Cerebral Palsy + Cognitive Impairment

Question 1

Is cerebral palsy a diagnosis?

Answer 1

No

Question 2

Definition of cerebral palsy?

Answer 2

Disorder of movement and posture:

Permanent, non-progressive

Due to defect/lesion in developing brain

Question 3

Prevalence

Answer 3

0.2% of live births

Increases with low birth weight or premature births

Question 4

Casues of cerebral palsy…

Answer 4

1. Prenatal causes 70-80%
   - congenital infections (TORCH)
   toxoplasmosis, rubella, cutomegalovirus, herpes)
   - vascular (stroke) in developing foetus
2. Perinatal 8-10%
   = hypoxia (cord around the neck), hypoglycaemia, severe jaundice, prolonged seizures
3. Postnatal (10%)
   Head injury, meningitis

Question 5

Different typea of physical affects on body

Answer 5

1. Spastic- increases tone (1-4 limbs)
2. Dyskinetic (dystonic
3. Hypotonic (decreased tone)

Question 6

Types of cerebral palsy
4

Answer 6

1. Monoplegia = 1 limb
2. Hemiplegia = 1 side of the body (1 arm, 1 leg)
3. Diplegia = symmetrical half (both legs or both arms)
4. Quadriplegia = all 4 limbs

Question 7

What is spasticity??

Answer 7

Velocity dependant resistance to movement

Affects 75%!!

Increased muscle tone, tendon reflexes

Affects mobility, ADL

Question 8

What is Dyskinetic… Cerebral palsy

Answer 8

1. Tone fluctuations in location and type = different muscle groups at different times
   =fluctuates between hypertonia (increased tone) and hypotonia (low tone)
2. Abnormal involuntary movements
   = rapid jerking movements (chorea)
   = slow withering movements (athetosis)

Question 9

Gross Motor Functional Classification System (GFMC)

5 LEVELS!

Answer 9

L1= AMBULATORY in all settings

L2= walks without aides, but has limits in community settings

L3= walks with aides

L4= mobility requires wheelchair

L5= dependant for mobility

Question 10

What % of cerebral palsy has intellectual disabilities?

Answer 10

40 - 50 %

Question 11

Associated conditions…

What % of cerebral palsy have epilepsy

Answer 11

Up to 50% children
Up to 20% adults

(General population = 1%)

Question 12

What are other associated conditions with cerebral palsy?

Answer 12

• reflux
• dysphagia
• underweight/ overweight if immobile
• nutritional deficiencies (iron and folate)

-chronic lung disease (common cause of death)
> aspiration, chest infections

• genitourinary problems
  > urinary incontinence, retention, infections
• musculosketal
  > spasticity, Osteoporosis (from longterm anticonvulsant therapy)

Question 13

What is sialorrhoea?

Answer 13

Drooling

Due to low muscle tone with poor lip closure

Question 14

How does ageing affect the existing conditions of a person with cerebral palsy?

Answer 14

Leads to
Deterioration of existing conditions

1. Mobility deterioration
2. Sensory impairments
3. Dysphagia

Question 15

Common medications used
7

Answer 15

1. Anticonvulsants (may be multiple)
2. PPIs
3. Laxatives
4. Anti spasmodics (baclofen, benzos)
5. Prophylactic antibiotics (esp in winter)
6. Nebulised meds (brochodilators, steroids)
7. Analgesics (panadol, pregablin)

Question 16

Do all patients with cerebral palsy have an intellectual disability?

Answer 16

No.

Usually have communication impairment but understand more than they can say.

Question 17

What is AAC communication system?

Answer 17

For people with communication impairments:

Augmenting and alternative communication systems
Eg

Gestures, body language, signs, communication boards, speech generating apps