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Pediatrics > Week 2: Cerebral Palsy > Flashcards

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

A
21
Q

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

A

True

22
Q

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

A

plantarflexed

23
Q

central hypotonia

A

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
Q

classification of CP by brain region

A

pyramidal (spasic) lesion

vs

extrapyramidal (dyskinetic)

25
Q

athetoid type CP

A

-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
Q

ataxia CP

A

uncoordinated movement; difficulty detecting errors in mvmt
- jittery mvmt pattern bc cerebellum has no regulatory control

27
Q

Gross Motor Functional Classification System (GMFCS)

A

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
Q

least to most severe

A

GMFCS 1&2 hemiplegia and diplegia

2 and 3 severe hemi and spastic diplegia

4 adn 5 : spastic quad, ataxia, athetosis

29
Q

T or F: some tests for CP, dont require you to touch the child at all

A

trueee– AIMS

30
Q

Pediatric Eval of Disability Inventory (PEDI)

A
31
Q

general movements time frame

A

9-10 wks to 5 wks post conception

32
Q

fidgety movements time frame

A

small circular

gross mvmts

  • post conception to 5 mo
33
Q

cramped syncronous mvmts

A

characterized by damage to immature brain

“baby in trouble”

34
Q

test of infant motor performance

A

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
Q

Peabody Developmental Motor Scaple

A

standardized norm referenced 1 hr test

  • age 0-6 yrs
36
Q

alberta infant motor scale

A

4 positions that parent places child in

37
Q

hammersmith infant neurological exam

A

tests motor patterns, behavior, auditory, posture, tone

38
Q

muscles of concern w children w CP

A

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
Q

should we stretch in cerebral Palsy?

A

no,

we should cast, orthotics, surgery

standing frames, night splinting, prpolonged functional stretching

40
Q

what type of therapeutic exercise? what does it help? how often?

A

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
Q

positioning w CP

A

functional positioning to avoid contractures

get them upright - use chairs, seating/standing devices

prevents asymmetry –> scoliosis

helps circulation, elimination, respiration

42
Q

serial casting improves what knee and ankle motion

A

knee ext
ankle all rom

43
Q

what GMFCS levels is selective dorsal rhizotomy for

A

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
Q

what to know

A
  • 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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