MC Content: Cerebral Palsy Flashcards
Define Cerebral Palsy?
A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain.
Note: Irreversible ie once the part of the brain is damaged it’s damaged (therefore also non-progressive).
What are the antenatal risk factors for CP?
- Prematurity and low birth weight
- Intrauterine infections (can cause initiation of pre-mature labour and the baby is susceptible to the damage caused by those infections)
- Multiple gestation (one baby can dominate the blood and nutrient supply from the mother)
- Pregnancy complications eg haemorrhage, pre-eclampsia, premature placental abruption, placenta previa, etc can put the baby at risk of neurological concern
What are the perinatal risk factors for CP?
- Birth asphyxia eg umbilical cord entangled around the neck is going to result in hypoxia = part of the brain can die
- Complicated labour and delivery
What are the post-natal risk factors for CP?
- Non-accidental injury
- Head trauma
- Meningitis/encephalitis
- Cardio-pulmonary arrest (circulation isn’t going to the brain)
How many people are living with CP in Australia? How often is a child born with CP in Australia?
34,000 living with CP
1 child born every 20hrs with CP in Aus
What two pathologies is a premature neonatal brain susceptible to?
Intraventricular haemorrhage (IVH) & periventricular leukomalacia (PVL)
What is IVH?
Intraventricular haemorrhage: bleeding into the ventricles of the brain. The blood vessels around the ventricles develop late in 3rd trimester, thus pre-term infants have underdeveloped periventricular blood vessels, predisposing them to increased risk of IVH. The risk of CP increases with the severity of IVH.
What is PVL?
Periventricular leukomalacia: brain damage that adversely affects white matter, causing cell death, creating empty spaces in that part of the brain. The periventricular white matter sends nerve impulses that control motor function. Spasticity, cognitive impairment and vision issues often result from PVL. Approx 60-100% babies with PVL will be diagnosed with CP.
How is Cerebral Palsy categorised in terms of motor types?
Spastic
Dyskinetic
Ataxic
What is spastic CP?
Damage to motor cortex
Muscles appear stiff and tight
Altered motor control (70-80% will have this type)
What is dyskinetic CP?
Damage to the basal ganglia
Characterised by involuntary movements
Different types eg dystonia (uncontrollable muscle contraction)
What is ataxic CP?
Damage to the cerebellum
Characterised by shaky movements (affects balance and sense of positioning in space). Coordination is impaired.
What are the categories of CP?
Quadriplegia bilateral: 4 limbs affected. The muscles of the trunk face and mouth are often affected
Diplegia/bilateral: 2 limbs affected. The arms may be affected to a lesser extent
Hemiplegia/unilateral: one side of the body (one arm/one leg) is affected
Order of prevalence: diplegia/bilateral, hemiplegia/unilateral & quadriplegia bilateral
How does tone present in spastic CP?
What normally happens to the upper limbs?
What normally happens at the lower limbs?
- Hypertonia or increased muscle tone
- Upper limbs will flex (elbow, wrist, fingers) = difficulty in ADLs using hands eg dressing & eating
- Lower limb = difficulty with standing/sitting upright, transfer, moving eg walking and running
- Hip flexion, adduction or scissoring of thighs, flexion at knees, equinovarus foot posture
What is the risk of adduction in CP patients?
Complications relating to posterior dislocation of the hip even just from a seated position
What is equinovarus foot posture? What is it a result of?
Toes point downwards and inwards with the heel off the ground - this results from tightness in the calf muscle.
What are some typical motor symptoms in hemiplegia CP?
Baby just responds with one hand, finishes the food only on half the side of the plate (occurs due to heminopia), only high fives with one hand, etc
Other signs
- Circumductive gait: reduced flexion on affected side requires swinging the leg outward to clear the ground.
- Early handedness: Decreased use of affected side; early preference for unaffected hand.
What are some typical motor symptoms in diplegia CP?
Scissor gait: increased tone in the hip adductor muscles causes legs to adduct past midline (like a pair of scissors) when the child is lift by the upper body.
Commando crawl: normal alternating movement of hands while crawling but drags legs behind due to lower limb weakness
What are some typical motor symptoms in quadriplegia CP?
- Wont be able to sit or stand independently (affects all limbs)
- Often affects swallowing
- High likelihood of seizures and cognitive impairment
What are some typical motor symptoms in extrapyramidal CP?
- Involuntary contraction of all the muscle groups, difficulty with speech and swallowing (issue with the extra pyramidal tracts)
- Normally intelligence and low risk of seizures
- upper body is slightly more affected than lower body
Prevalence & etiology of spastic hemiplegia?
25% of CP
Etiology: Stroke or IVH
Prevalence & etiology of spastic diplegia?
35% of CP
Etiology: PVL
Prevalence & etiology of spastic quadriplegia?
20% of CP
Etiology: PVL
Upper motor neuron signs (relevant to spastic hemiplegia, spastic diplegia & spastic quadriplegia)
- Spasticity
- Hyperreflexia
- Clonus
- Babinski sign
Prevalence & etoiology: Athetoid/extrapyramidal. Are there UMN signs?
15% of CP
Etiology: Birth asphyxia
Ataxic CP: key signs?
- Coordination impaired (unstead, shaky movements, tremor)
- Balance impaired
- Can affect upper and lower limb eg standing, walking, running all disturbed
- Commonly given weighted spoons so they can balance it without spilling
- Speech and swallowing can be affected eg slurred speech
- Struggle focusing their eyes
Dyskinetic CP: key signs? Three types?
- Dyskinetic (Athetoid) CP: trouble controlling muscle movement- twisting, abrupt movements.
- Change or fluctuation of the tone quite rapidly (fluctuating between hypotonicity and hypertonicity)
Three types
* Dystonia: involves involuntary muscle contractions that lead to twisting and repeating movements
* Athetosis: slow, writhing movements
* Chorea: irregular, abrupt movements (whole body is shaking, difficult to swallow, irregular movement)
Cerebral Palsy (babies): key signs?
Cerebral Palsy signs (babies)
* Low muscle tone (baby feels ‘floppy’ when picked up)
* Unable to hold up his/her own head while lying on their stomach/ sitting position
- At 3 months of age if the child is not able to clear off their nose they won’t be able to breathe (red flag)?
* Muscle spasms or feeling stiff eg during nappy changes
* Poor muscle control, reflexes and posture eg not maintain posture in a high chair, shifting to one side/preferring one side
* Delayed development (can’t sit up or independently roll over by 6 months = red flag
* Feeding or swallowing difficulties eg choking
* Prefers to use one side of their body eg latching to one breast, or just lies on one side, etc
Key physical development concerns for CP in young children?
Not walking by 12-18 months (tippie toes walking, sole of one foot is generally not worn) & not speaking simple sentences by 24 months.
