Cerebral Palsy and Down Syndrome Flashcards
Generally describe cerebral palsy
- Non-progressive lesion in the brain prior to 2 years old
- caused by damage to or abnormalities in the developing brain areas that disrupt movement control, posture, and balance
- wide spread consequences w/deficits in multiple organ systems regions of body leading to sensory deficits, oral motor speech problems, musculoskeletal problems, problems in GI motility, seizures, & mental retardation
- movement related effects can he classified generally based on location & severity of lesion
Cerebral palsy (cp) movement problems based locaten of lesion
- Pyramidal/corticospinal pathways: spastic cp
- Basal ganglia: dyskinatic cp
- Cerebellum: ataxic cp
Cerebral palsy (cp) movement problems based on severity of involvement
- Monoplegic: one limb
- Diplegic: two limbs
- Hemiplegic: one side
- Quadriplegic: all 4 limbs
Describe choreo-athetoid cp type (dyskinetic cp)
- Lack postural control, trunk muscles co-activation
- lack midrange motor control the most, use end range motions to accomplish tasks
Describe the gross motor function classification system (GMFCS) for cp
- Based on age & functional skills, need for assistive devices, & wheeled mobility
- Age groups: before 2nd bday, b/w 2-4 bday, b/w 4-6 bday, b/w 6-12 bday, & blu 12-18 bday
- Functional level for each age group: I = mildest through V = most severe for that age grap
Incidence and etiology of cerebral palsy cp
- 2nd most common neurological impairment affecting children after MR
- exact cause/time period is unknown but happens due to damage in the motor control systems of the brain during prenatal, perinatal, or postnatal periods
- incidence generally associated with low birth weight but can happen with normal birth weight
Risk factors for cerebral palsy (cp) during pre, peri, and post natal stages
- Prenatal: maternal infection, maternal diabetes
- Perinatal: low birth weight (<1750g), low Apgar scores (< or equal to 4 at 5 min)
- Postnatal: neonatal infection, kernicterus, cerebrovascular accident
Pathophysiology of cerebral palsy (cp)
- no consistent pathology
- various types of pathophysiological reasons
- genetic malformations
- hemorrhage intraventricular: injury from pressure
- hypoxia: tigers Ca influx -> cytotoxicity -> cell death; can result from decreased persuasion, thrombus, or embolus
Postural reactions that might be delayed due to cerebral palsy (cp)
- Righting reactions: orients head in space and aligns head and body, used for developing head control and turning head & body, integrated in 5yrs when child starts to stand
- Protective reactions: downward LE, forward UE, sideways, backward, stepping; integration persists
- Equilibrium reactions: allows body to maintain equilibrium by keeping COG over BOS during slow movements, last to develop and integration persists
Head and trunk righting developmental milestones for postural reactions
- Head righting: neck (immature) = 34wk gestation onset & 4-6mo integration; neck (mature) = 4-6mo onset & 5yrs integration; labyrinthine & optical = birth-2mo onset & integration persists
- Trunk righting: body (immature) = 34wks gestation onset & 4-6mo integration; body (mature) = 4-6mo onset & 5yrs integration; landau = 3-4mo onset & 1-2 yrs integration
Protective and equilibrium developmental milestones for postural reactions
- Protective (integration persists): downward LE = 4mo onset; forward UE = 6-7mo onset; sideways UE = 7-8mo onset; backward UE = 9mo onset; stepping LE = 15-17mo onset
- Equilibrium (persists): prone = 6mo onset; supine = 7-8mo onset; sitting = 7-8mo onset; quadruped = 9-12mo onset; standing = 12-24mo onset
Clinical manifestations of cerebral palsy (cp)
- persistence of primitive developmental righting reflexes: ATNR, STNR, TLR
- delayed development/persistence of postural reactions cause delayed achievement of developmental milestones
- motor control problems due to spasticity, dyskinesia (athetosis, chorea), and/or ataxia
- spasticity in iliopsoas & hip adductors (pushes femoral head posterolaterally)
Musculoskeletal problems associated with cerebral palsy (cp)
- decreased sarcomeres
- weakness
- disadvantageous length tension relationship (bones grow faster than muscles)
- increased risk for contractures with increasing age
- oral motor problems causing feeding/speech problems
Non-motor problems associated with cerebral palsy (cp)
- sensory impairment
- respiratory impairment
- GI motility problems
- seizures
- headache/vomiting (due tohydrocephalus)
- learning disabilities
How to diagnose the location of lesson for cerebral palsy (cp)
- CT/MRI
- abnormal MRI findings in more than 89% of centenary palsy (cp) cases
Treatment options for cerebral palsy (cp)
- Pharmacologic: muscle relaxants for spasticity management (baclofen, botulinum)
- Neurosurgery: dorsal rhizotomy, resecting posterior roots to decrease spasticity, usually performed at L2-L5 for near independent ambulators with abnormalities in posture & gait
- Orthopedic surgery: muscle/tendon releases (for contractures), muscle transfers (for muscle imbalances), bone procedure to correct alignment
General prognosis for cerebral palsy (cp)
- most children with mild to moderate CP have normal life span with increased mortality risks before age 4 & after 50yrs due to respiratory/CV complications