Ch 10 - Peds: TBI and CP Flashcards
What does not indicate severity of TBI?
Presence or absence of skull fractures
What can result in greater shearing injury in children?
Incomplete myelination
What are causes of neonatal brachial plexus injuries?
– Trauma
– Obstetrical complications
What is Erb–Duchenne Palsy?
Due to sudden traction to the neck, causing injury to the upper trunk of the brachial plexus (C5–C6 roots)
What is Klumpke’s Palsy?
Due to violent upward pull of the shoulder, causing damage to the lower trunk (C8–T1 roots)
What can be associated with Klumpke’s Palsy?
Horner’s syndrome can be associated with injury of the C8 and T1 roots, which affects the superior cervical sympathetic ganglion
What are verbal scores for GCS in <2 yo?
1: no response
2: Inconsolable crying, irritable
3: Cries but is inconsistently consolable, moaning
4: Cries but consolable, interacts inappropriately
5: Smiles, oriented to sound, follows objects, interacts
Which children are more likely to sustain TBI?
Hyperactive children
How does hypopituitarism present after TBI in children?
Growth failure and delayed or arrested puberty
When is HO MC in TBI in children?
> 11 yo
More severe injury
2 extremity fractures
When are children considered to have posttraumatic epilepsy?
2 or more late seizures
Which has a better prognosis, TBI or anoxic brain injury?
TBI
What is cerebral palsy?
Primarily of movement control and posture but associated with cognitive and sensory problems resulting from a nonprogressive lesion to an immature brain
What is the leading cause of childhood disability?
Cerebral palsy
When do the majority of cerebral palsy cases occur?
70-80% in prenatal period
What are risk factors of CP during the prenatal period?
- Prenatal intracranial hemorrhage
- Placental complications • Gestational toxins
- Gestational teratogenic agents
- Congenital malformations of the brain and cerebral vascular occlusions during fetal life
- TORCH infections
- Socioeconomic factors
- Reproductive inefficiency
- Prenatal hypoxicischemic injury
- Maternal causes (seizures, MR, hyperthyroidism)
What is the MC antecedent of CP?
Prematurity
What are the types of CP?
– Spastic (pyramidal) (75%)
– Dyskinetic (extrapyramidal)
– Mixed type
What is the MC type of CP?
Spastic diplegia
LE»UE
What is a typical cause of spastic diplegia CP?
IVH at 28-32 weeks gestation
What is seen on MRI with IVH in spastic diplegia CP?
Periventricular leukomalacia or post-hemorrhagic porencephaly
What is Athetosis?
Slow writhing involuntary movements, particularly in the distal extremities
What is chorea?
Abrupt, irregular jerky movements, usually occurring in the head, neck, and extremities
What is Choreoathetoid CP?
Combo of athetosis and choreiform movements
Gen large amp involuntary movements
Dominating pattern is the athetoid movement
What is Dystonia
A slow rhythmic movement with tone changes generally found in the trunk and extremities; associated with abnormal posturing
What is Ataxia?
Uncoordinated movements often associated with nystagmus, dysmetria, and a widebased gait
What is associated with Ataxia CP?
Sensorineural hearing loss which has been associated with hyperbilirubinemia and neonatal jaundice
What is the MC mixed type of CP?
Spastic athetoid (predominant dyskinetic movement pattern with an underlying component of spasticity)
Where does ischemia occur in spastic diplegic CP?
Hypoperfusion of the germinal matrix of the periventricular region of the premature fetus
Which CP group has the highest disability?
Quadriplegic
What is a GMFCS Level 1?
Walks without restrictions
Limitations in more advanced gross motor skills
Does not need handrails
What is a GMFCS Level 2?
Walks without assistive devices
Limitations walking outdoors and in the community
Uses handrails
What is a GMFCS Level 3?
Walks with assistive mobility devices
Limitations walking outdoors and in the community
What is a GMFCS Level 4?
Self-mobility with limitations
Transported or use power mobility outdoors and in the community
What is a GMFCS Level 5?
Self-mobility severely limited even with use of assistive devices
What are good prognosis for ambulation in CP?
Independent sitting by 2 years
Ability to crawl on hands and knees by 1.5 to 2.5 years
What is a poor prognostic sign for ambulation in CP?
Persistence of 3 or more primitive reflexes at 18 to 24 months
What is the MC visual deficit in CP?
Stabismus
What is a good indication of intellectual
potential in CP?
Speaking in two to three word sentences by age 3
Which CP type MC has MR?
Spastic quadriplegia
Which CP type MC has seizures?
Spastic quadriplegia
Hemiplegia
Which CP type MC has oromotor issues?
Spastic quadriplegia
Dyskinetic
What is the most widely used therapuetic exercise method in CP?
Bobath
Also known as neurodevelopmental treatment (NDT)
Describe the Asymmetric tonic neck reflex.
Head turning to side causes Extremities extend on face side, flex on occiput side (“fencer position”)
Describe the palmar grasp reflex.
Touch or pressure on palm or stretching finger flexors causes flexion of all fingers
