U11W1: Cerebral Palsy Flashcards
What is cerebral palsy?
Is a clinical description of children who share features of a non-progressive brain injury or legion acquired during the antenatal, perinatal or early postnatal period.
Often presents as difficulty in motor function, also high risk of problems with other senses, communication and intellectual disability.
What are the risk factors of cerebral palsy?
Majority of the causes are congential meaning developed before birth, many of the specific reasons are unknown.
Preterm birth
Low birth weight
Perinatal ischaemic stroke
Multiple gestations
Placental abnormalities
Fetal growth retardation
Hyperbilurubinaemia - often from reactivity between maternal and infant blood e.g rhesus factor.
Birth asphyxia - often due to complicated vaginal delivery.
Infections during pregnanacy of early infancy
Injury to babies head
Hypoglycemia of baby
What is the genetic link behind cerebral palsy?**
FBX031- regulating cell cycle and neuronal migration
RHOB - signals for cell proliferation, mutation cause cause apoptosis in neuron - normally spontaneous.
DHX32 -regulates proliferation through beta-catenin, increases invasive potential
ALK - nervous system development
Increases risk or predisposition not causative.
What are the common signs and symptoms of cerebral palsy?
Most CP cases are spastic
Delays in reaching developmental milestones
Difficulties with muscle and coordination of fine and gross movement - including muscle tone, spasticity, ataxia, tremors
Difficulty in speech and eating
Intellectual disabilities
Impaired senses, sight, hearing etc.
Delayed social development or behavioural problems.
Bladder control problems
Pain sensations.
What are some common complications of cerebral palsy?
Contracture - muscle shortening due to severe muscle tension, this can affect bone growth and joint structure
Malnutrition - due to difficulty swallowing and feeding, impair growth and infant health, some may need a feeding tube
Mental health conditions - social isolation, challenges of coping, behavioural issues
Heart and lung disease - difficulty swallowing increases risk of aspiration pneumonia.
Osteoarthiritis - from pressure or misalignement of joints
What is the normal gait?
Consits of a stance phase (foot on floor) and a swing phase (foot off floor)
Stance (60%): heel strike, flat foot, midstance, heel off, toe off
Swing: middle swing (split into acceleration up until middle and desceleration down towards the ground), heel strike. (40%)
What are the different terms used in the new gait cycle?
Intial contact (heel strike)
Loading response (shifting weight from one foot to another from heel strike to other foot off ground)
Mid stance - other foot off and up
Terminal stance - other foot coming down
Preswing - from heel off to toe off
Intial swing - foot off and up
midwing - foot coming down
Terminal swing - toe down to heel stike
What are some common gait abnormalities?
Trendelenburg gait
Antalgic gait
Ataxis gait
Parkinsonian gait
Hemiplegic gait (foot drop)
Steppage gait (foot drop)
Diplegic gait (spasticity, tiptoeing and toe dragging)
What is a trendelenburg gait?
When standing on the leg with the effected gluteus medius/minimus muscle the contralteral side of the pelvis will drop
Defective hip abductor.
Contrlateral Toe will drag when not compensated, or lean to side of affected muscle to compensate
What is an antalgic gait?
Abnormal pattern of walking secondary to pain - causes a limp.
Stance phase is shortend on affected leg relative to swing phase
What is an ataxic gait?
Poor cordination of the lower limbs
Changing step length
Foot often crosses midline
Stumbling
Wide stance
High risk of falls
May sway from side to side when standing still - this is known as titubation.
What is a parkinsonian gait?
Small shuffling steps
Struggle to pick up feet
Usually hunched posture
Slow to initiate movement
What are the features of a hemiplegic gait?
Effects the upper and lower limbs on only one side of the body
Unilateral weakness of the affected side, arm flexed, adductoed and internally roated.
When walking tends to hold arm close to body and drags affected lef in a semicircle, due to weakness of distal muscles (often also has foot drop)
What is a steppage gait?
Inability to lift the foot while walking due to the weakness of muscles that cause dorsiflexion of the ankle joint (anterior leg)
What is a diplegic gait?
Patient have involvement on both sides with spasticity in lower extremities worse than upper extremities
Patiesn walk with an abrnoamlly wide base, dorgging both legs and scrapping the toes.
Flexion of hip and knees, tight adduction of the knee, normally internally rotates feet so circular swining of legs and midgard position of upper extremetiies.
What are the key brain changes that may be seen on cerebral palsy?
Identified by an MRI
Hypoplasia - incomplete developement of the coretx, low cell division
Polymicrogyria - to many gyri which are abnormally small
Periventricular leukomalacia - white matter surrounding the ventricles is deprived of blood or oxygen, can be associated with ischemia, inflammation and tissue vulnerability, causes death or sfotening of the white matter, causes loss of motor neuron tracts. Appears on MRI with an abnormally high signal intensity.
What are the different types of cerebral palsy?
Spastic (most common)
Dyskinetic
Ataxic
Mixed
Hypotinic
What is spastic cerebral palsy?
Spastic (primary motor cortex is affected so damaged UMNL) can be hemiplegic, diplegic or quadriplegia
Is the most common type and the patient normally presents with
Hyperreflexia, increased deep tendon reflexes, clonus, increased muscle tone and muscle weakness.
What is dyskinetic cerebral palsy?
Primarily injury of the basal ganglia
Unable to initiate movement or prevent unwanted movmenet
Chorea - jerky, rhytmic movement
Athetosis - involutnary writing movement
Dystonia - sustain involuntary muscle contractions - presents as slow reptitive movment or abnormal posture (painful)
What is ataxic cerebral palsy?
INjury to the cerebellum
Loss of tone, blance, coordination and posture
Can present with wide based giat and loss of balance (ataxia), dysdiadochokinesia (inability to perform rapidly alternative muscle movements)
Dysmetria - abnormal finger to nose test. (no direction or range control over movement)
Hypotonia and muscle weakness.
What is hypotonic cerebral palsy?
Low muscle tone
Difficult to generate movement
Require more support surface contact.
Can be precuros for spastic or dyskinietic CP
What are the features of an upper motor neuron lesion?
Muscle weakness
Midl atrophy if any
No fasciculations
Positive Babinski sign
Increased reflexes
Increased muscle tone/spasticity
What are the features of a lower motor neuron lesion?
Muscle weakness
Muscle atrophy
Fasciculations
Decreased reflexes
Decreased muscle tone
Describe the structure of tendons.
Dense Regular Fibrous Connective tissue that joins muscle to bones.
Consists of mainly type 1 collagen and parallel fibroblasts (tenoblasts or tenocytes) which continuously produce ECM, alongside elastin and type 3 collagen.
Relatively well organised and can withstand greater tensile force
Surrounded by a loose connective tissue sheath the epitenon
Endotenon - subdivides the tendon internally into fascicles that act as connective tissue septae.
What is the function of the corticospinal tracts?
Anterior - motor innervation to the axis (trunk)
Lateral - motor innervation to the limbs
What are some important ligaments/tendons around the knee?
Patella tendon
Quadriceps tendon
Medial collateral ligament
Lateral collateral ligament
Anterior Cruciate ligament
Posterior Cruciate ligament
Medial and lateral meniscus ligament
Transverse ligament of the knee