Cerebral Palsy Managment

Question 1

Prognosis
- Critical Milestones

Answer 1

Upright sitting/standing
Independent ambulation

Question 2

When independent sitting is not achieved by this age, there is very little chance of achieving functional independent walking

Answer 2

3 y/o

Question 3

True or False
Independent sitting by 24 months is the best predictor of ambulation

Answer 3

True

Question 4

Children with a GMFM score of 56

Answer 4

This means they have a 50% chance of walking ten steps unsupported

Question 5

Principles of Treatment in CP

Answer 5

Family-centered and relationship-focused services
Address child and family priorities and information needs
Effective communication and coordination with other service providers
Goal focused
Individualized intervention plans
Attention to relationship among body fxns and structures, activities and participation within the context of personal and environmental factors

Question 6

Principles of Treatment in CP
- Goal focused

Answer 6

Meaningful to and set collaboratively with child and family
Achievable
Revisited regularly

Question 7

Principles of Treatment in CP
Pt 2.

Answer 7

Management of health and co-morbidities
Prevention of secondary impairment or functional deterioration
Goal-related activities
Incorporate motor learning strategies

Question 8

Principles in CP Pt 2
- Goal-related activities

Answer 8

Age and devleopmentally appropriate
Active rather than passive
Functional
Fun and motivating
Challenging

Question 9

Principles in CP Pt 2
- Incorporate motor learning strategies

Answer 9

Problem-solving
Task specificity
Active trial and error
High-frequency of practice
Self-correction, exploration
Learning and practice in real-life enviornments
Compensations, task modifications, or environmental adaptations to accommodate a child
Life span approach

Question 10

Infancy

Answer 10

Early intervention
Family education
Collaborative goal setting
Optimizing learning through movement
Facilitate environmental exploration
Promote spontaneous and voluntary movements
Take advantage of neuroplasticity

Question 11

Spasticity
- Why?

Answer 11

Improving function
Preventing secondary impairments such as contractures and pain
Reducing the need for orthopedic surgeries

Question 12

Spasticity
- How?

Answer 12

Stretching for short-term reduction
Oral/intramuscular/intrathecal medications
Botox for muscles that have good ROM but are spastic and prone to developing contractures
Selective Dorsal Rhizotomy

Question 13

Spasticity
- How?
– Botox

Answer 13

Botox + therapy
Commonly used for calf muscles (equinus), UE and hip adductors
Often combined with casting, orthotics, night splinting, positioning and targeted motor training

Question 14

Spasticity
- How?
– Selective Dorsal Rhizotomy

Answer 14

Neurosurgical process
60-70% of the sensory nerve rootlets to the LE are cut selectively

Question 15

ROM

Answer 15

Passive stretching via casting, orthoses or positioning
Active stretching during functional activities
Combination of positioning, serial casting and botox is often used
Joint integrity

Question 16

ROM
- Joint integrity

Answer 16

Hip subluxation
Sleep positioning
Seating
Abduction bracing
Botox
Orthotics
Taping or theratogs

Question 17

Muscle weakness

Answer 17

Functional activities like sit to stand, step up and down, overhead activities, bimanual activities, single leg standing, etc
Intensity matters

Question 18

Neurodevelopment Treatment (NDT)

Answer 18

Known as the Bobath approach
Initially based on the neuromaturation theory
Evolved over the years with a shift towards function
Not effective for improving motor function in children with CP

Question 19

Motor learning based approaches

Answer 19

Constraint induced movement therapy (CIMT)
HABIT (hand-arm bimanual intensive training)
HABIT-ILE (Habit including lower extremities)

Question 20

Electrical stimulation

Answer 20

Functional Electrical Stimulation (FES)

Question 21

Hippotherapy

Answer 21

Utilizing the triplanar movement of the horse, which closely resembles the human pelvic motion during gait
Movements of the horse are utilized to promote relaxation, increase ROM, strengthening, proximal control, and so on toward a functional outcome