Cerebral palsy

Question 1

Risk factors for cerebral palsy

Answer 1

• CP = abnormality of movement and posture, causing activity limitation attributed to non-progressive disturbances that occured in the developing fetal or infant brain.
• 2 in 1000 births
• brain injuries occuring up to 2 years of age
• after this = acquired brain injury
• Antenatal (80%)
  
  • risk factors: IUGR, prematurity, twin births, African ethnicity, maternal age > 35 years
  • ​vascular occlusion
  • cortical migration disorders
  • structural maldevelopment of the brain
  • genetic deletions
  • genetic syndromes
  • congenital infection
• Perinatal
  
  • ​hypoxic-ischaemic injury (10%)
    
    • preterm infants at risk of PVL and IVH
• Postnatal (10%)
  
  • meningitis
  • encephalitis
  • encephalopathy
  • head trauma- non-accidental/ accidental injury
  • symptomatic hypoglycaemia
  • hydrocephalus
  • hyperbilirubinaemia

Question 2

Distinguish the different types of CP

Answer 2

• spastic (90%)
  
  • ​damage to UMN
  • hypertonia
  • hyperreflexia
    
    • hemiplegia
      
      • ​upper or lower leg and arm (arm more affected)
      • tip toe walking
      • present age 4-12 m
      • if stroke cause- hemianopia on same side
    • quadriplegia
      
      • ​all 4 limb involvement
      • poor head control
      • seizures, microcephaly, severe ID
      • history of HIE
    • diplegia
      
      • ​all 4 limb involvement but legs worse
      • abnormal
      • pre-maturity and PV brain damage
• dyskinetic (6%)
  
  • ​involuntary, uncontrolled movements (chorea, athetosis, dystonia)
  • poor trunk control
  • floppy
  • delayed motor deviation
  • abnormal movements owards 12m
  • extrapyramidal lesion (BG)
  • kernicterus, HIE
• ataxic (4%)
  
  • ​hypotonic CP
  • if acquired cerebellum injury- ipsilateral side
  • early
    
    • trunk and limb hypotonia
    • poor balance
    • delayed motor developments
  • late
    
    • ​inco-ordinate movements
    • intention tremor
    • ataxic gate
• mixed pattern can occur

Question 3

Clinical presentation of CP

Answer 3

• abnormal limb and/ or trunk posture and tone in infancy with delayed motor milestones
• slowing of head growth
• feeding difficulties
• oromotor inco-ordination
• slow feeding
• gagging
• vomiting
• abnormal gait
• risk of visual/ hearing/ learning difficulties, speech, epilepsy, nutrition and psychiatric impairments

Question 4

Treatment of CP

Answer 4

• MDT: paediatrician, physiotherapist, OT, SALT, clinical psychologist, specialist health visitor, socia worker, parent support groups
• Posture and movement
  
  • ​physio
  • strengthening exercises
  • orthotics
  • botox
  • surgery
• Communication
  
  • ​SALT- feeding, laguage development, AAC aids- Makaton sign language, Bliss symbol boards, voice synthesisers
• Medical
  
  • ​seizure control (anti-epileptics)
  • constipation (laxtives)
  • malnutrition
  • spasm control (baclofen pumps)
• Ortho/ neurosurgical
  
  • ​sclolisis corrections
  • tendon lengthening