Cerebral palsy- Clinical examination Flashcards
Name the subheadings under which the evaluation/assessment of CP is done
- History/Observation
- Gross Motor Function/Fıne motor Function
- Reflexes and Reactions
- Muscle Tone
- Musculoskeletal
- Functional mobility assessment
- Gait analysis
- Assessment of daily life skills (Activity performans)
- Participation
- Assessment of Health-Related Quality of Life
- Environmental factors (Tools, Orthotics And
Equipment.) - Personal factors
Which is not a question taken in the perinatal history during CP evaluation?
◦ History of asphyxia at birth
◦ History of prolonged labour pain
◦ Type of delivery (Forceps, vacuum delivery)
◦ Presentation of child (Breech)
History of TORCH
infection
History of TORCH
infection
At what point during history taking in CP do we ask the following:
◦ Any medical, surgical or physiotherapy treatment taken
before
◦ What treatment was used?
◦ Was the treatment effective or not?
◦ What was the ability level of child at that time?
◦ What obstructs the child from progress?
◦ Apgar Score from the case-sheet
Postnatal history taking
Describe the scale used to assess Gross Motor Function (GMF) in CP
The Gross Motor Function Classification System, is a five-level clinical classification system that describes the gross motor function of people with CP on the basis of self-initiated movement
abilities.
Distinctions between levels are based on functional abilities; the need for walkers, crutches, wheelchairs, or canes/walking sticks;
and to a much lesser extent, the actual quality of
movement.
According to GMFCS scale, arrange the following
a) Can walk indoors and outdoors and climb stairs without using their hands for support. Can run and jump.
Has decreased speed, balance, and coordination.
b) Walking ability is severely limited, even with assistive devices.
Uses a wheelchair most of the time and may propel their own power wheelchair.
May participate in standing transfers
a) Level I
b) Level IV
According to GMFCS scale, arrange the following:
a) Can walk indoors and outdoors and climb stairs using a railing.
Experiences difficulty with uneven surfaces, inclines, or while in crowds.
Can minimally run or jump
b) Has physical impairments that restrict voluntary movement control and the ability to maintain head and neck position against gravity.
Experiences impairment in all areas of motor function.
Can’t sit or stand independently, even with adaptive equipment.
Can’t independently walk, though may be able to use powered mobility devices.
a)GMFCS Level II
b)GMFCS Level V
Describe GMFCS Level III
Walks with assistive mobility devices indoors and outdoors on level surfaces.
May be able to climb stairs using a railing.
May propel a manual wheelchair; may require assistance for long distances or uneven surfaces.
What are the 2 mechanisms of spasticity and which applies to CP
- Spinal mechanism concerning changes in the
functioning of the spinal neurons and motor
subsystems.
2. Supraspinal and suprasegmental mechanisms.
In Cp, supraspinal mechanism is affected: The major problem is a loss of control of the spinal reflexes. Spinal reflex activity is normally tightly regulated and if inhibitory
control is lost, the balance is tipped in favor of excitation, resulting in hyperexcitability of the spinal reflexes.
Alternatively, The problem
is in the descending system. It
cannot inhibit gamma motor
neuron activity because the
descending nerve pathways
are damaged. Therefore,
gamma motor norons send
continuous stimulation to the
muscles and the muscle
cannot relax.
The spasticity/ muscle tone assessment is commonly done
using which 2 scales?
Modified Ashworth scale and
➢ Tardieu scale.
What is the main difference between the modified Ashworth and Tardieu scales?
Tardieu: a scale for measuring spasticity that takes into
account the resistance to passive movement at both slow
and fast speeds.
-Can differentiate between contracture and spasticity
-Velocity dependent
M. Ashworth:
-Widely used in research
-Can’t differentiate spasticity and contracture
-May not detect small changes
In the evaluation of the MSK(joint) system in CP, provide the tests used for the following conditions:
a) Hip flexion contracture
b) Adductor contracture
c) Femoral anteversion
d) Hamstring contracture
e) Rectus femoris spasticity
f) Equinus deformity(gastrosoleus contracture/spasticity)
g) Tibial torsion malalignment
a) Hip flexion contracture: Thomas’ hip flexion test & Staheli prone extension test
b) Adductor contracture: Phelp’s test
c) Femoral anteversion: The Craig’s
test/Trochanteric prominence test
d) Hamstring contracture: popliteal
angle test
e) RF spasticity: Duncan-Ely’s/Prone
Rectus test
f) Equinus: Silverskiold test
g) Tibial torson: Thigh foot angle & Bi-malleolar axis
method
The following descriptions are a characteristic of what?
I. Velocity dependent
II. Clasp knife reflex
III. Lesions in the pyramidal tract
IV. Resistance more in one direction than the other.
V. +clonus, +hyperreflexia, -tremor
VI. Increase in gamma activity
Spasticity
The following descriptions are a characteristic of what?
I. Seen in extrapyramidal lesions
II. Same resistance in all directions
III. Not velocity dependent
IV. Cogwheel and leadpipe
V. -clonus, -hyperreflexia, + tremors
VI. Increase in alpha nad gamma activities
Rigidity
The Spinal Alignment and Range of Motion
Measure (SAROMM) scale measures what?
1) spinal alignment and
2) range of motion and muscle extensibility
The Medical Research Council (MRC) grading is used in CP to measure what?
Muscle strength
Describe The Functional Mobility Scale (FMS)
o classify the extent of
mobility in children, taking into account the range
of assistive devices a child might use for mobility
The FMS rates walking ability at three specific
distances such as 5, 50, and 500 m and is
further graded from 1 to 6 depending on the level
of mobility.
Gait analysis can be done with different techniques
such as?
observational gait analysis,
➢ videographic gait analysis,
➢ instrumented 3D gait analysis
Discuss prevalence of gait ambulation in CP
Gaitproblems: Estimations report that 75% of children with CP are ambulatory. However, they face problems while walking and their common problems are asymmetry during gait and reduced gait velocity.
The majority of ambulatory children with CP are either
spastic diplegia or spastic hemiplegia. Due to the
normal half of the body, most of children with spastic
hemiplegia can walk.
Which of these is true of gait patterns in spstic hemiplegia?
a) Type 2 hemiplegia gait – Drop foot type
b) Type 1 hemiplegia gait – True equinus with or without recurvatum knee
c) Type 3 hemiplegia gait – Stiff knee gait
d) Type 4 hemiplegia gait – In sagittal plane, ankle in equinus, knee in flexion, hip in flexion and anterior pelvic tilt is present. In
coronal plane, hip adduction and internal rotation
a) F- Type I hemiplegia (dropfoot)
b) F-Type 2 hemiplegia (True equinus with or without recurvatum knee)
c) T
d) T
Which muscles are affceted in the 4 types of unilateral spastic CP (hemiplagia)
- Type1: weak/paralysed dorsi flexors (drop foot)
* Type2: type 1 + contracture of triceps surae muscles
– 2a= knee neutral,
– 2b= knee requrvatum
* Type 3: Type 2 + spasticity of hamstring / rectus femoris muscles
* Type 4: Type 3 + spasticity of hip flexor and adductor muscles
What are the gait patterns in bilateral spastic CP (Diplegia or Quadriplegia)
a) Type 1 – True equinus
b) Type 2 – Jump gait
c) Type 3 – Apparent equinus
d) Type 4 – Crouch gait
TJAC
WeeFIM is an 18-item, 7-level ordinal scale instrument that measures a child’s consistent performance in essential daily functional skills (Activity performance of the ICF)
Name its three main domains
(self-care, mobility, and
cognition)
Canadian Occupational Performance Measure
(COPM) and Goal Attainment Scaling (GAS) are used to measure what component of the ICF model?
Participation
Name 2 scales for the ASSESSMENT OF HEALTH-RELATED
QUALITY OF LIFE
Pediatric HRQL (health related quality of life )
Cerebral Palsy Quality of Life Questionnaire for
Children (CPQOL-Child)
