The Child with Cerebral Palsy/ Learning Difficulties Flashcards
What is the definition of cerebral palsy?
An impairment of movement and posture that results primarily from either injury, abnormal development of the cerebral cortex and other components of the brain associated with movement, strength and muscle tone
(doesn’t always present with spasticity)
Which infants are at increased risk of CP?
- Preterm (<25 weeks significant)
- Low birth rate (<1.5kg significant)
How can CP present?
- Hypertonia (usually spasticity)
- Hypotonia (or atonia), tends to preceed hypertonia
- Dystonia (fluctuating tone)
- Dyskinesia
- Ataxia (drunken gait, manifestation of midbrain abnormalities)
- Combination/ mixed pattern
- Athetosis
What is the chronological progression of gross motor development based on?
Cephalo-caudal myelination and maturation, the nervous system is myelinated from the top down therefore gross motor progress descends as the child ages
What is the moro reflex?
Holding the child at the back of the neck/ head and lowering them suddenly, arms will abduct then adduct symmetrically
What is the tonic neck reflex?
Moving the child’s head to one side leads to ipsilateral arm extension and contralateral arm flexion
(will be asymmetrical in CP)
Where do the UMNs reside?
The motor cortex
What are the broad functions of the upper and lower motor neurons?
- UMNs are inhibitory
- LMNs are excitatory
Where do UMNs derive?
Pleuripotential embryonic neuroectoderm, gives rise to the motor cortex, midbrain and brainstem
Where do LMNs derive?
Pleuripotential embryonic neuroectoderm, originally primarily in the spinal cord as anterior horn cells
What is volitional movement?
The extended execution of an action eg. planned movement
What can alteration of UMN physiology result in?
- Impaired volitional motor function
- Loss of inhibition of the LMNs (hyperreflexia, weakness, hypertonia)
What are the causes of cerebral palsy?
- All congenital abnormalities
- CNS malformation/ disruption
- Intrauterine infection
- Multiple births
- Perinatal stroke
- Intracranial haemorrhage (1/3 due to coagulopathy, thalamic hemorrhage predominantly)
- Acquired post natal causes (trauma, infection, hyperthermia)
- Kernicterus
Do intrapartum events that may lead to asphyxia correlate with CP?
No
What causes 10-20% of CP cases?
Hypoxic-ischaemic encephalopathy
What clinical examinations are essential for suspected CP?
Newborn head circumference (diminished)
What are the autonomic signs of CP?
- Diaphragmatic dysfunction
- GORD
- Velopharyngeal discoordination (dribbling)
- Alterations in peristalsis
- Bladder dysfunction (UMN/ spastic bladder)
- Vasomotor dysfunction
When will primitive reflexes disappear?
6-9 months
When will definitive motor actions develop (plan a movement and carry out smoothly)?
5-7 months
(as primative reflexes decline)
What are the types of CP?
- Monoplegia (one extremity)
- Hemiplegia (two ipsilateral extremities)
- Diplegia (two contralateral extremities of the same type eg. two arms or two legs)
- Quadriplegia (four extremities)
Which type of CP tends to be associated with development of seizures?
Hemiplegia
Which type of CP will not likely lead to seizure development?
Diplegia
What are the two most common forms of CP?
- Spastic quadriplegia
- Spastic hemiplegia
What are the priorities for management of cerebral palsy?
- Parental education (most important)
- Seating, positioning (early developmental milestones)
- Ambulation (goal is community ambulation)
- Child’s education (diagnosis does not always mean intellectual impairment)
- Feeding/ nutrition
- Social/ emotional wellbeing
