CP exam

Question 1

what makes diagnosis of CP

Answer 1

combination findings from neurological assessment, neuroimaging, assessment of movement and posture

Question 2

< 5 months corrected age

Answer 2

MIR 86-89% sensitivity
general movement assessment 98%
HINE 90%

Question 3

> 5 months corrected age

Answer 3

MRI 86-89%
Hine 90% sensitivity
developmental assessment 83%

Question 4

Hammersmith Infant Neurological Examination (HINE)

Answer 4

a diagnostic tool
3-24 months AGE
10-15 mins

identify and detect as early as 5 months

key tools for accurate, early idenfitication: GMA, HINE, MRI

Question 5

Gross Motor Classification Scale Expanded and Revised level 1

Answer 5

walks independently without restriction

may see differences

Question 6

GMFCS level 2

Answer 6

walks without devices

some awkwardness but can walk on their own feet
usually with cane or walker to support them

Question 7

GMFCS level 3

Answer 7

walks with mobililty device

are also wc user for distances

Question 8

GMFCS level 4

Answer 8

self mobility with limitations, may use powered mobility

wheel chair users but able to use it independelty
can be power or manual wc

Question 9

GMFCS level 5

Answer 9

self mobility is severely limited even with the use of supporting technology

full time wheel chair users

need a lot of support for posture or body control

Question 10

childrens assessment of participation and equipment (CAPE) and Preferences for activitives of children (PAC)

Answer 10

CAPE
- 55 items
- 30-45 mins
- child completed or assisted version
- AGES 6-21

have you done this activity in the last 4 months
if yes how often
with whom do you do this most often
where do you do this most often
how much do you like doing this activity

Question 11

common MSK impairments

Answer 11

muscle tightness/hypoextensibility
contractures
bony alignment problems
osteoporosis/osteopenia
fractures
degenerative joint disease
scoliosis

reduced force production capability due to decreased muscle volume, fascicle length, and speed of contraction

Question 12

make test:

Answer 12

patient exerts maximum, voluntary effort against FIXED resistance (CHILDREN)

Question 13

break test:

Answer 13

patient exerts MAX voluntary effort against INCREASING resistance

Question 14

KEY TAKEAWAYS

Answer 14

GMA and HINE are diagnostic tools for CP

GMFCS is a classification tool

the GMFM was used to develop the GMFCS

all ICF components should be considered when identifying needs and goals

Question 15

where to start administration of ECAB for a GMFCS level 1/2

Answer 15

item 8

Question 16

where to start for administration of ECAB for GMFCS 3/4/5

Answer 16

item 1

Question 17

where to start administration of ECAB for hemiplegia/monoplegia

Answer 17

item 4

Question 18

Edinburgh Visual Gait Score

Answer 18

reliability - moderate to excellent (60-92%)
validity - good correlation with GMFM and 3D gait analysis
MCID 2.4

Question 19

clinical diagnosis of CP is made by

Answer 19

child does not reach early milestones and exhibits abnormal muscle tone or qualitative differences in movement patterns

Question 20

GMA

Answer 20

looks at the general movements of the awake infant

has been highly affective at detecting CP by age 3 months

typical movement - spontaneous and figidity from birth to 20 weeks

general movements that are absent or abnormal are at higher risk for CP

Question 21

common gait tests and measures - participation and function

Answer 21

patient specific functional scale
PEDI CAT
GMFM
TUG
dyanmic gait index ( as young as 6 yo)

Question 22

common gait tests and measures - body functino and structure tests

Answer 22

3D gait analysis
Edinburgh visual gait scale
endurance/speed
motor control (SCALE)
ROM and strength

Question 23

gold standard for gait

Answer 23

3D gait analysis
is required for surgical intervention

Question 24

edinburgh gait score

Answer 24

valid and reliable measure of gait deviatoins
17 observations of each leg

higher score = greater deviations

Question 25

activation of tib anterior in gait

Answer 25

more in CP

Question 26

ankle lever arm dysfunction

Answer 26

toe walking decreases ankle power generation by 50% (requires 1/2 the strength than heel-toe walking)

this may be a beneficial COMPENSATION STRATEGY for children with CP

can develop contracture

Question 27

joint and bony abnormalities

Answer 27

a set of conditions in which level arms become more distorted because of bony or positional deforminities

muscle activation imbalance can lead to bony or positional deformities such as femoral anteversion and genu recturvatum

Question 28

jump knee gait

Answer 28

ankle in equinus, particularly in late stance
knee and hip inn hyperflexion in early stance, followed bt extension to a variable degree in late stance, pelvis within normal ROM or anterior tilt

often in younger children GMFCS level 2/3

increased hip and knee flexion at initial contact and in early stance

rapid hip ext, knee ext and PF in midstance

PF/knee ext couple

looks like jumping from one foot to another

Question 29

true equinus gait

Answer 29

ankle in equinus during stnace, full knee and hip extension, pelvis within norma ROM

toe walkinf with PF in stance

Question 30

apparent equinus gait

Answer 30

ankle normal ROM, knee and hip in hyperflexion throughout stance, pelvis normal

toe walking with neutral DF in stance

Question 31

crouch gait

Answer 31

ankle in excessive DF throughout stance, knee and hip in hyperflexion, pelvis normal

increased hip, knee and DF
commonly develops or worsens as child ages

associated with decreased force production relative to BW

high energy cost

Question 32

stiff knee gait

Answer 32

reduction in knee flexion during swing is coupled with excessive hip circumduction

tight Rectus Femoris