Neurology - Cerebral Palsy Flashcards
What is cerebral palsy?
Permanent neurological problems due to brain damage at birth
What are the different causes of cerebral palsy?
Antenatal
- Maternal infections
- Trauma during pregnancy
Perinatal
- Birth asphyxia
- Pre-term birth
Postnatal
- Meningitis
- Severe neonatal jaundice
- Head injury
What are the different types of cerebral palsy?
Spastic
Hypertonia and reduced function due to damage to UMNs
Dyskinetic
Problems controlling muscle tone, hypertonia and hypotonia, causing athetoid movements and oro-motor problems
Ataxic
Coordinated movement problems
Mixed
Mix of spastic, dyskinetic and/or ataxic features
What causes dyskinetic CP?
Damage to basal ganglia
What causes ataxic CP?
Damage to cerebellum
How is spastic CP also known?
Pyramidal CP
How is dyskinetic CP also known?
Athetoid CP or Extrapyramidal CP
What are the different patterns of spastic CP?
Monoplegia
Hemiplegia
Diplegia (four limbs affected but mostly legs)
Quadriplegia (four limbs affected more severely, often with seizures, speech disturbance and other impairments)
What are the signs and symptoms of CP?
More evident during development
- Failure to meet milestones
- Increased or decreased tone
- Hand preference below 18 months
- Problems with coordination, speech or walking
- Feeding or swallowing problems
- Learning difficulties
What do the following gaits indicate?
Hemiplegic / diplegic
Broad based / ataxic
High steppage
Waddling
Antalgic
Hemiplegic / diplegic gait
Indicates an upper motor neurone lesion
Broad based gait / ataxic gait
Indicates a cerebellar lesion
High stepping gait
Indicates foot drop or a lower motor neurone lesion
Waddling gait
Indicates pelvic muscle weakness due to myopathy
Antalgic gait
Idndicates localised pain
Complete the table
What causes hemiplegic or diplegic gait in CP?
Increased muscle tone and spasticity in the legs
Leg extended with plantar flexion of feet and toes
They have to swing the leg around in a large semicircle when moving leg from behind to in front, not enough space to swing leg in straight line in front
What complications and conditions are associated with CP?
- Learning disability
- Epilepsy
- Kyphoscoliosis
- Muscle contractures
- Hearing and visual impairment
- Gastro-oesophageal reflux
How is CP managed?
Management will involve a MDT approach
Physiotherapy
Stretch and strengthen muscles to maximise function and prevent contractures
Occupational therapy
Help with every day activities
SALT
Speech and swallowing, may need NG tube or PEG tube if can’t swallow
Dieticians
Nutritional needs
Orthopaedics
Release contractures or lengthen tendons (tenotomy)
Paediatrics to give medications
- Muscle relaxants
- Anti-epileptic drugs
- Glycopyrronium bromide - for excessive drooling
Social workers
Charities and support groups
