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MSK > Cerebral Palsy > Flashcards

Cerebral Palsy Flashcards

1
Q

What is cerebral palsy

A

-Chronic disorders of posture + movement
-Due to non-progressive (+permanent) CNS lesions sustained before 2 years old
-Results in:
Delayed motor development
Evolving CNS signs
Learning disabilities
Epilepsy

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2
Q

Survival of cerebral

A
  • 20yrs if quadriplegic

- Much longer if less affected

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3
Q

Signs of cerebral palsy

A
  • Weakness
  • Paralysis
  • Delayed milestones
  • Seizures
  • Language/speech problems
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4
Q

4 types of cerebral palsy

A
  • Spastic
  • Dyskinetic
  • Ataxic
  • Mixed
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5
Q

What kind of lesion does spasticity suggest

A

Pyramidal lesion

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6
Q

What kind of lesion do dystonias (uncoordinated, involuntary movements + postures) suggest

A

Basal ganglia lesion

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7
Q

Describe spastic hemiplegia in relation to CP

A
  • Arm>leg
  • Early development of hand preference (<12mth)
  • Delay in walking
  • Increased deep reflexes in affected limb
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8
Q

Describe spastic diplegia

A
  • Both legs affected worse than arms
  • Child looks normal until picked up
  • Legs “scissor” (hip flexion, adduction + IR with knee extension + plantar flexion)
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9
Q

Describe spastic quadriplegia

A
  • Most severe form
  • Associated with seizures + reduced IQ
  • Swallowing difficulties (may lead to aspiration pneumonia)
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10
Q

Describe dyskinetic CP

A
  • Unwanted actions
  • Poor movement flow/posture control
  • Spasticity
  • Hypotonia
  • Dysarthria
  • Hearing reduced
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11
Q

Describe ataxic CP

A
  • Uncommon

- May be hypo or hypertonia

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12
Q

Rx of spasticity in CP

A
  • Baclofen
  • Diazepam
  • Botulinum Toxin
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13
Q

Basic symptoms for CP

A
  • Spasticity
  • Lack of voluntary
  • Weakness
  • Poor coordination
  • Sensory impairment (hearing)
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14
Q

4 orthopaedics priorities in CP

A
  • Spine
  • Hip
  • Feet
  • Torsional lower limb problems
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15
Q

3 investigations for CP

A
  • Gait analysis
  • Radiographs
  • MRI
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16
Q

5 prerequisites for normal gait

A
  • Stability in stance
  • Clearance of swing
  • Preposition of foot
  • Adequate step length
  • Energy conservation
17
Q

4 ways of analysing gait in CP

A
  • By observation
  • By video
  • By 3D instrumented analysis
  • +/- EMG, energy expenditure
18
Q

Define cadence, step + stride length and velocity

A
  • Cadence = Steps/minute
  • Step length = RIC to LIC
  • Stride length = RIC to RIC
  • Velocity = Distance/time

RIC = right initial contact

19
Q

What is kinematics

A

Study of how the body moves through space

20
Q

Common spinal problem in CP

A

Scoliosis

21
Q

Does the severity of CP and scoliosis relate to each other

A
  • Yes

- Severity of scoliosis parallels neurological involvement

22
Q

Reason for surgical Rx of scoliosis in CP

A
  • Maintain seating
  • Maintain resp. function
  • To avoid rib/pelvic impingement
23
Q

What does GMF stand for

A

Gross Motor Function

24
Q

How is GMF graded

A

GMFCS (gross motor function classification system)

  • Level 1 = Walks without limitations
  • Level 2 = Walks with limitations
  • Level 3 = Walks using hand-held mobility device
  • Level 4 = Self mobility with limitations, may use powered mobility
  • Level 5 = Transported in a manual wheelchair
25
Q

How does GFMCS relate to hip dislocation in CP

A

Higher the GFMCS higher the risk of dislocation

26
Q

3 forms of management in CP

A
  • Posture management
  • Spasticity management
  • Deformity management
27
Q

2 ways to manage posture

A
  • Physiotherapy

- Seating

28
Q

Management of spasticity

A

General

  • Baclofen
  • Diazepam

Specific

  • Botulinum toxin
  • Surgery
29
Q

Deformity management

A
  • Soft tissue release (adductors + hamstrings)

- Bony realignment (varus derotation osteotomy + pelvic osteotomy)

30
Q

Pros + cons of surgical Rx

A

Pros

  • Reduced risk of dislocation + pain
  • Better seating

Cons

  • Not all would have gone on to dislocate
  • “Big surgery”
31
Q

How to review patients with spastic hemiplegia CP

A
  • Annual examination

- X-ray at 6 years of age

32
Q

How to review patients with spastic diplegia/quadriplegia CP

A
  • X-ray at 9-18 months of age

- Annual examination

33
Q

How to review patients with GMFCS 4/5

A
  • X-ray at 6-12 months of age

- Annual examination + X-ray every 2 years

MSK (28 decks)

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