cerebral palsy and special needs

Question 1

complex exceptional needs categories

Answer 1

motor skills 
communication
learning + mental functions 
self care
hearing, vision

Question 2

CEN if

Answer 2

• severe impairment 4+ categories and enteral/parenteral feeding
• severe impairments 2+ categories and ventilation/CPAP

impairment >6m and ongoing

Question 3

ex CEN with ortho involvement

Answer 3

muscular dystrophy 
cerebral palsy 
neurofibromatosis
spina bidifa
downs and turner syndromes

Question 4

cerebral palsy

Answer 4

permanent and non-progressive motor disorder due to brain damage before birth or in first 2yrs life

Question 5

cerebral palsy: prenatal causes

Answer 5

placental insufficiency 
toxaemia 
smoking 
alcohol 
drugs 
infection: rubella, herpes II

Question 6

cerebral palsy: perinatal causes

Answer 6

premature
anoxic injury 
infection 
kernicterus
haemolytic disease of newborn

Question 7

cerebral palsy: postnatal causes

Answer 7

head trauma

infection: CMV, rubella

Question 8

cerebral palsy: physiological classification

Answer 8

spastic: pyramidal system, motor cortex
athetoid: extrapyramidal system, basal ganglia
ataxia: cerebellum, brainstem
mixed: combo spastic and athetoid

Question 9

cerebral palsy: anatomical classification

Answer 9

monoplegia
hemiplegia
diplegia
quadraplegia

Question 10

cerebral palsy: gross motor function classification system level I

Answer 10

walk without limitations

Question 11

cerebral palsy: gross motor function classification system level II

Answer 11

walks with limitations

Question 12

cerebral palsy: gross motor function classification system level III

Answer 12

walks using handheld mobility device

Question 13

cerebral palsy: gross motor function classification system level IV

Answer 13

self-mobility with limitations (may use powered mobility)

Question 14

cerebral palsy: gross motor function classification system level V

Answer 14

transported in manual wheelchair

Question 15

cerebral palsy issues

Answer 15

spasticity 
lack of voluntary limb control 
weakness
poor coordination 
impaired senses: hearing, vision, touch, taste

Question 16

cerebral palsy complications

Answer 16

joint subluxation, dislocation
dynamic contractures
fixed muscle contractures

Question 17

cerebral palsy ortho priorities

Answer 17

spine, hip, feet 
torsional problems 
upper limb function 
maintain sitting balance
optimise gait
improve/maintain standing posture

Question 18

cerebral palsy hip problems

Answer 18

born with normal hips, 1/3 have hip displacement by maturity

dislocation

• painful
• upset sitting posture
• higher GMFCS higher the risk

Question 19

cerebral palsy non-op Rx

Answer 19

posture management: physio, seating

spasticity management

• generalised: oral baclofen, diazepam
• localised: botox, baclofen intra-thecal pump

Question 20

cerebral palsy surgery pros

Answer 20

reduce risk dislocation
reduce pain
better seating

Question 21

cerebral palsy surgery cons

Answer 21

not all would have went on to dislocate

big surgery

Question 22

cerebral palsy surgical Rx

Answer 22

soft tissue realise: hamstrings, adductors

bony realignment: pelvic osteotomy, varus deterioration osteotomy

Question 23

equinovarus foot deformity (clubfoot)

Answer 23

hindfood in varus, midfoot adducted, ankle in equinus

Question 24

risk factors for clubfoor

Answer 24

male 
FHx
parental smoking 
pressure theories: oligohydramnios, abnormal fetal position 
placental insufficiency 
constriction bands

Question 25

clubfoot Rx

Answer 25

casting and manipulation
5 casts changed weekly

1st cast corrects cavus and adductus deformities
remaining casts correct varus deformity and equinus

Question 26

scoliosis

Answer 26

any deviation of spine in coronal plane

Question 27

non-structural scoliosis

Answer 27

due to extrinsic cause e.g. leg length discrepancy

resolves when causative factor fixed

Question 28

structural scoliosis

Answer 28

abnormal rotation of vertebrae
intrinsic spine problem
potential to progress

Question 29

scoliosis: aetiological classification

Answer 29

congenital 
idiopathic
neuromuscular 
post trauma
infection
degenerative

Question 30

scoliosis: classification by age presentation

Answer 30

infantile <3yrs
juvenille 3-10yrs
adolescent >10yrs

Question 31

scoliosis: classification by area of spine

Answer 31

thoacic
lumbar
thoracolumbar
double

Question 32

scoliosis: Ix

Answer 32

AP erect x-ray whole spine +/- lateral

MRI: cord abnormality, vertebral anomalies, tumour

Question 33

scoliosis: early diagnosis matters becuase

Answer 33

outcome less favourable from severe curves: cardioresp compromise, pain from pelvic/rib abutement
neuromuscular causes at high risk progression

Question 34

scoliosis non-op Rx

Answer 34

bracing

• need to wear 23/24hrs
• delays curve progression

Question 35

scoliosis surgical Rx

Answer 35

complex , extensive
approach: ant, pos, both
intra-operative spinal cord monitoring

Question 36

scoliosis surgical complications

Answer 36

nerve root damage
cord traction injury
problems with growth: growing roots, changing roots