Cerebral Palsy Flashcards
What is cerebral palsy
-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
Survival of cerebral
- 20yrs if quadriplegic
- Much longer if less affected
Signs of cerebral palsy
- Weakness
- Paralysis
- Delayed milestones
- Seizures
- Language/speech problems
4 types of cerebral palsy
- Spastic
- Dyskinetic
- Ataxic
- Mixed
What kind of lesion does spasticity suggest
Pyramidal lesion
What kind of lesion do dystonias (uncoordinated, involuntary movements + postures) suggest
Basal ganglia lesion
Describe spastic hemiplegia in relation to CP
- Arm>leg
- Early development of hand preference (<12mth)
- Delay in walking
- Increased deep reflexes in affected limb
Describe spastic diplegia
- Both legs affected worse than arms
- Child looks normal until picked up
- Legs “scissor” (hip flexion, adduction + IR with knee extension + plantar flexion)
Describe spastic quadriplegia
- Most severe form
- Associated with seizures + reduced IQ
- Swallowing difficulties (may lead to aspiration pneumonia)
Describe dyskinetic CP
- Unwanted actions
- Poor movement flow/posture control
- Spasticity
- Hypotonia
- Dysarthria
- Hearing reduced
Describe ataxic CP
- Uncommon
- May be hypo or hypertonia
Rx of spasticity in CP
- Baclofen
- Diazepam
- Botulinum Toxin
Basic symptoms for CP
- Spasticity
- Lack of voluntary
- Weakness
- Poor coordination
- Sensory impairment (hearing)
4 orthopaedics priorities in CP
- Spine
- Hip
- Feet
- Torsional lower limb problems
3 investigations for CP
- Gait analysis
- Radiographs
- MRI
5 prerequisites for normal gait
- Stability in stance
- Clearance of swing
- Preposition of foot
- Adequate step length
- Energy conservation
4 ways of analysing gait in CP
- By observation
- By video
- By 3D instrumented analysis
- +/- EMG, energy expenditure
Define cadence, step + stride length and velocity
- Cadence = Steps/minute
- Step length = RIC to LIC
- Stride length = RIC to RIC
- Velocity = Distance/time
RIC = right initial contact
What is kinematics
Study of how the body moves through space
Common spinal problem in CP
Scoliosis
Does the severity of CP and scoliosis relate to each other
- Yes
- Severity of scoliosis parallels neurological involvement
Reason for surgical Rx of scoliosis in CP
- Maintain seating
- Maintain resp. function
- To avoid rib/pelvic impingement
What does GMF stand for
Gross Motor Function
How is GMF graded
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
How does GFMCS relate to hip dislocation in CP
Higher the GFMCS higher the risk of dislocation
3 forms of management in CP
- Posture management
- Spasticity management
- Deformity management
2 ways to manage posture
- Physiotherapy
- Seating
Management of spasticity
General
- Baclofen
- Diazepam
Specific
- Botulinum toxin
- Surgery
Deformity management
- Soft tissue release (adductors + hamstrings)
- Bony realignment (varus derotation osteotomy + pelvic osteotomy)
Pros + cons of surgical Rx
Pros
- Reduced risk of dislocation + pain
- Better seating
Cons
- Not all would have gone on to dislocate
- “Big surgery”
How to review patients with spastic hemiplegia CP
- Annual examination
- X-ray at 6 years of age
How to review patients with spastic diplegia/quadriplegia CP
- X-ray at 9-18 months of age
- Annual examination
How to review patients with GMFCS 4/5
- X-ray at 6-12 months of age
- Annual examination + X-ray every 2 years
