Cerebral Palsy (CP) Flashcards
What are the F-words in chldhood disability?
Function
Family
Fitness
Fun
Friends
Future
Challenge yourself to apply these factors in your work with children with disabilities and their families
Define cerebral palsy
- group of permanent disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain
The motor disorders of cerebral palsy are also accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.
Describe the diagnostic process: how would one diagnose & when?
- No diagnostic test
- based on clinical presentation and medical history
- Diagnosis is usually made before the age of 2
True or False: This is the most common motor disability in children, with girls being more impacted than boys
False: more common in boys (57%)
What are the common causes of CP?
- Prematurity
- Low Birth Weight (LBW)
- Multiple Gestation
- Cerebrovascular Accident (CVA)
- Others
Prematurity/LBW commonly leads to:
1. spastic quadriplegia
2. spastic hemiplegia
3. spastic diplegia
4. dystonia
3) spastic diplegia - Prematurity/LBW also commonly see white matter disorder
True or False: Triplets are more likely to get CP compared to twins
True - risk of CP increases with multiple gestations
define hypertonia and what it consists of
“Abnormally increased resistance to externally imposed
movement about a joint”
Consists of:
* Spasticity
* Dystonia
* Rigidity (uncommon in children with CP)
Define spasticity
- Resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or resistance to externally imposed movement rises rapidly above a threshold speed or joint angle
define dystonia
involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
Name the types of CP
Spastic
* Spastic bilateral (spastic diplegia / spastic quadriplegia)
* Spastic unilateral (spastic hemiplegia)
Dyskinetic
* Dystonic
* Choreo-Athetotic
Ataxic
Mixed (presents with both spastic and dyskinetic features)
Which type of CP is most common?
1. bilateral/diplegia
2. unilateral/hemiplegia
3. dystonia
4. bilateral/quadriplegia
2) unilateral/hemiplegia (40%)
How would a spastic hemiplegic pt present?
- Spasticity noted on arm & leg of same side
- Since it affects grey matter, seizures may be present
- Most children walk independently but gross motor milestones are delayed and have difficulty with high level balance skills
What is the leading cause of spastic unilateral CP?
perinatal stroke (MCA infarct) and congenital malformations
Why are legs more often affected by damage to the periventricular leukomalacia than the
arms in spastic bilateral CP?
Because leg fibres of the corticospinal tract run closest to the ventricles
What other medial issues is spastic quadriplegia typically asspciated with?
visual, auditory,
seizures, cognitive, digestive
what is choreo-athetosis?
Slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture
Describe each level of the GMFCS classification system
GMFCS I: Walks without restrictions; limitations in more advanced gross motor skills
GMFCS II: Walks without assistive devices; limitations in walking outdoors and in the community
GMFCS III: Walks with assistive mobility devices; limitations in walking outdoors and in the community
GMFCS IV: Self-mobility with limitations; children are transported or use power mobility outdoors and in the community
GMFCS V: Self-mobility is severely limited even with the use of assistive technology
What is the clinical presentation of CP?
Quite varied!
Gross motor function limitations are due to a combination of:
* musculoskeletal impairments (spasticity, strength, range of motion, skeletal alignment)
* sensory deficits (visual, proprioception, vestibular)
* motor coordination impairments
What are classic muscles affected by spasticity in the UE and LE?
AKA ALL FLEXORS
- U/E: shoulder adductors/IR’s, elbow flexors, forearm pronators, wrist flexors, finger flexors, thumb adductors/flexors
- L/E: hip flexors/adductors, knee flexors, ankle PF’s
Commonly affects bi-articular muscles: biceps brachii, gracilis, hamstrings, gastrocnemius
Spastic muscles are weak muscles. Is this a primary or a secondary impairment?
Primary impairment - longer sarcromeres
How does bone/joint deformities impact a child with CP? What causes this?
- alterations to posture & alignment
Caused by: - abnormal skeletal development
- increased tone pulling on developing skeleton
- abnormal ground reaction force on developing skeleton
Name 3 sensory deficits that could occur with CP
- Decreased proprioception
- Visual impairment
- Vestibular dysfunction (auditory impairment)
What are 2 gait classifications used for individuals with CP?
- Spastic diplegic classification - identifies the static position of each lower limb in mid stance in
the sagittal plane (can be different for each leg) - spastic hemiplegic classification - identifies the static position of the hemiplegic limb in mid stance in the sagittal plane and also may describe the limb position at other phases of the gait cycle
Name some PT goals of treatment with CP pts
- Maximize present and future gross motor function
- Prevent secondary impairments
-
Optimize quality of life
→ Function (mobility, independence, ADL’s)
→ Pain
→ Ease of caregiving for the caregivers
Is CP progressive?
Non-progressive
What is the difference between the Hypertonia Assessment Tool (HAT) and the Modified
Ashworth Scale (MAS) or Modified Tardieu Scale?
HAT: used to classify the type(s) of tone present / MAS or MTS: assessment of severity and location (R2-R1 = degree of “dynamic component” with a large difference meaning they are likely to respond to BTX)
What is the “dynamic window”?
The difference between R1 and R2, the range where tone is having most impact on function
What is the most common orthopaedic condition in CP?
Equinus contracture
What are potential side-effects of botulinum toxin A?
Most common is weakness in adjacent muscles caused by diffusion of BTX and less commonly can cause weakness in more distant muscle groups.
What surgical procedure cuts a percentage of sensory (dorsal) nerve rootlets to decrease excitatory afferent inputs on the motor neuron, to then reduce spasticity?
Selective Dorsal Rhizotomy (SDR)
What does an Intrathecal Baclofen Pump (ITB Pump) do at the spinal cord?
Works at the level of the spinal cord by inhibiting monosynaptic and polysynaptic reflexes possibly by decreasing excitatory neurotransmitter release.
What treatment strategy for dystonia takes advantage of neuroplasticity and neuromodulation?
Deep Brain Stimulation (DBS)
