Cerebral Palsy (CP)

Question 1

CNS vs PNS

Answer 1

CNS

• UMN: cortical
• other: basal ganglia, cerebellum

Question 2

definition

Answer 2

a 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

Question 3

motor disorders are accompanied by

Answer 3

disturbances of sensation, perception, cognition, communication, and behavior by epilepsy, and secondary musculoskeletal problems

Question 4

prevalance/incidence

Answer 4

8 year old children

3 in 1,000

Question 5

pathogenesis/etiology

Answer 5

brain malformations
brain lesions
-white matter damage
-grey matter damage
-focal vascular insults

Question 6

disease course

Answer 6

may be present at birth but not identified
0-2 y:atypical motor development identified, CP diagnosed
childhood:increase in motor function
after 8 y, high risk for decline in function due to inability to maintain function with growth and secondary musckuloskeletal conditions

Question 7

clinical findings

Answer 7

spasticity (damage to cortex cortical spinal track)
inc reflex activity (damage to cortex cortical spinal track)
involuntary movements (basal ganglia injury)
insufficient force generation
atypical extensibility of muscles
impaired selective control of muscle activation (motor cortex or corticalspinal tract)
impaired anticipatory postural control

Question 8

long-term consequences

Answer 8

25% experience mobility decline
84% significant pain
59% hip and back deformities
malnutrition/obesity
fatigue
OA
osteoporosis

Question 9

classifications

Answer 9

movement abnormality resulting from common brain lesions
function using the Gross Motor Function Classification System
neuroanatomical findings

Question 10

classifications-movement abnormality

Answer 10

pyramidal/spastic (97%)
-defects or damage to the motor cortex or corticospinal pathways
extrapyramidal (3%)
-damage to nerve cells/neural pathways in the basal ganglia or cerebellum

Question 11

pyramidal/spastic

Answer 11

hemiplegia-involvement of UE and LE on one side of body
diplegia-LE more involved than UE
quadriplegia- involvement of all four extremities and trunk

Question 12

extrapyramidal

Answer 12

ataxic

dyskinetic

Question 13

ataxic

Answer 13

s/s: characterized by general instability of movement
function: GMFCS 4-5
brain areas affected: cerebellum
common MRI findings: MRI normal

Question 14

dyskinetic

Answer 14

s/s: characterized by intermittent muscular tension of extremities/trunk and involuntary movement patterns,
function: GMFCS 4-5
brain areas affected: cortical-basal ganglia-thalamic loop
common MRI findings: gray matter injury

Question 15

GMFCS

Answer 15

lvl 1: walks without restrictions
lvl 2: walks without AD
lvl 3: walks with AD
lvl 4: self-mobility with limitations
lvl 5: self-mobility severely limited

Question 16

Prognosis based on GMFCS

Answer 16

lvls 3-5 decline with age

Question 17

classifications-malformations

Answer 17

abnormal proliferation
abnormal neuroblast migration
abnormal neocortical organization

Question 18

periventricular leukomalacia

Answer 18

involves necrosis of the white matter dorsal and lateral to the external angles of the lateral ventricles

Question 19

intraventricular hemorrhage

Answer 19

a hemorrhage of the germinal matrix which lines the ventricles, it also damages the white matter tracts

Question 20

spastic hemiplegic

Answer 20

s/s: inc tone/spasticity 1 side of body UE & LE
function:GMFCS 1-3
brain areas affected: motor cortex or white matter projections to and from the cortical sensorimotor areas
common MRI findings: focal vascular insult

Question 21

spastic diplegia

Answer 21

s/s: inc tone/spasticity LE>UE
function:GMFCS 1-3
brain areas affected: motor cortex or white matter projections to and from the cortical sensorimotor areas
common MRI findings: white matter injury

Question 22

spastic quadriplegic

Answer 22

s/s: inc tone/spasticity UE and LE
function:GMFCS 4-5
brain areas affected: motor cortex or white matter projections to and from the cortical sensorimotor areas
common MRI findings: gray matter injury

Question 23

diagnosis

Answer 23

medical history-birth defects, placental abnormalities, lesions during perinatal period, neonatal seizures, infections
clinical exams-atypical tone, reflexes, movement control, abnormal motor development
neuroimaging studies-MRI, cranial US

Question 24

medical management-maximize function and participation

Answer 24

foster autonomy, belonging, competence
child-active rehab: function
assistive technology

Question 25

medical management-minimize/prevent secondary impairments

Answer 25

spasticity management
musculoskeletal management
pain management
nutrition management
fitness programs

Question 26

key concepts

Answer 26

early identification is essential for optimal outcome
a clear differential diagnosis is required (if significant decline in function is noted, it is not likely CP and further diagnostic testing is required)
children diagnosed with CP need a body that lasts a lifetime