS Level IV:
Self-mobility with limitation; children are transported or use power mobility outdoors and in the community: most likely to have power wheelchair
GMFCS Level V:
Self-mobility is severely limited even with the use of assistive technology
GMFCS 0-2 Age Band
Level I
- -Sits on floor with hands free
- -Moves in and out of floor sitting
- ‐Crawls on hands and knees
- ‐Pulls to stand and takes steps holding onto furniture
- ‐Walks between 18-‐24 months without assistive mobility devices, AMD
GMFCS 0-2 Age Band
Level II
- ‐Maintains balance in floor sitting but may use hands for support
- ‐Creeps on stomach or crawls on hands and knees
- ‐May pull to stand and take steps holding onto furniture
GMFCS 0-2 Age Band
Level III
Maintains floor sitting with low back support
-‐Rolls and creeps forward on stomach
GMFCS 0-2 Age Band
Level IV
Head control but trunk support required for floor sitting
-‐Rolls to supine, may roll to prone
GMFCS 0-2 Age Band
Level V
Limited voluntary control of movement
- ‐Unable to maintain head and trunk postures in prone and sitting
- ‐Requires assistance to roll
GMFCS 2-4 age band
Level I
- Sits on floor with hands free
- Requires assistance to move in and out of floor sitting and standing
- Walks without AMD as preferred mobility method
GMFCS 2-4 age band
Level II
May have balance difficulty in hands free sitting on floor
- Requires assistance to move in and out of sitting on floor
- Pulls to stand on stable surface
- Crawls using reciprocal pattern
- Cruises holding onto furniture
- Walks using AMD as preferred mobility method
GMFCS 2-4 age band
Level III
Maintains floor sitting, often by “W-sitting”; may require assistance to assume
- Creeps on stomach or crawls on hands and knees, often without reciprocal leg movements as primary means of mobility
- May pull to stand on stable surface and cruise short distances
- May walk short distances indoors using AMD and assistance for steering and turning
GMFCS 2-4 age band
Level IV
Floor sits when placed but uses hands support to maintain alignment and balance
- Frequently requires adaptive equipment for sitting and standing
- Self-mobility for short distances in room through rolling, creeping on stomach, or crawling on hands and knees without reciprocal leg movement
GMFCS 2-4 age band
Level V
Restricted voluntary control of movement and ability to maintain antigravity head and trunk postures
- Limited motor function including sitting and standing that are not fully compensated for through use of adaptive equipment and assistive technology
- No independent mobility and are transported; some achieve self-mobility using
Manual Ability Classification System, MACS
observed ability to handle objects in daily activities, e.g., eating, dressing, playing, drawing, writing
5 levels, 4-18 years
MACS Level I
handles objects easily and successfully
