CP from Textbook

Question 1

AACPDM hip guidance GMFCS II, x-ray

Answer 1

Age 2, 6, and 10

Question 2

Degree of scoli for CP fusion

Answer 2

40 skeletal immature

50 skeletal mature

Question 3

Are arms or legs closer to ventricles (medial)

Answer 3

legs, hence PVL causing diplegia

Question 4

3 criteria of CP

Answer 4

1. Neuromotor control problem
2. Static brain lesion
3. injury before birth or first year

Question 5

Movement pattern on 25% of CP

Answer 5

dyskinetic, ataxic, hypotonic

Question 6

If you haven’t walked by this age, you prob won’t walk

Answer 6

4

Question 7

AACPDM Hip guidance GMFCS IV and V, x-ray

Answer 7

Age 2 to 12 twice a year, then yearly to 16

Question 8

Definition of CP

Answer 8

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

Question 9

Epidemiology of CP

Answer 9

Increasing due to more premies surviving, more term with CP, and longer survival. There are more kids with severe CP now.

Question 10

Extra risks for low Bone Mineral density

Answer 10

• increasing severity of neurological findings
• Increased feeding difficulty
• anticonvulstants
• low weight

Question 11

Risk factors for CP

Answer 11

• placental abruption
• birth asphyxia
• neonatal medical problems
• prematurity
• Infection
• Inflammation
• coagulopathy

Question 12

What is the greatest risk factor for CP

Answer 12

prematurity

Question 13

What are TORCH infections

Answer 13

TO– Toxoplasmosis
R–Rubella
C–Cytomegalovirus
H–Herpes

Question 14

Movement type of 75% of CP

Answer 14

Spastic (and a touch of dystonic)

Question 15

Cause found for most CP

Answer 15

No

Question 16

What is tonic labyrinthine tonic neck reflex

Answer 16

Basically “crunches”. lay back and body will extend. Flex neck, legs will flex

Question 17

other MRI CP findings

Answer 17

Neuronal migration disorders:

• Lissencephaly
• polymicrogyria
• schizencephaly
• holoprosencephaly

Question 18

What is an indicator of hemiplegic CP

Answer 18

Hand preference before 18 months

Question 19

What trimester does PVL happen

Answer 19

2nd

Question 20

GMFCS I

Answer 20

Run and stairs no help or hands

Question 21

Percentage quadriplegic v diplegia v hemiplegic

Answer 21

Quadriplegic 20%
Hemiplegic 40%
Diplegic 40%
(ish)

Question 22

What GMFCS are most quadriplegics

Answer 22

25% I-III

75% IV-V

Question 23

What GMFCS are most hemiplegics

Answer 23

I-III (99%)

Question 24

V

Answer 24

No means of independent mobility

Question 25

Schizencephaly is...

Answer 25

Abnormal Schiz (clefts) (division) (cleavage) (split) parts of one or both sides (open or closed lip)

Question 26

What defines dystonia

Answer 26

involuntary sustained or intermittent muscle contractions causing twisting and repetitive movements and abnormal postures

Question 27

Most common CP MRI

Answer 27

white matter near lateral ventricles

Question 28

What is polymicrogyria

Answer 28

Too many folds (gyria)

Question 29

When was the big MetaAnalysis on SEMLS published

Answer 29

2012, 31 studies, not all good studies

Question 30

Does bracing work for CP Scoli

Answer 30

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

Question 31

Incidence of scoliosis in CP

Answer 31

20% overall, 70% in quadriplegic CP

Question 32

Who might walk with CP

Answer 32

``` 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 ```

Question 33

GMFCS III

Answer 33

Crutches or manual wheelchair

Question 34

GMFCS II

Answer 34

Walk only (not run) and holds rail

Question 35

What are 3 methods of making better social connections in CP

Answer 35

1. Cognitive behavioral therapy 2. Stepping Stones Triple P 3. Acceptances and Commitment Therapy

Question 36

AACPDM hip guidance GMFCS I, x-ray

Answer 36

None unless Type I gait, then 2, 6, and 10

Question 37

IV

Answer 37

Walker or power chair

Question 38

What curve is cut off for progression

Answer 38

40 degrees

Question 39

Most significant MRI finding

Answer 39

Periventricular leukomalacia

Question 40

What is lissencephaly

Answer 40

"smooth brain" no folds (gyry) and grooves (sulci)

Question 41

Other MRI CP findings

Answer 41

cortical infarcts of hemiplegia

Question 42

What defines Spasticity

Answer 42

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

Question 43

What GMFCS are most diplegics

Answer 43

I-III (98%)

Question 44

AACPDM hip guidance GMFCS III, x-ray

Answer 44

Age 2 to 8, yearly, then every other until 16

Question 45

% of kids with neuroimaging abnormalities

Answer 45

80%

Question 46

Which GMFCS has most chance decreased bone mineral density

Answer 46

IV and V. Bone mineral density z score less than -2.0