MIDTERMS: Cerebral Palsy

Question 1

a disorder of movement and posture resulting from a non-progressive lesion or injury to the developing brain. It affects muscle tone, DTRs, primitive reflexes, and postural reactions, with secondary effects like muscle weakness, contractures, spasticity, reduced aerobic capacity, and osteoporosis

Answer 1

Cerebral Palsy (CP)

Question 2

What are the main causes of CP?

Answer 2

70-80% of cases are caused by prenatal factors, with pre-term birth being the most common antecedent. Other causes include compromised cerebral blood flow, leading to intraventricular hemorrhage due to fragile vasculature.

Question 2

What are some secondary conditions associated with CP?

Answer 2

Muscle weakness.
Contractures.
Spasticity.
Reduced aerobic capacity.
Osteoporosis.
Fracture risk.

Question 2

What is the epidemiology of CP?

Answer 2

CP is the leading cause of childhood disability.
It affects 2-3 per 1000 live births.
Common risk factors include gestational age < 32 weeks and birth weight < 2500 grams.

Question 2

What are some prenatal risk factors for CP?

Answer 2

Congenital malformations.
Socioeconomic factors.
Maternal infections (IU).
Maternal mental retardation (MR).
Multiple gestations.
Rh factor incompatibility.
Hyperthyroidism.
Placental complications (e.g., Placenta Previa, Abruptio Placenta).
Teratogenic agents.
Abdominal trauma (e.g., domestic abuse).

Question 3

What are perinatal risk factors for CP?

Answer 3

Prolonged labor > 18 hours.
Hypoxia due to cord coil or cephalopelvic disproportion.
Respiratory Distress Syndrome (RDS).
Preeclampsia (hypertension during pregnancy).
Eclampsia (seizures during pregnancy).

Question 3

What are placental complications that increase the risk of CP?

Answer 3

Placenta Previa: Placenta near the cervix, potentially leading to the placenta being delivered first.
Abruptio Placenta: Premature separation of the placenta, leading to oxygen deprivation for the infant.

Question 3

What are postnatal risk factors for CP?

Answer 3

Infections (e.g., UTI).
Head injuries or trauma.
Vascular accidents.

Question 3

What are the subtypes of hypoxic-ischemic neuropathology according to Volpe?
Parasagittal Cerebral Injury: ?
Periventricular Leukomalacia: ?

Answer 3

Parasagittal Cerebral Injury: Affects the parietal lobe, leading to spastic quadriplegia.
Periventricular Leukomalacia: Softening of white matter, affecting motor function.

Question 3

What are the grades of Intraventricular Hemorrhage (IVH)?

Answer 3

Grade I: Germinal matrix hemorrhage.
Grade II: Hemorrhage in the ventricles with normal size.
Grade III: Ventricles are dilated due to hemorrhage.
Grade IV: Parenchymal hemorrhage (larger hemorrhage).

Question 3

What are the subtypes of hypoxic-ischemic neuropathology according to Volpe?
Selective Neuronal Necrosis: ?

Answer 3

Selective Neuronal Necrosis: Coexists with other lesions, related to O2 deprivation.

Question 3

What are the characteristics of Parasagittal Cerebral Injury?

Answer 3

Lesions in full-term infants (38-42 weeks).
Involves bilateral cortical and subcortical white matter.
Upper extremities are more affected.
Common consequence: spastic quadriplegia.

Question 3

What are the subtypes of hypoxic-ischemic neuropathology according to Volpe?
Focal and Multifocal Ischemic Brain Necrosis: ?
Status Marmoratus:?

Answer 3

Focal and Multifocal Ischemic Brain Necrosis: Focal (one area) and multifocal (diffuse).
Status Marmoratus: Neuronal injury in the thalamus and basal ganglia.

Question 3

What are the effects of Periventricular Leukomalacia?

Answer 3

Occurs in premature infants.
Smaller lesions cause lower extremity spasticity.
Larger lesions affect both upper and lower extremities, leading to a scissoring gait and spastic diplegia/quadriplegia.

Question 3

What are the long-term manifestations of Ischemic Brain Necrosis?

Answer 3

Commonly affects the middle cerebral hemisphere.
More frequent in the left hemisphere.
Long-term effects: spastic hemiplegia, spastic quadriplegia, and seizures.

Question 3

What are the classifications of CP according to topographic distribution?

Answer 3

Monoplegia: 1 extremity affected.
Diplegia: Lower extremities more affected.
Triplegia: Both upper extremities or one lower extremity affected.
Quadriplegia: Equal weakness in all limbs.
Hemiplegia: One side (right or left) affected.
Paraplegia: Lower extremities affected.

Question 3

What is Selective Neuronal Necrosis?

Answer 3

The most common variety of injury.
Coexists with other lesions.
Related to oxygen deprivation and excitotoxic amino acids.

Question 3

What is Status Marmoratus and its manifestations?

Answer 3

Rarest lesion affecting the thalamus and basal ganglia.
Long-term manifestations include choreoathetosis (involuntary movements).

Question 3

What are the characteristics of Spastic CP?

Answer 3

Most common (75% of cases).
Upper motor neuron involvement.
Signs: hyperreflexia, clonus, Babinski response, and persistent primitive reflexes.
Clinical manifestations: pyramidal signs, abnormal posture.

Question 3

What are the characteristics of Ataxic CP?

Answer 3

Loss of orderly muscle coordination.
Movements are unsteady and inaccurate.
Symptoms include nystagmus and dysmetria.

Question 3

What are common associated conditions with CP?

Answer 3

High incidence of sensorineural hearing loss.
Dental enamel dysplasia.
Pseudobulbar involvement (dysarthria, swallowing difficulty, drooling).

Question 3

What are common manifestations of Ataxic CP?

Answer 3

Unsteadiness, nystagmus, and wide-based gait.
Generally hypotonic at birth; may develop scoliosis.

Question 3

What additional problems are seen in children with CP?

Answer 3

Drooling: About 10% of children, caused by oromotor dysfunction.
Dental problems: Dental malocclusion, enamel dysplasia, poor oral hygiene.
Pulmonary issues: Chronic respiratory infections and complications from pulmonary dysplasia.
Communication problems: Related to hearing impairments and cognitive deficits.

Question 3

What are some secondary effects of CP?

Answer 3

Poor growth, sleep disorders, and poor nutrition.
Upper airway obstruction and aspiration pneumonia.
Spinal deformities, osteoporosis, contractures, and communication disorders.

Question 3

What are the associated deficits in Dyskinetic CP?

Answer 3

No cognitive deficits.
Mental retardation: 30%–50% incidence, mostly in severe cases.
Seizures: Occurs in 50% of cases, often starts in infancy or prenatally.
Oro-motor problems: Difficulty in swallowing, sucking, and chewing.

Question 4

What are the characteristics of Dyskinetic CP?

Answer 4

Extrapyramidal movement patterns.
Types: choreo-athetoid (abrupt irregular movements) and dystonic (slow rhythmic movements with tone changes).

Question 4

What gastrointestinal problems are common in CP?

Answer 4

GERD: Due to trunk flexion leading to food reflux.
Constipation: Common in children with CP.
Precautions during seizures: Side-lying to the left to prevent aspiration.

Question 4

What visual impairments are associated with CP?

Answer 4

Strabismus: Internal (esotropia) and external (exotropia).
Amblyopia: Lazy eye, indicated by head tilting and squinting.
Retinopathy of Prematurity: Scar formation in retinal blood vessels leading to potential blindness.

Question 4

What is central to the diagnosis of CP?

Answer 4

History taking is essential.
Ancillary procedures to rule out other diagnoses.
No single assessment procedure directly diagnoses CP.
Persistence of abnormal righting and equilibrium responses.

Question 4

What validated assessment tools are used for CP diagnosis?

Answer 4

GMFM (Gross Motor Function Measure)
GMFCS (Gross Motor Function Classification System)
Edenburg Scale
Measures of mixed or asymmetrical gross motor function (GMFM-66/GMFM-88).

Question 4

What medications are commonly used in the management of CP?

Answer 4

Spasticity: Baclofen, delivered intrathecally.
Seizures: Medications like “Bar” and others (VA, L).
Other conditions: Pain management, GERD treatment, etc.

Question 5

What are common surgical and injection interventions for CP?

Answer 5

Intramuscular Neurolysis: Targets spastic motor neurons.
Botulinum toxin A (BoTox): Provides relief for 3–6 months.
Surgery: Tenotomy for spastic muscle groups (e.g., adductors).

Question 6

What are the key therapeutic strategies for managing CP?

Answer 6

Early intervention and handling/therapeutic exercise.
Functional training and use of orthotics/positioning devices.
Seating modifications/wheelchair provision.
Occupational therapy (OT), speech-language therapy (SLP), and ADL training.

Question 7

What specialized therapies are included in the management of dysphagia in CP?

Answer 7

Oral Peripheral Muscles (OPM) exercises: For improving oromotor function.
Dysphagia management: Tailored strategies to assist with swallowing difficulties.