Management of CP

Question 1

Highest risk of CP

Answer 1

Infants with VLBW
Preterms

Maternal infection now thought to be a factor in development of CP especially in full term

Question 2

CP etiology

Answer 2

Unknown
Congenital malformation
Placental insufficiency
Toxic embryopathy
Maternal infection/viruses
Fetal competition
Genetic susceptibility
Intracranial hemorrhage
Anoxia

Question 3

Classification of CP

Answer 3

Types of motor impairment
Topography or distribution of impairment
GMFM level

Question 4

CP Types of Motor Impairment

Answer 4

Spastic
Dyskinetic or Athetoid
Ataxic
Hypotonic

Question 5

CP Topography or distribution of impairment

Answer 5

Diplegia
Quadriplegia
Hemiplegia
Double hemiplegia
Monoplegia

Question 6

Diplegia

Answer 6

LE > UE

Still involvement of UE

Question 7

Quadriplegia

Answer 7

All 4 limbs as well as head and trunk

Question 8

Double hemiplegia

Answer 8

When a child is very asymmetric

Diplegic distribution, but one side worse than the other

Question 9

Hemiplegia

Answer 9

Slightly more frequent on the right
Seldom diagnosed at birth
Motor development slightly delayed
35-43% seizures

Question 10

Spastic diplegia

Answer 10

Most common form of CP
2/3 cases caused by prematurity
Prognosis for independent ambulation good
Only 2% non ambul.
Intellect and speech normal or slightly impaired

Question 11

Spastic quadriplegia

Answer 11

Both arms and both legs

Question 12

Athetoid

Answer 12

Then to be bright kids
Basal ganglia involvement
Cognitive sparing

Question 13

Gross Motor Function Classification System

Answer 13

A 5 level system based on descriptions of functional motor abilities with focus on posture and mobility

Question 14

GMFM I

Answer 14

Walks sans restrictions
Limitations in more advanced gross motor skills

i.e. Balance, coordination

Question 15

GMFM II

Answer 15

Walks without assistive devices; limitations in walking outdoor and in the community

Question 16

GMFM III

Answer 16

Walks with an assistive mobility devices; limitations walking outdoors and in the community

ORTHOTICS DON’T COUNT

Question 17

CP

Answer 17

Convenient category denoting a wide spectrum of conditions having certain common characteristics

Question 18

GMFM IV

Answer 18

Self-mobility limitations; walk short distances, are transported or use power mobility outdoor and in the community

Primarily wheelchair users

Question 19

GMFM V

Answer 19

Self-mobility is severely limited, even with the use of assistive technology

Question 20

Communication disorders in CP

Answer 20

25%

Related to oral-motor function, central language dysfunction, hearing, and cognitive deficits

Question 21

Seizure disorders in CP

Answer 21

25-35%

Greatest in spastic quadriplegia and hemiplegia

There’s going to be a lot more structural damage to the brain, which could be a foci for where seizure activity develops

Question 22

Seizure treatment

Answer 22

Cannabinoids resolved seizures AND they upgraded levels

Cannabinoids target basal ganglia, too

Question 23

CP Selective motor control

Answer 23

More synergy patterns

Difficult to isolate motion

Question 24

CP Alignment and WB

Answer 24

Postural set off

Lower alignment problems in LE

Question 25

CP Strength

Answer 25

One of the underlying problems with spasticity is the underlying weakness Focus is an exercise and strengthening and not so much on facilitory techniques Rhizotomy (sp?) to eliminate reflex loop and then the children present as very weak

Question 26

Decorticate distribution in CP

Answer 26

Common from CORTICAL impairments Contributes to contractures

Question 27

Decerebrate distribution in CP

Answer 27

Common in those that have quadriplegia Contributes to contractures

Question 28

Hip sublux in CP

Answer 28

Spastic diplegia and quadriplegia a big problem

Question 29

Torsional deformities in CP

Answer 29

Femoral anteversion Tibial torsion Tibial torsion can go either way External tibial torsion more common

Question 30

Scoliosis in CP

Answer 30

Secondary impairment

Question 31

Back pain in CP

Answer 31

Lower back Often in anterior pelvic tilt Athetoid like CP have NECK pain

Question 32

Patello-femoral dysfunction

Answer 32

Spastic diplegia - quad spasticity and get patella alta, which causes PFD

Question 33

Genu recurvatum causes in CP

Answer 33

Quad spasticity | PF spasticity

Question 34

Therapeutic interventions in CP

Answer 34

``` NDT Sensorimotor Integration Electrical stimulation, FES, NMES, TES Strengthening Motor control/motor learning/dynamic systems approach ```

Question 35

TES in CP

Answer 35

Worn at night | Low level for a mm that looks to improve its strength and bulk

Question 36

Task practice in CP

Answer 36

Whole tasks more beneficial Those with CP NEED to practice Constraint reduced therapy included in this

Question 37

Aging with CP

Answer 37

Increased UTIs Progression of or development of swallowing difficulties Lack of dental care Osteoporosis ***Combat by using standing devices when they're younger so they can get used to being in an upright position

Question 38

Degenerative arthritis

Answer 38

Can lead to cessation of ambulation due to pain if subjects have not already stopped due to fatigue or inefficiency

Question 39

Spondylotic myelopathy

Answer 39

Particularly problematic in athetoid CP

Question 40

Tendon lengthening and transfers for CP

Answer 40

Gastroc/soleus, hamstring, hip flexors, ADD Rectus, tib ant, tib post, ADD UE - less common... you need a child who is going to participate in post-op rehab

Question 41

Boney procedures CP

Answer 41

Femoral derotation osteotomies Femoral osteotomy Subtalar stabilization Triple arthodesis Wrist fusion Scoliosis procedures ***SEMLS - one period of recovery, one period of rehab, one bout of GA

Question 42

Rebound

Answer 42

Immediate flex up after cast removal | Pain response to cast removal

Question 43

Oral med goals

Answer 43

Decrease positive signs | Improve negative signs

Question 44

Neurolytic nerve blocks for...

Answer 44

Paresthesia complaints Ethanol Phenol

Question 45

Botox

Answer 45

Interferes with the release of ACh at the nm junction No systemic affect May be administered without anesthesia EMG guidance for small mm Results typically last 3-6 months

Question 46

Ethanol and Phenol disadvantages

Answer 46

Require greater skill to inject | Increased risk of paresthesias, dyesthesias

Question 47

Botox disadvantages

Answer 47

More expensive than other injections, may develop antibodies

Question 48

Surgery vs botox

Answer 48

For botox you need a DYNAMIC contracture ***A joint or limb that's being held in a position by TONE Focal spasticity or focal impact of spasticity Opportunity for learning to use opposing muscle group Can use BOTOX as a trial before surgery

Question 49

GABA

Answer 49

Inhibitory CNS transmitter Presynaptic inhibition of Ca++ Baclofen

Question 50

Intrathecal vs oral

Answer 50

Intrathecal... Lower doses than those required with oral administration Potentially fewer systemic side effects Oral... Low BBB penetration with high systemic absorption and low CNS absorption Lack of preferential SC distribution Adverse effects, such as drowsiness, for some patients

Question 51

Indications for ITB therapy Positive response to screening test

Answer 51

Pts will get a spinal injection with infused Baclofen so watch what happens to the spasticity Full Ashworth scale before Infusion Full Ashworth scale after at time intervals and look for a response Make sure it's a family that frequently comes to their appointments -- pt's can suffer from withdrawal

Question 52

Selective Dorsal Rhizotomy

Answer 52

Dorsal sensory NR severed Each rootlet within root is stimulated Abnormally-responding rootlets are severed Children 7-10 years Usually involves 6-12 mos of intensive therapy Complications include possible sensory loss Need relatively good cognition Spastic diplegia Good cooperation Good anti-gravity strength

Question 53

SDR disadvantages

Answer 53

Permanent - may need spasticity for fx Potential adverse effects; spinal, sensory Not effective for dystonia - of central origin and not from SC level

Question 54

Selection criteria SDR

Answer 54

Spastic CP At least 2 years of age Adequate strength Motivation and ability to participate in PT Exclusion - non-CP, mixed tone, rigidity, severe scoliosis, no potential for fxl gains