Genetics

Question 1

Cerebral Palsy (CP)

Answer 1

• Nonprogressive lesion of the brain occurring prior to 2 yrs of aging

Question 2

CP may be accompanied by impairment of the:

Answer 2

• MSK system, e.g., hip dislocation and scoliosis
• Oral motor and GI function, e.g., speech, feeding
• Sensory disturbances, e.g., vision and hearing
• Many common comorbidities

Question 3

Spastic CP

Answer 3

• Most common
• Velocity dependent resistance to passive stretch
• Graded by use of the modified Ashworth scale

Question 4

Forms of CP

Answer 4

• Monoplegia
• Hemiplegia
• Diplegia
• Quadriplegia (tetraplegia)

Question 5

Ataxic CP

Answer 5

• Incoordination of voluntary movements
• Poor accuracy, targeting, and grading of movement

Question 6

Modified Ashworth Scale 0

Answer 6

No increase in tone

Question 7

Modified Ashworth Scale 1

Answer 7

slight increase in tone
catch/release at end ROM

Question 8

Modified Ashworth Scale 1+

Answer 8

slight increase in tone
catch/release and resistance through rest ROM (1/2)

Question 9

Modified Ashworth Scale 2

Answer 9

more marked increase in tone through ROM but effected part moved easily

Question 10

Modified Ashworth Scale 3

Answer 10

considerable increase in tone, passive movement difficult

Question 11

Modified Ashworth Scale 4

Answer 11

affected part in rigid flexion and extension

Question 12

Dyskinetic (Athetoid, Choreoathetoid, and Dystonic)

Answer 12

• Involuntary sustained or intermittent ms contractions resulting in sustained end range postures
• Involuntary distal writhing movements (athetosis) and poorly graded proximally voluntary movements (chorea)
• Intelligence rarely affected
• Hyperactive facial muscles (drooling)

Question 13

Rigidity

Answer 13

Lead-pipe quality to the resistance to passive stretch

Question 14

5 level system

Answer 14

Child walk with no limitations
Child walk with limitations
Child walk using handheld mobility device
Self mobility with limitations
Transported in wheel chair

Question 15

CP can be caused by

Answer 15

• Exposure to radiation and infection during fetal development
• Hypoxia
• Head trauma or a period of O2 deprivation

Question 16

CP
Abnormal head circumference Associated with

Answer 16

hydrocephalus and microcephaly

Question 17

CP
Associated abnormalities

Answer 17

Intellectual disability, learning disabilities, seizure disorders, sensory impairment, B&B, risk for UTI, orthopedic disabilities

Question 18

CP Treatment

Answer 18

• Multidisciplinary
  
  • Family, PT, OT, ST, MD, RN, special educators, Psycho
• Pharmaceuticals
  
  • Baclofen, diazepam, anti seizure
• Neurosurgery
  
  • Motor point block, Botox, dorsal rhizotomy
• Orthopedic surgery
  
  • E.g., Mm lengthening and bony procedures

Question 19

Mild CP Prognosis

Answer 19

Resolution with maturity and mild impairment

Question 20

Moderate CP Prognosis

Answer 20

limited mobility

Question 21

Severe CP Prognosis

Answer 21

poor

Question 22

• Ambulation Potential
  
  • Based on motor milestones
    
    • Independent sitting before 2

Answer 22

positive indicator of ambulation

Question 23

CP Ambulation Potential
If it is going to occur, ambulation takes place by age of

Answer 23

8

Question 24

Rehabilitation Implications

Answer 24

• Hypotonia
  
  • Wide based sitting
  • Head lag
  • Decreased reaching and kicking

Postoperative care

Adaptive equipment

ROM

Orthoses

Question 25

Spina Bifida Failure of neural tube closure produces defects

Answer 25

- Common in lumbosacral - Can occur in the sacral, thoracic, and cervical

Question 26

What vitamin deficiency is involved in Spina Bifida?

Answer 26

Folic Acid (B9)

Question 27

Spina Bifida Pathogenesis Day 20 after conception

Answer 27

neural groove is developed

Question 28

Spina Bifida Pathogenesis Day 23

Answer 28

the tube is completely closed except for an opening at each end

Question 29

Spina Bifida Pathogenesis Day 25

Answer 29

Upper end closes

Question 30

Spina Bifida Pathogenesis Day 27

Answer 30

bottom end closes to form the spinal cord

Question 31

When the posterior portion of the neural tube fails to close, lead to

Answer 31

- Cerebrospinal fluid, the meninges or the spinal cord, or both, to bulge out - Degree of dysfunction is related to the anatomic level of the defect

Question 32

Spina Bifida Occulta

Answer 32

Incomplete fusion of the posterior vertebral arch. The spinal cord, meninges, and spinal fluid intact

Question 33

Spina Bifida Occulta Does not protrude visibly but is often accompanied by:

Answer 33

- A depression or dimple in the skin A tuft of dark hair Soft fatty deposits Port‐wine nevi A combination of these abnormalities on the skin at the level of the underlying lesion Does not cause neurological dysfunction Rarely cause bowel and bladder disturbances or foot weakness

Question 34

Myelomeningocele Protrusion of the

Answer 34

meninges and SC or cauda equina

Question 35

Myelomeningocele Thoracic Deficit

Answer 35

- No LE movements, strong trunk - HKAFOs, RGO‐(reciprocal gait orthosis) - Wheelchair user, independent in transfer (may require sliding board) - Therapeutic standing and ambulation as children

Question 36

Myelomeningocele High Lumbar Defects (L1-L2)

Answer 36

- Have some hip flexion - KAFOs - Independent in all transfers - Household ambulation with walkers or forearm crutches for short distance - W/C for most mobility

Question 37

Myelomeningocele Low Lumbar Defect (L4-L5)

Answer 37

- KAFOs, crutches, or AFO - Household and community ambulator as children

Question 38

Myelomeningocele Sacral Defects

Answer 38

- Foot and ankle weakness - Usually community ambulator (occasionally with some equipment, e.g., FO)

Question 39

Myelomeningocele Characteristics

Answer 39

- Flaccid (commonly) or spastic paralysis - Delayed automatic (equilibrium) reactions - 90% have normal intelligence (IQ > 80) - Some may have learning disabilities - 90% present with hydrocephalus - Bowel and bladder incontinence - Sensory disturbances usually parallel motor dysfunction - MSK deformities - Scoliosis, hip dysplasia, hip dislocation, clubfoot (talipes equinovarus) - Hip and knee flexion contractures