Week 2: Cerebral Palsy Flashcards
Cerebral Palsy is
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
Placenta Abruption
medical emergency where placenta pulls away from uterus wall and causes bleeding and immediate anoxia
Placenta Previa
placenta shifts and drops to opening of cervix; common to occur after a mother has had multiple children
nuchal cord
cord strangulation causing anoxia
most common pathology type in 1st trimester
brain pathology in germinal matrix
most common pathology in second semester
hypoxic ischemic events or infections
most common pathology in 3rd trimester
placenta previa/ abruption or positional –> HIE from labor
4 main types of lesions
- hemorrhagic
1. PVL ischemic lesion> necrosis
2. IVH
3. Focal Infarct
-ischemic lesion
4. diffuse scarring across MRI due to HIE
Periventricular Leukomalacia (PVL)
increased periventricular echogenicity
- grades 1-4: progression of developing into cysts (LOOK @ yellow CHART)
Intraventricular Hemorrhage grades
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
Hypoxic Ischemic Encephalopathy HIE
result of perinatal asphyxia and due to ischemia and hypoxemia/anoxia
- preterm & full term babies
Infant stroke - focal ischemic brain necrosis
specific areas of neuronal death caused by infarction of specific cerebral arteries
*middle cerebral artery most frequent
*typically unilateral –> spastic hemiplegic CP
corticospinal tract
pyramidal mainly excitatory tract
- mvmt of limbs (lateral tract) and trunk (ipsilateral medial/ant tract)
vestibulopsinal tract
mainly excitatory tract controlling posture, balance, antigravity, UE flexion & LE ext
Reticulospinal tract
mainly excitatory tract
- lateral decreases tone!
- medial increases tone!
rubrospinal tract
mainly excitatory to flexors / inhibitory to extensors
- postural tone & FM skills
tectospinal tract
for visual stimulation
major features of CP
impared delayed development
sensory deficits
cognitive deficits
speech disorders
auditory impairments
urinary incontinence
constapation
pain
spasticity selective to 2 joint muscles
iliopsoas, RF, adductors, sartorious, gracillis
spasticity def
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
maximal force production achieved by stiff CP muscle is LESS than in NL muscle
(sarcomeres are OVERLY stretched or inefficient)
LOOK @ TENSION CURVE BTW CP AND NORMAL MUSCLE
T or F: stiffness of the ankle ROM in CP is greater than in normal muscle due to hypOextensibility
True
maximal force occurs at a more ___ position than in normal muscle
plantarflexed
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
classification of CP by brain region
pyramidal (spasic) lesion
vs
extrapyramidal (dyskinetic)
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
ataxia CP
uncoordinated movement; difficulty detecting errors in mvmt
- jittery mvmt pattern bc cerebellum has no regulatory control
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
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
T or F: some tests for CP, dont require you to touch the child at all
trueee– AIMS
Pediatric Eval of Disability Inventory (PEDI)
general movements time frame
9-10 wks to 5 wks post conception
fidgety movements time frame
small circular
gross mvmts
- post conception to 5 mo
cramped syncronous mvmts
characterized by damage to immature brain
“baby in trouble”
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
Peabody Developmental Motor Scaple
standardized norm referenced 1 hr test
- age 0-6 yrs
alberta infant motor scale
4 positions that parent places child in
hammersmith infant neurological exam
tests motor patterns, behavior, auditory, posture, tone
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
should we stretch in cerebral Palsy?
no,
we should cast, orthotics, surgery
standing frames, night splinting, prpolonged functional stretching
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
positioning w CP
functional positioning to avoid contractures
get them upright - use chairs, seating/standing devices
prevents asymmetry –> scoliosis
helps circulation, elimination, respiration
serial casting improves what knee and ankle motion
knee ext
ankle all rom
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
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
