Cerebral Pasly Flashcards
Define cerebral palsy
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.
Wh at are the causes of cerebral palsy ?
- hypoxic-ischemic encephalopathy
- kernicterus
- TORCH syndrome
- intraventricular hemorrhage
- intra uterine growth retardation
What are the risk factors for cerebral palsy ?
- 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
What does APGAR score mean ?
Activity (muscle tone), Pulse, Grimace (reflex irritability), Appearance (skin color), Respiration.
What is a kernicterus ?
It’s a complication of untreated jaundice in babies caused by excess of bilirubin damaging the brain or CNS. (Also called bilirubin encephalopathy).
What are the causes of physiological jaundice ?
- conversion of fœtal hemoglobin to adult hemoglobin
- slow conjugation and excretion of bilirubin by immature liver
- breast feeding
What is the level of serum bilirubin in physiological jaundice ?
< 20mg/dl
What treatment is efficient for physiological jaundice ?
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.
What are the causes of kernicterus ?
- liver disease
- rhesus incompatibility
- erythroblastosis
What is the level of serum bilirubin in kernicterus ?
> 20mg/dl
What are the components of the BIND score ?
- mental status
- muscle tone
- cry pattern
Which BIND score predicts cerebral palsy ?
BIND score > ore equal to 4
What are the causes of TORCH syndrome ?
Congenital infections (transmitted by the mother in utero) including:
- toxoplasmosis
- HIV
- Zika
- Syphilis
- Rubella
- Cytomegalovirus
- Herpes simplex
In cerebral palsy, what are common abnormalities seen on MRI ?
- Hydranencephaly
- Periventricular leukomalacia (most common)
- Porencephaly
- Schizencephaly
What are the different types of cerebral palsy according to neurological signs ?
- Ataxic
- Dyskinetic (including dystonic and choreo athetotic)
- spastic
Describe ataxic cerebral palsy
Uncoordinated movements due to imprecision of movement speed and rhythm.
Describe dystonic cerebral palsy.
- hypokinesia
- hypertonia
Describe choreo-athetotic cerebral palsy.
- Hypotonia
- Hyperkinesia
- Stereotyped slow writhing movements
Describe spastic cerebral palsy
- increased muscle tone
- persistence of primitive reflexes
- hyperreflexia
- enlargement of reflex zone
- pyramidal tract signs (ex: Babinski sign)
What is the most prevalent subtype of cerebral palsy in Europe (according to neuro signs) ?
Bilateral spastic (60%)
Which scale is the best to measure spasticity, when is spasticity characterized ?
Tardieu scale
When R2-R1 is > or equal to 10°
For which conditions can GMFM-88 be used ?
- Cerebral palsy
- Down Syndrome
- Heriditary spastic paraplegia
- Acquired brain injury
What are the differences between GMFM-88 and GMFM-66?
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.
How to define an effective intervention?
It is the causation of clinical improvement.
What is a confounding factor ?
Anything that has the same/opposite effect as your intervention.
Is a change in GMFM-88 score an indication for progression or regression ?
No because age is a Confounder. It may also be due to chance.
What are the different GMFCS levels with their general headings.
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
Define serial casting.
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.
State EBP for serial casting.
NICE guidelines: spasticity improvement is better with Botox combined with serial casting than Botox or serial casting alone.
State the clinical rationale for serial casting.
- 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
