Cerebral Palsy (Part 1) Flashcards
(91 cards)
1
Q
Define Cerebral Palsy
A
A group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain
2
Q
The motor disturbances of CP are often accompanied by disturbances of what?
A
- sensation
- perception
- cognition
- communication
- behavior
3
Q
__% of children with CP have mental retardation, when combined with the slow learners and persons with disabilities that number climbs to __%
A
40
75
4
Q
Epilepsy occurs in __% of children with CP
A
35
5
Q
Visual impairments occur in __% of children with CP
A
20
6
Q
Hydrocephalus occurs in __% of children with CP
A
9
7
Q
What is a way to distinguish CP from other diagnoses?
A
CP is nonprogressive
8
Q
True or False
No upper age limit has been determined for postnatal onset of CP
A
True
9
Q
Why has there been an increase in the prevalence of babies with CP?
A
There is increased survival of preterm and very preterm babies
10
Q
The incidence of CP is - per every 1000 live births
OR
_ in every 300 babies
A
2-3
1
11
Q
The prevalence of CP in twins is said to be __ per every 1000 live births
A
15
12
Q
The prevalence of CP in triplets is said to be __ per every 1000 live births
A
80
13
Q
The prevalence of CP in quadruplets is said to be __ per every 1000 live births
A
43
14
Q
75% of all CP cases are due to what?
A
Changes in prenatal brain development
15
Q
What are some potential prenatal (before birth) causes of CP?
A
- vascular events such as middle cerebral artery infarct
- maternal infections during the 1st and 2nd trimesters
- metabolic disorders
- maternal ingestion of toxins
- rare genetic syndromes
16
Q
What are some potential perinatal (during birth) causes of CP?
A
- obstructed labor
- antepartum hemorrhage
- cord prolapse
- hypoxic-ischemic encephalopathy
- untreated jaundice
- severe neonatal infection
17
Q
Perinatal asphyxia is though to cause -% of CP
A
6-8
18
Q
What percentage of CP is thought to be caused postnatally?
A
10-18%
19
Q
What are some potential postnatal (after birth) causes of CP?
A
- metabolic encephalopathy
- infections
- injuries
20
Q
What are some maternal characteristics that are associated with a higher likelihood of CP development?
A
- delayed onset of menstruation
- irregular menstruation
- long intermenstrual intervals
- unusually short or long interval between pregnancies
21
Q
What paternal characteristic is associated with a higher likelihood of CP development? What specific type of CP?
A
advanced age
athetoid dystonic CP
22
Q
What are the likely causes of perinatal asphyxia?
A
- prolapsed cord
- massive intrapartum hemorrhage
- prolonged or traumatic birth
- large baby with shoulder dystocia
- maternal shock
23
Q
What APGAR scores are associated with an 81-fold increased risk of CP?
A
0-3 a 5 minutes
24
Q
Why is the diagnosis of CP so difficult?
A
The immature brain has much more plasticity, which allows for the uninjured part to assume the function of the injured part of the brain
25
When will a child be diagnosed with CP prior to 2 years of age?
The present with:
- abnormal muscle tone
- atypical posture
- movement with persistence of primitive reflexes
26
Milder cases of CP may not be diagnosed until _-_ years of age
4-5
27
What are the 3 key elements when diagnosing CP?
- evaluation of motor skills
- neuroimaging
- evidence that symptoms are not progressing
28
What neuroimaging studies can show the location and type of brain injury?
- cranial ultrasound
- CT
- MRI
29
What neuroimaging technique is preferred?
MRI
30
When is cranial ultrasound used? Why?
In high-risk preterm infants, because it is less invasive then other techniques
31
When neuroimaging is unremarkable, what should you suspect next?
Other disorders that mimic the diagnosis of CP, such as metabolic or mitochondrial disorders
32
Cerebral hemorrhages may be associated with CP, what are the 3 types of hemorrhages? Describe each
- Intraventricular hemorrhages (IVH): bleeding into the ventricles
- Germinal matrix hemorrhages (GMH): bleeding into the tissue around the ventricles
- Periventricular intraventricular hemorrhages (PIVH): bleeding into both areas
33
What may form in the area where the bleed occurred once the acuteness has resolved?
Periventricular cyst (PVC)
34
What are 2 known risk factors for hemorrhages?
- mechanical ventilation
| - injury during critical periods of brain development
35
When is the periventricular white matter most sensitive to insult? What is the most predominant cause of this?
Between 24-34 weeks of gestation
Mother uses drugs
36
What are the grades of hemorrhages from least to most severe?
Grade I
Grade II
Grade III
Grade IV
37
True or False
The grade of the hemorrhage is enough o predict the development or severity of CP
False
38
Prudent obstetrical care can help reduce the risk of CP, what does this include?
- Management of preeclampsia with magnesium sulfate
- Management of infections with antibiotics
- Management of preterm labor with corticosteroids
39
What is the major cause of CP in infants born preterm?
cystic periventricular leukomalacia (PVL)
40
Other than neuroimaging techniques doctors tend to analyze what 2 things?
- the infant's "general movements" (GMs)
| - cognitive abilities
41
What is the first and the second strongest predictor if survival of the child with CP?
1) intellectual ability
| 2) severity of the physical impairments
42
What are the most common causes of mortality in kids with CP?
- respiratory and circulatory system impairments
- certain cancers
- neurologic complications
43
What are the 3 ways in which movement disorders can be classified?
- type of movement disorder
- anatomic location of the child's impaired motor function
- scope of motor dysfunction
44
What are the 5 types of movement disorders?
- spastic
- hypotonic
- dyskinetic
- athetoid
- ataxic
45
Spasticity occurs in approximately __% of all children with CP
75
46
Define spasticity
Increased resistance to passive movement which increases with increased velocity of movement
47
What scale is the most widely used scale for assessing spasticity?
Modified Ashworth Scale
48
Describe the scoring system for the MAS
```
00 = hypotonia
0 = normal tone
1 = slight increase in tone manifested by a slight catch and release or min resistance to joint ROM
1+ = slight increase in tone manifested by a slight catch and minimal increased resistance to joint ROM for half of the joint range
2 = more marked increase of tone though most of the whole joint (the affected joint is easily moved)
3 = considerable increase in muscle tone; passive movement difficult but possible
4 = affected joint is stiff and cannot be moved
```
49
What treatment methods does spastic CP respond to?
- Botox
- baclofen
- selective dorsal rhizotomy
- orthopedic surgery
50
Muscle changes associated with spastic CP can cause what secondary disorders?
- hip dislocation
- scoliosis
- knee contracture
- torsional malalignments of the femur and tibia
51
What are the 3 classifications based on anatomical location of the impaired motor function?
- diplegia
- hemiplegia
- quadriplegia
52
What is the most common form of spastic CP?
diplegia
53
What leads to spastic CP?
white matter infarct in the periventricular areas
54
Describe the presentation of a child with spastic diplegic CP
- increased lumbar lordosis
- anterior pelvic tilt
- B hip internal rotation
- B knee flexion
- intoeing
- equinovalgus foot position
55
What is the largest concern for kids with spastic diplegic CP?
Gait deficits such as equinus and crouched gait posture
56
Describe spastic hemiplegic CP
the child's upper and lower extremity on the same side of the body are affected
57
What are the 4 main types of brain lesions that result in hemiplegic CP?
- periventricular white matter abnormalities
- cervical-subcortical lesions
- brain malformations
- nonprogressive postnatal injuries
58
Which extremity is more affected in spastic hemiplegia? Is the involvement more proximal or distal?
upper
distal
59
Describe the presentation of children with spastic hemiplegic CP
- shoulder protraction
- elbow flexion
- wrist flexion and ulnar deviation
- pelvic retraction
- hip IR and flexion
- knee flexion
- forefoot contact (due to plantarflexed feet)
60
Do children with hemiplegia achieve all gross and fine motor milestones?
Yes, but not within the typical time frame
61
When do children with hemiplegia begin to walk?
18-24 months
62
What are 2 standardized assessments that are used to evaluate the quality of UE function on children with hemiplegia?
- SHUEE
| - Assisting Hand Assessment (AHA)
63
Is cognitive function impaired in children with spastic diplegia or hemiplegia?
No, but they tend to have social and emotional deficits
64
What is spastic quadriplegic CP?
A subtype of CP in which volitional muscle control of all 4 extremities is severely impaired
65
What are the most common neuroimaging findings in children with spastic quadriplegia?
periventricular white matter lesions
66
Typically damage to what spinal tract leads to spastic diplegia? When does it result in quadriplegia?
cortical spinal tract
when it extends laterally
67
Is cognition impaired in children with quadriplegic CP?
It depends on the child and can range from normal to severely impaired
68
Define dyskinesia
Uncontrolled and involuntary movement
69
Dyskinesia typically occurs because there is damage it what brain area?
Deep gray matter lesions, and to a lesser extent periventricular white matter lesions
70
What does dyskinesia include?
- athetosis
- rigidity
- tremor
- dystonia
- ballismus
- choreoathetosis
71
Describe athetosis
involuntary movements that are slow and writhing, abnormal in timing, direction, and spatial characteristics
72
Athetoid movements usually effect what joints?
proximal joints
73
Athetosis is often found in combination with what other dyskinetic movement pattern?
chorea
74
What sensory and motor feed-forward and feedback circuit results in athetosis when impaired?
cortical-basal ganglia-thalamic loop
75
What are older individuals with athetoid CP at risk for acquiring?
Devastating neurological deficits owing to IVD degeneration and instability in the C-spine (most notably C5-C6)
76
How do individuals with athetoid CP typically initiate and attempt to control of movement?
with the jaw and head
77
Is cognitive function impaired in children with athetoid CP?
No, they tend to have normal or above normal intelligence levels
78
What can be defined as a rhythmic movement of small magnitude, that usually affects smaller joints?
tremor
79
Tremors are rarely the only isolated disorder in CP, and are more commonly found in combination with what disorders?
- athetosis
| - ataxia
80
What can be defined as a slow motion with a torsional element that may involve one limb or the entire body
dystonia
81
What is the most rare dyskinetic movement disorder that involves random motion in large, fast patterns usually of a single limb?
Ballisnus
82
What dyskinetic movement disorder involves jerky movement, commonly of the digits and varies in ROM?
choreoathetosis
83
Describe ataxic CP
it is a disorder of balance and control in the timing of coordinated movements along with weakness, incoordination, a wide-based gait, and a noted tremor
84
Damage to what area of the brain results in ataxic CP?
cerebellum
85
What do children with ataxic CP have the most difficulty with?
transference of skills
May benefit from a specific task-oriented approach to treatment
86
Hypotonia in a child with CP can be permanent, but is often transient in the evolution of what?
athetosis or spasticity
87
Hypotonia is commonly seen as part of a mixed tone presentation, what does this mean?
Some children with quadriplegia may present with spastic LEs and hypotonic UEs
88
In summary, damage to the cortex tends to lead to what type of CP? Damage to the basal ganglia tends to lead to what type of CP? Damage to the cerebellum tends to lead to what type of CP?
spastic (hemiplegia, diplegia, quadriplegia)
dyskinetic (athetoid, dystonic)
ataxic
89
What classification system is based on gross motor function of children with CP?
Gross Motor Functional Measure (GMFM)
aka Gross Motor Functional Classification System (GMFCS)
90
The GMFCS helps to measure what?
the severity of movement disability
91
Describe the levels of the GMFCS
- Level I: independent
- Level II: walks without assistive devices; limited in outdoor and community level ambulation
- Level III: walks with assistive devices; limited in outdoor and community level ambulation
- Level IV: self-mobility with limitations; children are transported or use power mobility outdoors and in community
- Level V: difficulty controlling all movements; self mobility is severely limited even with use of assistive technology.
