Neuromuscular condition 1: Cerebral Palsy Flashcards
What is cerebral palsy
Group of common childhood onset neurological motor disorder due to permanent disturbances in the developing fetal or infant brain
Cerebral palsy is ______, but _______
Permanent but NON progressive
What is the cause of cerebral palsy
Abnormal development or damage to brain during fetal development or early infant life
Damages include: White matter Basal ganglia lesions Cortical and subcortical lesions Brain malformations
What are the different types of cerebral palsy
Spastic cerebral palsy
Ataxic cerebral palsy
Athetoid/dyskinetic cerebral palsy
Mixed cerebral palsy
Spastic cerebral palsy is
Occurs due to:
Causes:
Most common (around 70%)
Occurs due to damage in upper motor neuron lesion, motor cortex
Causes muscle tightness/stiffness
Hypertonic
Ataxic cerebral palsy
Occurs due to:
Causes:
Occurs due to damage to cerebellar structures
Causes problems in coordination, poor balance
Hypotonic
Athetoid/dyskinetic cerebral palsy
Occurs due to:
Causes:
Occurs due to damage to basal ganglia
Causes problems in control of muscle ton, involuntary, uncontrolled movements
Both hyper and hypotonic
What are the characteristics of cerebral palsy
Abnormal development of movement and posture
Difficulties with thinking, learning, feeling, communication and behavior
Spasticity, spasms, involuntary movements
Musculoskeletal impairment: abnormal muscle tone, reflexes, coordination
The gross motor functioning classification system for cerebral palsy has
5 levels
Level 1 of gross motor functioning classification system for cerebral palsy
Walk and runs without support
Coordination, speed and balance reduced
Level 2 of gross motor functioning classification system for cerebral palsy
Walks without support
May use support in some situations
Difficulty running
Level 3 of gross motor functioning classification system for cerebral palsy
Walks with support
Often uses wheeled mobility for commuting
Level 4 of gross motor functioning classification system for cerebral palsy
Uses powered mobility or pushed mobility for most mobility needs
Level 5 of gross motor functioning classification system for cerebral palsy
Transported in wheelchair for all mobile situations
What are the clinical problems for cerebral palsy
Motor impairment
Causes: Bone deformity Contracture Muscle atrophy Osteoporosis
Obesity
Hypertension
Dyslipidemia
What does the bone deformity, Contracture, Muscle atrophy and Osteoporosis as a result from motor impairment lead to
Falls and fractures
What does the obesity, hypertension and dyslipidemia as a result from motor impairment lead to
Cardiovascular/metabolic diseases/cancer
What happens earlier in cerebral palsy compared to general population
Aging effect
Muscle weakness and atrophy
In cerebral palsy patients what is there a high rate of
High rate of incidence of falls
Due to:
Low muscular strength
Low functional mobility
Deficits in postural stability
Chain of Clinical problems associated with Osteoporosis
Low bone mineral density
Fragility fracture
Immobilisation
Lower bone mineral density
Muscle weakness
Functional and physical limitation
What are the medications that treat and manage cerebral palsy
Improve ADLs
Anticonvulsant medication
Antispastic medicine
What are the surgeries that treat and manage cerebral palsy
Selectjve dorsal rhizotomy surgery - reduction in spasticity
Orthopedic surgery - posture and balance improvement
What are the mobility related equipment that treat and manage cerebral palsy
Ankle foot orthoses
Canes, crutches or walkers
Manual/powered wheelchairs
What is the exercise response to cerebral palsy
Very limited information based on research
An increase in energy expenditure for a given external work rate
A reduction in peak aerobic capacity
Bipedal locomotion is disrupted which causes what
Reduction in walking efficiency
The energy required to walk _______ and the aerobic economy of walking is ________
Increased
Decreased
What is the recommendation for exercise testing for cerebral palsy
Basic CDD4 recommendations for class level 1
People with class level 2 - 4 may need individualised adaptive measures
Functional mobility testing is preferred with class 5
What are the goals of exercise programs for cerebral palsy
Maintain mobility
Increase physical activity
Counteract a sedentary lifestyle
Reduce the physical and time burdens on cargivers
Improve quality of life
Exercise programming for cerebral palsy consists of
Basic CDD4 as start
FITT not set
Adaptations dependent on age and class level
Most work toward a 150 minutes per week
Flexibility exercise should be performed daily
Consider upper limb strength with adaptions where applicable
Benefits of exercise for people with cerebral palsy
Not much research done
Stretching is most common
Aerobic provides some physiological benefits
Resistance strength exercise can be helpful
Improves sense of wellness
Increased capacity to perform daily activities
Lessen severity of symptoms
Resistance training in cerebral palsy can help
Skeletal health
Muscular health
Functional mobility
Hypotension is one of the secondary systemic injury in spinal cord injury
True
After acute spinal cord injury, neurons and cells go through cellular alterations, such as neutrophils and anti-inflammatory cytokine releases
False
After spinal cord injury, patients typically go through cycle of deconditioning with low physical activity leading to high risk factors and chronic diseases, and get worse. =
True
Decreased cardiovascular performance may be found in individuals with complete spinal cord injury above T6 because they have no cardiac sympathetic innervation which can limit peak heart rate to ~130 bpm
True
Spastic cerebral palsy is the most common type of cerebral palsy affecting 70% of population with cerebral palsy
True
Musculoskeletal impairment is a typical characteristic of cerebral palsy
True
According to Gross Motor Function Classification System (GMFCS), level IV and V indicate the individuals with cerebral palsy use methods of mobility that require physical assistance or powered mobility
True
For patients with cerebral palsy, GMFCS level I-III can go through exercise testing using 6 min walk test
True
One of the characteristics of ataxic cerebral palsy is ____
Problems in coordination
_______ is a secondary clinical problem with individuals with cerebral palsy
Oesteporosis
Diabetes mellitus
Cardiovascular disease
Obesity
