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Paediatrics > Cerebral Pasly > Flashcards

Cerebral Pasly Flashcards

1
Q

Define cerebral palsy

A

CP describes a group of permanent disorders of the development of movement and posture, causing activity limitations, due to non-progressive disturbances that occurred during the developing fœtal or infant brain. Motor disorder are often accompanies by disturbances of sensation, perception, cognition, communication and behavior; by epilepsy and by secondary MSK problems.

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2
Q

Wh at are the causes of cerebral palsy ?

A
  • hypoxic-ischemic encephalopathy
  • kernicterus
  • TORCH syndrome
  • intraventricular hemorrhage
  • intra uterine growth retardation
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3
Q

What are the risk factors for cerebral palsy ?

A
  • Premature birth
  • low birth weight
  • abnormal cardiotocography
  • gestational age above 41 weeks
  • Low APGAR score
  • prolonged membrane rupture
  • shoulder dystocia
  • nuchal cord
  • inhalation of meconium
  • chorioamnionitis
  • congenital heart disease
  • vacuum extraction
  • forceps delivery
  • emergency caesarean section
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4
Q

What does APGAR score mean ?

A

Activity (muscle tone), Pulse, Grimace (reflex irritability), Appearance (skin color), Respiration.

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5
Q

What is a kernicterus ?

A

It’s a complication of untreated jaundice in babies caused by excess of bilirubin damaging the brain or CNS. (Also called bilirubin encephalopathy).

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6
Q

What are the causes of physiological jaundice ?

A
  • conversion of fœtal hemoglobin to adult hemoglobin
  • slow conjugation and excretion of bilirubin by immature liver
  • breast feeding
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7
Q

What is the level of serum bilirubin in physiological jaundice ?

A

< 20mg/dl

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8
Q

What treatment is efficient for physiological jaundice ?

A

Phototherapy: aims to expose the baby’s skin to as much light (blue-green light) as possible to convert unconjugated bilirubin molecules into water soluble isomers that can be excreted by the usual pathways.

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9
Q

What are the causes of kernicterus ?

A
  • liver disease
  • rhesus incompatibility
  • erythroblastosis
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10
Q

What is the level of serum bilirubin in kernicterus ?

A

> 20mg/dl

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11
Q

What are the components of the BIND score ?

A
  • mental status
  • muscle tone
  • cry pattern
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12
Q

Which BIND score predicts cerebral palsy ?

A

BIND score > ore equal to 4

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13
Q

What are the causes of TORCH syndrome ?

A

Congenital infections (transmitted by the mother in utero) including:
- toxoplasmosis
- HIV
- Zika
- Syphilis
- Rubella
- Cytomegalovirus
- Herpes simplex

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14
Q

In cerebral palsy, what are common abnormalities seen on MRI ?

A
  • Hydranencephaly
  • Periventricular leukomalacia (most common)
  • Porencephaly
  • Schizencephaly
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15
Q

What are the different types of cerebral palsy according to neurological signs ?

A
  • Ataxic
  • Dyskinetic (including dystonic and choreo athetotic)
  • spastic
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16
Q

Describe ataxic cerebral palsy

A

Uncoordinated movements due to imprecision of movement speed and rhythm.

17
Q

Describe dystonic cerebral palsy.

A
  • hypokinesia
  • hypertonia
18
Q

Describe choreo-athetotic cerebral palsy.

A
  • Hypotonia
  • Hyperkinesia
  • Stereotyped slow writhing movements
19
Q

Describe spastic cerebral palsy

A
  • increased muscle tone
  • persistence of primitive reflexes
  • hyperreflexia
  • enlargement of reflex zone
  • pyramidal tract signs (ex: Babinski sign)
20
Q

What is the most prevalent subtype of cerebral palsy in Europe (according to neuro signs) ?

A

Bilateral spastic (60%)

21
Q

Which scale is the best to measure spasticity, when is spasticity characterized ?

A

Tardieu scale
When R2-R1 is > or equal to 10°

22
Q

For which conditions can GMFM-88 be used ?

A
  • Cerebral palsy
  • Down Syndrome
  • Heriditary spastic paraplegia
  • Acquired brain injury
23
Q

What are the differences between GMFM-88 and GMFM-66?

A

GMFM-88 can be used for other conditions than CP (Down syndrome, hereditary spastic paraplegia, acquired brain injury), can be made using orthosis or mobility aids and is an ordinal scale.

GMFM-66 targets only CP, is used via a software to calculate percentile scores and predict future expected changes in gross motor function. It is an interval scale.

24
Q

How to define an effective intervention?

A

It is the causation of clinical improvement.

25
Q

What is a confounding factor ?

A

Anything that has the same/opposite effect as your intervention.

26
Q

Is a change in GMFM-88 score an indication for progression or regression ?

A

No because age is a Confounder. It may also be due to chance.

27
Q

What are the different GMFCS levels with their general headings.

A

Level: walks without limitations
LevelI: walks with limitations
Level III: walks using a hand-held mobility device
Level IV: self-mobility with limitations; may use powered mobility
Level V: transported in a manual wheelchair

28
Q

Define serial casting.

A

The process of applying and removing a series of casts to a body part with the goal of improving anatomical alignement, providing a progressing increase in ROM and improving function.

29
Q

State EBP for serial casting.

A

NICE guidelines: spasticity improvement is better with Botox combined with serial casting than Botox or serial casting alone.

30
Q

State the clinical rationale for serial casting.

A
  • non-invasive
  • compliance is at the discretion for patient
  • provides a prolonged stretch to soft tissue
  • provides circumferential pressure
  • provides stability to the joint
  • allows lower limb weight bearing

Paediatrics (4 decks)

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