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Elsa AACN > Ch 19 Cerebral Palsy > Flashcards

Ch 19 Cerebral Palsy Flashcards

1
Q

CP is a

A
  • neurodevelopmental motor condition
  • compromised posture, balance, muscle control, movement
  • disturbances of sensation, perception, cognition, communication, behavior by epilepsy and musculoskeletal problems
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2
Q

Is CP a permanent disorder?

A

yes

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3
Q

Is CP progressive or non progressive

A

non progressive

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4
Q

Where did CP occur?

A

developing fetus or infant brain

occurs early in the brain development

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5
Q

Onset of CP?

A

before 2 or 3 years

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6
Q

How is CP diagnosed

A

formal neurodevelopmental exam
observation
history of activity limitation
MRI

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7
Q

Findings on MRI if CP positive?

A

White matter damage
cortical and subcortical lesions (basal ganglia)
brain malformation
postnatal injury

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8
Q

Birth asphyxia is the major cause of CP. T or F

A

False

birth aphyxia accounts for minority (10-20%) of cases

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9
Q

Where does CP originate?

A

pyramidal and extrapyramidal systems of the brain

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10
Q

what is the pyramidal system?

A

the system that connects regions of the cortex involved with motor control to muscle via corticospinal tract

initiates and carries signals that allow for volunary skilled movements

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11
Q

Damage to pyramidal system results in…

A

spastic CP (majority of cases - 70-85%)

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12
Q

Characteristics of spastic CP? (name 3)

A

abnormally high muscle tone
occurs more frequently in children born preterm than full term
associated with underlying periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH)

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13
Q

Pyramidal motor system CP accounts for what percentage of CP?

A

70-85%

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14
Q

How many subtypes of CP are there within the pyramidal motor system?

A

3 subtypes

  1. spastic hemiplegic CP
  2. spastic diplegic CP
  3. spastic quadriplegic CP
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15
Q

Phenotypes/subtypes of CP are described based on what factor?

A

which limbs are affected

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16
Q

1st subtype of pyramidal motor system CP - Spastic hemiplegic CP

A

involves arm and leg of one side
usually more arm than leg affected
most common subtype of CP in full term babies
L hemisphere is affected in 2/3 of cases

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17
Q

prognosis of spastic hemiplegic CP

A

almost ALL can learn to walk

more than half have normal IQ

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18
Q

MRI finding of spastic hemiplegic CP/neuropathology/cause?

A

unilateral MCA stroke

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19
Q

typical time of injury of spastic hemiplegic CP?

A

prenatal

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20
Q

Which hemisphere is usually affected in spastic hemiplegic CP

A

Left hemisphere

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21
Q

2nd subtype of pyramidal motor system CP - Spastic diplegic CP

A

involves the lower extremities
upper also affected but less (usually clumsy hand movements)
most common subtype of CP in pre term babies

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22
Q

MRI findings/ Neuropathology of spastic diplegic CP/cause?

A

white matter damage of prematurity, esp PVL

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23
Q

Prognosis of spastic diplegic CP

A

severity of motor disability correlates with severity of cog impairment

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24
Q

typical time of injury for spastic diplegic CP

A

prenatal

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25
Q

3rd subtype of pyramidal motor systems CP - spastic quadraplegic CP

A

involves all 4 extremities, trunk, neck (FULL body)
50% happen prenatally
30% happen perinatally
20% happen posnatally

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26
Q

MRI finding of spastic quadraplegic CP/neuropathology/cause?

A

anoxia

b/l gray matter injury

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27
Q

Problems with Spastic quadraplegic CP? Prognosis?

A

most severe type
epilepsy
impaired IQ

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28
Q

What is the extrapyramidal motor system?

A

comprised of the cerebellum, basal ganglia, brainstem

function: fine tune movements of the pyramidal system by making adjustments to posture and coordination

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29
Q

What happens when extrapyramidal system is damaged?

A

results in non spastic CP (15-30% of cases)

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30
Q

What is the percentage of non spastic CP?

A

15-30%, minority of cases

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31
Q

Characteristics of non spastic CP

A

all extremities affected (more upper than lower)

normal IQ

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32
Q

subtypes of non spastic CP are delineated by what factors?

A

the kind of abnormal motor movements that occur

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33
Q

Two subtypes of non spastic CP

A

1) dyskinetic CP

2) Ataxic CP

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34
Q

Characteristic of Dyskinetic CP

A

variations in muscle tone and involuntary athetoid or dystonic movements

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35
Q

trouble with dyskinetic CP?

A

abnormal movements make it hard to sit comfortably and coordinate muscles for walking and sleeping

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36
Q

What is Dyskinetic CP caused by?

A

underlying hypoxic-ischemic injury

usually in full term infants

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37
Q

Characteristic of Ataxic CP

A

lack of coordination during voluntary gross and fine motor movements

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38
Q

What is ataxic CP caused by

A

cerebellar dysfunction

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39
Q

Problems with Ataxic CP?

A

poor balance, unsteadiness, wide based gait, shakiness, tremor

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40
Q

What % does Mixed CP account for?

A

20% of cases

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41
Q

Characteristics of Mixed CP

A

abnormalities in pyramidal and extrapyramidal systems

exhibit mixed motor signs

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42
Q

Risk factors for CP

A

preterm birth - most important RISK FACTOR

Low birth weight

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43
Q

maternal risk factors for CP

A

IQ
infection, toxic during pregnancy
diseases during pregnancy (epilepsy, thyroid, HTN)

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44
Q

Fetal risk factors for CP

A 
multiple births
co twin dead in uterus
male 
IUGR
developmental brain malformation
thrombophilic disorders
45
Q

Perinatal risk factors for CP

A 
prematurity, although majority of CP cases are born full term
Low Birth weight
anoxic damage (10-14%)
low apgar scores at 5 minutes
abnormal muscle tone
perinatal stroke
46
Q

Postnatal risk factors for CP

A

infections and brain injury

47
Q

Other risk factors for CP

A

SES not well established

black race

48
Q

Prevalence of CP in developed countries

A

2-2.5/1000

49
Q

Has the prevalence of CP changed?

A

No, it has remained stable because of IVF, improved survival rates

50
Q

physical morbidity - mobility

A

33% cannot walk
17% require assistance to walk
50-60% can walk without assistance

51
Q

physical morbidity - musculoskeletal complication

A

spasticity

52
Q

physical morbidity - pain

A

75% children and 70% adult have chronic pain

53
Q

epilepsy rate of CP

A

28-50% incidence

54
Q

physical morbidity - oral motor impairment

A

affects chewing, swallowing, saliva
feeding tube for failure to thrive
speech articulation problems, may need augmentative communication

55
Q

physical morbidity - visual and occulomotor impairment

A

28% of children of some form of visual/occulomotor impairment

  • 10% blindness
  • 10-12% hearing impairment
56
Q

physical morbidity - bladder control

A

urinary incontinence 25%

57
Q

physical morbidity - sleep

A

sleep disorder 20-25%

fatigue

58
Q

physical morbidity - skin

A

pressure sores

59
Q

Cognitive morbidity

A

30-35% of kids have IQ score < 70

50% of kids have IQ score < 50

60
Q

What predicts cognitive morbidities in CP?

A

motor impairments and epilepsy

61
Q

Which subgroup has the worst cognitive functions?

A

spastic quadraplegic

62
Q

Which factor is NOT a reliable indicator of cognitive impairment

A

motor involvement

63
Q

People with severe CP can have normal IQ. True or False

A

True

64
Q

People with mild CP cannot experience severe cognitive impairment. True or False

A

False

65
Q

Social Emotional Morbidity

A

social difficulties
depression
low self esteem
25% behavioral problems

66
Q

Mortality - increased or decreased life expectancy?

A

life expectancy increased
survival rates improved
mild CP comparable with general population

67
Q

leading cause of death in severe CP

A

respiratory infection

68
Q

CP is classified as which types in their severity?

A

mild, moderate, severe

69
Q

Standardized measure of CP severity in children

A

Gross motor function classification system (GMFCS)

70
Q

Gross motor function classification system (GMFCS)

A

5 level ordinal rating based on functional mobility and activity limitation
higher number = more severe

71
Q

GMFCS Level I

A

Level I = can walk and climb stairs independently and without limitation; some problems with gross motor skills (running, jumping, speed, balance coordination)

72
Q

GMFCS Level V

A

severe limitations in voluntary control of movement
impaired mobility even with assistance
wheelchair bound

73
Q

Can CP be diagnosed in utero?

A

No, because it’s based on clinically observable motor manifestation

74
Q

Is it hard to detect CP during infancy (1-12 mos)

A

Yes, because motor patterns change, early motor abnormalities can be transient

precocious motor signs can be a sign of CP

absence of motor abnormalities in infancy does NOT mean there is no CP (50% of kids with CP may have unremarkable pre and perinatal history)

75
Q

precocious motor signs (e.g. early standing before 12 months) can mean

A

hypertonia (stiffness and rigidity) in legs

76
Q

precocious motor signs (e.g. strong hand preference in 12 - 18 mos) can reflect

A

weakness in the other hand

77
Q

most kids exhibit full motor signs of CP at what age?

A

2 years or beyond

78
Q

when can a definitive dx of CP be made?

A

2-3 years old

79
Q

in mild CP cases, when can definitive diagnosis be made?

A

4-5 years

80
Q

can children with the CP dx outgrow the disorder (no longer exhibit signs of CP?)

A

yes! by age 7

81
Q

% of children with CP who outgrow the disorder

A

50%

82
Q

which types of CP cases are more likely to be outgrown by age 7 in children?

A

mild
monoparetic (one extremity only)
diplegic
extrapyramidal types

83
Q

will children who outgrow motor symptoms of CP continue to suffer from other neurological problems?

A

yes! such as seizures, ID

84
Q

Is CP progressive?

A

No, but motor manifestations can worsen (e.g. caused by stress on the body, osteoporosis, arthritis)

85
Q

NP results for CP

A

no typical profile BUT

  1. Verbal skills better than Visuospatial skills
  2. attention and processing speed affected (white matter and subcortical involvement)
  3. EF not an issue if motor skills are accounted for
86
Q

IQ in CP

A

varies from severe ID to giftedness
75% affected
50% borderline to impaired
IQ correlated with degree of motor impairment

87
Q

Learning in CP

A

SLD 25-30%

88
Q

Attention in CP

A

affected by periventricular white matter and subcortical damage
epilepsy affects attention

89
Q

Processing speed in CP

A

hard to measure, but some slowing

90
Q

speech and language in CP

A

oral motor control affects speech, dysarthria

verbal, language skills are not mostly normal

91
Q

visuospatial in CP

A

impaired

92
Q

memory in CP

A

attention, visual impairment contribute to memory problems

93
Q

EF in CP

A

questionable

94
Q

sensorimotor function in CP

A

motor abnormalities
28% have visual/ocular-motor impairment
10-12% have hearing impairment
disturbances in sensory, touch, pain, sound…

95
Q

emotion and personality in CP

A

more behavioral and social problems

96
Q

PVT SVT

A

fatigue and pain interfere with alertness, engagement
boredom
motivation, frustration tolerance

97
Q

Psychological Treatment of CP

A

Family centered interventions

98
Q

medication for CP

A

more effective at treating SPASTICITY than addressing muscle weakness, incoordination, or movement abnormalities

99
Q

Medication for spasticity

A

muscle relaxant
neuromuscular blocker
benzo

100
Q

How does muscle relaxant work?

A

e.g. balcofen
works on the brain
inhibits descending excitatory motor pathways that activate reflex

101
Q

How does neuromuscular blocker work

A

e.g. botox
works on muscle
inject into muscle and extremities to cause focal muscle paralysis and reduce muscle contraction

102
Q

How does benzos work

A

e.g. diazepam
works on the brain
relax muscles by enhancing effect of GABA (inhibitory NT)

103
Q

Spasticity

A

muscle tightness and stiffness due to prolonged muscle contraction
increased muscle tone

104
Q

Apgar scores

A

performed 1 min and 5 min after birth
1 min - see how well baby tolerated birthing process
5 min - see how well baby is doing outside of the womb

105
Q

What does APGAR stand for

A 
Appearance
Pulse
Grimace response (reflex irritability when stimulated)
Activity (muscle tone)
Respiration
106
Q

What APGAR scores are associated with risk for CP

A

lower than 3, but not determining factor

107
Q

athetosis

A

slow and writhing involuntary movement

repetitive, rhythmic

108
Q

dystonia

A

involuntary sustained or intermittent muscle contraction that cause repetitive and twisting movement

Elsa AACN (35 decks)

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