Cerebral Palsy chp 18 Flashcards
What causes CP and what exactly is it
Permanent but changeable
Caused by non progressive defect or lesion in 1 or multiple locations
Utero/during or shortly after birth
Infectious meningitis and trauma are the most common causes of acquired CP
Produces motor and possible sensory deficits
Involves 1 or more limbs and usually the trunk
Voluntary motor function deficits
Produces multiple symptoms
Anatomic sites of involvement, degree of disability, associated dysfunction and causes are heterogeneous
Cognitive decifits in about 23 -44 percent of the cases and IQ is below 70 percent
Are auditory issues present
Visual disturbances
Learning disabilites a lot have learning disabilities
seizure disorders
Auditory impairments in 25%
Visual disturbances in 40-50%
Strabismus, esotropia, nystagmus, homonymous hemianopsia
Learning Disablities 50-70 percent
Seizure disorders 25-25
Disc Dengeration and cervical spine in stability
How do we classify CP
Area of the body exhibiting impairments
Movement abnormalities resulting from brain lesions
Degree of severity of CP
How to classify movment differences in CP there are 4 of them.
Spastic- motor cortex hemiparesis, diplegia, quadriplegia 2. Dyskinetic- basal ganglia athetosis (weird slow withering movement of hands, dystonia, choreiform movements, ballismus, tremor) 3. Ataxia- cerebellar lesion 4. Atonia, hypotonic
Spastic - usally involves the mnotor cortex hyperreflexia, abnormal movment pattern.
showing upper motor neuron involvement (hyperreflexia, abnormal movement patterns, weakness, loss of dexterity) -motor cortex
Describe Athetosis, dystonia, choreilform, bailismus, tremor
Athetosis- showing signs of extrapyramidal involvement with involuntary movements slow writhing movements of face and extremities
Dystonia -rhythmic, changing tone proximally leading to slow uncontrolled movements with a tendency towards fixed postures -basal ganglia
Choreiform movements- rapid jerky movements of face and extremities
Ballismus – coarse flinging movements of extremities with wide amplitude of motion
Tremor – fine shaking of head and extremities
Rarer types of CP so you have like Hypotonic and ataxic which are usally what type of lesions?
Hypotonic- showing severe depression of motor function and weakness
Ataxic- showing signs of cerebellar involvement with ataxia (rare) -cerebellar lesion
Mixed lesions combine characteristics of spastic, athetoid and ataxic groups
Characteristics of Hypotonia CP just think along the lines of characteristics describing muscle weakness
Flaccidity
Extreme floppiness
Inability to generate muscle force
Transient- reclassified spasticity or athetosis
Characteristics describing Spastic CP
Dystonia
Resistance to passive stretch
Hyperactive stretch reflexes (hyperreflexia)
Changes in muscle structure & function
Abnormal muscle activity elicited by changes in head or body positions
UE flexion/ LE extension
Atheoid CP
Without a fixed steady position and may involve choreiform or writhing movements
Maintain fixed dystonic posture
Involuntary movements at rest and during movements
Joints often hyper mobile and dislocations occur especially if spasms are present
Ataxic CP this one is water on the brain so you cant move.
Uncommon
Hydrocephalus, head injury, encephalitis, or cerebellar tumor
Difficulty controlling rate, range, direction and force of movements
Cortical basal ganglia
Cerebellar lesions
Cerebral Cortex and pryamidal tracts
What impairments do you see if these areas are injuried
Cortical Basal ganglia thalamic loop- dyskinesia or athetosis, intermittent muscular tension of extremities or trunk, involuntary movement patterns
Cerebellar lesion- ataxia, general instability of movement
Cerebral cortex & pyramidal tracts- spasticity
Hypotonic classification- diminished resting muscle tone and decreased ability to generate voluntary muscle force
Describe the diffrent GMFSC levels age 6-12
and second 12-18
6-12 - Level 1 Children walk at home go up and down stairs without holding onto rails children peform gross motor skills but, speed balance and coordination are off
Level 2- children walk but, still hold onto the rails when climbing stairs may expericence difficulty walking long distances may use wheeled mobliity over longer distances children have minimal ability to perform gross motor skills
Level 3- children use a hand held mobility device in indoor settings. need supervision when climbing the stairs and need wheeled mobility when travleing long distances and may self propel for short distances.
Level 4 - Children need supervision when walking shorter distances. Children need wheelchair when at school or traveling along in the community
Level 5- children are transported in a manual wheelchair. Children are limited in their ability to maintain antigravity head and trunk position and control leg and arm movements
AGES 12-18
samething as above just need more assistance when doing transfers
What are some secondary impairments people can get with CP
So CP is really not D/x until what
Expressed in muscular and skeletal systems damage occurred in the CNS Insufficient force generation Spasticity (vel dependent) tone Abnormal extensibility Exaggerated or hyperactive reflexes Malalignments (femoral anteversion/ femoral & tibial torsion)
D/x usally occurs when the child doesn’t reach motor milestones like other children do. still have abnormal primitve reflexes assymetry
Some tests to help ID CP are the Test of Infant motor performance, Neurosensory Motor Developmental Assessment
Multi system impairments
Expressed in the Neuromuscular system
Poor selective control of muscles
Poor regulation of activity in muscle groups in anticipation of postural changes
Decreased ability to learn unique movements
