Quiz 2 Flashcards
definition of CP
group of permanent disorders of movement/posture development that causes activities limitations that are attributed to non progressive disturbances that occurred in the developing brain
what does CP look like
plegia
spasticity
dyskinesia
ataxia
mixed
how common is CP
most common physical disability of childhood (2 per 1000) births
how is CP diagnosed
clinical and neuro signs
what age is CP diagnosed at
12-24 months
motor types for CP
spasticity
dyskinesia
ataxia
mixed
hypotonia
most common motor type for CP
spastic
limbs affected in spastic quadriplegia/ bilateral
both arms and legs
trunk face and mouth can also be affected
limbs affected in spastic diplegia/ bilateral
both legs
limbs affected in spastic hemiplegia unilateral
one side (arm and leg)
GMFCS level 1
kids walk and climb stairs w/o limitations
can run and jump but speed, balance and coordination are impaired
GMFCS level 2
kids walk and climb stairs holding onto railings. limitations on uneven surfaces and includes and in crowded spaces
GMFCS level 3
kids walk on level surface with AD. May climb stairs w/ railing. May propel WC manually or transported for longer distances
GMFCS level 4
kids may walk short distances on a walker and relay on wheeled mobility at home and in community
GMFCS level 5
restricted voluntary control of environment and ability to maintain anti gravity head and trunk posture. all areas of Motor control limited. transported, no independent mobility
common co morbidities of CP
inability to walk, inability to talk, pain, epilepsy, behavioral disorders, intellectual impairment, vision impairment, bladder control problems, sleep disorders, salvia control
types of etiology of CP and occurance
prenatal 80%
post natal 10%
peri natal 10%
risk factors for CP
low birth weight
premature birth
multi births
maternal conditions
prenatal infections/ toxin exposure
perinatal: breech birth, complication LD
postnatal: meconium aspiration
what is the leading cause of CP in preterm infants
periventricular leukomalacia
what is PVL
damage to white matter
what is IVH or ICH
bleeding in brain d/t weak or fragile blood vessels
does genetics play a role in CP
yes
symptoms of IVH
apnea
bradychardia
cyanosis
weak suck
high pitch cry
seizures
swelling/ bulging of fontanelles (soft spots)
anemia
perinatal causes of CP
birth asphyxia
hypoxic ischemic encephalopathy
neonatal stroke
postnatal causes of CP
non-accidental injury
head trauma
meningitis/encephalitis
cardiopulmonary arrest
is CP an UMN or LMN problem
UMN patho
where do UMN synapse onto LMN
ventral (anterior) horn of SC
where do UMN travel through
pyramidal tracts
+ signs of UMN lesion
muscle spasticity d/t reduced descending inhibitory signals from brain
- signs of UMN lesion
weakness of loss of dexterity d/t reduced descending excitatory signals from brain
do lesions of extrapyramidal tracts cause UMN signs?
no b/c they modulate and refine movement
what does selective dorsal rhizotomy do
sacrifice sensory rootlets to reduce spasticity and inc. LE dissociation
manual ability classification system
levels 1-5 (1 is handles objects easily and 5 is does not and has sever limits for simple actions)
communication function classification system
levels 1 -5 with 1 least severe
eating and drinking ability classification system
levels 1-5 (1 least severe)
primary considerations with CP
neurological insult
secondary considerations with CP
abnormal growth and development of the MSK system
Tertiary considerations with CP
movement compensations for NM and MSK for person to achieve functional mobility
barriers to ambulation for youth with CP
limited access to community resources
barriers to PA and fitness opportunities
more sedentary
more deconditioned
how much time is spent in sedentary behavior for kids with CP
75-98%
3 components of PT exam
history
systems review
exam
BS/BF exam for CP
vitals, height, weight, BMI, strength, ROM, aerobic capacity, balance, endurance, power
spasticity and SMC
activity exam for CP
PEDI
gait speed
GMFM 66
motor planning and performance observations
participation measures for CP
COPM
GAS
PEM-CY
SFA
CAPE
How to measure strength for CP
MMT or HHD- best
isokinetic, isotonic, functional strength
how to measure endurance for CP
submax: 10 MWT, 1,3, or 6MWT (or 6m WC push)
functional mobility: modified TUG (FTST)
max aerobic: shuttle run test
anaerobic/power: muscle power sprint
muscle endurance: 30 sec RM lateral step ups and sit to stands
PA: accelerometers, pedometers, PA record
precautions with CP and exercise
cardiopulmonary conditions
monitor vitals
obesity is higher rate
covid (long haul)
how to measure BMI with CP
use CP BMI growth chart for kids (gender specific)
how to measure pain for kids with CP
self report (verbal, questionnaire, analogue)
behavioral cuing (expressions, sweating, cardiorespiratory change)
pain checklist (non communicators)
pain assessment instrument for CP
FLACC or FACES
measures for spasticity
modified tardieu scale
modified ashworth scale
what is SCALE
selective control assessment of lower extremity
to quantify LE selectivity voluntary motor control
what does SCALE test specifically and scoring?
hip flex/ext
knee flex/ext
ankle DF/PF
subtler inversion/eversion
toe flex/ext
2 (normal), 1 (impaired), 0 (unable)
balance measures for CP
pedi reach test
pedi balance scale
righting or equilibrium rxns
SATCo
SATCo levels (general)
1 (C7 only head control)
2-4 thoracic control
5-6 lumbar control
7 full trunk control
CP MSK exam for BS/BF
scoliosis
ROM or hips
alignment and symmetry of LE
what to look at ROM for CP
hip IR/ER
Hip abd
Thomas and ober tests
what to look for alignment for CP
femoral anteversion
tibial torsion
galeassi for LLD
components of hip surveillance for CP
parent/child questions on pain and stiffness and changes
X-ray
physical exam based on age and GMFCS level
when to refer to MD after hip surveillance for CP
migration % greater than 30% on x ray
hip ABD end range (R2) less than 30 deg
hip abduction or Thomas test shows deterioration or asymmetry
yes to questions
best way to measure muscle strength for CP
HHD
correlated to GMFM
do you do break test or make test for CP
make
shuttle run versions for CP, distances, and GMFCS levels
SRT-1: 10m, level 1
SRT-2: 10m, level 2
SRT-3: 7.5m, level 3
how to test muscular endurance for CP
sit to stand
lateral step ups
1/2 kneel to stand
sit to stand differences between GMFCS levels
1 and 2: no hand support
3: hand support for balance only
lateral step up differences between GMFCS levels
1 and 2: 20cm bench
3: 13cm with hand support
how to measure RPE in kids
OMNI 0-10
five dimensions of gross motor function measure
lying and rolling
sitting
crawling and kneeling
standing
walking, running, jumping
ages for PEDI
6 months - 7.5 years
ages for PEDI CAT
birth to 21 yo
true equines gait
hip and knee extended
knee recurvatum
equinus
jump gait
anterior pelvic tilt
lumbar lordosis
hip and knee flexed
equines
apparent equinus
increased hip and knee flexion
decreased equinus
crouch gait
excessive hip and knee flexion
scissoring
excessive dorsiflexion
what pre does DGI
activity
grades for SFA
K-6
ages for CAPE
6-21
Ages for PEM CY
5-17
meds for spasticity
baclofen
botox
