Cerebral Palsy Flashcards
What is CP
Non progressive neurological disorders of posture and movement
Insult to the developing fetal/ infant brain <5years
Often accompanied by other co morbidietes
Associated musculoskeletal problems eg scoliosis and hip dislocations
No cause found for CP in >75% of cases
Co morbidites with CP common 8
Sensation/ perception tactile < 70% vision 30% hearing 12%
Cognition ( worse the motor likely worse the cognition problem)
Communication 38%
Behavior
Epilepsy 43%
Communication
GOR dysphasia
2ary problem hip dislocation/ Scolisois /contracture /pain
Incidence of CP
Diagnosis and Ix
2-2.5/1000 in Australia Diagnosis Paed neurologists Blood test urine test USS OF HEAD MRI OF HEAD EEG Biopsy’s SCREENing test high risk eg very prem infant can do a general movement assessment Video the kids about term -18 weeks Analyze the video high 95% Sn/Sp to diagnosis of CP Good for early intervention
Causes of CP
1 unknown 80% of cases 2 problems at birth 5% small Genetic malformations Maternal infection rubella Stroke in uterine Prematurity Traumatic BI Near drowning Stroke Cerebral hemorrhage Encephalitis meningitis
Red flags for CP ( think it could be something else)
Family history of cp
No definite insult
Any development regression
Doesn’t look right
Progressive disorder ( remember cp is non progressive )
Multi system involvement remember CP motor movement and posture)
Diurnal variation
Movement disorders of CP
Spacticity hyper reflexia and contracture
Dystopia something you see rather than feel on examination no increased reflexes (touch their leg and their other arm moves ) worsened with anxiety
3 combination of above
Classify children with CP along a Gross motor function classification system 1-5
Manual ability classification system how both hands work together 1-5
Communications 1-5
Eating and drinking
GMFCS
Reliable and valid for children with CP up to 18years of age
Predictive and helps treatment choices and management
Helps to guide treatment
All kids get strengthening and stretching
Some may need splinting botulism serial casting
Orthopedics surgery
Oral meds
Pumps scoliosis surgery
Hip displacement and GMFCS
Hip dislocation 35% overall
GMFCS grade 1. Have 0% hip dislocation
Grade 5 has 90% hip dislocation
Higher the grade increased risk of hip dislocation
Hip surveillance can be ceased in some children at 5 years of age
Need regular hip dislocation survelince
Orthopedics in CP
Aims are to maintain functional mobility
And maintained hip enclosure
Monitor for scoliosis
Common in Grade 4 and 5 but screen for it in 1-3
Scoliosis screening Cobb angle
The scoliosis can compress the lung space
Aim of treatment is to have functional sitting /standing transfers
Respiratory function and miniseries pain and max care
Medical monitoring in CP
Hip sub/dislocation Scoliosis Contracture Pressure areas Tone management Others GOR Epilepsy Respiratory Osteopenia micro # Eyes and vision problems 20-30% of cases Hearing problems 15% ID 60%
Treatment for CP
1 THERAPY. Strengthening stretching splints casts
Modifications
2 botulism used for spcticity blocks the release of Ach at the Nrm junction lasts 6-12 weeks provides a window fo opportunity to change the rom and t strength can use in LL or UP might combine with casting and stretching
3 medications baclofen ( spciticity and dystopia)levodopa dystopia and benzhexol dystopia
4 surgery pumps orthopedics neurosurgical deep brain stimulation is currently trial only may have a role to play needs more evidence
Dystopia
Stiff individual partner no hyper reflexia no contracture
Spacticity
Hyper reflexia / contracture/ stiffness /individual pattern
Treat with baclofan /botulism / deep brain stimulation /serial casts with the botulism
