Review Of CP Flashcards
Definition of CP
Disorder of development of movement and posture causing activity limitations
Attributed to non progressive disturbances that occurred in the developing brain — the pathology DOES NOT GET WORSE
What does the lesion result in?
Motor disturbances
Disturbances in sensation, perception, cognition, communication, behavior, epilepsy
Secondary MSK problems
What are the risk factos associated with CP?
- Antenatal — 70-80% of CP
- prematurity and low birth weight
- intrauterine infection
- multiple gestations
- pregnancy complications - Perinatal — 10% of CP
- birth asphyxia or complications during labor and delivery - Postnatal — often happens during the 1st 2 years of birth
- non accidental injury
- head trauma
- meningitis/encephalitis
- CardioPulm arrest
What type of injury occurs typically with a preterm infant?
Vascular type of injury
CP results from an ischemic type of insult or hemorrhagic type of lesion within the developing brain
Either periventricular leukomalacia or periventricular hemorrhagic infarction
What is periventricular leukomalacia
Ischemic necrosis to periventricular white matter
- arterial perfusion from periphery — goes to deep cortical structures — no blood to the supporting cells required to form myelin tracts in white matter — kids with CP PVL have development of bilateral lesions along those white matter tracts so no more myelin
- affects distal more than proximal B LE
- blocks descending CST input — so affects quality of movement
What is periventricular hemorrhagic infarction
Hemorrhage into germinal matrix and ventricles
- typically more unilateral and diffuse
- still see LE involvement more distal than proximal
- still affecting ascending and descending tracts
What type of injury typically occurs with a term infant
Infarction in para sagittal watershed areas, MCA stroke
— typically a cortical and deep grey matter lesion
Basal ganglia and thalamic injury
— athetosis, chorea, seizures, cog impairments
— hemiplegia>diplegia
How is CP classified?
- Movement disorder and anatomic distribution
- Can also classify based on severity of the condition using GMFCS levels
What are the movement disorder classifications of CP
Hypertonia — spasticity, dystonia, rigidity
Hyperkinetic — athetosis, chorea, dystonia, myoclonus, tics, tremor
Negative — ataxia, weakness, decreased selective motor control
What are the anatomic distributions classifications of CP
Hemiplegia
Diplegia
Triplegia
Quadriplegia
What are the GMFCS level classifications of CP
5 Levels — functional qualifier. Gold standard for evaluating child’s functional ability
Level 1 — walks without limitations
Level 2 — walks with limitations
Level 3 — walks using a hand held device for mobility
Level 4 — self mobility with limitations, may use a powered mobility AD
Level 5 — transported in a manual wheelchair
Growth and development x severity graph for kids with CP
Across time the GMFCS scores change but at some point they plateau
- lower GMFCS levels tend to show greater scores and they plateau at older ages
- lower scores and higher levels tend to plateau at younger ages.
What are the positive signs of neuromuscular impairments on MSK systems
Things that are added to the system that we do not want
— loss of inhibition to LMN = leads to positive UMN syndrome
Spasticity, hyperreflexia, clonus, co-contraction
What are the negative signs of neuromuscular impairments on MSK system
Things taken away from the system that we wanted to keep
— loss of connections to LMN = negative features of UMN syndromes
Weakness, fatigueability, poor balance, sensory deficits
How do positive and negative signs contribute to the MSK pathology?
Positive signs are neural
Negative signs are mechanical
Both can lead to MSK pathology that result in long term impairments
— mm shortening -> bony torsion -> joint instability -> degenerative arthritis
