Neuro = cerebral palsy

Question 1

define cerebral palsy

Answer 1

an umbrella term for brain disease causing muscle stiffness/chorea
neurodevelopmental disease

Question 2

how does cerebral palsy progress?

Answer 2

cerebral palsy DOES NOT PROGRESS

Question 3

causes of CP

Answer 3

ante-natal (80%) - brain strokes
Hypoxic ischaemic encephalopathy, radiation, infection

post natal - head trauma, infection, hypoxia

Question 4

are preterms at a lower, equal or increased risk of cerebral palsy?

Answer 4

increased risk

Question 5

what are the three types of cerebral palsy?

Answer 5

spastic
dyskinetic/athetoid
ataxia

Question 6

presentation of someone with spastic cerebral palsy?

Answer 6

stiff, tight muscles, with brisk reflexes
(this is an upper motor neuron lesion pattern - cerebral damage)

scissor gait (adducter thigh muscles flexed)
calves flexed - toe walk

Question 7

presentation of someone with dyskinetic/athetoid cerebral palsy?

Answer 7

basal ganglia damage means they can’t inhibit movements

dystonia (random slow movements)
chorea ( random non repetitive dance like movements)
athetoid (slow writhing movements - fingers)

Question 8

presentation of someone with ataxic cerebral palsy?

Answer 8

damage to the cerebellum

reduced co-ordination and precision

Question 9

three types spastic cerebral palsy?

Answer 9

unilateral - one side of body, face unaffected [fist, flexed arm, pronated, tip toe walk, flaccid then stiff]

bilateral (quadriplegia ) - both sides, worse. may have intellectual impairment, seizures, microcephaly

bilateral (diplegia) usually just the legs affected, arms not so bad. most associated with preterms and periventricular brain damage

Question 10

diagnostic features of cerebral palsy

Answer 10

altered tone/posture
delayed motor milestones
oromotor incoordination (feeding difficulties)
abnormal gait
hand asymmetry before 1year
persistent primitive reflexes 

(also - pain from stiff muscles, sleep, eating, speaking and learning problems,

Question 11

management of cerebral palsy - for hyper tonia.
2 medical
1 surgical

Answer 11

botulinum toxin
baclofen (muscle relaxant)
dorsal rhizotomy - cut spinal cord nerve roots