Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Neuro extras > Cerebral Palsy Part 1 > Flashcards

Cerebral Palsy Part 1 Flashcards

1
Q

What causes CP?*

A

Due to static lesion in CNS occurring

during pre/peri/neonatal periods!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Actual manifestations, or presentation will

A

change over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Five essential elements:

A

– Group of disorders
– Permanent but not unchanging
– Disorder of movement and/or posture and motor function (SUPER IMPORTANT)
– Due to non-progressive etiology
– Etiology arises in developing/immature brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CP is the most common cause of

A

physical disability

in developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prevalence over time?

A

Not declined because many more babies survive after born prematurely like 24 week gestation due to technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prenatal Associated Factors

A
  • Prenatal Malnutrition
  • Poor Maternal Prenatal Condition

• Maternal Infection*

  • Urinary tract infections
  • Viral Infections (Rubella, Cytomegalovirus)
  • Intrauterine infection – Causes fetal inflammation leading to CNS damage

• Multiple Gestation (placenta providing nutrition for multiple babies)
• Genetic/chromosomal anomalies• Thyroid disorder and treatment with
thyroid hormone
• Treatment with estrogen, progesterone
• Seizure disorder
• Bleeding in third trimester (prenatally born babies receive 02 support which put pressure on their vulnerable vessels, causing them to bleed)*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Perinatal Risk Factors

A

– Preterm births

– High or Low birth weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Postnatal factors

A 
– Trauma (dropping)
– Near Drowning
– Shaken Baby Syndrome
– Infections
– Infectious and toxic substances exposure
– Tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Three types of lesions:

A

– Hemorrhage

– Encephalopathy from anoxia/hypoxia

– Brain malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Prevention:

For encephalopathy

A

therapeutic hypothermia
reduces infant mortality and major
neurodevelopmental disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prevention: during premature labor to decrease frequency mod-severe CP in preterm infants

A

Maternal administration of magnesium sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prevention: in vitro fertilization

A

Avoidance of multiple embryo implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Topographic Distribution (4)/ distribution of tone

A

– Monoplegia

– Diplegia (more tone in LE than UE)

– Hemiplegia

– Quadriplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spastic CP: where in brain and presentation

A

motor cortex, white matter projections
– spasticity and hyperreflexia resulting in atypical posture
and movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dyskinetic CP: where in brain and presentation

A

basal ganglia
– Dystonia - involuntary sustained or intermittent m. contraction with repetitive movements and atypical posture
– Athetosis - involuntary distal writhing movement, poorly graded proximal voluntary movement, underlying hypotonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ataxic CP: where in brain and presentation

A

cerebellum

– Lack of normal or expected voluntary movement (weak core, so strengthen their core)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mixed CP: presentation

A

– Spasticity and dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GMFCS level 1* : walks with, limitations in

A

– Walks without restrictions

– Limitations in more advanced gross motor skills (speed, balance, coordination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GMFCS level 2* : walks with, limitations in

A

– Walks without assistive devices

– Limitations walking outdoors and in the community (uneven terrain, jumping, need person support them on stairs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GMFCS level 3* : walks with, limitations in

A

– Walks with assistive mobility devices (crutches, canes, wheelchair)
– Limitations walking outdoors and in the community (walks stairs with supervision, creep on stomach without leg movements)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GMFCS level 4* : walks with, limitations in

A

Self-mobility with limitations (creep and crawl on short distances. Physical assist one or two persons required. Powered wheelchair is best for them)
– Transported or used power mobility outdoors and in the community

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GMFCS level 5*: walking ability, limitations

A

– Self-mobility is severely limited even with use of assistive technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Prognosis: Growth Curves

A

90% potential reached at 3 years for Level V

and at 5 years for Level I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Strongest predictor of walking ability for all types of CP

A

Cognitive functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CP correlated with presence of (3)

A

Visual and hearing impairments and

epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

By Age 8: Plegias Diagnosis and prognosis for functional ambulation percentages

A

– Mono/Hemiplegia - 100%
– Diplegia – 60-90%
– Quadriplegia – 0-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

By Age 8: Prognosis for functional ambulation with motor function Best predictor

A

– Sit independently by 2 – GOOD Best predictor

• If not sitting by 3, POOR (important to sit due to postural control, indicates great chance for child to walk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Spasticity definition

A

velocity-dependent resistance of
muscle to stretch, excessive inappropriate
involuntary muscle activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What leads to spasticity for people with CP

A

UMN injury leads to decreased cortical input to reticulospinal and corticospinal tracts.
Loss of descending inhibitory input through reticulospinal tract increases excitability of alpha motor neurons (extrafusal) and gamma motor neurons (intrafusal) leading to spasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hypoextensibility of Muscle with CP patients

A

• Mechanical changes in muscle
– Resistance to passive stretching at a
shorter length than normal muscle

• Contractures
– Accumulation of collagen in muscles
– Decreased muscle performance
– Muscle Imbalance
– 2 joint muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Nature of spastic muscles

A

• Reduced maximal neuromuscular activation
• Type-1 fiber predominance (some
disagreement)
• Fatty replacement
• Short and stiff muscle fibers
• Grow at slower rate than bones (55% rate)

32
Q

Muscle strength with Children with CP

A

unable to generate normal
voluntary force in a muscle or normal torque
about a joint/ lever arm biocmechanics

• Inappropriate co-activation of antagonistic muscles

33
Q

How muscle changes with CP affects the skeletal system and what deformities come up

A

• Delayed skeletal maturation (no weight
bearing therefore lacking ossification)•

Skeletal Deformities
– Leg length discrepancies
– Lower limb deformities
– Congenital talipes equinus varus (Club feet)
– Other foot deformities
34
Q

Joint Deformities: causes and prevalance in GMFCS levels 1 and 5

A

Hip subluxation and dislocation (lack weight bearing prevents femoral head to dig into acetabulum)
– Not seen in Level I
– 90% in Level V

35
Q

What happens when you see child with LLD with hip subluxation?

A

Refer to orthopedic surgeon, re access every time you see the kid as the LL can change.

36
Q

Neuromotor System: Poor selective control

A

– Co-contraction of agonists and antagonists
– Reduced speed, mirror movements ( child reaches with right arm but left arm also reaches to the right. Dangerous when baby needs left hand to grab a handle) , abnormal reciprocal activation

37
Q

Neuromotor System: poor control in which areas

A

Postural, balance, coordination, motor control

38
Q

Gait issues

A 
Toe walking, crouched gait, scissoring gait,
windblown pelvis (pelvis swayed sideways), intoeing, out-toeing, leg length discrepancy, subluxation/dislocation, bony abnormalities, scoliosis, kyphosis, lordosis
39
Q

Atypical movement

A
  • Delayed postural reactions
  • Persistence of primitive reflexes – is the best strategy they have!
  • Delayed movement onset, poor timing of force generation, poor force production, decreased speed of movement, increased co-contraction
40
Q

Medical Management of Spasticity: Oral Meds, when to use them

A

Night

41
Q

Medical Management of Spasticity: Botox, what does it do and rules of administering

A

Decreases ACH release to the muscle to paralyze it. Rule is giving botox injects to the child’s individual muscles 3 months at a times. Only use 12 months to botox because over time, you cannot recruit a paralyzed muscle and deperipheralize the CNS.

42
Q

Medical Management of Spasticity: Alcohol (etyl/phenol), what does it do?

A

nerve block

43
Q

Medical Management of Spasticity: Baclofen, what does it do, two ways to administer, dosage

A

GABA agonist

  1. Oral (bad for weak child as it affects child systemically)
  2. ITB/ Intrathecal

Low dose for who is really stiff and risk of bedsores and difficulty going on assistive device.

44
Q

Medical Management of Spasticity: SDR/ Selective dorsal rhizotomy

A

Cut some sensory nerve fibers that come from the muscle and enter the spinal cord. Using EMG to see which LE muscle rootlets cause spasticity, these are cut.

45
Q

Soft tissue surgeries

A

– tendon lengthening
• May lead to effective weakening of MTU
– tendon transfers

46
Q

Bony surgeries

A

– Arthrodesis ( fuse unstable joints)

– Derotational osteotomy

47
Q

Spinal Surgeries

A

Neuromuscular scoliosis – spinal stabilization

48
Q

Pros of orthopedic surgery for CP patients with different GMFCS levels

A
  • Improve ambulation – GMFCS levels II and III
  • Pain Free sitting – GMFCS levels IV and V (preventing skin breakdown)
  • Hygiene
49
Q

Botox done when

A

Early spasticity management to prevent
deformity/contractures
– Botox 2-6 y.o.

50
Q

What surgeries done while growing

A

Soft tissue surgeries– Heel cord lengthenings most effective after 6 y.o.
– Adductor tenotomy and iliopsoas recession to prevent hip dislocation

51
Q

What surgeries done after growth

A

Bony surgeries– Derotational osteotomy after 8 y.o.

52
Q

Orthopedic surgery is effective in

A

adolescents and

young adults!

53
Q

Gross Motor Function Measure (GMFM): Purpose

A

– Measure gross motor function in children with CP
– Evaluate the magnitude of change over time or after intervention
– Determine goals

54
Q

Gross Motor Function Measure (GMFM): Norm vs criterion referenced*

A

Criterion referenced

55
Q

Gross Motor Function Measure (GMFM): For who

A

– No specific age
– Test validated on children 5 months to 16 years
– A TD child of the age of 5 should be able to perform all skills in all dimensions

56
Q
  • Can GMFM be adapted for use in infancy below

age of 2?

A

some
issues – 66 doesn’t encapsulate and 88 doesn’t
give credit for immature skills

57
Q

Manual Muscle testing be a reliable
measure of muscle strength in children with CP?
What is the best alternative?*

A

May not

• Muscle testing in functional activities and hand held dynanometry

58
Q

Modified Ashworth scale (MAS) used for grading of spasticity/ tone: 0,1, 1+, 2, 3, 4

A

0: No change in muscle response to flex/ext

1 : A slight catch and release or by minimal resistance at end of ROM
when affected part is moved in flex/ext

1+ : Slight increase in muscle resistance into flex/ext followed by minimal resistance throughout
remainder (less than 1⁄2) of ROM

2: Notable increase in muscle resistance throughout most of
range but joint is easily moved

3: Marked increase in muscle resistance, passive movement
is difficult into flexion or extension

4: Affected part is rigid into flex/ext when passively moved

59
Q

Tardieu Scale: Differentiates between… More reliable than…

A

• Differentiates between tone and
contracture
• More reliable than Ashworth Scale (it doesn’t give info on when does the muscle fire, like hamstrings fires too early, person unable to swing their feet over as far as they should, resulting in decreased step length)

60
Q

Modified Tardieu Scale: R1 and R2

A

– R1: angle of resistance (fast stretch)

– R2: angle of PROM (slow stretch to see how much extensibility that patient has)

61
Q

Most considered sensory deficit for CP patients ***

A

• Pain***

• Precise assessment of light touch, proprioception,
sharp/dull, 2-point discrimination difficult

62
Q

Pain is most prevalent in…

A

More prevalent in females, older, GMFCS level V

63
Q

Visual-Motor deficiencies and what to do when you observe them

A

– Strabismus – double image
– Difficulty separating eye movement with head
movement – inconsistent feedback, poor
perceptual base
– Behavioral vision therapy, prism lenses
(observe if children are closing their eyes when taking steps!)
- Refer them to neuro ophthalmology

64
Q

Most considered cognitive deficit for CP patients

A

learning!

65
Q

What are you trying to prevent with CP patients

A

Contractures

66
Q

What are you trying to facilitate

A

That treatment is working by reaccessing

67
Q

Nutrition considerations in PT eval

A

– Required for dendritic proliferation, myoneuronal junction efficiency
– Hydration for healthy fascia
– Increased risk of osteopenia
– Often less nutritive caloric consumption than is
required

68
Q

NMES/ Neuromuscular electrical stimulation: what does it do (3)

A

• Stimulation of muscle through its motor
nerve
• Improve ROM
• Decrease in muscle tone (muscles that are tight and short are the ones we want to apply E-stim to)

69
Q

FES/Functional electrical stimulation

A

When NMES serves as orthosis or
functional assist

  • Muscular Implantation of electrodes
  • Used simultaneously with exercise programs – activation of weak muscles during stance , unilateral loading, weight transfer, limb advancement
70
Q

Segmental Assessment of Trunk Control (SATCO): what is it measure, reliability

A

Static, active, reactive trunk control in different levels of support down the body, from shoulder girdle (level 1, head control SATCo level) to no support/ straps removed ( level 7, full trunk control SATCo level)

Good reliability!

71
Q

Whole Body Vibration: Single Session

A

Reduced reflex excitability, hypertonicity, coordination deficits and mobility in children and adults with CP

72
Q

Whole Body Vibration: Multiple Sessions

A

improved muscle mass and bone mineral density (BMD)

73
Q

Whole Body Vibration: General benefits

A

Reduced spasticity, improved GMFM,

improved strength, improved gait and mobility

74
Q

Treadmill Training: Scientific Basis (4)

A
  • Motor learning
  • Prolongation of stepping (more step on treadmill than being on ground)
  • Muscle strengthening
  • Velocity (changing treadmill speed imposes higher velocities)
75
Q

Treadmill Training: Why is Velocity important?

A

Hitting the threshold speed is what it takes to get from stepping to walking, the self selective speed is the speed which you go automatic. When kids walk slow, they never reach that threshold/automaticity place.

Peds Neuro extras (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions