CP and LD (Week 9) Flashcards
Group of permanent or chronic neurological disorder, affecting movement, balance and posture
Cerebral palsy
When does CP occur?
fetal period, during birth, or in early infancy but not diagnosed until later
4 topographical classification of CP
- Monoplegia/ Monoparesis
- Diplegia/ Diparesis
- Hemiplegia/ Hemiparesis
- Quadriplegia/ Quadriparesis
2 Motor function classification of CP
- Pyramidal
2. Extrapyramidal
Extrapyramidal is broken into what 2 categories
- Dyskinetic
2. Ataxia
If injury to pyramidal area what type of mvmt is affected?
voluntary
If injury to extrapyramidal area what type of mvmt is affected?
involuntary mvmt bc areas like basal ganglia, thalamus, cerebellum are affected
Most common type of CP (3)
- spastic CP (pyramidal)
o 1. Hemiplegia
o 2. Diplegia
o 3. Quadriplegia
Type of dyskinetic CP with symptoms:
Writhing mvmts, repetitive, rhythmic, slower
Athetoid
Type of dyskinetic CP with symptoms:
Jerky almost like a spasm
Chorea
Type of dyskinetic CP with symptoms:
- Sustained posture esp. in trunk
- move, fix, and then come out of the mvmt
Dystonic
Type of dyskinetic CP seen along w/spastic quadriplegia frequently
Dystonic
What is chorea commonly seen with?
chorea athetosis
CP that affects balance and coordination
Ataxic CP
9 risk factors for CP
- Prematurity & SGA
- Multiples
- Prenatal infections: CMV, toxoplasmosis, rubella
- Rh disease
- Challenging labor
- Placental inefficiencies
- Brain infections (post birth)
- Toxin exposure: mercury
- Brain injury
3 complications that put baby at higher risk of getting CP
1. Interventricular Hemorrhage (IVH)
2. Hypoxic-Ischemic Encephalopathy (HIE)
3. Periventricular Leukomalacia (PVL)
Bleeding into the ventricular space within the brain hemispheres
Interventricular Hemorrhage (IVH)
Risk factors for IVH (3)
o prematurity, SGA,
o respiratory distress syndrome
o patent ductus arteriosus (PDA)
When can IVH occur?
in-utero or after they are born esp. premies
What grade of IVH is when bleeding expands beyond germinal matrix into the ventricular system?
Grade II
What occurs during Grade III IVH?
Bleeding dilates the ventricles and they are pushing on other brain tissue
What % of Grade III IVH get CP?
30%
What grade of IVH has periventricular Hemorrhagic Infarction (PHL-IVH) in addition to IVH?
Grade IV
Describe Grade I IVH?
Bleeding into a network of blood vessels in the roof of the lateral ventricles (isolated to germinal matrix)
What % of Grade IV IVH get CP?
75%
What do the following symptoms indicate?
- bulging fontanelle
- seizures
- decreased reflexes, tone, suck
- apnea, bradycardia, anemia
IVH
Why is a mom given prenatal corticosteroids?
if they know the mom may deliver early to try to prevent a premature birth
If mom has increased risk of bleeding or bleeding disorder what can she take?
Vitamin K
2 medical internventions for IVH
- Effective resuscitation and ventilation
2. Maintain hemodynamic stability (BP stable)
in a scissoring gait, what muscles are overactive?
adductors
why do kids with CP sometimes walk in a crouched position?
compensate for balance issues
In kids with CP, is supination or pronation more challenging?
supination
What arm position is common for kids with CP?
fingers flexed into fist, FA pronate, wrist UD
3 tone reducing medications for CP
botox
baclofen pump
oral meds such as valium
5 surgical intervention for CP?
tendon lengthening muscle transfer de-rotation osteotomy spinal fusion selective dorsal rhizotomy
What is the most important factor when thinking about adaptive equipment?
ALIGNMENT
T/F: learning disabilities are recognized before entering school
false
This LD has an issue with reading written language
dyslexia
This LD has an issue with math and problem solving
dyscalculia
This LD has an issue with writing
dysgraphia
This LD has an issue with gross/fine motor and function
dyspraxia
This LD has an issue with understanding vision or hearing despite normal vision or hearing
Auditory and Visual Processing Disorders
What is a common comorbidity with ADHD?
executive function problems
When is the DSM-V used to diagnose LDs?
private practice
When is the ICD-11 used to diagnose LDs?
private practice
When is the IDEA used to diagnose LDs?
public school system
What is the name of a custom intervention strategy for a kid with a LD/Special Education?
IEP
Brain damage due to hypoxia or ischemia
Hypoxic-ischemic Encephalopathy (HIE)
Most significant risk factor for HIE?
asphyxia
primary cause of HIE
placental insufficiency
Does HIE happen after birth or in utero typically?
in utero
What % of babies w/HIE get CP?
10-25%
What would the following symptoms indicate?
- decreased activity level
- poor suck and feeding
- respiratory difficulty
- seizure in first 24 hrs
- temperature instability
HIE
White matter closest to the ventricles sustains injury/damage due to hypoxia or ischemia resulting in brain tissue death
Periventricular Leukomalacia (PVL)
4 risk factors for PVL
- prematurity
- intrauterine infection
- bleeding during pregnancy
- IVH
What % of babies w/PVL get CP?
60-90%
When is critical window to damage oligodendrocytes?
23-24 weeks GA
3 early signs to test for CP
- lack of integrated reflexes
- signs of UMN damage (increased tone)
- developmental delays
Result of delayed or absent righting rxns in kids w/CP
- trouble protecting themselves when sitting esp. if fall backwards
3 characteristics of GMFCS Level 1
o Walks without limitation (started late 18-24 mo)
o Soft neurologic signs,
o They can sit, crawl
What GMFCS Level?
o severe head & trunk control limitations,
o transported in a manual wheelchair
o cognitively may be ok but very low motor development
GMFCS Level V
Describe GMFCS Level IV (4)
o Starts to become more sever
o May need adaptive seating and supported sitting
o May walk short distances w/assistance
o Self-mobility with powered mobility assistance
What GMFCS Level?
o Walks with limitations (by age 4)
o can sit but tough to do UE activity like playing
GMFCS Level II
What GMFCS Level?
o walks with adaptive equipment assistance like a walker
o can sit independently or with limited support; some independence in standing transfers
GMFCS Level III
