Cerebral palsy

Question 1

What is the definition of cerebral palsy? When is the onset of cerebral palsy?

Answer 1

Cerebral palsy is an umbrella term defined as a heterogeneous group of clinical syndromes with motor and postural dysfunction due to a defect or lesion of the immature brain.

(Arising in early stages of development (< 2 y of age).)

Question 2

True or false: Cerebral palsy is caused by a progressive damage/lesion, hence clinical picture changes over time.

Answer 2

False. It is caused by a non-progressive damage/lesion, but the clinical picture still changes over time.

Question 3

What are the most common causes of cerebral palsy in premature infants?

Answer 3

Intraventricular hemorrhage (mostly grade 3 and 4).
Periventricular leukomalacia.

Question 4

What are common causes of cerebral palsy?

Answer 4

Prematurity (IVH and PVL). 
Perinatal asphyxia. 
Neonatal stroke.
Hyperbilirubinemia (kernicterus).
Syndromes/cerebral malformations.

Question 5

When may asphyxia cause injury?

Answer 5

Asphyxia may cause injury if:
– 5 min Apgar < 4
– Umbilical cord: pH < 7.0 and/or BE < -12-16
– Moderate-severe hypoxic ischaemic
encephalopathy (HIE)

Question 6

What is choreoatethosis?

Answer 6

Choreoathetosis is the occurrence of involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing).

Question 7

What is schizencephaly?

Answer 7

Neuronal migration disorder; a developmental disorder of the brain during second trimester.

Question 8

In term babies, how many cases of cerebral palsy are of unknown cause?

Answer 8

30-50 %.

Question 9

What can be causes of acquired cerebral palsy?

Answer 9

Acquired CP can be sequela after
– Severe epilepsy
– Meningitis/encephalitis
– Injuries/drowning
– Metabolic crisis

Question 10

How is cerebral palsy diagnosed?

Answer 10

CP is a clinical diagnosis - often doctor and physiotherapist in cooperation.
Cerebral MRI can be used to establish etiology.
Sometimes other investigations are used to rule out other causes.

Question 11

What are early clinical signs of cerebral palsy?

Answer 11

In general: Poor quality/delayed motor milestones. Asymmetrical pattern of movement. Muscular hypertonia (although hypotonia early). Persisting primitive reflexes and increased deep tendon reflexes.

Feeding difficulties
Poor or ”too good” head control
Abnormal pattern of movement
Fisting of one hand
Early favouring of one hand
“Limp” when starts to walk
Scissoring of the legs after 2 months of age (due to increased hip adduction)
Extension of the legs
”Good” head control in prone position

Question 12

What aspects of the disorder is used classify cerebral palsy?

Answer 12

Motor type.
Parts of the body involved.
Gross motor skills.

Question 13

What are the main motor types related to cerebral palsy? Which type is the most common?

Answer 13

Spastic motor type. (The most common - 70-80 %.)
Ataxic motor type.
Dyskinetic motor type.
Combination types.

Question 14

What is spasticity?

Answer 14

Spasticity is defined as a velocity-dependent increase in muscle tone that manifests with resistance to movement and involuntary muscle spasms and contractions. Occurs mainly in disorders of the CNS affecting the upper motor neuron.

Question 15

How are part of the body involved in the disorder used to classify cerebral palsy?

Answer 15

Quardiplegia (bilateral): All four limb are effectd.
Diplegia (bilateral): Both lower limbs are effected, and sometimes arms are effected to a lesser extent.
Hemiplegia (unilateral): Limbs on one side of the are effected.

Question 16

What types of cerebral palsy are commonly associated with normal/good cognitive function?

Answer 16

Unilateral spastic CP. (Hemiplegia unilateral)

Bilateral spastic CP. (Diplegia bilateral)

Question 17

What are common causes of bilateral spastic CP (quardiplegia)?

Answer 17

Early factors in pregnancy.

Hypoxic ischemic encephalopathy II-III.

Question 18

What are common comorbidities associated with cerebral palsy?

Answer 18

Intellectual impairment. (Mild CP may also include specific learning problems/speech problems.) 
Epilepsy and seizures.
Visual and/or hearing problems.
Perceptual problems.
Feeding difficulties.
Gastroesophagal reflux.
Constipation.
Respiratory difficulties.

Question 19

What are complication of cerebral palsy?

Answer 19

Scoliosis.

Hip luxation.

Question 20

What are goals of treatment for cerebral palsy?

Answer 20

Best possible cognitive/motor function.
Improve level of functioning, daily living.
Reduce spasticity.

Question 21

What therapies can be used as treatment of cerebral palsy?

Answer 21

Physiotherapy. (Training correct movement. Stretching, avoiding contractures.)
Occupational therapy. (Focus on daily skills, such as eating, sitting, dressing.)
Botox as symptomatic treatment of involuntary muscle contraction.
Intrathecal baclofen (Only in spastic bilateral quadriplegia CP and certain indications.)
Orthopaedic surgery. (Indications include fixed contractions or joints in wrong position.)
Treatment of comorbidities, such as epilepsy, constipation, respiratory problems etc.