L2.4 Cerebral Palsy Flashcards by Naomi Nakazato

Introduction

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

Cerebral Palsy

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Introduction

Ration of newborn children that develop cerebral palsy

2:1000

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

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Introduction

How many babies a diagnosed with CP each year?

10,000

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Introduction

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

True

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Introduction

Leading cause of disability amongst children

Autism

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Introduction

CP is caused by

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

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Introduction

When can the cause of CP occur?

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

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Introduction

Described as hemiplegic regif, paraplegic and generalized types.

Known as CP diplegic type or diplegic CP

Little’s Disease

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Risk Factors to CP

Significant risk factor to CP

Prematurity

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Risk Factors to CP

Antenatal Risk Factors

Prematurity ans low birth weight
Intrauterine infections
Multiple gestation
Pregnancy complications

70-80% of CP

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Risk Factors to CP

Perinatal Risk Factors

Birth Asphyxia
Complicated labor and delivery

10% of CP

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Risk Factors to CP

Postnatal Risk Factors

Non-accidental injury
Head trauma
Meningitis/encephalitis
Cardiopulmonary arrest

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Risk Factors to CP

Most common perinatal risk factor

Asphyxia

Lack of O2 during delivery

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Gestational Toxins

Iodine

Diplegia

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Gestational Toxins

Organic Mercury

Quadriplegia

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Gestational Toxins

Intrauterine Subdural Hemorrhage

Hemiplegia

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Antenatal Pathology

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

Fetoplacental and uterine infection or inflammation

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Antenatal Pathology

Underdeveloped fetal brains are more suseptible to what?

Inflammation and inflammatory cytokines

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Antenatal Pathology

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

Cytokines

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Antenatal Pathology

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

Chorioamnionitis

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Antenatal Pathology

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

True

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Antenatal Pathology

TORCH Acronym

Toxoplasmosis
Other infections (varicella zoster, adenovirus, enterovirus)
Rubella
Cytomegalovirus
Herpes simplex virus
Syphilis

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Antenatal Pathology

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

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Antenatal Pathology

Multiple gestation increases the risk of antenatal complications such as?

Preterm labor
Growth restriction
Low birth weight
Death of co-twin

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

Neuropathologic changes that lead to CP

# Antenatal Pathology Prevalence of CP in the surviving twin

15x higher than average

# Antenatal Pathology Single strones risk factor for the development of CP

Twinning

# Antenatal Pathology Lead to placental vascular injury and clotting of the featal vessels

Thrombophilias

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

Hemorrhage and Preeclampsia

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

Birth Asphyxia

# Perinatal Pathology Complications in Premature

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

# Perinatal Pathology In term Complications

1. Abruptio Placenta 2. Placenta Previa 3. Meconium Apsiration causing asphyxia

# Postnatal Pathology Postnatal Complications

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

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

Magnesium Sulfate

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

Antibiotics

# Obstetrical Care Inhibits cytokine production thus preventing PVL

Corticosteroids | Infection causes increase in cytokine

# Pathophysiology The premature neonatal brain is susceptible to two main pathologies:

1. Intraventricular Hemorrhage 2. Periventricular Leukomalacia

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

PVL

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

Periventricular Region

# Pathophysiology Why do both IVH and PVL cause CP?

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

# Pathophysiology Bleeding from the subependymal matrix into the ventricles of the brain

Intraventricular Hemorrhage

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

Underdeveloped periventricular blood vessels, which increases risk of IVH

# Pathophysiology The risk of CP increases with __

The severity of IVH

# Gross Motor Function Classification Able to climb curbs and stairs without physical assistance or railing

GMFCS I

# Pathophysiology The pathogenesis of PVL arises from?

1. Ischemia/Hypoxia 2. Infection/Inflammation

# Gross Motor Function Classification Perform gross motor skills such as running and jumping but speed, balance, and coordination are limited

GMFCS I

# Gross Motor Function Classification Can walk in most settings but environmental factors and personal choice influence mobility choices

GMFCS II

# Gross Motor Function Classification Require hand held mobility device for safety and climb stairs using railings; may use wheeled mobility for long distances

GMFCS II

# Gross Motor Function Classification Youth are capable of walking using hand helf mobility device and climbs stairs using railing with supervision and assist

GMFCS III

# Gross Motor Function Classification Uses powered mobility in school and wheelchair or powered mobility outdoors

GMFCS III

# Gross Motor Function Classification Used wheeled mobility in most setting and required physical assist +1-2

GMFCS IV

# Gross Motor Function Classification Youth may walk short distances with assist indoors

GMFCS IV

# 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

GMFCS V

# Gross Motor Function Classification Self-mobility is severely limited even with use of assistive tech

GMFCS V

# Spastic Cerebral Palsy Most common type of CP

Spastic CP | Affects 75% of children

# Spastic Cerebral Palsy Manifestations of Spastic CP

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

# Spastic Cerebral Palsy What must be monitored in spasitc CP

Hip dislocation and scoliosis

# Spastic Cerebral Palsy Spastic muscle imbalance leads to what

Infantile Coxa Valga and femoral anteroversion

# Types of Spastic Cerebral Palsy Muscle stiffnes mainly in the legs, with the arms less affected | Most common in premature babies

Diplegia | Possiblity of (+) Scissoring Gait

# Types of Spastic Cerebral Palsy Affects only one side of the body and results form focal perinatal injury (usually MCA)

Hemiplegia

# Types of Spastic Cerebral Palsy Common manifestation of Hemiplegic Spastic CP

Failure to use the involved hand

# Types of Spastic Cerebral Palsy All four limbs are involved (total body involved) | Highest incidecne of significant cognitive disability

Quadripelgia

# Types of Spastic Cerebral Palsy Indicated all four limbs are involved but upper limbs are weaker

Double Hemiplegia

# Types of Spastic Cerebral Palsy Three limbs are affected

Triplegia

# Types of Spastic Cerebral Palsy Triplegia Symmetric Involvement : __ Asymmetric Involvement: __

1. Lower limbs 2. Upper limbs

# Types of Spastic Cerebral Palsy All four limbs are involved with neck and head | Accompanied by eating and breathing complications

Pentaplegia

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

Dyskinetic CP

# Types of Dyskinetic Cerebral Palsy Abnormal movements are evident in affected extremities by ___

18 months

# Types of Dyskinetic Cerebral Palsy Writhing involuntary movements are first noted where

Hands and fingers

# Types of Dyskinetic Cerebral Palsy Slow writhing involuntary upper distal extremity movement

Athetoid

# Types of Dyskinetic Cerebral Palsy Abrupt, irregular, jerky movements usually in the head, neck and extremities

Chorea

# Types of Dyskinetic Cerebral Palsy Slow rhythmic movement, trunk is affected

Dystonia

# Types of Dyskinetic Cerebral Palsy Sudden violent involuntary flinging or ballistic high amplitude movement ipsilateral arm and leg

Ballismus

# Types of Dyskinetic Cerebral Palsy Combination of athetosis and choreiform movements; large amplitude involuntary movements

Choreoathetoid

# Types of Cerebral Palsy Problems with balance and coordination, unsteady when they walk, and have a hard time with quick movements.

Ataxic CP

# Types of Cerebral Palsy Most common type of mixed CP

Spastic-dyskinetic CP

# Types of Cerebral Palsy Involves only a small percentage of patients

Hypotonia

# Signs and Symptoms of Hypotonia Lacking of sitting after 6 months

Gross motor delay

# Signs and Symptoms of Hypotonia Opisthotic posture, handedness at less than 1

Abnormal Motor Characteristics

# Signs and Symptoms of Hypotonia Posterior pelvic tilt due to hamstring tightness and crouch gait

Abnormal movement pattern

# Signs and Symptoms of Hypotonia Early hypotnoia then gieves way to later hypertonia

Alteration in tone

# Signs and Symptoms of Hypotonia Prescence of primitive relfexes after 6 months is deemed abnormal

Reflex Abnormalities

# Associated Problems 50% incidence; most severe in rigid, atonic, and severely spasitc quadriplegia | Milds in diplegia and hemiplegia

Mental Retardation

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

Seizures

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

Oromotor

# Associated Problems Reflux, constipation

Gastro-intestinal

# Associated Problems Enamel dysgenesis, malocclusion

Dental

# Associated Problems 50% strabismus, esotropia, exotropia or hypertropia | Common in diplegia and quadriplegia

Visual

# Associated Problems Infection, medications, bilirubin encephalopathy

Hearing Impairment

# Associated Problems Hemiplegia

Cortical Sensory Deficit

# Associated Problems Deficient ventilation, microaspiration

Pulmonary

# Differential Diagnosis Syndromes of early hypotonia and developmental delay

Prader Willi Syndrome and Sotos Syndrome

# Differential Diagnosis Thyroid, infant of diabetic mother

Metabolic Disorders

# Differential Diagnosis Werdnig Hoffman Disease

Congenital Neuromuscular Disease