Cerebral palsy

Question 1

what is the most common type of cerebral palsy and what is damaged?

what other types are there and what is it due to?

Answer 1

• spastic, motor cortex and connections
• dystonic (athetoid): damage to the basal ganglia. Characterised by irregular or involuntary movements, which may be continuous or on voluntary movement
• Ataxic cerebral palsy: damage to cerebellum.
  Characterised by hypotonia, incoordination and intention tremor.

Question 2

what would you find on PNS of cerebral palsy?

Answer 2

• Clasp-knife hypertonia
• brisk deep tendon reflexes
• ankle clonus
• Positive Babinski

Question 3

how can spastic cerebral palsy be classified further?

Answer 3

• spastic hemiplegia
• spastic diplegia
• spastic quadriplegia

Question 4

describe a patient with spastic hemiplegia with regards to walking, development

Answer 4

• arm more affected than leg
• decreased spontaneous movements on affected side
• delayed walking until 18-24 months
• child will walk on tiptoes
• arm in dystonic position when running

Question 5

who is most likely to get spastic diplegia?

describe how it first presents

Answer 5

• common in prematurity
• both legs involved, and arms less affected
• first indication when baby starts to crawl and legs drag behind
• difficult putting on a nappy due to excessive hip adduction
• legs take up scissoring picture when baby suspended
• feet held in equinovarus position and child walks on tiptoes

Question 6

why is spastic quadriplegia so much more difficult to manage?

Answer 6

• speech disorders
• behaviour disorders
• feeding difficulties
• undernutrition and poor growth
• respiratory problems

Question 7

what group of babies may be monitored for cerebral palsy diagnosis because of high risk?

what clues might give it away in neonatal period?

Answer 7

• those who suffered a cerebral insult perinatally
• difficulty sucking
• irritability
• convulsions
• abnormal neuro exam

Question 8

when is the diagnosis of cerebral palsy normally made?

what criteria may be used to diagnose?

Answer 8

• after 1st year of life
• abnormalities of tone (spasticity)
• delay in motor development: delays in sitting and rolling over, marked head lag
• abnormal movements
• persistence of primitive reflexes:
  Moro, grasp and asymmetric tonic neck reflex persists

Question 9

what kind of associated problems would you expect? (5)

Answer 9

• learning difficulties
• epilepsy
• visual impairment
• squint
• hearing loss

Question 10

do you need to do any investigations?

Answer 10

• most often evident from the history

Question 11

how can you manage cerebral palsy?

Answer 11

• effects of spasticity and development of contractures must be minimised by regular physio
• provide the child with walking aids
• appropriate education and schooling needs
• help child to integrate
• MDT!

Question 12

what other MDT people do you want managing this?

Answer 12

• Physio
• Speech therapy
• medication (baclofen to reduce spasms)
• Occupational therapy
• Orthopaedic surgery of equinus deformity or thigh dislocation
• nutrition