Neuromuscular condition 1: Cerebral Palsy Flashcards by Deleted Deleted

What is cerebral palsy

Group of common childhood onset neurological motor disorder due to permanent disturbances in the developing fetal or infant brain

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Cerebral palsy is ______, but _______

Permanent but NON progressive

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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

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What are the different types of cerebral palsy

Spastic cerebral palsy

Ataxic cerebral palsy

Athetoid/dyskinetic cerebral palsy

Mixed cerebral palsy

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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

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Ataxic cerebral palsy

Occurs due to:

Causes:

Occurs due to damage to cerebellar structures

Causes problems in coordination, poor balance

Hypotonic

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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

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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

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The gross motor functioning classification system for cerebral palsy has

5 levels

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Level 1 of gross motor functioning classification system for cerebral palsy

Walk and runs without support

Coordination, speed and balance reduced

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Level 2 of gross motor functioning classification system for cerebral palsy

Walks without support

May use support in some situations

Difficulty running

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Level 3 of gross motor functioning classification system for cerebral palsy

Walks with support

Often uses wheeled mobility for commuting

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Level 4 of gross motor functioning classification system for cerebral palsy

Uses powered mobility or pushed mobility for most mobility needs

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Level 5 of gross motor functioning classification system for cerebral palsy

Transported in wheelchair for all mobile situations

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What are the clinical problems for cerebral palsy

Motor impairment

Causes:
Bone deformity
Contracture
Muscle atrophy
Osteoporosis

Obesity
Hypertension
Dyslipidemia

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What does the bone deformity, Contracture, Muscle atrophy and Osteoporosis as a result from motor impairment lead to

Falls and fractures

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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