Chapter 05.1 Cerebral Palsy Flashcards
Cerebral Palsy: A group of disorders of the development of _______ and _______, causing activity limitations that are attributed to a _______ disturbance that has occurred in the developing fetal or infant brain.
Cerebral Palsy: A group of disorders of the development of movement and posture, causing activity limitations that are attributed to a nonprogressive disturbance that has occurred in the developing fetal or infant brain.
The greatest risk factor is _______; _______ _______ is the best predictor of CP in term infants.
The greatest risk factor is prematurity; neonatal encephalopathy is the best predictor of CP in term infants.
Risk factors include prenatal, perinatal, and postnatal infection, stroke, toxins, neonatal encephalopathy, complications of _______ (SGA, BW 800 g, IVH), maternal chorioamnionitis, fever during labor, coagulopathy or bleeding, placental infarction, thyroid disease, hyperbilirubinemia, and trauma.
Risk factors include prenatal, perinatal, and postnatal infection, stroke, toxins, neonatal encephalopathy, complications of prematurity (SGA, BW 800 g, IVH), maternal chorioamnionitis, fever during labor, coagulopathy or bleeding, placental infarction, thyroid disease, hyperbilirubinemia, and trauma.
CP Movement Type: \_\_\_\_\_\_\_\_ (70% to 85%); \_\_\_\_\_\_\_\_; \_\_\_\_\_\_\_\_; Ataxic; Mixed
CP Movement Type: Spastic (70% to 85%); Dyskinetic; Hypotonic; Ataxic; Mixed
CP Anatomic Distribution
________ (UEx > LEx, one side of body);
________(LEx > UEx);
________ (entire body)
CP Anatomic Distribution
Hemiparesis (UEx > LEx, one side of body);
Diparesis (LEx > UEx);
Quadriparesis (entire body)
CP GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM
Level 1. Walks _____ and _____ and climbs _____ without limitations;
Level 2. Walks _____ and _____, climbs _____ with a _____, and has limitations _____ on uneven surfaces and inclines;
Level 3. Walks _____ and _____ on a _____ surface with an _____ device; may climb stairs with a rail and use a manual _____;
Level 4. May walk short distances with assistive device but may rely on _____ mobility;
Level 5. Self-mobility severely limited;
CP GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM
Level 1. Walks indoors and outdoors and climbs stairs without limitations;
Level 2. Walks indoors and outdoors, climbs stairs with a rail, and has limitations walking on uneven surfaces and inclines;
Level 3. Walks indoors and outdoors on a level surface with an assistive device; may climb stairs with a rail and use a manual wheelchair;
Level 4. May walk short distances with assistive device but may rely on power mobility;
Level 5. Self-mobility severely limited;
> 80% have abnormal neuroimaging, most often ______ following ______ in premature infants, focal cortical infarcts secondary to MCA stroke in hemiparesis, basal ganglia and thalamic lesions in dystonic CP, brain malformations, and generalized encephalomalacia in spastic quadriparesis.;
______ more likely to show an abnormality compared with CT;
Persistence of primitive reflexes after ______ months, ______ or ______ response;
Early ______/failure to use the involved hand;
Early ______ (from tone)
> 80% have abnormal neuroimaging, most often PVL following IVH in premature infants, focal cortical infarcts secondary to MCA stroke in hemiparesis, basal ganglia and thalamic lesions in dystonic CP, brain malformations, and generalized encephalomalacia in spastic quadriparesis.;
MRI more likely to show an abnormality compared with CT2;
Persistence of primitive reflexes after 6 months, asymmetry or obligatory response;
Early handedness/failure to use the involved hand;
Early rolling (from tone)
CP ASSOCIATED DISORDERS:
________ impairments, especially in hemiparesis;
Hearing, visual, cognitive, psychological, oralmotor, nutritional, genitourinary, respiratory, bone mineral density, and dental impairments;
Seizures in 15% to 55%;
________ dysplasia and dislocation;
Spine – ________, lordosis, and scoliosis;
Spasticity and ________;
Gait impairment: scissoring due to ________ tone, anteversion – intoeing, and psoas and hamstring tightness – crouch gait. Stiff knee ankle PF tone toe gait.
CP ASSOCIATED DISORDERS:
Sensory impairments, especially in hemiparesis;
Hearing, visual, cognitive, psychological, oralmotor, nutritional, genitourinary, respiratory, bone mineral density, and dental impairments;
Seizures in 15% to 55%;
Hip dysplasia and dislocation;
Spine – kyphosis, lordosis, and scoliosis;
Spasticity and contractures;
Gait impairment: scissoring due to adductor tone, anteversion – intoeing, and psoas and hamstring tightness – crouch gait. Stiff knee ankle PF tone toe gait
TREATMENT of CP
Therapy: no clear evidence for any particular approach;
________, ________, tone management, and functional training;
Spasticity management: Oral medications, Chemical neurolysis, Intrathecal baclofen;
Selective posterior rhizotomy: Sectioning of a portion of abnormal ________-________ sensory nerve rootlets to reduce excitatory input; Favorable in patients aged 3 to 8 years who have selective motor control and functional strength and lack significant contractures;
Negative effects of selective posterior rhizotomy: hypotonia usually transient, weakness, bladder dysfunction (usually transient), spine deformity including spondylolysis/listhesis, and hip dislocation;
Botulinum toxin: different dosing guidelines for children: Reported distant side effects in children with CP;
Orthopedic surgery: lengthening, transfers, and osteotomy
TREATMENT of CP
Therapy: no clear evidence for any particular approach;
Stretching, strengthening, tone management, and functional training;
Spasticity management: Oral medications, Chemical neurolysis, Intrathecal baclofen;
Selective posterior rhizotomy: Sectioning of a portion of abnormal L2-S1 sensory nerve rootlets to reduce excitatory input; Favorable in patients aged 3 to 8 years who have selective motor control and functional strength and lack significant contractures;
Negative effects of selective posterior rhizotomy: hypotonia usually transient, weakness, bladder dysfunction (usually transient), spine deformity including spondylolysis/listhesis, and hip dislocation;
Botulinum toxin: different dosing guidelines for children: Reported distant side effects in children with CP;
Orthopedic surgery: lengthening, transfers, and osteotomy
OUTCOMES of CP: Good prognosis for ambulation
Molnar: independent ______ by age 2 years
Badell: reciprocal ______ at 1½ to 2½ years
Fedrizzi transition: ______ to ______ by 18 months
OUTCOMES of CP: Good prognosis for ambulation
Molnar: independent sitting by age 2 years
Badell: reciprocal crawl at 1½ to 2½ years
Fedrizzi transition: supine to prone by 18 months
OUTCOMES of CP: Poor prognosis for ambulation
Bleck: presence of ______ or more primitive ______ at 18 to 24 months
Life expectancy: reduced with immobility and inability to self-feed
OUTCOMES of CP: Poor prognosis for ambulation
Bleck: presence of three or more primitive reflexes at 18 to 24 months
Life expectancy: reduced with immobility and inability to self-feed
Causes of CONGENITAL BRACHIAL PLEXUS PALSY: Increase in birth \_\_\_\_\_\_, Shoulder \_\_\_\_\_\_, Traumatic delivery, Breech, Multiparous
Causes of CONGENITAL BRACHIAL PLEXUS PALSY: Increase in birth weight, Shoulder dystocia, Traumatic delivery, Breech, Multiparous
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
________ palsy − C5, 6, 7 − 80%
“Waiter’s tip” (shoulder irritation and ________, elbow ________ and ________, wrist ________)
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
Erb palsy − C5, 6, 7 − 80%
“Waiter’s tip” (shoulder irritation and adduction, elbow extension and pronation, wrist flexion)
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
________ palsy C7, 8, T1, rare to occur exclusively
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
Klumpke C7, 8, T1, rare to occur exclusively
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
Spontaneous recovery in ________% to ________%
Clinical Presentation of CONGENITAL BRACHIAL PLEXUS PALSY:
Spontaneous recovery in 50% to 90%
Associated Injuries of CONGENITAL BRACHIAL PLEXUS PALSY Facial palsy, \_\_\_\_\_\_\_\_\_\_, Clavicle or \_\_\_\_\_\_\_\_\_\_ fracture, Torticollis, Cervical spine injury, Diaphragmatic paralysis, Horner syndrome (with lower plexus injury), Examination and Testing
Associated Injuries of CONGENITAL BRACHIAL PLEXUS PALSY Facial palsy, Cephalohematoma, Clavicle or humerus fracture, Torticollis, Cervical spine injury, Diaphragmatic paralysis, Horner syndrome (with lower plexus injury), Examination and Testing
Sensory of CONGENITAL BRACHIAL PLEXUS PALSY
Reflexes;
ROM;
EDX studies in the first few days, then after several months for re-innervation; ________ present in insensate areas; preganglionic lesion/ root avulsion;
MRI
Sensory of CONGENITAL BRACHIAL PLEXUS PALSY
Reflexes;
ROM;
EDX studies in the first few days, then after several months for rein-nervation; SNAP present in insensate areas; preganglionic lesion/ root avulsion;
MRI
Treatment of CONGENITAL BRACHIAL PLEXUS PALSY
Goals are to normalize limb function, optimize nerve regeneration, and allow elbow flexion and shoulder stabilization;
Early pinning to avoid shoulder stretch and gentle ROM to consider pain due to ______ ______;
Position to increase awareness, ROM, splinting, and developmental training;
Surgery indicated if antigravity strength not present at the elbow at ______ months ______;
Other literature cites early surgical intervention between age 3 and 9 months;
Neurosurgery – neurolysis of scar and fibrotic tissue, end-to-end anastomosis, nerve transfer sural or great auricular, and end-to-side neurorrhaphy;
Orthopedic: tendon releases and transfers
Treatment of CONGENITAL BRACHIAL PLEXUS PALSY
Goals are to normalize limb function, optimize nerve regeneration, and allow elbow flexion and shoulder stabilization;
Early pinning to avoid shoulder stretch and gentle ROM to consider pain due to traumatic neuritis;
Position to increase awareness, ROM, splinting, and developmental training;
Surgery indicated if antigravity strength not present at the elbow at 6 months 10;
Other literature cites early surgical intervention between age 3 and 9 months;
Neurosurgery – neurolysis of scar and fibrotic tissue, end-to-end anastomosis, nerve transfer sural or great auricular, and end-to-side neurorrhaphy;
Orthopedic: tendon releases and transfers
Complications of CONGENITAL BRACHIAL PLEXUS PALSY
______ ______;
______;
Developmental concerns;
Glenoid dysplasia with posterior subluxation (reduced ER);
Cosmetic;
Pain may be indicated by biting the limb (possibly more in children who had surgery)
Complications of CONGENITAL BRACHIAL PLEXUS PALSY
Muscle atrophy;
Contracture;
Developmental concerns;
Glenoid dysplasia with posterior subluxation (reduced ER);
Cosmetic;
Pain may be indicated by biting the limb (possibly more in children who had surgery)
Prognosis of CONGENITAL BRACHIAL PLEXUS PALSY
Recovery by ______ months is a good indicator for normal function,
Poor-grade elbow flexion at ______ months may be predictive
Prognosis of CONGENITAL BRACHIAL PLEXUS PALSY
Recovery by 3 months is a good indicator for normal function,
Poor-grade elbow flexion at 6 months may be predictive
DEVELOPMENTAL MILESTONES at 2 months
Raises ______ when prone,
Turns to voice, ______, and responsive smile
DEVELOPMENTAL MILESTONES at 2 months,
Raises head when prone
Turns to voice, coos, and responsive smile
DEVELOPMENTAL MILESTONES at 4 months
Lifts head and chest in prone and _____ _____ prone to supine;
Reaches for objects and brings hand to _____ and mouth;
_____.
DEVELOPMENTAL MILESTONES at 4 months
Lifts head and chest in prone and rolls over prone to supine;
Reaches for objects and brings hand to midline and mouth;
Laughs.