Midterm #2 (Lecture 16 - Cerebral Palsy)

Question 1

What is Cerebral palsy?

Answer 1

Cerebral: of the brain
Palsy: lack of muscle control
CP is a group of disorders that affect a person’s ability to move and maintain balance and posture

Question 2

Stats

Answer 2

CP is the most common childhood motor impairment (2-3/1000)

Question 3

Associate impairments of cerebral palsy

Answer 3

 Cognitive impairment (20-45%)
 Epilepsy (20-40%)
 Changes in sensation (40-50%)
 Speech impairment (40-80%)
 Visual impairment (60-70%)
 Hearing impairment (25%)
 Feeding difficulties (swallowing)
 Bowel and bladder control issues

Question 4

What does cerebral palsy clinical classification depend on?

Answer 4

1) Type of movement disorder (spasticity, athetosis, ataxia, combo)
2) Number of limbs involved

Question 5

What is spasticity in CP, and what are the stats?

Answer 5

 Most common; ~65-80%
 Damage to the motor cortex (controls movement)
 Observed as:
- hypertonic muscle tone (too much)
- co-contraction of opposing muscle groups (e.g.
biceps and triceps or wrist flexors and extensors)
 May lead to contractures over time; joint
deformity

Question 6

Examples of gait in people with spastic CP

Answer 6

Scissors gait (knees and feet inwardly rotating)
Hemiplegic gait (one side of body looks like it’s internally rotating)

Question 7

What is athetosis in CP?

Answer 7

 Caused by damage to the basal ganglia (gross motor function)
 Observed as:
- Lack of controlled and coordinated movement
- Often experience involuntary movements
- Variable muscle tone in different muscles (hypertonic vs. hypotonic)

Question 8

What is ataxia in CP?

Answer 8

 Caused by damage to the cerebellar-vestibular region (balance and coordination)
 Observed as:
- Balance and coordination problems
- Hypotonia (low postural tone)

Question 9

What are the names for number of limbs involved?

Answer 9

Quadriplegia - All four are severe
Diplegia - All four (both legs more affected than arms)
Hemiplegia - One side (usually one arm affected more than the leg)
Triplegia - Three limbs (usually 2 arms and a leg)
Monoplegia - One limb (usually arm)

Question 10

What is the other method of diagnosing CP? (not clinical method)

Answer 10

Gross motor function classification system (GMFCS)
Based on self-initiated movement, primary criterion is that distinctions must be meaningful in daily life
Level I: Walks without limitations
Level II: Walks with limitations
Level III: Walks using a hand-held mobility device
Level IV: Self-mobility with limitations; may use powered mobility
Level V: Transported in a manual wheelchair

Question 11

PA levels of people with CP

Answer 11

 Children with CP are less active
 The majority of adolescents with CP don’t meet PA recommendations
 Little research available about adults with CP and PA

Question 12

PA recommendations - Cardiovascular fitness

Answer 12

CV fitness is often a barrier, so that raining is recommended
Interval training successful (rest periods)
- walking, biking, running, swimming (low joint impact)

Question 13

PA recommendations - Muscular strength + endurance

Answer 13

Often a barrier, so resistance training recommended
Lead to increased functional capacity
Don’t negatively influence spasticity or flexibility
Aquatic-based programs successful (easy on joints, variable resistance, less strength to overcome gravity)

Question 14

Are there recommendations on frequency, intensity, time that would be most beneficial for people with CP?

Answer 14

Not yet

Question 15

PA considerations

Answer 15

 Muscle weakness (significant limb dominance); lack of coordination between limbs
 Lack of balance and postural control
 Limited range of motion (braces/splints/orthotics)
 Incorporation of assistive devices (canes, walkers, wheelchairs)
 Medication

Question 16

Be sure to go over the last few slides of this notes package!

Answer 16

Some revision stuff, nbd