CP

Question 1

What is CP

Answer 1

Diverse group of non-progressive (and permanent) syndromes that affect the brain and cause motor or cognitive defects beginning in early infancy

500,000 cases in the US

CNS disorder

CP is a type of TBI

If the TBI happens before 24 months, it is called CP

Question 2

Causes of CP

Answer 2

genetic or environmental
metabolic disease
hyperbilirubin
nutritional
toxemia
blood incompatibility
infection - rubella, cmv, meningitis
brain malformation
anesthesia
trauma during delivery
head injury
CVA
near drowning
lead poisoning

Question 3

Strokes in early life

Answer 3

PVL (periventricular leukomalacia)
- damage to white matter (basically leaves holes)
- common in preemies before 32 weeks

Hypoxic or ischemic encephalopathy
- loss of O2 to the brain for any reason
- utero to 2 years

IVH - Intraventricular hemorrhage
- bleeding into the brain
- preemies

Congenital malformation of the brain

Acquired CP - one month to 2 years

Question 4

Types of CP

Answer 4

Spastic
Dyskinetic/ Athetoid (extrapyramidal)
Ataxic (extrapyramidal)
Mixed

Question 5

Spastic CP

Answer 5

Increased muscle tone
Prolonged primitive reflexes - walking, sitting, suck reflex
Rigidity of extremities
Contractures
65-75% of all cases

Question 6

Dyskinetic/ Athetoid (extrapyramidal) CP

Answer 6

Extreme difficulty with fine motor and purposeful movement
- Dystonia: muscles contract involuntarily
Jerky, uncontrolled movement
Tone fluctuates
Injury to basal ganglia or extrapyramidal tracts
20-25%

Question 7

Ataxic CP

Answer 7

Gait disturbances and instability
Nystagmus
Hypotonic at birth but develop stiffness of trunk in late infancy
5%
Like a less extreme version of athetoid

Question 8

Types of plegia with CP

Answer 8

Monoplegia – one limb
Paraplegia – 2 extremities, usually both lower
Diplegia – 2 extremities, usually both upper limbs
hemiplegia – 2 limbs, usually leg and arm on same side (ipsilateral)
Quadriplegia – effects 4 limbs

Plegia – means effects not paralyze

Question 9

Mixed CP

Answer 9

• 13% of all people with CP
• Seizures: 35-50%
• Cognitive delay: 50-75% and depends on which part of the brain is damaged
• Visual impairment: 50%
• Hearing, communication, respiratory, bowel and bladder, and orthopedic
• Cognitive and physical limitations do not necessarily run hand in hand.
• Executive functions: budgeting

Question 10

Diagnosing CP

Answer 10

Diagnosis can be difficulty
- The earlier the better
- Suspected when:
*Birth issues
*Poor eaters (poor motor control of mouth)
*Sides don’t match
*Only using one side
*Difficulty separating legs for diaper change
Runs Mild to Severe
- Outcome: “almost normal” to severe

Question 11

CP impact on function

Answer 11

Question 12

Signs and symptoms of CP

Answer 12

Tone abnormalities-hyper or hypo or both
Reflex abnormalities
Atypical Posture or motor performance
Delayed Motor Development
Cognitive impairment
Ortho issues
Seizure disorders
Visual and Oral issues
Gastroesophageal Reflux

Question 13

Medical and surgical management of CP

Answer 13

Symptom management
Alleviate the cause
Medication to decrease tone
Valium – systemic drug (muscle relaxer); it decreases the tone for everything
Baclofen (oral or pump) – most common; systemic drug (muscle relaxer); it decreases the tone for everything; may decrease some of their function
Botox (botulinum toxin A) – only lasts about 3 months
Orthotics/Splints/casting
AFO
CIMT-Constraint Induced Movement Therapy

Question 14

CP impact on occupation

Answer 14

Feeding
- Often the first to show up
Dressing and other ADLS
Education
- Adaptations and IEPS (individualized education plan)
Sleep
Work
PLAY and Social Participation