CP Flashcards
Twisting of the femur
torsional deformity
highly correlated with CP
IVH. But not predictive (just correlation)
questions to determine prognosis regarding pregnancy
ask about pregnancy history (illness (fever) during 21-40 weeks AGA, infection during labor and delivery, intrauterine crowding, family history of CP, delivery type, prematurity, Apgar scores at 1 min, birth weight
any one born before 38 weeks are
premature
any one born 28-32 weeks are
less good prognosis (larissa worries about them) GMFCS III and II
24-28 weeks
generally GMFCS IV and V
The key thing that will help with prognosis
Gross Motor Function Classification Scale
Precaustions or contraindications
shunt precautions, seizure disorders
If you think your pt has vision problems, who do you refer to?
opthamology
what causes bronchopulmonary dysplasia
supplemental oxygen as a neonate
SDR surgery has best outcomes when performed on patients with what type of CP
spastic diplegia
common places for scarring
gastroc and popliteal fossa
APA in standing
fast forward reach, standing on one foot, coming up on tip toes. (CP pts have excessive co-contraction)
RPA in standing
distal to proximal pattern for ankle strategy. Hip strategy (proximal to distal) not as much of a problem for CP pts
knee wobble is the same thing as
jump gait (quad spasticity or gastroc)
STRENGTHEN the PLANTAR FLEXORS
yes do it
All femurs have a _____ twist
medial (condyles move in)
antetorsion is
an excessive medial twist of femur (you cannot change this voluntarily)
anteversion
femur is rotated in in relation to the acetabulem ( you can change this voluntarily) This is a common intervention to change this (less anteversion) to make their feet point forward.
baby tibias starts out
with no twist
The adult tibia has a
lateral twist
kissing patellas indicate
femur first (probably your biggest problem)
if patellas are forward, but still have negative FPA (pigeon toed)
think tibia
Thigh foot angle test
measures relationship between tib-fib
T/F do modified ashworth before ROM
T because if you want to test spasticity, you don’t want to stretch them first.
Maternal risk factors for CP
fever during 21-40 weeks, labor/delivery complicated by infection, multiple births complicated by growth restrictions, genetic component, smoking/illicit drug use
birth history risk factors for CP
emergency c section, early gestational age (less than 32 weeks). very premature less than 26 weeks, Apgar score at 1 min, low birth weight
an area of neural precursor cells with fragile vasculature that increases risk of hemorrhage
germinal matrix
Germinal matrix hemorrhage grade 1
subependymal hemorrhage only confined to germinal matrix
Germinal matrix hemorrhage grade 2
intraventricular hemorrhage without hydrocephalus
Germinal matrix hemorrhage grade 3
intraventricular hemorrhage with hydrocephalus
Germinal matrix hemorrhage grade 4
intraparenchymal hemorhage
parenchymal hemorrhage leads to perventricular leukomalacia which is
a strong predictor of CP
3 types of CP
spastic, athetoid dystonic, ataxic
T/F almost all pts with spastic hemiplegia are ambulatory
T
T/F arms are more affected than legs in spastic diplegia
F. Legs are
regarding movement patterns, what is the difference between spastic diplegia and hemiplegia
diplegia-symmetrical, hemi-asymmetrical
T/F almost all spastic quadriplegia pts are ambulatory
F most are wheelchair bound
Athetoid dystonic quadraplegia preferr
end range (difficulty maintaining midline)
ataxic CP patients prefer
midline (avoid end range)
T/F almost all athetoid dystonic quads are ambulatory
F most are wheelchair bound
T/F almost all pts with ataxic CP are ambulatory
T
T/F Ataxic CP pts have symmetrical mvmt
T
Walks without limitations
GMFCS 1
Walks with limitations
GMFCS 2
walks using a hand-held mobility device
GMFCS 3
self-mobility with limitations, may use powered mobility
GMFCS 4
Transported in manual w/c
GMFCS 5
Fine motor control and coordination efficiency limitations
MACS 1
reduced speed/quality of mvmt
MACS 2
environmental accommodations needed
MACS 3
require continuous help for participation
MACS 4
performs only simple movements
MACS 5
Practice parameters for intervention for children with CP
strength training for min of 6 weeks with frequency 3x per week.
Aerobic training 2-4 times per week for 6 weeks
9 interventions that improve coordination
constraint induced mvmt therapy, bimanual therapy, goal directed training, context focused therapy, balance training, home programs, biofeedback, hippotherapy, assistive technology
regarding force production, is upper or lower strength training more important
lower
recommended interventions for improving flexibility
serial casting, orthotics, surgical management
serial casting
usually 4-6 weeks, change it every week with more flexibility
when managing spasticity which three drugs have systemic effects?
diazepam, tizanidine, dantrolene
downfall of oral mm relaxants
drowsy
spasticity injectables
botox, phenol
What is the good thing about intrathecal baclofen
good for pts with lots of spasticity and does not have the cognitive effects
Which patients do we think selective dorsal rhizotomy will work best
spastic diplegia pts who can walk
Good ways to reduce negative foot progression angle and reduce pain
theratogs, kinesiotape
how do we simplify the movement
part practice or limit degrees of freedom (body weight support, assistive device, orthotics, manual support)
precautions or contraindications
shunt precautions, seizure disorder
potential non-PIPs
cognition, social-emotional development, visual impairment, hearing impairment
regarding cardiopulm, question that determines need for referral
ask about history of supplemental oxygen for 1st 28 days
common places for contracture
gastroc, iliospoas, adductors, and hamstring length
in an infant unable to maintain head in midline while in supine, suggests lack of activation of ____ _____. forearms an thighs are on the surface, suggests lack of activation of _____ _____ as well as ____ and _____
bilateral SCM.
pectoralis/biceps.
iliospoas, adductors
in prone, what is a common impairment for children with CP
to lift head against gravity ( no activation of cervical/thoracic paraspinals)
Common gait patterns in patients with spastic hemiplegia (5)
drop foot true equinus true equinus with recurvatum knee true equinus with jump knee true equinus with jump knee and hip flexion, adduction, and internal rotation
what is impaired during drop foot
TA activation, timing/sequencing TA and gastroc, muscle tone of gastroc
what is impaired during true equinus
excessive activation of gastroc, length of gastroc, muscle tone of gastroc
what is impaired during true equinus with recurvatum knee
length of gastroc
what is impaired during true equinus with jump knee
muscle tone in gastroc and quad
What is impaired during true equinus with jump knee and hip flexion, adduction, and internal rotation
muscle tone in gastroc, quad, hamstrings;
muscle length gastroc, iliopsoas, medial hamstrings;
excessive antetorsion;
medial tib-fib torsion
excessive plantarflexion with knee wobble in SLS, along with a negative FPA
true equinus with jump knee and hip flexion, adduction, and internal rotation
excessive plantarflexion with knee wobble in SLS
true equinus with jump knee
excessive plantarflexion with knee hyperextension in SLS
true equinus with recurvatum knee
excessive plantarflexion during SLS
true equinus
Excessive plantarflexion during SLA
drop foot
common gait patterns of pts with spastic diplegia
true equinus
jump knee
apparent equinus
crouch gait
apparent equinus impairments
excessive activation of gastroc, length of gastroc, muscle tone of gastroc
excessive plantarflexion to neutral during SLS
apparent equinus
crouch gait impairments
muscle power in gastroc, length of hamstrings, muscle tone of hamstrings, length of iliopsoas
excessive hip flexion, knee flexion, and ankle dorsiflexion
crouch gait
an adaptive assessment that includes domains of self-car, mobility, and social functions for kids under 7. it is sensitive to small changes
pediatric evaluation of disability inventory
Activity level measures recommended for CP
GMFM, quality of upper extremity skills test
evaluate change in gross motor function in children with CP. each dimension is validated independently
Gross Motor Function Measure
Evaluate change in fine motor function in children with CP. must perform entire measure, not separate domaines
quality of upper extremity skills test
impairments related to a negative foot progression angle
medial tibiofibular torsion, internal rotation contracture, femoral anteversion, femoral antetorsion
If patella is in frontal plane in standing, then hypothesize
medial tibiofibular torsion
if patella is medial to frontal plane in standing, then hypothesize
internal rotation contracture, femoral anteversion and femoral antetorsion
what is the thigh foot angle test for
to determine the magnitude of rotation of the leg in medial tibiofibular torsion
what is the axial tibiofibular torstion test used for
to determine the magnitude of tibiofibular axial rotation in medial tibiofibular torsion
the typical adult has a ___ thigh foot angle
10 lateral
an infant has a thigh foot angle of
0 that increases with age
what is an atypical thigh foot angle
thigh angle is negative (medial)
To perform the axial tibiofibular rotation test, you rotate the leg, ankle, and foot ____ to max end range
medially and laterally
when interpreting the axial tibiofibular rotation test, the lateral rotation should be ___ as much as the medial
twice
Ratio should be ___ when looking at medial and lateral hip rotation
1:1
atypical hip rotation
lateral hip rotation less than 25 degrees
what test estimates femoral antetorsion
ryder’s test
Typical ryder’s for teens and adults
0 degrees (estimate antetorsion = 16 degrees medially
Typical ryder’s for infants
25 degrees medial (estimate antetorsion= 40 degrees medial)
Atypical ryders for adults
greater than 15 degrees medial for over 14 years old
atypical ryders for under 14 years old
greater than 25 degrees medial
which spasticity measure has the best test-retest and inter-rater reliability in kids with CP
Tardieu. but the modified ashworth is also used
