Cerebral Palsy Flashcards
Describe cerebral palsy
- umbrella term for a group of UMN disorders
- disorder of movement/posture/motor function
- non progressive
- occurs in the developing fetal or infant brain
- most cases unknown but can be genetic or chromosomal disorders, intrauterine CMV
What are the long term effects of spasticity and dystonia?
- contracture
- weakness
- fatigue
- motor control
What are risk factors for CP?
Male Premature Low birth weight <2500 Traumatic birth with time in NICU/SCN Multiple births Islander
What 3 components form the basis for describing CP?
- Type of movement disorder
- Topographical distribution
- Functional classification
What are the main movement disorders?
- Spastic (80%)
- Dyskinetic (6%)
- Mixed
- Ataxic (3%)
What are the 3 different types of dyskinesia?
Myoclonus - sudden involuntary jerking of a mm or mm groups consists of a mm twitch followed by relaxation
Athetosis - slow involuntary non-stereotypical non-purposeful writhing movements with a propensity to affect the upper limbs
Dystonia - involuntary mm contractions that cause slow repetitive movements or abnormal movements; movements can be painful or have tremor
What are the types of topographical descriptors of CP
Diplegia (36%) - legs affected more than arms; lower body mainly
Hemiplegia (39%)- arm+leg on one side of the body
Quadiplegia (22%)- all 4 limbs affected
(Also mono + triplegia)
Describe GMFCS Level 1
- Can walk on all surfaces; can run+jump
- Reduced speed, balance, coordination
- 35% of population (the most common of CP)
Describe GMFCS Level 2
- Trouble walking uneven surfaces, crowds, inclines
2. Needs railing for stairs (worse downstairs)
Describe GMFCS Level 3
- Assistive mobility device for walking
- Wheelchair for longer distances
- Independent floor mobility
Describe GMFCS Level 4
- Powered mobility outdoors+community
- Very limited mobility
- Supported sitting
- Transfers with assistance
Describe GMFCS Level 5
- No independent mobility; Transporter by carer
- Poor antigrav head+trunk mm’s
- Needs tilt in space+seating systems
Describe the Functional Motor Scale (FMS)
Kids assessed over 3 distances:
5m
50m
500m
- each distance rated 6-1; 6 is completely independent and increasing assistance with lower score
‘C’ score = crawling
‘N’ score = did not complete the distance
FMS grading
6 = independent on all surfaces 5 = independent on level surfaces only; railing for stairs; 4 = uses 1 or 2 sticks to walk; uses walls, furniture, other support to walk 3 = uses crutches to walk 2 = uses walker or frame to walk 1 = uses wheelchair
What is the medical management for CP spasticity?
- BOTOX
- Baclofen
- SELECTIVE DORSAL RHIZOTOMY
Briefly describe BOTOX and its effects
- blocks release of acetylcholine
- peaks 3-4 weeks and lasts 3-6 months
- produced from bacteria clostridium botulinum - uses neurotoxin botulinum
- can be used together with serial casting
- good for athletes
- stimular + EMG used to find location
Baclofen
- anti spasticity meds delivered right into CSF via a pump
- dampens down spinal reflexes - GABA agonist
- used in level 4+5
SELECTIVE DORSAL RHIZOTOMY
What are the essential criteria?
- dorsal roots (sensory) cut and descending impulses modified; 20-30% removed
Essential criteria = DOAMES Diagnosis Outcome favorable (pt should show potential for improvement in functional skills; no sign of basal ganglia involvement on MRI) Age Mobility Exlcusions Support
What are contracture interventinos?
SERIAL CASTING
Single event multi-level surgery (multiple surgeries for bone and soft tissue problems; rehab can be 18 months)
Stretching - ineffective
Active hip surveillance (XRs, spasticity management, good seating)
What are ways to improve strength?
Hydrotherapy
Estim
PROGRESSIVE RESISTANCE TRAINING
Ways to improve bone density
Standing
Biphosphonates
Whole body vibration
Vitamin
Ways to improve function
CIMT BIMANUAL TRAINING FITNESS TRAINING CONTEXT FOCUSED THERAPY GOAL DIRECTED TRAINING HOME PROGRAM
Orthotics
Hippotherapy
Functional taping
What does ‘standard care’ for CP involve?
Assessment:
- every 12 months
- spasticity, ROM, GMFCS+FMS, gait analysis
Spasticity management:
- BOTOX, baclofen, SDR
Aims to manage:
- ROM
- Strength
- Function
