Cerebral Palsy - Classification & Prognosis Flashcards
Classification of CP:
topography
type of muscle tone
function
Topographic Classification =
areas of the body affected by CP
primary categories include:
hemiplegia
diplegia
tetraplegia
quadriplegia
hemiplegia =
38% of cases
often small, unilateral hemorrhage or pediatric stroke
affects one side of body; arm, leg, trunk, and head
diplegia =
37% of cases
often bilateral hemorrhage
lower limbs affected more often
tetraplegia and quadriplegia =
~24% of cases
often large HIE = hypoxic ischemic encephalopathy
tetraplegia = affects 3 limbs, and trunk, and head
*fairly uncommon
quadriplegia = affects all 4 limbs, trunk, and head
Type of CP Classified by Muscle Tone:
diskinetic
ataxic
spastic
multiple areas
diskinetic =
lesion of basal ganglia
involuntary movement
Includes both athetosis (slow, writhing movements) and dystonia (involuntary muscle contractions)
ataxic =
lesion of cerebellum
shaky movement
poor balance
Characterized by poor coordination and balance, with decreased muscle tone (hypotonia)
spastic =
lesion of motor cortex or corticospinal tracts
muscles appear stiff
most common type of CP
Characterized by increased muscle tone (spasticity) and exaggerated reflexes
multiple areas =
combination of types
Spastic Cerebral Palsy CHARACTERISTICS =
Most common (~86%)
Increased Muscle Tone/Stiffness
Described by parts of body that are affected:
Spastic Diplegia
Spastic Hemiplegia
Spastic Quadriplegia
Spastic Diplegia
spastic cerebral palsy that primarily affects the legs, with less involvement of the arms
increased muscle tone in the legs, which can lead to stiffness and difficulty with walking
“scissoring” gait where the legs cross over each other while walking
arms are generally less affected but may show some mild motor impairment or tone abnormalities
difficulty with balance, coordination, and fine motor skills
leading to gait and balance issues
Spastic Hemiplegia
affects one side of the body, including both the arm and the leg on that side
increased muscle tone and stiffness affecting one arm and one leg on the same side of the body
arm might be held in a flexed position, and the leg may have difficulties with movement, leading to walking challenges
difficulties with tasks requiring the use of both hands or legs, such as dressing or running
Motor difficulties are confined to one side of the body, leading to asymmetrical movement and strength
resulting in asymmetric motor impairments
Ataxic Cerebral Palsy CHARACTERISTICS -
~5%
Balance and coordination impairments
They will appear unsteady
Shaky movements
Movements that require a lot of control are super challenging (e.g., writing, dressing, etc.)
appear to stagger or have difficulty walking straight
Problems with tasks that require precise hand-eye coordination, such as writing, buttoning clothes, or using utensils
Spastic Quadriplegia
most severe form of spastic cerebral palsy and involves spasticity affecting all four limbs (both arms and legs)
can also affect the trunk and may involve difficulty with head control, sitting, and maintaining balance
difficulties with speech, swallowing, and other bodily functions due to the widespread involvement of motor control
leading to severe motor and functional impairments
Dyskinetic Cerebral Palsy CHARACTERISTICS -
~6%
Involuntary, variable movement
Dystonia – Twisting, repetitive
Athetosis - Slow, continuous, writhing movements
Chorea - Quick, dance-like, irregular, unpredictable
Choreoathetosis – combination of chorea and athetosis
Movement System Diagnoses
fractionated movement deficit
force production deficit
motor coordination deficit
Most prevalent impairment that impacts function will help determine where treatment may begin
Fractionated Movement Deficit
inability to control and execute movements in a discrete, controlled manner
difficulties with isolating and coordinating individual muscle movements, which can lead to stiff or awkward motions
Impaired Dexterity: Difficulty with tasks requiring fine motor control, such as writing or manipulating small objects.
Movement Inaccuracy: Challenges in achieving precise, controlled movements, leading to imprecise or jerky motions.
Force Production Deficit
difficulty generating the necessary strength or force to perform movements effectively
can result from weakness or reduced muscle power
Limited Endurance: Difficulty sustaining force production over time, leading to fatigue or incomplete tasks.
Functional Limitations: Challenges with activities that require force, such as lifting objects, climbing stairs, or maintaining posture.
Motor Coordination Deficit
difficulties in coordinating and integrating motor skills to perform tasks smoothly and accurately
challenges with the timing, sequencing, and integration of movements
playing sports or performing intricate hand movements = hard
Clumsiness: Increased likelihood of dropping objects or making unintended movements due to poor coordination.
Types of CP Classified by Function
5 levels
Gross motor function classification system isn’t based on muscle tone or topography, but it is based on the individual’s motor function
Lower levels associated with greater function
NOT associated with their self reported quality of life!!!!
level 1
walks without devices
able to perform all basic activities of daily living and participate in most activities
may have difficulties with more advanced motor skills, such as running or jumping, but does not need assistive devices for walking
level 2
walks without devices
Requires some assistance or the use of mobility aids for long distances or challenging terrains
Can walk independently in familiar environments but may have difficulty with more complex motor tasks
level 3
walks with mobility devices
Requires a mobility aid (walker or wheelchair) for most activities and may be able to walk short distances with assistance
Has significant limitations in independent mobility and daily activities
level 4
self mobility with limitations, may use powered mobility
very limited independent mobility and requires significant support for most activities
wheelchair for most mobility and needs assistance with many daily tasks and personal care
level 5
self mobility is severely limited even with use of supporting technology
very limited control over voluntary movements and is dependent on others for most aspects of care and mobility
Requires full assistance with daily activities and uses a wheelchair for mobility
GMFCS Stability
Classification tool!
*should not be used
as an outcome
measure
GMFCS level of a child with CP is generally stable once the child reaches around 2 to 4 years of age
Gross motor function increases in those early years of life and levels off around 6
GMFCS levels 3 - 5: there is a dip in function starting in age 7-9 = likely due to secondary impairments (importance of PT for prevention strategies)
Prognostic Predictor for Ambulation
sitting independently (without arm support) by 24 months
walking with or without assistance
reflects the child’s core strength, postural control, and motor coordination
Children who achieve this milestone are more likely to achieve further motor milestones, including walking
GMFCS level 1 - 6-12 yrs
children walk at home, school , outdoors and in the community
they can climb stairs without the use of a railing
perform gross motor skills such as running and jumping
speed, balance, and coordination are limited
GMFCS level 2 - 6-12 yrs
children walk in most settings and climb stairs holding onto a railing
may experience difficulty walking long distances and balancing on uneven terrain inclines, in crowded areas, or confined spaces
may walk with physical assistance, a hand-held mobility device or use wheeled mobility over long distances
only minimal ability to perform gross motor skills such as running and jumping
GMFCS level 3 - 6-12 yrs
children walk using a hand-held mobility device in most indoor settings
may climb stairs holding onto a railing with supervision or assistance
use wheeled mobility when traveling long distances and may self-propel for shorter distances
GMFCS level 4 - 6-12 yrs
children use methods of mobility that require physical assistance or powered mobility in most settings
may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned
at school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility
GMFCS level 5 - 6-12 yrs
children are transported in a manual wheelchair in all settings
children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
GMFCS level 1 - 12- 18yrs
youth walk at home, school , outdoors and in the community
they can climb stairs without the use of a railing
perform gross motor skills such as running and jumping
speed, balance, and coordination are limited
GMFCS level 2 - 12- 18yrs
youth walk in most settings but environmental factors and personal choice influence mobility choices
at school or work they may require a hand-held mobility device for safety and climb stairs holding onto a railing
outdoors and in the community youth may use wheeled mobility when traveling long distances
GMFCS level 3 - 12- 18yrs
youth are capable of walking using a hand-held mobility device
may climb stairs holding onto a railing with supervision or assistance
at school, they may self-propel a manual wheelchair or use powered mobility
outdoors and in the community they are transported in a wheelchair or use powered mobility
GMFCS level 4 - 12- 18yrs
youth use wheeled mobility in most settings
physical assistance of 1-2 people is required for transfers
indoors, youth may walk short distances with physical assistance, use wheeled mobility or a body support walker when positioned
may operate a powered chair, otherwise are transported in a manual wheelchair
GMFCS level 5 - 12- 18yrs
youth are transported in a manual wheelchair in all settings
children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
self-mobility is severely limited, even with the use of assistive technology
Cerebral palsy can be classified by:
topography, type of muscle tone, and motor function
One early gross motor milestone that is most predictive of walking is =
sitting independently by 2 years of age
