Cerebral Palsy

Question 1

CP definition

Answer 1

A group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fatal or infant brain.

Question 2

Motor types

Answer 2

Spastic (70-80%) - most common form. Muscles appear stiff and tight. Arises from motor cortical damage.
Dyskinetic (6%) - characterised by involuntary movements. Arises from basal ganglia damage
Ataxia (6%) - characterised by shaky movements. Affects balance and sense

Question 3

Motor types: main features

Answer 3

Spasticity 
- velocity dependent increase in resistance to passive movement 
- hyperreflexia
-clonus
-usually in association with hypertonia
Dyskinesia
- involuntary movements 
- hypo kinetic type = dystonia (rigid posturing)
- hyperkinetic type = athetosis (writhing movements); chorea (rapid, jerky movements)
Ataxia and hypotonia 
- ataxia = cerebellar symptoms
- hypotonia - low tone

Question 4

GMFCS (5)

Answer 4

Level 1 = Ambulant; 35.3%; Walks without limitations
Level 2 = Ambulant; 24.2%; walks with limitations (AFO, splints, etc)
Level 3 = Semi-ambulant; 11.8%; walks using a hand held mobility device
Level 4 = Non-ambulant; 13.3%; can still do a stand transfer, prone standing
Level 5 = Non-ambulant; 15.3%; doesn’t have head control

Question 5

Manual Abilities Classification system (MACS) (5)

Answer 5

Level 1 - handles objects easily and successfully
Level 2 - handles most objects but with somewhat reduced quality and/or speed of achievement
Level 3 - handles objects with difficulty; needs help to prepare and/or modify activities
Level 4 - handles a limited selection of easily managed objects in adapted situations
Level 5 - does not handle objects and has severely limited ability to perform simple actions

Question 6

Viking Speech Scale (VSS) (4)

Answer 6

Level 1 = speech is not affected by motor disorder
Level 2 = speech is imprecise but usually understandable to unfamiliar listeners
Level 3 = speech is unclear and not usually understandable to unfamiliar listeners
Level 4 = no understandable speech

Question 7

Aetio-pathogenic classification (3)

Answer 7

1 - brain maldevelopments
2 - Periventricular white matter lesions
3 - cortical/deep matter lesions

Question 8

Associated impairments (10)

Answer 8

Unable to walk
Unable to talk
Experience pain
Epilepsy
Behaviour disorders 
Intellectual impairment
Severe vision impairment
Bladder control problems
Sleep disorder
Saliva Control Problems

Question 9

Risks for CP (3)

Answer 9

Maternal risks (thyroid, pre-eclampsia, bleeds)
Born Premature (<28 weeks =10%)
Term born - encephalopathy = 12%

Question 10

Ante-natal Causes (0-40 weeks)

Answer 10

Maternal infections
Malformations of cortical development
Middle cerebral artery occlusions

Question 11

Perinatal Causes (around birth)

Answer 11

Birth asphyxia
Pre-term delivery
Low birth weight