Cours 8 : Cerebral Palsy Flashcards
Is Intellectual Disability more common among individuals with CP?
Yes (50%), it is more common
What does cerebral means?
Brain
What does Palsy means?
Decrease in muscle control (paralysis of the brain)
Non-progressive but not unchanging (symptoms can change) disorder of movement and/or posture, due to an insult to or abnormality of the developing brain. Speech and sense like hearing and vision can also be impaired.
What are the things to remember in Cerebral Palsy?
Is not contagious
Is not hereditary (not transmitted)
Is not life-threatening (life expectancy is similar to able-bodied individuals)
Are the people in the picture presented at slide 3 paraplegic, quadriplegic or both?
Paraplegic, we are using the field definition
What is the incidence of Cerebral Palsy?
2 to 2.5 cases per 1000 births (incidence has not declined over the last 60 years despite medical advances.
15 000 people in Quebec
50 000 people in Canada
More males than females (1.33 male for 1 female)
Why did the incidence not decline over the last 60 years despite medical advances?
Increase of the survival rate of pre-term babies
Why are the males more prone to get Cerebral Palsy than the females?
The reasons are uncertain. Males born very preterm also appear to be more vulnerable to white matter injury and intraventricular hemorrhage than females. Sex hormones such as estrogens provide protection against hypoxic-ishemic injury, and the neonatal brain is also influenced by these hormones.
What are the CP causes? - 90% before or during birth
Maternal infections (aids, rubella, herpes)
Chemical toxins (alcohol, tobacco, drugs)
Injuries affecting fetal development
Damage to the brain or oxygen
Deprivation during deliveries –>genetic disorders, chromosomal, abnormality, faulty blood supply
What are the CP causes? - 10% before or during birth
Brain infections (meningitis)
Cranial traumas (accidents, shaken baby syndrome) and oxygen deprivation (near drowning)
What are the other factors of CP causes?
Age of the mother ( under 20 and up 34 years old)
Premature + decrease of birth weight babies
What are the early signs of cerebral palsy?
Before 3 years of age
Motor skills not developing normally (coordination + balance)
Abnormal muscle tone : hypotonia (1st), hypertonia )2nd)
Favour one side of the body
Which leg was more affected in Sophia’s walking pattern?
Right leg
- Toe walking
- Foot dragging
- Favours left when standing up
- She must have better proprioception and control over their muscles
What are the classifications by the number of limbs affected?
Quadriplegia (all 4 extremities)
Diplegia (lower extremities more frequent than upper)
Hemiplegia (the entire left or right side is affected)
Triplegia (3 extremities, usually both legs + 1 arm)
Monoplegia (1 extremity)
What are the classification by the movement disorder?
Spastic CP - tug-og-war or co-contraction (muscles are tight)
Athetoid CP - mixed muscle tone, constant motion (muscles move a lot)
Ataxic CP - look unsteady and shaky (ex : Sophia in the video)
What are the areas touched in Spastic CP?
Motor cortex
Premotor cortex
What are the areas touched in Athetoid CP?
Basal ganglia
Tremors
What is the area touched in Ataxia CP?
Cerebellum
What is an example of an individual who has Spastic CP?
Quadraplegia : all four limbs and the trunk are affected
Diplegia : all four limbs are affected, the legs more severely than the arms
Because cerebral palsy results from brain damage, it is not uncommon for individuals with cerebral palsy to have associated disorders. Other conditions most frequently associated with CP are reflex disorders; seizures; and speech, hearing, or visual problems. In about 40% of people with CP, some degree of mental retardation also may be present. When working with individuals with cerebral palsy, it is important to determine whether the person has associated disorders so you can modify instruction appropriately. Is is also very important not to assume that speech problems and CP automatically imply mental retardation. Individuals with CP may be of normal or superior intelligence
What is Spasticity?
Abnormal muscle tightness + stiffness
- Most common (65% of people with CP)
- Caused damage to the motor cortex + cortical tracts
- If there’s more damage to the basal ganglia + cerebellum than it an exacerbate spasticity
- Spastic muscles interfere with voluntary movements
- Interventions :
Surgical lengthening of tendon
Dorsal rhizotomy
What is the monosynaptic reflex arc is composed of?
Sensory neutron from muscle and tendon going into the spinal cord and connecting to a motor neurone exiting the spinal cord going to muscle. Stimulating the tendon causes the muscle to contract. The ling tracts represent neurone that pass up and down the spinal cord and modify the action of the reflex arc. Injury to these tracts usually causes the reflex arc to become hyperactive (spastic)
What is Athetosis?
Constant, unpredictable, and purposeless movement cased by fluctuating muscle tone (hypertonia-hypotonia)
Damage to basal ganglia
+- 25% of people with CP
Problems with facial expression, eating, speaking, head control, fingers + wrist control
most people with athetosis are quadriplegic
** Poor balance, arms and hand movement, regular shake or as sudden spams. Uncontrolled movements are often worse when the child is excited or tries to do something**
What is Ataxia?
Disturbance of balance and coordination characterized by hypotonia + decrease postural tone
Results from disorders of the cerebellum + vestibular system (system located in the ears that provide information of where our body is moving in space)
What is the abnormal gait associated with Spastic CP?
Scissors gait
Legs = flexed + inwardly rotated + toe walking
