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Physiotherapy Across the Lifespan > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

Describe cerebral palsy

A
  • 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
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2
Q

What are the long term effects of spasticity and dystonia?

A
  • contracture
  • weakness
  • fatigue
  • motor control
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3
Q

What are risk factors for CP?

A 
Male
Premature
Low birth weight <2500
Traumatic birth with time in NICU/SCN
Multiple births
Islander
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4
Q

What 3 components form the basis for describing CP?

A
  1. Type of movement disorder
  2. Topographical distribution
  3. Functional classification
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5
Q

What are the main movement disorders?

A
  1. Spastic (80%)
  2. Dyskinetic (6%)
  3. Mixed
  4. Ataxic (3%)
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6
Q

What are the 3 different types of dyskinesia?

A

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

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7
Q

What are the types of topographical descriptors of CP

A

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)

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8
Q

Describe GMFCS Level 1

A
  1. Can walk on all surfaces; can run+jump
  2. Reduced speed, balance, coordination
  3. 35% of population (the most common of CP)
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9
Q

Describe GMFCS Level 2

A
  1. Trouble walking uneven surfaces, crowds, inclines

2. Needs railing for stairs (worse downstairs)

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10
Q

Describe GMFCS Level 3

A
  1. Assistive mobility device for walking
  2. Wheelchair for longer distances
  3. Independent floor mobility
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11
Q

Describe GMFCS Level 4

A
  1. Powered mobility outdoors+community
  2. Very limited mobility
  3. Supported sitting
  4. Transfers with assistance
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12
Q

Describe GMFCS Level 5

A
  1. No independent mobility; Transporter by carer
  2. Poor antigrav head+trunk mm’s
  3. Needs tilt in space+seating systems
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13
Q

Describe the Functional Motor Scale (FMS)

A

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

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14
Q

FMS grading

A 
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
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15
Q

What is the medical management for CP spasticity?

A
  1. BOTOX
  2. Baclofen
  3. SELECTIVE DORSAL RHIZOTOMY
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16
Q

Briefly describe BOTOX and its effects

A
  • 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
17
Q

Baclofen

A
  • anti spasticity meds delivered right into CSF via a pump
  • dampens down spinal reflexes - GABA agonist
  • used in level 4+5
18
Q

SELECTIVE DORSAL RHIZOTOMY

What are the essential criteria?

A
  • 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
19
Q

What are contracture interventinos?

A

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)

20
Q

What are ways to improve strength?

A

Hydrotherapy
Estim
PROGRESSIVE RESISTANCE TRAINING

21
Q

Ways to improve bone density

A

Standing
Biphosphonates
Whole body vibration
Vitamin

22
Q

Ways to improve function

A 
CIMT
BIMANUAL TRAINING
FITNESS TRAINING
CONTEXT FOCUSED THERAPY
GOAL DIRECTED TRAINING
HOME PROGRAM

Orthotics
Hippotherapy
Functional taping

23
Q

What does ‘standard care’ for CP involve?

A

Assessment:

  • every 12 months
  • spasticity, ROM, GMFCS+FMS, gait analysis

Spasticity management:
- BOTOX, baclofen, SDR

Aims to manage:

  • ROM
  • Strength
  • Function

Physiotherapy Across the Lifespan (14 decks)

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