CP from Textbook Flashcards
AACPDM hip guidance GMFCS II, x-ray
Age 2, 6, and 10
Degree of scoli for CP fusion
40 skeletal immature
50 skeletal mature
Are arms or legs closer to ventricles (medial)
legs, hence PVL causing diplegia
3 criteria of CP
- Neuromotor control problem
- Static brain lesion
- injury before birth or first year
Movement pattern on 25% of CP
dyskinetic, ataxic, hypotonic
If you haven’t walked by this age, you prob won’t walk
4
AACPDM Hip guidance GMFCS IV and V, x-ray
Age 2 to 12 twice a year, then yearly to 16
Definition of CP
Group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to no progressive disturbances that occurred in the developing fetal or infant brain
Epidemiology of CP
Increasing due to more premies surviving, more term with CP, and longer survival. There are more kids with severe CP now.
Extra risks for low Bone Mineral density
- increasing severity of neurological findings
- Increased feeding difficulty
- anticonvulstants
- low weight
Risk factors for CP
- placental abruption
- birth asphyxia
- neonatal medical problems
- prematurity
- Infection
- Inflammation
- coagulopathy
What is the greatest risk factor for CP
prematurity
What are TORCH infections
TO– Toxoplasmosis
R–Rubella
C–Cytomegalovirus
H–Herpes
Movement type of 75% of CP
Spastic (and a touch of dystonic)
Cause found for most CP
No
What is tonic labyrinthine tonic neck reflex
Basically “crunches”. lay back and body will extend. Flex neck, legs will flex
other MRI CP findings
Neuronal migration disorders:
- Lissencephaly
- polymicrogyria
- schizencephaly
- holoprosencephaly
What is an indicator of hemiplegic CP
Hand preference before 18 months
What trimester does PVL happen
2nd
GMFCS I
Run and stairs no help or hands
Percentage quadriplegic v diplegia v hemiplegic
Quadriplegic 20%
Hemiplegic 40%
Diplegic 40%
(ish)
What GMFCS are most quadriplegics
25% I-III
75% IV-V
What GMFCS are most hemiplegics
I-III (99%)
V
No means of independent mobility
Schizencephaly is…
Abnormal Schiz (clefts) (division) (cleavage) (split) parts of one or both sides (open or closed lip)
What defines dystonia
involuntary sustained or intermittent muscle contractions causing twisting and repetitive movements and abnormal postures
Most common CP MRI
white matter near lateral ventricles
What is polymicrogyria
Too many folds (gyria)
When was the big MetaAnalysis on SEMLS published
2012, 31 studies, not all good studies
Does bracing work for CP Scoli
No (probably) –
Miller J Pedi Ortho 1996 21 kids, 5 years, 23 hours a day, no difference from 22 kids no bracing. No difference in curve, shape, or progression
Incidence of scoliosis in CP
20% overall, 70% in quadriplegic CP
Who might walk with CP
If primitive reflexes persist at 2 years, unlikely to walk Sitting by age 2 more likely to walk Hemi, 100% Di, 85% Quadriplegia, much less and variable
GMFCS III
Crutches or manual wheelchair
GMFCS II
Walk only (not run) and holds rail
What are 3 methods of making better social connections in CP
- Cognitive behavioral therapy
- Stepping Stones Triple P
- Acceptances and Commitment Therapy
AACPDM hip guidance GMFCS I, x-ray
None unless Type I gait, then 2, 6, and 10
IV
Walker or power chair
What curve is cut off for progression
40 degrees
Most significant MRI finding
Periventricular leukomalacia
What is lissencephaly
“smooth brain” no folds (gyry) and grooves (sulci)
Other MRI CP findings
cortical infarcts of hemiplegia
What defines Spasticity
2 things
- Resistance to external movement which increases with increasing speed and varies with direction of joint movement
- and/or
- resistance to external movement rising rapidly above a threshold speed or joint angle
What GMFCS are most diplegics
I-III (98%)
AACPDM hip guidance GMFCS III, x-ray
Age 2 to 8, yearly, then every other until 16
% of kids with neuroimaging abnormalities
80%
Which GMFCS has most chance decreased bone mineral density
IV and V. Bone mineral density z score less than -2.0
