Cerebral Palsy Neuro Conditions Flashcards
What are participation restriction for CP patients?
environmental access, peer related activities, sports/recreational activities, family routines
What is the PSFS?
patient specific functional scale
How is CP defined?
describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances (lesion) that occurred in the developing fetal or infant brain
What are symptoms that often accompany the motor disorder of CP?
distrubance of sensation, perceotionm cognition, communication, and behavior, by epilepsy and by secondary MSK problems
What are the areas of the brain typically implicated in the diagnosis of CP
motor cortex, basal ganaglia, and cerebellum
Why would a person with spastic diplegia CP have more involvement of their legs than their arms and face?
Hemorrhages impacting tracts closer to the vulnerable periventricular region will affect the legs more
Which type of CP is least common based on TOPOGRAPHIC distribution?
tetraplegia or quadriplegia
what are the three types of risk factors for CP?
prenatal
perinatal
postnatal
What are the types of lesions?
hemorrhage
hypoxic ischemic encephalopathy (HIE) often from birth asphyxia
perventricular white mmatter injury
malformation of the CNS
What are the clinical signs of hypoxic-ischemic encephalopathy?
lethargic, decreased activity, hypotonia, weak suck, incomplete Moro, bradycardia
What causes HIE?
lack of O2 and substrate delivery to brain from decreased blood flow– birth or parental aphyxia
What are HIE associated factors/comorbitieis?
cognitive delays, behavorial issues, speech difficulties, auditory problems, seizure disorders, vision issues, urinary incontence, constipation, sensory impairment, growth distrubances and sleep disturbances
How is CP classified?
by topography, type of muscle tone and function
What are the topographic distribution classifications of CP?
hemiplegia or hemiparesis 38%
diplegia 37%
tetraplegia or quadriplegia ~24%
what is the most common topographic distribution of CP?
hemiplegia or hemiparesis
What are the types of CP classified by muscle tone and brain area?
spastic 85-91% motor cortex or white matter dyskinetic 4-7%basal ganglia ataxic 4-6cerebellar lesion mixed atonic/hypotonic (early infancy)
What are the positive signs of spastic CP?
spasticity and hypertonicity
hyperreflexia
retention of some primitive reflexes
clonus
What are the movement system diagnoses of CP?
fractionated movement deficit
force production deficit
motor coordination deficit
** most all types and dsitrubtions have some degree ot the above, the most prevalent impairment will guide where treatment begins
How many levels are there in the GMFCS and what does it stand for?
gross motor function classification system
5 levels
Describe Level I of GMFCS for children 6-12?
level 1= Walks without restriction. Children walk at home, school, outdoors, and in the community. Climb stairs without using a railing. Balance and coordination are limited but can perform gross motor skills.
Describe Level II of GMFCS for children 6-12
Level II– Walks without assistive devices but climbs stairs holding onto railing. May have difficulty walking long distances, balancing on uneven terrain, inclines, or crowded spaces. May walk with assistive or mobility device for longer distances. Minimal gross motor skills.
Describe Level III of GMFCS for children 6-12
Level III-Walks with assistive devices in most indoor settings. Climb stairs using railing or with supervision and or assistance. Wheelchairs are used for longer distances and may propel themselves for short distances.
describe level IV of GMFCS for children 6-12?
Self-mobility with limitations. Require physical assistance or powered mobility in most settings. May walk for short distances at home with assistance or use body support walker or powered mobility. In school or community settings children are transported in manual wheelchairs or use powered mobility.
Describe Level V of GMFCS for children 6-12?
Severely limited self-mobility even with the use of supporting technology. Children are transported in manual wheelchairs in all settings. Limited in ability to maintain antigravity head and trunk postures and control leg and arm movements.
At what age should an experience PT or pediatrician be able to diagnose CP?
6 months
What are the things that children need to have the potential for future independent walking with or without support in CP?
head control by 9 months
rolling supine to prone by 18 months
sitting without arm support by 24 months
reciprocal creeping by 30 months
integration of primitive reflexes by age 2
What types of CP have a 100% ambulation potential?
hemiplegia and dyskinesia/ataxia
What does CAPE and PAC stand for and what are they used for in CP?
CAPE= children's assessment of participation and enjoymen PAC= preferences for activities of children
What tests could you use to measure general participation/ goal setting for CP?
patient specific funcitonal scale (PSFS)
general goal attainmnet scale (GAS)
What is the participation measure for children age 0-5 with CP?
YC-PEM- young children’s participation and environment measure
What is the participation measure for children age 5-17 with CP?
PEM-CY= pariticpation and environment measure for children and youth
What developmental tests measure gross motor skill for younger children or GMFCS levels I and II?
AIMS, PDMS-2, BOT-2
What test is used to help determine the GMFCS level of children with CP?
gross motor function measures (GMFM 66 or 88)
What are the tests you could look at to measure activity/function nor CP?
gross motor skill gross motor funciton measure (GMFM) gross motor performance measure (GMPM) gait balance PEDI- pediatric evaluation of disability inventory school funciton assessment
What tests are most appropriate for children with CP?
GMFM 66 and 88 and the PEDI
What two tests can be used to measure participation or activity?
PEDI of school function assessment
What are the five areas of the GMFM?
evaluate change in GMF in children with CP lying and rolling crawling and kneeling, sitting standing walking, running, jumping *** can be used with or without an AD 5-16 y.o.
What are the five areas of the GMPM?
evaluates the QUALITY alignment coordination stability weight shift dissociated movement **5-12 y.o.
What are the three domains and the three parts of the PEDI?
three domains= self-care, mobility, social function
three parts= functional skills; child capabilities, caregiver assistance, modifications: environment or equipment
What tests of functional strength and or balance are used in both child and adult CP populations?
TUG
functional reach
pediatric balance scale
What are the sensory and pain tests to measure CP for SERMAS?
pain = faces pian scale, FLACC (faces, legs, activity, crying, consolability sensation= tactile, proprioception, vestibular
What are the endurance tests and measure for CP for SERMAS?
vital signs
endurance test= 6MWT, @mWT
muscles power sprint test
10 m shuttle test
What is hypoextensibility in terms of ROM for CP in SERMAS?
muscle tnesion disproprotionate to muscle activity
stiffness— more force for a given length change
-stiffer fiber bundles
overstretched sarcomere in series
higher collagen content
muscle hibers have less cross-sectional area/volume
What are secondary impairments in the MSK system for CP?
muscle tightness/hypoextensibility contractures bony alignment problesm osteoporosis/osteopenia fractures degenerative joint disease overuse syndromes scoliosis
What are the motor control tests for SERMAS for CP?
selective control assessment of the lower extremity (SCALE)– similar to stream for stroke
What is the frequency of strengthing for individuals with CP?
strength 5-40 weeks
What is the frequency of funcitonal training for CP?
6-8 weeks
What is the frequency of treadmill training for CP?
2-12 weeks
what is the frequency of neurodevelopmental treatment for CP?
6-16 weeks
What are green light interventions for a child with CP?
activity focused/context focuses/goal directed functional therapy
fitness training
constraint induced movement therapy
bimanual training
casting for improved range of motion
HEP for improving motor performance self care
strenght/power training
What type of CP is constraint induced movement therapy good for?
UE function of child with hemiplegic CP
**2 hr/day for 60 days
What does bimanual training do?
promotes use of both hemiparetic and dominant hand together
What are the benefits of serial casting for CP?
improved ROM, small changes in ankle DF,
protocol= serial casting for 4-6 weeks with weekly changes, followed by orthotics
What are the 5 components of home program for CP?
develop collaborative relationships
set mutually agreed measurable goals
select therapeutic, routine bases activities
support with communication and reinforcement
evaluate outcomes
What are the yellow light interventions for CP?
assitive technology EI for motor outcomes electrical stimulation hippotherapy hydrotherapy/aquatic orthoses treadmill training theratofs stretching
Why is stretching a yellow light intervention for CP?
limited evidence that manual stretching can increase ROM, reduce spasticity, or improve walking efficiency
no gain in length
clinical implications = night splinting or ppositions for daily routines
Are all infants diagnosed with CP born early or with low birth weight?…
NO
At what age do function levels decline for GMFCS level 3, 4, 5?
after age 8
What is a primary driver of functional limitation in people with CP?
muscular weakness
What type of training will make more improvemments in strength and function than regular training for CP ?
power-based strength training
What are contraindications for power-based strength training in CP?
recent ortho surgery
unable to follow directions of complete action safely
<3 years
unhealed wound
NM disease where strength is contrainidcated
What is the reccommended dose of POWER for power based strength training in CP?
6 sets of 6 reps
60% to 80% of 1 rep max
FAST concentric, SLOW eccentric
What is the reccommended dose for STRENGTH for power based strength training in CP ?
3 sets of 5-8 reps
>80% of `1RM
SLOW and CONROLLED throughout
What balance strategy is typically seen in children with CP, compared to typical peers?
a more proximal than distal initial balance strategy?
with Which gait pattern associated with CP is the major problem increased body size and decreased strength of LEs?
crouch gait
If a child has crouch gait which orthortic would you suggest?
ground reaction force AFO
What gait related test and measures are appropriate for an 8 yo with CP?
TUG, muscle powerr spirnt test,
walk, running, jumping domain of the GMFM-66
What gait related test and measures are NOT appropriate for an 8 yo with CP?
dynamic gait index
Why would a child with CP walk on their toes?
a maintained position of PF requires 1/2 the strength of heel-toe gait
For a 10-year-old child with CP who is classified as a GMFCS level V with severe bilateral lower extremity spasticity and hypertonicity in many muscle groups, which of the following is the best pharmacologic intervention to make a daily hygiene routine easier for a caregiver?
intrathecal baclofen pump
What are the orthopedic procedures done with children with CP?
hemi-epiphysiodesis
varus derotation oseotomy
percutaneous achilles tendon lengthening
What adpated chair is designed to provide a low load stretch to adductors for a child with spastic diplegic CP?
bolster chair
What is the primary role on a team considering a new communication device for a child with CP?
determining the best way for the child to access the device
What are the best tests of postural control in pediactrics?
functional reach test
pediatric balance scale
TUG
P-CTSIB
