Common Neurological Conditions in infants

Question 1

cerebral palsy definition

Answer 1

a group of permanent disorders of the development of
movement and posture, causing activity limitation, that are
attributed to non-progressive disturbances that occurred in
the developing fetal or infant brain”

Question 2

name the rate of incidence of cerebral palsy in children

Answer 2

100-150 children born with CP in Ireland each year
17 million worldwide yearly

Question 3

how can cerebral palsy be classified

Answer 3

using the classification tree for sub-types
Gross motor function classification system
topographical classification system
functional classification e.g. Manual ability classification system (MACS), communication function classification system (CFCS), Eating and drinking ability classification system (EDACS)

Question 4

How does the classification tree put cerebral palsy into sub categories

Answer 4

increased(spastic) /decreased (hypotonia) muscle tone
if increased muscle tone is bilateral or unilateral
if the tone is varying (dyskinetic) or consistent
if there is hypotonia is paired with signs of ataxia
https://www.intechopen.com/chapters/63463

Question 5

how does topographical classify cerebral palsy

Answer 5

unilateral - monoplegia or hemiplegia
bilateral - diplegia, triplegia or quadriplegia

Question 6

what is the level I of the Gross motor function classification system

Answer 6

can walk and climb stairs independently unaided but will have difficulty running or jumping

Question 7

describe level II of Gross Motor Function Classification system

Answer 7

can walk independently unaided short distances on level surface but may need upper limb support from a hand rail when climbing stairs. cannot run or jump

Question 8

describe level III of Gross Motor Function Classification System

Answer 8

can walk independently with a hand held mobility device on level surface but will need assistance from adults climbing stairs, or will need help travelling long distances, outdoors or uneven surfaces

Question 9

describe level IV of Gross Motor Function Classification System

Answer 9

at best can walk independently with a mobility device and adult supervision but can have difficulty maintaining balance on uneven surfaces.
can use self powered wheelchair

Question 10

describe level V of Gross Motor Function Classification System

Answer 10

Requires the assistance and mobility device to mobilise regardless of ambulatory distance or surface level

Question 11

symptoms of cerebral palsy

Answer 11

altered muscle tone e.g. spasticity can cause impaired lengthening of muscle fibres, impaired voluntary muscle control, difficulty isolating movements, impaired recipricol inhibition => altered resting posture of limbs, difficulty balancing agonist/antagonist
muscle weakness, delayed milestones
persistence of primitive reflexes

Question 12

describe how spasticity may present itself across CP

Answer 12

worse in LL in B/L CP
worse in UL in U/L CP

Question 13

What causes spasticity

Answer 13

UMN lesion

Question 14

define spasticity

Answer 14

A velocity dependent increase in stretch
reflex

Question 15

describe the F words ICF framework

Answer 15

body structure = fitness
activity = functioning
participation = friends
environment = family
personal = fun
https://canchild.ca/system/tenon/assets/attachments/000/004/249/original/ICFFramework_and_Fwords_ENG-ACCESS.pdf

Question 16

motor types

Answer 16

spastic
ataxic
dyskinetic

Question 17

dyskinesia

Answer 17

involuntary movement from basal ganglia damage

Question 18

ataxia

Answer 18

shaky movements - affects balance and sense of positioning
cerebellum damage

Question 19

what is the importance of regulating muscle tone

Answer 19

maintain posture
for purposeful co-ordinated movement

Question 20

children with CP are at risk of developing

Answer 20

hip joint condition
joint or muscle contracture
emergent dystonia
increase body mass and possible underlying muscle weakness

Question 21

describe the integrated pathway of cerebral palsy

Answer 21

established integrated pathway in australia, UK
Pelvic X ray at age 2, 6 and 16
more frequent x rays increased if possible risk of hip dislocation is detected
a clinical exam is conducted every 6 months between the ages 2-6
clinical exam completed annually from 6-16

Question 22

spina bifida definition

Answer 22

congenital malformation in which the spinal column is split (bifid) as a result of failed closure of the embryonic neural tube, during the fourth week post-fertilization
https://www.cdc.gov/ncbddd/spinabifida/facts.html

Question 23

list three types of spina bifida

Answer 23

occulta - mildest form with a gap in the spine but not sac and the spinal cord and nerves are normal and intact
meningocele - a gap in spine but a formation in a sac of fluid but no nerve damage
myelomeningocele - most severe sac formation comprised of nerves and spinal, involves nerve damage

Question 24

how can neural tube defect be detected during pregnancy

Answer 24

scan conducted at 20 wks
ultrasound
AFP - alpha fetoprotein the foetus produces and is sent to mother’s bloodstream. higher AFP levels can indicate spina bifida

Question 25

purpose of MRI for spina bifida

Answer 25

determines level of lesion in antenatal period

Question 26

if the child has a spina bifida lesion at thoracic level T1 T2 will they able to walk, will they require a shunt, will the bowels be affected

Answer 26

all children will be wheelchair users
9/10 require shunt
bowels affected

Question 27

if the child has a spina bifida lesion at lumbar level L1 L2 will they able to walk, will they require a shunt, will the bowels be affected

Answer 27

all children will be wheelchair users
10/10 require shunt
bowels affected

Question 28

if the child has a spina bifida lesion at lumbar level L3 will they able to walk, will they require a shunt, will the bowels be affected

Answer 28

8/10 children will be wheelchair users
9/10 require shunt
bowels affected

Question 29

if the child has a spina bifida lesion at lumbar level L4 will they able to walk, will they require a shunt, will the bowels be affected

Answer 29

5/10 can walk
7/10 require shunt
all children bowels affected

Question 30

if the child has a spina bifida lesion at lumbar level L5 will they able to walk, will they require a shunt, will the bowels be affected

Answer 30

3/4 children walk
7/10 require a shunt
all children bowels affected

Question 31

if the child has a spina bifida lesion at sacral level will they able to walk, will they require a shunt, will the bowels be affected

Answer 31

9/10 children walk
6/10 require shunt
all children bowels affected

Question 32

describe motor function of child with meningomyelocele spina bifida at thoracic level and L1-3

Answer 32

cannot stand unsupported
wheelchair bounds
may face spinal curves, hip dislocation, knee contracture, talipes
needs assistance with ADLs

Question 33

describe motor function of child with meningomyelocele spina bifida at L4-5

Answer 33

assistive device needed for walking, may need wheelchair for longer distances
orthotics - AFO, KAFO
may face hip dislocation, knee contractures, talipes
need help w/ ADL

Question 34

describe motor function of child with meningomyelocele spina bifida at sacral level

Answer 34

stands unsupported
may need AFO/orthotics
may have orthopaedic needs

Question 35

surgical intervention of spinal bifida

Answer 35

not all children with spina bifida get surgery
children with hydrocephalus get surgical stunt

Question 36

signs of spina bifida

Answer 36

Full or bulging fontanelle (soft spot), Seizures, Enlarged
head size, Headache, Swelling or redness along the shunt tract,
Fever, Irritability, Vomiting, Drowsiness, Loss of previous abilities,
Change in appetite, Prominent veins on scalp

Question 37

what other complications can children with spina bifida face

Answer 37

syringomyelia - collection of CSF in spinal cord
tethered spinal cord - loss of free movement. of spinal cord may require surgery
bladder issues - may require clean intermittent catheterisation
may require bowel management through diet, regular routine and medical support

Question 38

list rate of incidence in obstetric brachial plexus

Answer 38

1 in 200 births

Question 39

method of injury in obstetric brachial plexus injury

Answer 39

baby’s shoulder stuck in mother’s pelvis - shoulder’s dystocia

Question 40

symptoms of upper obstetrics brachial plexus injury

Answer 40

cannot flex elbow

Question 41

symptoms of lower obstetrics brachial plexus injury

Answer 41

loss of wrist/hand function
flexed claw like position of fingers
scapular control issues

Question 42

what possible stretch nerve injury could occur in obstetrics in birth

Answer 42

neuropraxia
rupture - can be partial and may require surgery
avulsion injury - nerve pulled from cord mat require surgery or nerve transplant

Question 43

what is developmental co-ordination disorder / dyspraxia

Answer 43

child has difficulty co-ordinating movement

Question 44

diagnosis of DCD

Answer 44

Childhood onset - longstanding problems w/ motor function
no alternative explanation
at least 5 years old
subjective axam - DCD-Q-R
objective 5th centile for age on M-ABC2 = unequivocal

Question 45

what is the physio intervention for children with DCD

Answer 45

flexibility
strength
endurance

Question 46

transverse myelitis

Answer 46

inflammation of spinal cord

Question 47

hereditary spastic paraplegia

Answer 47

inherited disorder including weakness, spasticity, and stiffness or paralysis of legs