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PT10121 MedSurg3 > L2.4 Cerebral Palsy > Flashcards

L2.4 Cerebral Palsy Flashcards

1
Q

Introduction

Describes a problem with movement and posture that makes certain activities difficult

A

Cerebral Palsy

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2
Q

Introduction

Ration of newborn children that develop cerebral palsy

A

2:1000

40% of those born with CP will have a severe case

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3
Q

Introduction

How many babies a diagnosed with CP each year?

A

10,000

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4
Q

Introduction

T/F: CP is the most common cause of motor diability

A

True

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5
Q

Introduction

Leading cause of disability amongst children

A

Autism

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6
Q

Introduction

CP is caused by

A

A non progressive defect, lesion, or anomaly of the developing brain

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7
Q

Introduction

When can the cause of CP occur?

A

Utero, near the time of delivery, or within the first 3 years of life

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8
Q

Introduction

Described as hemiplegic regif, paraplegic and generalized types.

Known as CP diplegic type or diplegic CP

A

Little’s Disease

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9
Q

Risk Factors to CP

Significant risk factor to CP

A

Prematurity

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10
Q

Risk Factors to CP

Antenatal Risk Factors

A
  1. Prematurity ans low birth weight
  2. Intrauterine infections
  3. Multiple gestation
  4. Pregnancy complications

70-80% of CP

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11
Q

Risk Factors to CP

Perinatal Risk Factors

A
  1. Birth Asphyxia
  2. Complicated labor and delivery

10% of CP

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12
Q

Risk Factors to CP

Postnatal Risk Factors

A
  1. Non-accidental injury
  2. Head trauma
  3. Meningitis/encephalitis
  4. Cardiopulmonary arrest
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13
Q

Risk Factors to CP

Most common perinatal risk factor

A

Asphyxia

Lack of O2 during delivery

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14
Q

Gestational Toxins

Iodine

A

Diplegia

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15
Q

Gestational Toxins

Organic Mercury

A

Quadriplegia

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16
Q

Gestational Toxins

Intrauterine Subdural Hemorrhage

A

Hemiplegia

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17
Q

Antenatal Pathology

Infection that can cause initiation of preterm labour (which can lead to CNS injury and CP

A

Fetoplacental and uterine infection or inflammation

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18
Q

Antenatal Pathology

Underdeveloped fetal brains are more suseptible to what?

A

Inflammation and inflammatory cytokines

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19
Q

Antenatal Pathology

What is responsible foe the development of PVL (Periventricular Leukomalacia)?

A

Cytokines

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20
Q

Antenatal Pathology

Infecrtion of the chorion and amnion (2 membranes surrounding the developing fetus)

A

Chorioamnionitis

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21
Q

Antenatal Pathology

T/F: Chorioamnionitis is most frequently associated maternal infection in CP

A

True

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22
Q

Antenatal Pathology

TORCH Acronym

A
  1. Toxoplasmosis
  2. Other infections (varicella zoster, adenovirus, enterovirus)
  3. Rubella
  4. Cytomegalovirus
  5. Herpes simplex virus
  6. Syphilis
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23
Q

Antenatal Pathology

TORCH infections are associated with approx. __% of all CP cases

A

5%

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24
Q

Antenatal Pathology

Multiple gestation increases the risk of antenatal complications such as?

A
  1. Preterm labor
  2. Growth restriction
  3. Low birth weight
  4. Death of co-twin
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25
Q

Antenatal Pathology

What does the death of a co-twin induce upon the surviving twin?

A

Neuropathologic changes that lead to CP

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26
Q

Antenatal Pathology

Prevalence of CP in the surviving twin

A

15x higher than average

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27
Q

Antenatal Pathology

Single strones risk factor for the development of CP

A

Twinning

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28
Q

Antenatal Pathology

Lead to placental vascular injury and clotting of the featal vessels

A

Thrombophilias

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29
Q

Antenatal Pathology

Lead to premature delivery, conferring the same risk for CP as a premature infant

A

Hemorrhage and Preeclampsia

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30
Q

Perinatal Pathology

Commonly associated with CP and can be d/t cord coil, complicated labor or immature birth

A

Birth Asphyxia

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31
Q

Perinatal Pathology

Complications in Premature

A
  1. Birth weight under 800g
  2. Gr 3 & 4 Intraventricular hemmorhage
  3. Prolonged seizure
  4. APGAR Score: <3 at 20mins
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32
Q

Perinatal Pathology

In term Complications

A
  1. Abruptio Placenta
  2. Placenta Previa
  3. Meconium Apsiration causing asphyxia
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33
Q

Postnatal Pathology

Postnatal Complications

A
  1. Non-accidental injury stroke syndromes
  2. Drowning
  3. Head trauma
  4. Meningitis
  5. Cardiopulmonary Arrest
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34
Q

Obstetrical Care

Increases the seizure threshold in mothers with preeclampsia; May reduce the risk of CP

A

Magnesium Sulfate

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35
Q

Obstetrical Care

Used to treat bacterial vaginosis may reduce the rate of preterm delivery and risk of chromioamnionitis

A

Antibiotics

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36
Q

Obstetrical Care

Inhibits cytokine production thus preventing PVL

A

Corticosteroids

Infection causes increase in cytokine

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37
Q

Pathophysiology

The premature neonatal brain is susceptible to two main pathologies:

A
  1. Intraventricular Hemorrhage
  2. Periventricular Leukomalacia
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38
Q

Pathophysiology

Leading cause in preterm infants term and is the most predicative sign that a child mya have CP

A

PVL

39
Q

Pathophysiology

PVL is described as the underdeveloped or damaged white matter in which region?

A

Periventricular Region

40
Q

Pathophysiology

Why do both IVH and PVL cause CP?

A

Because of the corticospinal tract composed of descending motor axons, course through the periventricular region

41
Q

Pathophysiology

Bleeding from the subependymal matrix into the ventricles of the brain

A

Intraventricular Hemorrhage

42
Q

Pathophysiology

The blood vessels around the ventricles develop late in the third trimester thus preterm infants have what?

A

Underdeveloped periventricular blood vessels, which increases risk of IVH

43
Q

Pathophysiology

The risk of CP increases with __

A

The severity of IVH

44
Q

Gross Motor Function Classification

Able to climb curbs and stairs without physical assistance or railing

A

GMFCS I

44
Q

Pathophysiology

The pathogenesis of PVL arises from?

A
  1. Ischemia/Hypoxia
  2. Infection/Inflammation
45
Q

Gross Motor Function Classification

Perform gross motor skills such as running and jumping but speed, balance, and coordination are limited

A

GMFCS I

46
Q

Gross Motor Function Classification

Can walk in most settings but environmental factors and personal choice influence mobility choices

A

GMFCS II

47
Q

Gross Motor Function Classification

Require hand held mobility device for safety and climb stairs using railings; may use wheeled mobility for long distances

A

GMFCS II

48
Q

Gross Motor Function Classification

Youth are capable of walking using hand helf mobility device and climbs stairs using railing with supervision and assist

A

GMFCS III

49
Q

Gross Motor Function Classification

Uses powered mobility in school and wheelchair or powered mobility outdoors

A

GMFCS III

50
Q

Gross Motor Function Classification

Used wheeled mobility in most setting and required physical assist +1-2

A

GMFCS IV

51
Q

Gross Motor Function Classification

Youth may walk short distances with assist indoors

A

GMFCS IV

52
Q

Gross Motor Function Classification

Youth are transported in manual wheelchair in all settings and is limited in ability to maintain antigravity postures and control leg and arm movements

A

GMFCS V

53
Q

Gross Motor Function Classification

Self-mobility is severely limited even with use of assistive tech

A

GMFCS V

54
Q

Spastic Cerebral Palsy

Most common type of CP

A

Spastic CP

Affects 75% of children

55
Q

Spastic Cerebral Palsy

Manifestations of Spastic CP

A
  1. Hperreflexia
  2. Clonus
  3. (+) Babinski up to 2 years
  4. Persistent Primitive reflex
  5. Overflow reflex
  6. Extensor or flexor posturing
56
Q

Spastic Cerebral Palsy

What must be monitored in spasitc CP

A

Hip dislocation and scoliosis

57
Q

Spastic Cerebral Palsy

Spastic muscle imbalance leads to what

A

Infantile Coxa Valga and femoral anteroversion

58
Q

Types of Spastic Cerebral Palsy

Muscle stiffnes mainly in the legs, with the arms less affected

Most common in premature babies

A

Diplegia

Possiblity of (+) Scissoring Gait

59
Q

Types of Spastic Cerebral Palsy

Affects only one side of the body and results form focal perinatal injury (usually MCA)

A

Hemiplegia

60
Q

Types of Spastic Cerebral Palsy

Common manifestation of Hemiplegic Spastic CP

A

Failure to use the involved hand

61
Q

Types of Spastic Cerebral Palsy

All four limbs are involved (total body involved)

Highest incidecne of significant cognitive disability

A

Quadripelgia

62
Q

Types of Spastic Cerebral Palsy

Indicated all four limbs are involved but upper limbs are weaker

A

Double Hemiplegia

63
Q

Types of Spastic Cerebral Palsy

Three limbs are affected

A

Triplegia

64
Q

Types of Spastic Cerebral Palsy

Triplegia
Symmetric Involvement : __
Asymmetric Involvement: __

A
  1. Lower limbs
  2. Upper limbs
65
Q

Types of Spastic Cerebral Palsy

All four limbs are involved with neck and head

Accompanied by eating and breathing complications

A

Pentaplegia

66
Q

Composed of 5-8% cases; associated with kernicterus due to Rh diseases

A

Dyskinetic CP

67
Q

Types of Dyskinetic Cerebral Palsy

Abnormal movements are evident in affected extremities by ___

A

18 months

68
Q

Types of Dyskinetic Cerebral Palsy

Writhing involuntary movements are first noted where

A

Hands and fingers

69
Q

Types of Dyskinetic Cerebral Palsy

Slow writhing involuntary upper distal extremity movement

A

Athetoid

70
Q

Types of Dyskinetic Cerebral Palsy

Abrupt, irregular, jerky movements usually in the head, neck and extremities

A

Chorea

71
Q

Types of Dyskinetic Cerebral Palsy

Slow rhythmic movement, trunk is affected

A

Dystonia

72
Q

Types of Dyskinetic Cerebral Palsy

Sudden violent involuntary flinging or ballistic high amplitude movement ipsilateral arm and leg

A

Ballismus

73
Q

Types of Dyskinetic Cerebral Palsy

Combination of athetosis and choreiform movements; large amplitude involuntary movements

A

Choreoathetoid

74
Q

Types of Cerebral Palsy

Problems with balance and coordination, unsteady when they walk, and have a hard time with quick movements.

A

Ataxic CP

75
Q

Types of Cerebral Palsy

Most common type of mixed CP

A

Spastic-dyskinetic CP

76
Q

Types of Cerebral Palsy

Involves only a small percentage of patients

A

Hypotonia

77
Q

Signs and Symptoms of Hypotonia

Lacking of sitting after 6 months

A

Gross motor delay

78
Q

Signs and Symptoms of Hypotonia

Opisthotic posture, handedness at less than 1

A

Abnormal Motor Characteristics

79
Q

Signs and Symptoms of Hypotonia

Posterior pelvic tilt due to hamstring tightness and crouch gait

A

Abnormal movement pattern

80
Q

Signs and Symptoms of Hypotonia

Early hypotnoia then gieves way to later hypertonia

A

Alteration in tone

81
Q

Signs and Symptoms of Hypotonia

Prescence of primitive relfexes after 6 months is deemed abnormal

A

Reflex Abnormalities

82
Q

Associated Problems

50% incidence; most severe in rigid, atonic, and severely spasitc quadriplegia

Milds in diplegia and hemiplegia

A

Mental Retardation

83
Q

Associated Problems

35-40% incidence; Most frequent in hemiplegia and spastic quadriplegia

A

Seizures

84
Q

Associated Problems

Difficulty sucking, swallowing and chewing. Common in spastic quadriplegia and dyskinetic

A

Oromotor

85
Q

Associated Problems

Reflux, constipation

A

Gastro-intestinal

86
Q

Associated Problems

Enamel dysgenesis, malocclusion

A

Dental

87
Q

Associated Problems

50% strabismus, esotropia, exotropia or hypertropia

Common in diplegia and quadriplegia

A

Visual

88
Q

Associated Problems

Infection, medications, bilirubin encephalopathy

A

Hearing Impairment

89
Q

Associated Problems

Hemiplegia

A

Cortical Sensory Deficit

90
Q

Associated Problems

Deficient ventilation, microaspiration

A

Pulmonary

91
Q

Differential Diagnosis

Syndromes of early hypotonia and developmental delay

A

Prader Willi Syndrome and Sotos Syndrome

92
Q

Differential Diagnosis

Thyroid, infant of diabetic mother

A

Metabolic Disorders

93
Q

Differential Diagnosis

Werdnig Hoffman Disease

A

Congenital Neuromuscular Disease

PT10121 MedSurg3 (8 decks)

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