Pediatrics: Interventions: Cerebral Palsy Flashcards
Cerebral Palsy: Pathology
- Non-progressive encephalopathy caused by
- Hemorrhage below the lining of the ventricles
- Hypoxia
- Malformations and Trauma to the CNS
Cerebral Palsy: Classifications: One limb
- Monoplegia
Cerebral Palsy: Classifications: Two lower limbs
- Diplegia
Cerebral Palsy: Classifications: Upper and Lower limbs on one side of the body
- Hemiplegia
Cerebral Palsy: Classifications: All four limbs
- Quadriplegia
Cerebral Palsy: Classifications: Trunk
- Can be involved in all types
Cerebral Palsy: Movement Disorders: Spastic
- Increased tone
- Lesion of motor cortex
- Lesion of projections of motor cortex
Cerebral Palsy: Movement Disorders: Athetosis
- Fluctuating muscle tone
- Involuntary slow writhing movements
- Lesion of Basal Ganglia
Cerebral Palsy: Movement Disorders: Ataxia
- Instability of movement especially ambulation
- Lesion of cerebellum
Cerebral Palsy: Movement Disorders: Dystonia
- Involuntary movements with sustained contractions
Cerebral Palsy: Movement Disorders: Hypotonia
- Decreased Muscle Tone
Cerebral Palsy: Movement Disorders: Mixed
- Mixture of movement disorders
Cerebral Palsy: Impairments
- insufficient force generation
- Tone abnormality
- Poor selective control of muscle activity
- Poor anticipatory postural control
- Decreased ability to learn unique movemnts
- Abnormal patterns of movement in total flexion or extension
- Persistence of primitive reflexes
Cerebral Palsy: Spastic Cerebral Palsy
- Increased muscle tone in antigravity muscles
- Abnormal postures and movement with mass patterns of flexion and extension
Cerebral Palsy: Spastic Cerebral Palsy: Patterns of Contracture: Upper Extremity
- Scapular Retractors
- Glenohumeral extensors
- Glenohumeral adductors
- Elbow flexors
- Forearm pronators
Cerebral Palsy: Spastic Cerebral Palsy: Patterns of Contracture: Lower Extremity
- Hip flexors
- Adductors
- Internal Rotators
- Knee flexors
- Ankle plantar flexors
Cerebral Palsy: Spastic Cerebral Palsy: Other
- Visual
- Auditory
- Cognitive
- Oral
Motor deficits may be seen with spastic CP
Cerebral Palsy: Spastic Cerebral Palsy: Crouching Gait
Walks with - Hip flexion - Adduction - Internal rotation - Knee flexion May also toe walk
Cerebral Palsy: Athetoid Cerebral Palsy:
- Involuntary, slow, writhing movements
- Generalized decreased muscle tone (floppy baby syndrome)
- This is a result of basal ganglion involvement
Cerebral Palsy: Athetoid Cerebral Palsy: Stability
- Functional stability is impaired especially in proximal joints
Cerebral Palsy: Athetoid Cerebral Palsy: Ataxia and incoordination
When child assumes upright with
- Decreased base of support
- Muscle tone fluctuations
Cerebral Palsy: Athetoid Cerebral Palsy: Other
Deficits to
- Visual tracking
- Speech delay
- Oral motor
Cerebral Palsy: Athetoid Cerebral Palsy: Reflexes
Tonic reflexes like - ATNR - STNR - Tonic labyrinthine reflex May be persistent blocking functional postures and movement
Cerebral Palsy: Ataxic Cerebral Palsy
- Low postural tone and poor balance
- Stance and gait are wide based
- Intention tremor of hands
- Movement uncoordinated
- Ataxia follows initial hyoptonia
- Poor visual tracking and nystagmus
- Speech articulation problems
- May occur in conjunction with spastic or athetoid CP
Cerebral Palsy: Interventions and Goals: Minimize effects of impairment
- Static positioning and dynamic patterns of movement to habitual abnormal spastic patterns
- Symmetry in postures
- Elongate spastic Hamstrings and heel cords via stretching or in some cases serial casting
Cerebral Palsy: Interventions and Goals: Maximize Gross Motor Functional Level
- Functional motor skills
- Postural control
- Developmental activities
- Weight bearing
Cerebral Palsy: Interventions and Goals: Equipment: Seating
- Head neutral
- Trunk upright
- Hips, knees and ankles at 90 degrees flexion
- Wheel chair may be tipped posteriorly to decrease extensor tone and maintain hip flexion
Cerebral Palsy: Interventions and Goals: Equipment: Prone or Supine Standers and Parapodium
- Promotes weight bearing through LE
- Need at least 5 hours/week for bone mineralization
- Tonic Labrynthine Reflex will elicit extensor tone in supine and flexor tone in prone
Cerebral Palsy: Interventions and Goals: Equipment: Side Lying
- Will help decrease effect of tonic labyrinthine reflex
Cerebral Palsy: Interventions and Goals: Equipment: Rollator Walkers
- Posterior collator helps child maintain upright position and arm position helps decrease extensor tone
Cerebral Palsy: Prognosis
- Good prognosis for ambulation if child can sit independently by 2 years of age
- If ambulation takes place most often it will take place by 8 years of age
