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Paediatric Interventions > CP - Assessment & Classification > Flashcards

CP - Assessment & Classification Flashcards

1
Q

What is cerebral palsy?

A
  • Group of disorders of the development of movement and posture, causing activity limitation
  • Attributed to non-progressive disturbances that occurred in the developing foetal or infant brain
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2
Q

What are the motor disorders of CP often accompanied by?

A

Disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder

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3
Q

What is the epidemiology of CP?

A
  • Most common physical disability in childhood
  • 600-700 children born with CP in Aus each year
  • 2-2.5 per 1000 live births
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4
Q

What is the relationship between CP & premature delivery?

A
  • % of children with CP born premi has remained constant

- But increased survival rates of very preterm babies

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5
Q

What are the different causes of CP?

A
  • Prenatal (75%): Brain malformations, vascular insult, maternal infections
  • Perinatal (6-9%): Hypoxia, neonatal encephalopathy, HIE
  • Post natal (9-10%): ABI, vascular event, infections
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6
Q

What are the risk factors for CP?

A
  • Prematurity
  • Multiple birth
  • Genetic background
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7
Q

What are the positive features of UMN syndrome?

A
  • Increased proprioceptive reflexes producing spasticity

- Increased cutaneous reflexes producing flexor and extensor spasms & the Babinski response

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8
Q

What are the negative features of UMN syndrome?

A
  • Paralysis
  • Weakness
  • Loss of dexterity
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9
Q

What are the characteristics of the functional deficits associated with damage to the immature brain?

A
  • Reflect the neural lesion
  • Impacted by the changing state of multiple systems due to growth and development
  • Determined by what has been practised and achieved
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10
Q

What are the typical features of CP?

A
  • Delay in achievement of motor milestones
  • Atypical skill development not just a delay with abnormalities of posture and movement
  • Secondary impact on musculoskeletal system due to change in forces acting on the growing child e.g. spasticity, weight bearing alignment which further impact movement and posture
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11
Q

What are the abnormalities of posture & movement in CP?

A
  • Insufficient force generation
  • Spasticity, increased reflexes
  • Abnormal extensibility (usually hypo- but can have hyper-)
  • Poor selective control with inability to activate specific muscle without moving the whole limb
  • Poor regulation of activity in muscle groups in anticipation of postural changes & body movement leading to co-contraction of agonist and antagonist
  • Decreased ability to learn unique movements
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12
Q

How was CP previously classified?

A
  • Level of disability
  • Area of body affected (hemiplegia, diplegia, quadriplegia, monoplegia, triplegia)
  • Type of movement disorder (spastic, athetoid, dystonic, ataxic, hypotonic)
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13
Q

What are the current classification & assessment tools for CP?

A
  • Gross Motor Function Classification Scale (GMFCS)
  • Functional Mobility Scale (FMS)
  • Gait Classifications: Hemiplegia and Diplegia
  • Spasticity Measures: Tardieu, Australian Spasticity Assessment Scale (ASAS, Hypertonia Assessment Tool (HAT)
  • Cerebral Palsy Check-Up (CPUP)
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14
Q

What are the features of the GMFCS?

A
  • Summarises severity of disability in terms of function
  • 5 components: Lying/rolling, sitting, crawling/kneeling, standing, walking/running/jumping
  • Quantitative only
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15
Q

What are the features of the FMS?

A
  • Measure of independent mobility
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16
Q

What are the 3 types of ataxic CP?

A
  • Spasticity
  • Dystonia
  • Athetoid
17
Q

What is spasticity?

A
  • Velocity dependent increase in tonic stretch reflexes, with exaggerated tendon jerks resulting from hyper excitability of the stretch reflex
  • Background muscle activity present on EMG
18
Q

What are the features of spasticity?

A
  • Could be a compensation for weakness
  • Structural changes occur within the muscle cells causing muscle stiffness (hypertonia)
  • Changes with speed of movement, emotion, effort or posture
19
Q

What is hypo-extensibility due to in spasticity?

A
  • Spasticity
  • Adaptive changes in muscle
  • Alteration in growth
20
Q

What are stiff movements due to in spasticity?

A
  • Hypoextensibility
  • Changes in biomechanics
  • Lack of ability to generate sufficient force in appropriate muscle groups
21
Q

What are the measures for spasticity?

A
  • ASAS: Australian Spasticity Assessment Measure
  • HAT: Hypertonicity Assessment Tool
  • Tardieu: Used in musculo-skeletal assessment for R1 and R2 measures
  • Ashworth: Measure of muscle tone
22
Q

What are the features of the ASAS?

A
  • Scored on diagrammatic representation of the body

- Incorporates elements of Ashworth & Tardieu scale

23
Q

What are the features of the HAT?

A
  • 7 point scale which differentiates between the 4 limbs
  • Measures dystonia, spasticity & rigidity
  • Scores are 0 (negative) or 1 (positive)
    • Used with ASAS to give a clear picture of the areas of the body affected & type of movement disorder
24
Q

What is athetosis?

A

Involuntary writhing movements distally associated with low muscle strength and low tone

25
Q

What is the modified Tardieu scale?

A
  • Measures R1: Angle where catch occurs at V3
  • Measures R2: Angle of full PROM at V1
  • Difference between R1 & R2 is an indicator for botox
26
Q

What are the features of dystonia?

A
  • Basal ganglia abnormality
  • Abnormal muscle tone
  • Co-contractions
  • Involuntary twisting postures
  • Variable but not present in sleep
  • Worse with voluntary action, stress, pain, fatigue and startle
  • Distribution: Focal or generalised
  • Sustained or intermittent postures
27
Q

What are the differences between dystonia, spasticity & athetoid?

A
  • Dystonia: Tone variable, nil hyper-reflexia or contracture
  • Spasticity: Nil tone variability, does have hyper-reflexia & contracture
  • Athetoid: Nil tone variability, hyper-reflexia or contracture
28
Q

What is the “circle of spasticity”?

A
  • Increased muscle tone causes
  • Increased muscle stiffness causes
  • Muscle contracture causes
  • Increase muscle tone

Also affected by:

  • Bony lever arm maladaptation
  • Altered biomechanics
29
Q

What is the pathology of contracture?

A
  • Inappropriate neurological activity
  • Spasticity
  • Reduced muscle excursion
  • *need to intervene here
  • Failure of muscle growth, adaptive changes in muscle & change of bone shape
  • Restricted joint range leads to joint instability
  • Cartilage damage
  • Painful arthritis
30
Q

What does the musculoskeletal assessment of CP include?

A
  • UL & LL R1/R2
  • Spine: scoliosis, kyphosis
  • Pelvis: Anterior/posterior tilt or obliquity which impacts on sitting posture
31
Q

What is the CPUP?

A
  • Incorporates all aspects of assessment for all disciplines
  • Gold standard assessment & follow up of all children with CP in ACT/NSW
  • Uses assessment measures detailed in this lecture

Paediatric Interventions (27 decks)

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