Cerebral Palsy Flashcards
What is cerebral palsy? What does it cause?
- Non-progressive lesion to immature brain during the perinatal period
- Results in motor deficits and possible sensory deficits
List 3 possible pathophysiology underlying cerebral palsy.
- Subependymal hemorrhage
- Encephalopathy secondary to anoxia or hypoxia
- Neuropathy secondary to CNS malformation
What are the 4 subtypes of CP?
- Spastic
- Ataxia
- Athetoid
- Hypotonic
____ is the most common type of CP.
Spastic
The ____ extremity is typically more affected with quadriparesis/hemiparesis and the _____ extremity is more affected with diparesis.
UE more affected with quad and hemiparesis
LE more affected with diaparesis
Describe muscle tone in spastic, ataxic, athetoid, and hypotonic CP.
Spastic = increased tone Ataxic = slightly decreased tone Athetoid= fluctuates Hypotonic = decreased tone
Describe reaching in spastic, ataxic, athetoid, and hypotonic CP.
Spastic = difficulty getting to object/may move in opposite direction Ataxic = overshoot in small ranges Athetoid= overshoot in large ranges Hypotonic = hard to generate initial muscle power
Describe the movements seen in spastic and hypotonic children with CP.
Spastic: limited movement, movement available in small ranges
Hypotonic: difficulty moving against gravity
Describe the movement seen in ataxic CP.
Locks in midrange especially in the trunk
Describe the movement seen in athetoid CP. (3)
- Excessive, wide range movement
- No mid range control or gradation of movement
- Rarely in midline
Describe the righting and equilibrium reactions seen in all 4 types of CP.
Spastic: limited dependent on degree of spasticity
Ataxic: unreliable, slow initiation then overreacts
Athetoid: Present but exaggerated and disorganized
Hypotonic: minimal response seen
Describe the mobility seen in spastic CP. (2)
- Bunny hops using arms
- Walks with flexed hips and knees, legs internally rotated and adducted, lumbar lordosis, thoracic kyphosis with retracted arms
Describe the mobility seen in ataxic CP. (2)
- Slightly crouched gait with decreased arm swing and no trunk rotation
- Visually fixates on an object
Describe the mobility seen in athetoid CP. (2)
- Bunny hops using legs
2. Walks with high stepping gait (excessive flexion) or shuffling gait
Describe the mobility seen in hypotonic CP.
Walking with legs flexed but with external rotation, flat feet, arms rolled in
List 2 treatment principles to consider when treating children with spastic CP.
- Slow movement to reduce tone
2. Experience a wide variety of movement and positions
List 2 treatment principles to consider when treating children with ataxic CP.
- Speedy weight shifting
2. Transitional movements especially those with trunk rotation
List 2 treatment principles to consider when treating children with athetoid CP.
- Graded movement
- Midrange control
- Weight shifting in small range
List 2 treatment principles to consider when treating children with hypotonic CP.
- Bouncing and joint compression to increase tone
2. Increase movement against gravity
List 7 primary impairments associated with CP.
- Insufficient force generation
- Altered muscle tone (spasticity)
- Abnormal muscle extensibility
- Exaggerated/hyperactive reflexes
- Poor selective muscle activity
- Poor anticipatory regulation
- Impaired motor memory (emphasize repetition in treatment)
List 4 secondary impairments associated with CP.
- Skeletal malalignment (femoral anteversion, femoral/tibial torsion)
- Abnormal mechanical characteristics to muscle (hypoextensibility-stiffness)
- Hyperextensibility (overlengthening)
- Atrophy of fast fibers
List 3 functional limitations associated with CP.
- Delayed developmental skills
- Limited inefficient mobility
- Limited functional skills
List 2 gait predictors for children with CP.
- Sit independently by 24 months
2. Walk before age 8
List 4 gait deviations that may be present in children with CP (gage 1991).
- Abnormal PF/knee extension couple
- Crouched gait
- Limited swing phase knee motion
- Weak abductors & gastroc/soleus
List 4 characteristics of the GMF Classification System.
- 5 levels
- Ordinal system
- Self initiated movement (emphasis on sitting and mobility)
- Present level of function (usual NOT best performance)
List the 5 levels of the GMF classification system.
Level 1: Walks without restrictions; limitations in more advanced GM skills
Level 2: Walks without assistive devices, limited outdoor and community ambulation
Level 3: Walks with assist. Devices; limitations walking outdoors/in community
Level 4: Limited self mobility; transported/power mobility outdoors/in community
Level 5: Self mobility severely limited even with assistive technology
List 8 things to assess when evaluating a patient with CP.
- ROM
- Muscle tone
- Muscle strength
- Skeletal alignment
- Reflexes/reactions
- Developmental/functional skills
- Gait
- Cognitive
List 4 assessment tools used to asses patients with CP.
- Movement Assessment of Infants (MAI)
- Gross Motor Function Measure
- PEDI
- WeeFIM
What is a Quality based tool for 4 months of age (picks up early signs of CP)?
Movement Assessment of Infants (MAI)
List 4 abnormal/immature patterns apparent at the neck in CP patients.
- Hyperextension
- Shoulder elevation
- Inactive scapula
- Head and neck asymmetry (persistent ATNR)
List 3 abnormal/immature patterns apparent at the shoulder in CP patients.
- Prolonged extension of upper extremities
- Lack of scapular activity/ dissociation (hooked to GH joint movement)
- Poor weight bearing
What 2 things can occur as a result of an anterior pelvic tilt and poor abdominal strength?
- Overuse of hip external rotation and flexion for balance and weight shifting
- Substitutes lateral flexion to weight bearing side
What 3 things can occur as a result of an posterior pelvic tilt and over active extensors?
- Adduction and internal rotation
- Sacral sitting with knee flexion
- W sitting for function, bunny hopping
