Cerebral Palsy Flashcards
Define cerebral palsy (CP)?
Permanent disorder of movement and/or posture and of motor function due to a non-progressive abnormality in the developing brain
What other conditions are associated with CP?
Disturbances in:
- Cognition
- Communication
- Vision
- Perception
- Sensation
- Behaviour
- Seizure disorders
- Secondary musculoskeletal problems
List the causes of CP
- 80% antenatal:
- Cerebrovascular haemorrhage or ischaemia
- Cortical migration disorders
- Structural maldevelopment of the brain during gestation
- Genetic syndromes
- Congenital infection - 10% hypoxic-ischaemic injury before/during delivery
- 10% Postnatal:
- Meningitis/encephalitis/encephalopathy
- Head trauma
- Symptomatic hypoglycaemia
- Hydrocephalus
- Hyperbilirubinaemia
How does CP present?
Early features:
- Abnormal limb and/or trunk posture and tone in infancy with delayed motor milestones; may be accompanied by slowing of head growth
- Feeding difficulties
- Abnormal gait once walking achieved
- Asymmetric hand function before 12mths
Primitive reflexes may persist
Diagnosis made by clinical examination
What is the gross motor function classification system?
Level I = walks without limitations
Level II = walks with limitations
Level III = walks using a handheld mobility device
Level IV = self mobility with limitations; may use powered mobility
Level V = transported in a manual wheelchair
How is CP categorised?
- Spastic (bilateral, unilateral, not otherwise specified) - 90%
- Dyskinetic - 6%
- Ataxic - 4%
- Other
What is spastic CP?
- UMN lesion (pyramidal or corticospinal tract)
- Increased limb tone (spasticity)
- Brisk deep tendon reflexes
- Tone is velocity dependent (faster muscle is stretched = greater resistance)
- Clasp knife rigidity
List the three main types of spastic CP
- Unilateral (hemiplegia)
- Bilateral (quadriplegia)
- Bilateral (diplegia)
Describe unilateral hemiplegic CP
- Unilateral involvement of arm and leg
- Arm usually more affected
- Present at 4-12mths:
- Fisting of affected hand
- Flexed arm
- Pronated forearm
- Asymmetric reaching
- Toe pointing when lifting the child
- Tiptoe walk on affected side
- Affected limbs initially hypotonic but become hypertonic
Describe bilateral quadriplegic CP
- All four limbs affected
- Trunk involved with tendency to opisthotonus (extensor posturing)
- Poor head control
- Low central tone
- Sever = seizures, microcephaly, moderate or severe intellectual impairment
Describe bilateral diplegic CP
- All four limbs but legs affected to much greater degree than arms
- Motor difficulties in arms most apparent with functional use
- Walking = abnormal
- Associated with preterm birth due to periventricular brain damage
- Pattern with walking on their toes with scissoring of the legs (younger child)
- Crouch gait pattern is typical when child gets heavier (older child)
- Usually no feeding or communication difficulties and good cognition
What is dyskinetic CP?
- Involuntary, uncontrolled, occasionally stereotyped movements more evident with active movement or stress
- Tone = variable
- Primitive motor reflex patterns predominate
- Intellect may be relatively unimpaired
- Damage or dysfunction in the basal ganglia
- Most common cause = HIE at term
List the types of movements that can be present in dyskinetic CP
- Chorea - irregular, sudden and brief non-repetitive movements
- Athetosis - slow writhing movements occurring more distally such as fanning of the fingers
- Dystonia - Simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles often giving a twisting appearance
How does dyskinetic CP present?
- Floppiness
- Poor trunk control
- Delayed motor development
What is ataxic CP?
- Most are genetically determined
- Cerebellum or its connections damaged
- Early trunk and limb hypotonia
- Poor balance
- Delayed motor development
- Later signs:
- Incoordinate movements
- Intention tremor
- Ataxic gait
