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Week 2: Cerebral Palsy Flashcards

1
Q

Cerebral Palsy is

A

a PERMANENT disorder of movement and posture causing activity limitations that are attributed to a NON PROGRESSIVE disturbance that occurred in the DEVELOPING fetal or infant brain

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2
Q

Placenta Abruption

A

medical emergency where placenta pulls away from uterus wall and causes bleeding and immediate anoxia

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3
Q

Placenta Previa

A

placenta shifts and drops to opening of cervix; common to occur after a mother has had multiple children

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4
Q

nuchal cord

A

cord strangulation causing anoxia

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5
Q

most common pathology type in 1st trimester

A

brain pathology in germinal matrix

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6
Q

most common pathology in second semester

A

hypoxic ischemic events or infections

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7
Q

most common pathology in 3rd trimester

A

placenta previa/ abruption or positional –> HIE from labor

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8
Q

4 main types of lesions

A
  • hemorrhagic
    1. PVL ischemic lesion> necrosis
    2. IVH
    3. Focal Infarct

-ischemic lesion
4. diffuse scarring across MRI due to HIE

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9
Q

Periventricular Leukomalacia (PVL)

A

increased periventricular echogenicity

  • grades 1-4: progression of developing into cysts (LOOK @ yellow CHART)
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10
Q

Intraventricular Hemorrhage grades

A

grades 1 - small bleed in germinal matrics <10%

grade 2: blood occupying 10-50% of ventricular space

grade 3: >50% of ventricle fills and begins to dilate the ventricle

grade 4: fills, dilates, and spills into periventricular space affecting all motor tracts

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11
Q

Hypoxic Ischemic Encephalopathy HIE

A

result of perinatal asphyxia and due to ischemia and hypoxemia/anoxia

  • preterm & full term babies
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12
Q

Infant stroke - focal ischemic brain necrosis

A

specific areas of neuronal death caused by infarction of specific cerebral arteries

*middle cerebral artery most frequent

*typically unilateral –> spastic hemiplegic CP

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13
Q

corticospinal tract

A

pyramidal mainly excitatory tract

  • mvmt of limbs (lateral tract) and trunk (ipsilateral medial/ant tract)
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14
Q

vestibulopsinal tract

A

mainly excitatory tract controlling posture, balance, antigravity, UE flexion & LE ext

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15
Q

Reticulospinal tract

A

mainly excitatory tract

  • lateral decreases tone!
  • medial increases tone!
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16
Q

rubrospinal tract

A

mainly excitatory to flexors / inhibitory to extensors

  • postural tone & FM skills
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17
Q

tectospinal tract

A

for visual stimulation

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18
Q

major features of CP

A

impared delayed development
sensory deficits
cognitive deficits
speech disorders
auditory impairments
urinary incontinence
constapation
pain

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19
Q

spasticity selective to 2 joint muscles

A

iliopsoas, RF, adductors, sartorious, gracillis

20
Q

spasticity def

A

a motor disorder characterized by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated DTRs resulting from HYPERexcitability of the stretch reflex and LACK OF descending inhibition

21
Q

maximal force production achieved by stiff CP muscle is LESS than in NL muscle

A

(sarcomeres are OVERLY stretched or inefficient)

21
Q

LOOK @ TENSION CURVE BTW CP AND NORMAL MUSCLE

21
Q

T or F: stiffness of the ankle ROM in CP is greater than in normal muscle due to hypOextensibility

22
Q

maximal force occurs at a more ___ position than in normal muscle

A

plantarflexed

23
central hypotonia
gamma motor neuron or Fusimotor system which innervates muscle spindle - in central hypotonia, the fusimotor gamma system is disordered bc the descending pathways are damaged AND reticulospinal tract share projects w cstx to prox limb and axial muscle
24
classification of CP by brain region
pyramidal (spasic) lesion vs extrapyramidal (dyskinetic)
25
athetoid type CP
-extrapyramidal: basal ganglia - unwantied mvmts, writhing mvmts, difficulty w innitation & cessation of mvmt, dysarthria has a lot of closed chain mvmts to prevent unwanted mvmts
26
ataxia CP
uncoordinated movement; difficulty detecting errors in mvmt - jittery mvmt pattern bc cerebellum has no regulatory control
27
Gross Motor Functional Classification System (GMFCS)
levels 1-5 LOOK AT CHART 1: typiclal looking kid; may have trouble w gravel or uneven surfaces 2: needs to use hand rails on stairs or single limb 3: ambulatorily most of the day but will need wheeled mobility for some things 4: severe CP; have head ctrl, exercise ambulators only 5: severe CP; no head ctrl
28
least to most severe
GMFCS 1&2 hemiplegia and diplegia 2 and 3 severe hemi and spastic diplegia 4 adn 5 : spastic quad, ataxia, athetosis
29
T or F: some tests for CP, dont require you to touch the child at all
trueee-- AIMS
30
Pediatric Eval of Disability Inventory (PEDI)
31
general movements time frame
9-10 wks to 5 wks post conception
32
fidgety movements time frame
small circular gross mvmts - post conception to 5 mo
33
cramped syncronous mvmts
characterized by damage to immature brain "baby in trouble"
34
test of infant motor performance
infance under 4 mo to identify CP risk - predicts at 12 mo if child will need specialized care and can look at change overtime
35
Peabody Developmental Motor Scaple
standardized norm referenced 1 hr test - age 0-6 yrs
36
alberta infant motor scale
4 positions that parent places child in
37
hammersmith infant neurological exam
tests motor patterns, behavior, auditory, posture, tone
38
muscles of concern w children w CP
hip flexors - rectus - staheli test, not thomas test - duncan ely, + if hip rises hamstring - 90 90 test (surgery at >40 degrees popliteal angle ) gastroc soleus - silfverskiold test -- knee and ankle flexxed then dorsiflex limb to differentiate btw gastroc and soleus femoral antiversion: craigs test- prone, hip ext, knee flex NORM -20-20 degrees
39
should we stretch in cerebral Palsy?
no, we should cast, orthotics, surgery standing frames, night splinting, prpolonged functional stretching
40
what type of therapeutic exercise? what does it help? how often?
improves balance, 2-3x/wk fofr 6-10 wks at 65% MVIC strengthening hamstrings improves gait (yoga, pushing heavy objects) age appropriate play 10-15 min of intense activity 30-45 min of recreation games 2x/wk
41
positioning w CP
functional positioning to avoid contractures get them upright - use chairs, seating/standing devices prevents asymmetry --> scoliosis helps circulation, elimination, respiration
42
serial casting improves what knee and ankle motion
knee ext ankle all rom
43
what GMFCS levels is selective dorsal rhizotomy for
GMFCS 2-3 (not indicated for level 1) - operation where they cut sensory nerve fibers in lumbar spinal cord to disinhibit the feedback loop that was messed up
44
what to know
- neuroanatomy and pathophysiology - definition of CP - non progressive - premature infant highest risk - begins in fetal life - damage in brain - risk factors - ivh grade 1 vs 4 HIE main artery for intrauterine stroke MCA - milestones delayed red flags - CP muscle and difference btw ankle foot as hits ground - whats spasticity ? how to measure - MAS - ataxia(extraneous mvmt tremor) and axithosis (writhing) - dtr exaggerated - gmfcs levels - test levels - specific orthopedic tests - galliati sign - bartlow and ortolani test - child participation based on age - treatmill training post sereal casting and botox - obstacle testing

Pediatrics (4 decks)

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