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Peds Test 2 (partial) > Med/Surg Management of CP > Flashcards

Med/Surg Management of CP Flashcards

0
Q

CP causes __________ and _____________ damage that affects _____________ or ______________ of the child.

A

permanent; nonprogressive; posture; movement

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1
Q

Define CP

A

Cerebral Palsy

- an insult to the developing brain at any period of development

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2
Q

True/False - Cerebral Palsy is a diagnosis.

A

False - It is a description

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3
Q

CP results from _____________ of the ____________ brain.

A

encephalopathy; immature

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4
Q

CP literally means

A

“loss of movement or paralysis due to brain dysfunction”

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5
Q

CP is characterized by

A

sensorimotor dysfunction

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6
Q

CP results in __________ impairment of ____________ and ___________ of muscle action

A

variable; coordination; control

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7
Q

True/False - CP is never associated with affected speech, vision, and hearing.

A

False

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8
Q

True/False - CP is frequently associated with mental retardation and epilepsy.

A

True

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9
Q

Incidence of CP decreases as what increases?

A

birth weight

Fat babies are less likely to get CP

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10
Q

Antenatal

A

Prenatal

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11
Q

Antenatal causes of CP include

A

vascular infarct, maternal infection, metabolic disorders

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12
Q

Perinatal causes of CP include

A

problems during labor and delivery

antepartum hemmorhage

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13
Q

HIE

A

Hypoxic Ischemic Event

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14
Q

CVA

A

cerebrovascular accident

aka stroke

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15
Q

Postnatal causes of CP include

A

Metabolic encephalopathy, infection, traumatic injuries

Post-surgical correction for congenital malformations

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16
Q

In term infants, diffuse parasagittal injury (birth asphyxia) is associated with

A

spastic quadriplegia, mental retardation

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17
Q

What is diffuse parasagittal injury?

A

birth asphyxia

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18
Q

In term infants, focal ischemic necrosis (CVA) is associated with

A

spastic hemiplegia, athetosis, ataxia

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19
Q

What is focal ischemic necrosis?

A

CVA

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20
Q

In premature infants, germinal matrix bleed (gm/IVH) is associated with

A

spastic diplegia

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21
Q

In premature infants, chronic/acute hypoxia (RDS) is associated with

A

athetosis

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22
Q

gm/IVH

A

Germinal Matrix and Intraventricular Hemorrhage

germinal matrix bleed

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23
Q

RDS

A

Respiratory Distress Syndrome

chronic/acute hypoxia

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24
Q

What makes diagnosis and prognosis of CP difficult?

A

plasticity of the developing brain

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25
Q

GMH

A

germinal matrix hemorrhage

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26
Q

PIVH

A

Periventricular Intraventricular Hemorrhage

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27
Q

PVC

A

periventricular cyst

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28
Q

PVL

A

periventricular leukomalacia

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29
Q

Grades of CP

A

Severe
Moderate
Mild

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30
Q

Severe CP

A

Under 6 months

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31
Q

Moderate CP

A

diagnosed by 12 months of age

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32
Q

Mild CP

A

May not be diagnosed until after the child is walking independently or later

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33
Q

99%+ of children with CP initially demonstrate

A

hypotonia

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34
Q

CNS damage -> abnormal motor system -> abnormal (compensatory) movement patterns -> _____________________

A

less functional / less efficient system

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35
Q

CNS damage -> abnormal motor system -> ____________________ -> _____________________

A

abnormal (compensatory) movement patterns; less functional / less efficient system

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36
Q

CNS damage -> _______________ -> __________________ -> _____________________

A

abnormal motor system; abnormal (compensatory) movement patterns; less functional / less efficient system

37
Q

Habitual patterns -> contractures -> ______________

A

deformities

38
Q

Habitual patterns -> ______________ -> ______________

A

contractures; deformities

39
Q

_________________ -> abnormal motor system -> abnormal (compensatory) movement patterns -> less functional / less efficient system

A

CNS damage

40
Q

_____________ -> contractures -> deformities

A

Habitual patterns

41
Q

Classification systems for CP

A

Topographic distribution

Types of Impairment

42
Q

Topographic distribution

A

Identifies the parts of the body that are primarily involved

Pattern of motor expression

43
Q

Types of Impairment

A

Impairments in muscle tone and voluntary control of movement

44
Q

Topographic distribution of diplegic CP

A

LEs more affected

45
Q

Topographic distribution of hemiplegic CP

A

unilateral involvement

46
Q

Topographic distribution of quadriplegic/tetraplegic CP

A

all 4 limbs

47
Q

Topographic distribution of monoplegic CP

A

rarely reported

48
Q

Area of brain involvement in CP

A

generalized, extrapyramidal, cerebellar, pyramidal

49
Q

Spastic paresis is associated with impairment of what area of the brain?

A

motor cortex involvement

50
Q

Spastic paresis may present as

A
  • hemiparesis
  • spastic diplegia
  • spastic quadriparesis
51
Q

Dyskinesia (athetosis) is associated with impairment of what area of the brain?

A

basal ganglia

52
Q

dyskinetic movement abnormalities are known as

A

athetosis

53
Q

Ataxia is associated with impairment of what area of the brain?

A

cerebellum

54
Q

Spasticity and dyskinesia is associated with impairment of what area of the brain?

A

mixed involvement

55
Q

GMFM

A

Gross Motor Functional Measure

56
Q

The GMFM is based on

A

functional abilities and limitations

57
Q

Levels of GMFM

A

I to V

I - independent
V - difficulty controlling all movements

58
Q

GMFM age range

A

birth to 12 years

59
Q

Orthopedic disorders associated with CP

A

muscle contracture / power imbalance

skeletal abnormality / bony malalignment

60
Q

Muscle contracture / power imbalance can lead to

A

deformities / limited function

61
Q

Skeletal abnormality / bony malalignment can lead to

A

functional instability / inefficiency of muscle action

62
Q

What is the goal of neuromuscular blocks?

A

to relax antagonist to isolate function of the agonist

63
Q

Examples of neuromuscular blocks

A

Phenol

Botox

64
Q

Neuromedical interventions

A
  • diazepam
  • dantrolene
  • baclofen
  • tizanidine
  • clonidine
65
Q

SDR

A

Selective Dorsal Rhizotomy

66
Q

What is a Selective Dorsal Rhizotomy (SDR)?

A

selective division of posterior spinal nerve rootlets

67
Q

What is the purpose of a Selective Dorsal Rhizotomy (SDR)?

A

balance the decrease of normal inhibitory influences on the motoneurons

68
Q

Neurosurgical Interventions

A
  • Selective Dorsal Rhizotomy (SDR)

- Intrathecal Baclofen

69
Q

Intrathecal Baclofen

A

Insert a pump in abdomen

Deliver Baclofen to intrathecal space via catheter

70
Q

Common shoulder girdle and UE orthopedic sequelae associated with CP

A
  • Excessive axial extension
  • Poor capital flexion
  • Poor abdominal function
  • Tight pectoralis major
  • Scapula fixed in downward rotation and forward tip
71
Q

A scapula fixed in a downwardly rotated and forward tipped position reduces what movements?

A
  • Shoulder flexion
  • Abduction
  • ER
  • Sternoclavicular and acromioclavicular glide
72
Q

Common hip and pelvis orthopedic sequelae associated with CP

A
  • tight hip flexors, adductors, IR
  • limited hip extension, abduction, ER
  • leg length discrepancy
  • persistent femoral anteversion
  • hip subluxation or dislocation
73
Q

Common knee orthopedic sequelae associated with CP

A
  • limited flexion or extension

- excessive tibial torsion

74
Q

Tibial torsion should be assessed in what position?

A

prone or sitting

75
Q

Common foot orthopedic sequelae associated with CP

A
  • limited dorsiflexion
  • excessive dorsiflexion
  • restricted midtarsal movement
  • calcaneal mal-alignment
76
Q

Limited dorsiflexion is associated with

A

spastic involvement

77
Q

Excessive dorsiflexion is associated with

A

hypotonic or fluctuating tone

78
Q

How must dorsiflexion be assessed?

A

subtalar neutral

79
Q

Why must dorsiflexion be assessed in subtalar neutral?

A

to prevent hypermobility of forefoot and ensure excursion of hindfoot

80
Q

Why do hips migrate in children with CP?

A

because of muscle imbalance

81
Q

Knee flexion deformity is often related to

A

spastic, shortened hamstrings

may be secondary to hip flexion contracture

82
Q

Knee flexion deformity leads to

A

contracture of the knee joint capsule and shortening of the sciatic nerve

83
Q

An equinus deformity is related to

A

tendo-Achilles shortening

84
Q

Pes valgus

A

eversion, plantarflexion, and inclination of the calcaneus

abduction of the forefoot

85
Q

What is the goal of inhibitive casts?

A

decrease spasticity by immobilization to prolong stretch of muscles

using them progressively to improve ROM

86
Q

Dynamic ankle-foot orthosis

A

support and stabilization to arches of the foot

87
Q

Articulating ankle-foot orthosis

A
  • ankle articulation

- allows free dorsiflexion with a plantarflexion stop

88
Q

Floor reaction orthosis

A
  • Provides medial-lateral stability

- Posterior aspect open

89
Q

Supramalleolar orthosis

A
  • progression once child has more control and needs less support
  • medial-lateral stability for ankle joint
90
Q

Shoe inserts

A

when support for floor contact is required

Peds Test 2 (partial) (3 decks)

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