Cerebral palsy

Question 1

Describe your approach to the motor neurological examination of a child with cerebral palsy

Answer 1

Inspect 
- posture
- asymmetry
Feel muscle bulk (bicep + inner aspect thigh)
Assess tone
Log rolling 
Flick limbs off the bed 
Compare right vs left
Compare upper vs lower limb
Note spontaneous striatal toe

Question 2

Define cerebral palsy

Answer 2

A group of disorders involving a non progressive disturbance to the developing brain affecting movement and posture

Question 3

How is cerebral palsy classified?

Answer 3

Pyramidal
Spastic
- quadriplegic
- hemiplegic
- double hemiplegic
- diplegic

Extra-pyramidal
Dyskinetic
- chorea-athetoid
- dystonic 
Ataxic-hypotonic
Mixed

Question 4

Describe the GMFCS

Answer 4

1 - walks without restriction (advanced)
2 - walks without restriction; limitations outdoors
3 - walks with mobility device
4 - limited self mobility 
5 - severely limited self mobility

Question 5

Describe the MACS

Answer 5

1 - handles objects easily
2 - somewhat reduced quality
3 - handles with difficulty 
4 - limited selection in adapted situations
5 - does not handle objects

Question 6

What is the function of the frontal lobe?

Answer 6

Problem solving
Emotional traits
Reasoning
Speaking
Voluntary motor activity

Question 7

What is the function of the parietal lobe?

Answer 7

Knowing right from left
Sensation
Reading
Body orientation

Question 8

What is the function of the temporal lobe?

Answer 8

Understanding language
Behaviour
Memory
Hearing

Question 9

What is the function of the occipital lobe?

Answer 9

Vision

Colour perception

Question 10

What is the function of the cerebellum?

Answer 10

Balance
Coordination and control of voluntary movement
Fine mm control

Question 11

What is the function of the brain stem?

Answer 11

Breathing
Temperature
Digestion
LOC
Swallowing

Question 12

What are red flag signs in a CP diagnosis?

Answer 12

Normal MRI
Imaging abnormalities isolated to globus pallidus
Severe sx with no explanation
Consanguinity or pattern of inheritance
Developmental regression
Worsening of symptomatology
Isolated hypotonia
Rigidity
Paraplegia

Question 13

Which neurogenetic conditions mimic CP?

Answer 13

Dyskinetic disorders

• neurotransmitters
• glucose transporter defect
• brain iron accumulation
• organic acid disorder
• mitochondrial disorder

Spasticity disorders

• Pelizaeus Merzbacher
• hereditary spastic paraplegia
• lysosomal storage disorder
• migrational disorder
• disorder of forebrain cleavage

Question 14

What general principle dictates that a child will walk?

Answer 14

If the child sits independently before 2

Question 15

By what age is the majority of movement potential achieved?

Answer 15

<5yo

Question 16

What supportive intervention should you provide for a CP child?

Answer 16

Constraint induced movement therapy
Active hip surveillance
Early standing
Motor training
Treat comorbidities