Cerebral palsy Flashcards
4 types of CP and what brain structure is involved?
1) Spastic - white matter in cortical sensorimotor area or motor cortex (spastic and exaggerated movements)
2) Dyskinetic - basal ganglia
3) Ataxic - cerebellar (inability to generate normal or expected voluntary movement trajectory with a lack of orderly, coordinated, rhythmic movements)
4) Mixed - spasticity and dyskinesia present
2 subtypes of Dyskinetic CP
1) Dystonic - involuntary, sustained/intermittent muscle contraction with repetitive movement and abnormal posture
2) Athetosis - slow, continuous, writhing movements that prevent stable posture
Top 3 most common 2nd impairments of CP:
1) Cognitive
2) Behavior
3) Impaired speech
4) Impaired hearing
5) Impaired vision
6) Seizure
7) Urinary incontinence
8) Constipation
9) Sensory deficits
10) Visual-spatial deficits
IMPAIRED SPEECH (42-81%) VISUAL-SPATIAL (60-90%) IMPAIRED VISION (62-71%)
all others 25-40%
Occurs in male or female more?
Male
Which test has best combination of SNOUT and SPIN to predict CP in early months?
Pretchl’s Assessment of General Movement (GM)
How many weeks post-term is Pretchel good for?
20
What is the GMFCS?
Gross Motor Functional Classification System
what are age categories for GMFCS?
1) 6 month-2 year
2) 2-4years
3) 4-6 years
4) 6-12 years
5) 12-18 years
What is the MACS - Manual Ability Classification System ?
Tool for arm and hand function
Five Level Scale, Does not compare sides, Looks at function not quality, All age levels
What is FMS - Functional Mobility Scale
6 point ordinal scale to classify need for assistive mobility devices to move distances of 5, 50, and 500 meters
What is CFCS - Communication Function Classification System
tool used to classify the everyday communication of an individual with cerebral palsy into one of five levels according to effectiveness of communication. It consists of five levels which describe everyday communication ability.
When scoring the CFCS, a person classified at Level I is a more/less able communicator than a person classified at Level V.
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With GMFCS, do HIGHER or LOWER scores mean more independent movement
LOWER
Basic function for GMFCS 5 levels for 6 months-2 years
1) pull to stand, crawl, cruise, move in/out of sit, and walk with no device at 18-24 months
2) Sit with hand for balance, creep or crawl, pull to stand, cruise
3) sit with low support, creep, roll
4) Roll, head control, can sit with trunk support
5) limited voluntary movement, need assist for rolling, unable to maintain antigravity head/trunk control
Basic function for GMFCS 5 levels for 2-4 years
1) sit and push to stand with no support, walk with no support
2) walk with AD, cruise, pull to stand, move in/out sit with assist, unsteady sitting when hands are busy
3) w-sit, creep, pull to stand, cruise, walk with AD and adult assist
4) Can’t sit without use of hands, AD to sit and stand, self mobility on floor
5) self-mobile only with power wheelchair
Basic function for GMFCS 5 levels for 4-6 years
1) floor<>stand, floor<>chair, chair<>stand, walk indoors and outdoors, climb stairs, emerging run/jump
2) sit in chair with no support, floor<>chair and floor<>stand with surface to push on, walk indoors and level outdoors, walk up stairs with rail
3) sit in chair with pelvis support to use hands, chair transfers with stable surface, walk level surface with AD, climb stairs with adult
4) Adaptive seat, need assist for chair transfer, short walk with walker and supervision, power mobility in community
5) No means of independent movement, power mobility with extensive adaptations
GMFCS 5 levels ages 12-18
1) Walk everywhere, run and jump, walk up stairs with no support
2) walk but may use handheld mobility for environment and/or wheeled mobility for long distances, stairs with handrail
3) handheld mobility device to walk, stairs with rail and supervision, wheeled or power mobility in school/community
4) wheeled mobility most settings and 1-2 person assist for transfers
5) power mobility limited; pretty much need help for all
GMFCS function in 5 levels for age 6-12
1) Walk everywhere, run and jump, walk up stairs with no support
2) difficulty walking on uneven ground or long distances, walk but may use handheld mobility for environment and/or wheeled mobility for long distances, stairs with handrail
3) handheld mobility device to walk, stairs with rail and supervision, wheeled or power mobility in school/community
4) wheeled mobility in community, power mobility indoors, and can walk in walker with physical assist
5) power mobility limited; pretty much need help for all
General function classifications for GMFCS levels ages 6-18
1) Pretty much full function with mild imbalances
2) Need modifications
3) Consistent use of mobility devices
4) Need good amount of physical assist
5) Need all the assist
General function classification GMFCS levels ages 6 month-4 years
1) cruise/walk
2) unsteady sitting, crawl/walk with assist, pull to stand
3) poor sitting, creep
4) rolling for floor mobility, need trunk support
5) limited voluntary movement
With MACS does HIGHER or LOWER score mean they handle objects well?
LOWER
1 > 5
With FMS, does HIGHER or LOWER score mean increased independence with mobility
HIGHER
6 > 1
OPPOSITE OF GMFCS levels
What are 6 FMS levels
1) Independent on all surfaces
2) Independent on level surfaces
3) Walk with 1-2 canes/sticks
4) Walk with crutches
5) Walk with walker
6) Wheelchair
- C = crawling
- N = Does not apply = child didn’t complete distance
Put in order high>low percent kids with CP that use following mobility:
1) Unable to walk
2) Walk with aids
3) Walk independently
1) Walk independently 54%
2) No walking 30%
3) Walk with aids 16%
Which 2 types of CP least likely to walk
Dykinetic and bilateral
Which development milestone is best predictor of being able to walk 15_ meters w or w/out AD by 8 yoa?
sitting independently by 24 months
GMFCS levels 3-5 peak at what age?
7
What GMFCS level is most common?
Level 1
Spasticity in which 2 hip muscle groups can affect acetabular involvement?
ADD and flexors
Which scale was found to be most reliable in quantifying spasticity?
Tardieu
If you are assessing a child who has fatigable clonus at precise angle was level Tardieu is this?
3
*0 = no resistance 1 = slight resistance throughout 2 = catch and release 3 = fatigable clonus 4 = not fatigable
For how many months does Botox effect last and how long after injection does it peak?
Last 4 months
Peaks 2 weeks
Tardieu study found PF contracture prevented if muscle stretched beyond minimum threshold length for __ hours during daily activity?
6 hours
Name of 5 point ordinal scale based on severity of posturing and involuntary dystonic movements in 8 body regions
Barry-Albright Dystonia Scale
Spinal Alignment Range of Motion Measure (SAROMM) - estimates spine and ROM limitations in children with CP 4 point scale. HIGHER/LOWER the number, greater the limitation/ability to passively move the patient
HIGHER
Normal ROM 1) flexible deviation 2/3/4) mild, moderate, severe fixed limitation
What age should kid’s start to use stander?
1 yoa
what type of gait pattern may emerge as kid grows?
crouch
