Cerebral Palsy

Question 1

Definition: cerebral palsy

Answer 1

• non-progressive central motor impairment syndrome due to insult to or anomaly of the immature CNS

Question 2

Aetiology of cerebral palsy

Answer 2

• Prenatal events (75% of all cases)
	○ Malformations
	○ Vascular
	○ Infective (TORCH infections, esp T1 and T2)
	○ Genetic
	○ Metabolic (iodine deficiency)
	○ Toxic

• Perinatal events (15%)
○ Problems during labour and delivery (e.g. obstructed labour, APH, cord prolapse)
○ Neonatal problems (e.g. hypoglycaemia, untreated jaundice)
○ Prematurity (low BW risk factor)

• Postnatal causes (10%)
	○ Infectionse.g. encephalopathy
	○ Injuries
	○ CVA
	○ ABI < 2 years

Question 3

Classify cerebral palsy by motor disorder

Answer 3

• Spastic cerebral palsy (70%)
○ Increased muscle tone, reflexes and clonus, with characteristic clasp-knife quality
○ Underlying weakness
○ Pyramidal tract

• Dyskinetic/athetoid cerebral palsy
○ Dystonia: sustained muscle contractions that frequently cause twisting or repetitive movements
○ Atheosis: slow, writhing movememnts involving distal parts of limbs
○ Chorea: rapid, jerky, involuntary movements
○ Basal ganglia

• Ataxic cerebral palsy
	○ Fine tremor
	○ Poor balance
	○ Poor coordination
	○ Cerebellum

Question 4

Classify cerebral palsy by topographical distribution

Answer 4

• Diplegia
○ Predominant problem in lower limbs
○ Most children have normal intelligence

• Spastic hemiplegia
○ Normal intelligence
○ Epilepsy in 50-70%
○ Visual deficits

• Spastic quadriplegia
	○ Intellectual disability
	○ Epilepsy
	○ Visual impairment
	○ Poor trunk control and oromotor difficulties

Question 5

Classify cerebral palsy by motor disorder severity

Answer 5

Gross Motor Function Classification System (GMFCS):

• I: speed, balance, co-ordination impaired, gross motor ok
• II: limitations on uneven surfaces, inclines, crowds, need railing on stairs
• III: assistive mobility device walking, wheelchair if long distances
• IV: walker for short distances, wheelchair elsewhere
• V: wheelchair for all settings

Question 6

Clinical features of cerebral palsy

Answer 6

1. Developmental issues
   - Delayed motor milestones (especially in learning to sit, stand and walk)
   - in utero, antenatal and post-natal Hx: Premature?
   - Exposure Hx
   - Genetic Hx
2. Motor disorder
   • Development of asymmetrical movement patternse.g. chorea
   • Abnormal muscle tone (esp. spasticity, hypotonia)

3. Consequences of motor disorder	
○ Drooling
○ Incontinence
○ Undescended testes
○ Orthopaedic problemse.g. dislocation
○ Spasticity
○ Deformity, contracture

4. Associated disabilities
   ○ Visual problems (strabismus, refractive errors, VF defects, cortical visual impairments) - 40%
   ○ Hearing deficits
   ○ Communication disorders
   ○ Epilepsy - 50%
   ○ Cognitive impairments (ID, learning problems, perceptual deficits)
5. Mx issues
   • Management problems (e.g. feeding difficulties, behavioural abnormalities such as unexplained irritability)

Question 7

Who might be part of the MDT for Mx of cerebral palsy?

Answer 7

• Medical input
• Physiotherapy
• OT
• Speech pathologists
• Orthotists
• Social work
• Psychologist
• Special education teachers
• Dentist