Cerebral Palsy Flashcards
Cerebral Palsy Statistics
2.1 out of 1000 live births
most common childhood disability (1-323 identified in the US)
What is Cerebral Palsy
Group of common childhood-onset neurological motor disorders due to permanent disturbances in the developing fetal or infant brain
Permanent but non-progressive
Cause of CP
abnormal development or damage to brain during fetal development or early infant life
white matter, basal ganglia lesions, cortical and subcortical lesions, and brain malformations
Spastic CP
most common (70%)
- damage in upper motor neurton lesion, motor cortex
- muscle tightness/stiff
- hypertonic
Ataxic CP
classified by
- damage to cerebellar structures
- problems in coordination/poor balance
- hypotonic
Athetoid/dyskinetic CP
classified by
- damage to basal ganglia
- inability to control muscle tone, involuntary, uncontrolled movements
- both hypertonic and hypotonic
Characteristics of CP
- abnormal development of movement and posture
- difficulty with thinking, learning, feeling, communication and behavior
- spasticity, spasms, involuntary movements
- musculoskeletal impairment: abnormal muscle tone, reflexes, coordination
GMFCS 1
walks and runs without support by coordination, speed and balance are reduced
GMFCS 2
Walks without support but may use support in some situations, difficulty running
GMFCS 3
Walks with support
Often uses wheeled mobility in the community
GMFCS 4
Uses powered mobility or is pushed in a manual chair for most mobility needs
GMFCS 5
Transported in a wheelchair for all mobility situations
Motor Impairment leads to
bone deformity, contracture, muscle atrophy, osteoporosis
and
obesity, hypertension and dyslipidemia
bone deformity, contracture, muscle atrophy, osteoporosis lead to
falls/fractures
obesity, hypertension and dyslipidemia lead to
cardiovascular/metabolic diseases/cancer
Muscular Atrophy
Aging effect on musculature earlier than general population
Leads to a high rate of incidence of falls
because of low muscular strength and function, low functional mobility, and deficits in postural stability
Osteoporosis
Low bone mineral density> fragility fracture> immobilization > lower bone mineral density muscle weakness > functional and physical limitation
osteoporosis in CP
Greater severity in osteoporosis, fracture vs. fragility fracture, physical limitation and mortality
Medications for CP that improve ADL’s
Anticonvulsant medication
Antispastic Medicine
Selective dorsal rhizotomy surgery
Orthopedic Surgery
Orthopedic Surgery
improves posture and balance
Selective dorsal rhizotomy surgery
Reduction in spasticity
Antispastic Medicine
Antipasmodic
ex. botulinum toxin (botox)
Anticonvulsant Medication
antiseizure, antiepileptic
Therapy
- physical/movement therapy
- occupational therapy
Mobility-Related Equipment
Ankle Foot Orthoses
Canes, crutches or walkers
Manual or powered wheelchair
Exercise Response
Not a lot of information based on research
There is an increase in energy expenditure for a given external work rate
-bipedal locomotion synchronization is disrupted, causing reduction in walking efficiency
-the energy required to walk is increased and the aerobic economy of walking is decreased
Reduction in peak aerobic capacity
Testing for GMFCS level V
functional mobility testing is preferred
People in GMFCS 2-4
might need individual adaptive measures
GMFCS 1
Basic CDD4 recommendations may be appropriate
Goals of exercise program
maintain mobility
increase PA
counteract a sedentary lifestyle that predisposes to cardiovascular and metabolic diseases
reduce the physical and time burdens on caregivers
improve quality of life
Exercise programming
stat with CDD4
FITT not set
Adaptations for aerobic activities are necessary (level 2-4) goal of 150 min a week
Flexibility Exercises daily
upper-limb strengthening with adaptations: contraindicated in level V children or adults
Aerobic Benefits of Exercise
some physiological outcomes
General Benefits of Exercise
- improved sense of wellness, body image
- increased capacity to perform activities of daily living
- lessen the severity of some symptoms (spasticity and athetosis)
Resistance benefits of exercise
- bone mineral density
- strength and endurance
- balance
