Lecture 11 - Cerebral Palsy Flashcards
What is cerebral palsy?
An umbrella term which covers many motor impairments caused by lesions in the brain acquired early in development
What is the cutoff age for developing cerebral palsy?
2 years old
Who first referred to the disease as cerebral palsy in 1888?
William Olser
What did Sigmund Freud suggest in 1897?
That cerebral palsy may be related to the development of the brain in the womb
How prevalent is cerebral palsy?
1.5-2 per 1000 births
What is the cerebral palsy the leading cause of?
Childhood disability affecting function and movement
Which stage of development is most susceptible to cerebral palsy?
Prenatal
How is the severity of cerebral palsy classified?
By the Gross Motor Functional Classification Scale
How does the GMFCS classify the severity of cerebral palsy?
By describing the functional capabilities based on mobility
How many levels of severity are there according to the GMFCS?
Five
What is level I of the GMFCS?
Walks without restrictions; limitation in more advanced gross motor skills
What is level II of the GMFCS?
Walks without assistive devices; limitations are walking outdoors and in the community
What is level III of the GMFCS?
Walks with assistive mobility devices; limitations are walking outdoors and in the community
What is level IV of the GMFCS?
Self-mobility with limitations; children are transported or use powered mobility outdoors in the community
What is level V of the GMFCS?
Self-mobility is severely limited even with the use of assistive technology
What are the two major areas affected by cerebral palsy?
Motor centers, pyramidal cells, and corticospinal pathway
What are motor centers responsible for?
Direct voluntary movement
What are pyramidal cells responsible for?
Motor cortex neurons
What is the corticospinal pathway responsible for?
Begins at pyramidal cells and synapses directly to spinal motor neurons
What is the mechanism of injury for cerebral palsy?
Injury to the motor cortex neurons with decreases input to the spinal neurons
What is the effect of injury to the motor cortex neurons?
Affects motor control
Decreases the number of effective units
Produces abnormal muscle control and weakness
What are the signs and symptoms of cerebral palsy?
Known hypoxic or ischemic event
Muscle tone alterations
Delayed or failure to meet developmental milestones
Persistence of primitive reflexes
What type of muscle tone alterations can occur with cerebral palsy?
Spasticity
What is spasticity?
Stiffness of muscles
What is the recommended age for diagnosis of cerebral palsy?
3-5 years of age
Why is there a suggested delay in diagnosis for cerebral palsy?
Because signs and symptoms often change through child development. Some children “outgrow” their cerebral palsy
How does a physician examine a patient for cerebral palsy?
MRI/CT Spinal alignment Active and passive ROM in joints Motor power Muscle tone Movement disorders Limb deformities
What is the only way to definitively diagnose cerebral palsy?
Brain scan (MRI/CT)
What type of spinal abnormalities can occur as a result of cerebral palsy?
Kyphosis, lordosis, and scoliosis
What is kyphosis?
Excessive upper curvature of the spine
What is lordosis?
Excessive lower curvature of the spine
What is scoliosis?
Medial/lateral curve of the spine
How are gait abnormalities assessed?
Using the observational gait scale
What characteristics of gait are looked for using the observational gait scale?
Pez equinus Crouched gait Jumping gait Scissoring Windblown pelvis
What is pez equinus?
Excessive curling of the toes causing the individual to walk on top of their toes
What are some common arm deformities associated with cerebral palsy?
Shoulder internal rotation Elbow flexion Forearm pronation Wrist flexion Thumb in palm
What are some common leg deformities associated with cerebral palsy?
Hip flexion Hip adduction Knee flexion Ankle equinus Hindfood valgus Toe flexion
How can cerebral palsy be classified in terms of affected extremities?
Monoplegia, hemiplegia, diplegia, and quadriplegia
What is monoplegia?
Affects only one limb, usually an arm
What is hemiplegia?
Affects one side of the body including arm, leg, and trunk
What is diaplegia?
Affects symmetrical parts of the body (legs or arms)
What is quadriplegia?
Affects all four limbs
What are some non motor symptoms associated with cerebral palsy?
Epilepsy Speech impairment Vision Dental problems Poor nutrition Psychological and cognitive problems
Is there a cure for cerebral palsy?
No
How can cerebral palsy be treated?
Physical therapy Occupational therapy Speech therapy Botox CIT Dorsal Rhizotomy Tendon transfer/muscle lengthening
How can botox be used to treat cerebral palsy?
To relax spasticity of muscles
What is CIT?
Constraint Induced Therapy
How can CIT be used to treat cerebral palsy?
By placing a cast on the good limb to force use of bad limb in functional activities and train it
How can a dorsal rhizotomy be used to treat cerebral palsy?
By cutting off some of the sensory feedback coming to the dorsal root of the spine to dampen reflexes
