Lecture 15 - Cerebral Palsy

Question 1

Define Cerebral Palsy

Answer 1

umbrella term for a group of UMN disorders
disorder of movement and or posture and of motor function

any event that happens before birth and up to 28 days post birth

Question 2

UMN syndrome/CP results in

Answer 2

spasticity - velocity dependent muscle tone
dyskinesia - abnormal muscle tone/posture

Long term sequeale: weakness, fatigue, contracture

Question 3

What are some associated impairments of an CP

Answer 3

visual - 35%
hearing - 10%
speech - 61%
swallowing 
intellectual 
epilepsy - 28%
scoliosis

Question 4

What is the incidence rate of CP

Answer 4

2-2.5/1000

Question 5

What are some risk factors for CP

Answer 5

male
premature
low birth weight
traumatic birth 
aboriginal 
multiple birth

Question 6

Age of diagnosis - what percentage of children are diagnosed with CP when 0-6 m old, and 7-12 m old

Answer 6

0-6 = 26%

7-12 =27%

Question 7

What are the 3 ways to describe CP

Answer 7

predominant movement disorder
topographical movement disorder
functional classifications

Question 8

what are the 4 types of topographic CP and there most affected areas

Answer 8

Diplegia - 36% - legs bilaterally
Hemiplegia - 39% - unilateral arm and leg
Quadriplegia - 22% - arms and legs bilaterally

Question 9

Explain the 5 levels of gross motor functional classification

Answer 9

Level 1 - walks independently on all surfaces
Level 2 - has difficulty with uneven surfaces, climbs stairs holding onto rails
Level 3 - assistive mobility device
Level 4 - power mobility
Level 5 - no independence, transported by carer in wheelchair

Question 10

Explain the functional mobility scale

Answer 10

looks at mobility over 3 distances: 5m, 50m, 500m

6 - no walking aids, all surfaces
5 - no walking aids, requires rail for stairs
4 - uses sticks, without help from another person
3 - crutches without help
2 - walker
1 - wheelchair

Question 11

Treatments for CP medical and therapy

Answer 11

• Reduce Spasticity - baclofen, botox, SDR
• Improve ROM and prevent contracture - casting, surgery
• Improve Strength - hydrotherapy, E-stim, resistance
• Improve Bone density - standing, vit d
• Improve function - goal directed, home therapy, content focused

Question 12

What are 3 ways to reduce spasticity

Answer 12

Botox: binds to cholinergic nerve endings and blocks acetyl choline - modulates spasticity, peak impact 3-4 weeks post injection

Baclofen: dampens down spinal reflexes, for level 4 and 5 use only

Selective Dorsal Rhizotomy - modifies reflexes and descending inputs from dorsal nerve root - gets permanent reduction in spasticity. surgeon exposes nerve fibers and tests them, cuts the ones that cause spasticity

Question 13

What is some essential criteria for SDR

Answer 13

• at least 2 years of age
• spastic diplegia
• must have some form of mobility with or without assistive devices
• patients must exhibit potential for improvement with or without assistive devices
• exclusions - no damage to basal ganglia on MRI
• support - motivated family

Question 14

Ways to improve ROM and reduce contracture

Answer 14

casting
surgery
education for family