WEEK 4: Cerebral Palsy

Question 1

What is cerebral palsy?

Answer 1

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.

The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems.

Question 2

Question: What is the primary cause of cerebral palsy according to the information provided?

Question: In what ways can cerebral palsy affect individuals?

Question: Is cerebral palsy a temporary or permanent condition?

Question: Can signs of cerebral palsy improve or worsen over time?

Question: Besides motor impairments, what other types of impairments may individuals with cerebral palsy experience?

Question: What components of movement and coordination can be affected by cerebral palsy?

Question: When does the damage leading to cerebral palsy occur?

Question: Is cerebral palsy a uniform condition, or does it affect people in different ways?

Question: Can the impairments associated with cerebral palsy include not only physical aspects but also cognitive and sensory functions?

Answer 2

CP is an umbrella term for a group of disorders that affects a person’s ability to move

CP is due to damage to the developing brain before, during or after birth.

CP affects people in different ways. It can affect body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance.

Although CP is a permanent life-long condition, some of these signs of cerebral palsy can improve or worsen over time.

People who have CP may also have visual, learning, hearing, speech, epilepsy and intellectual impairments.

Question 3

Question: What is the most common physical disability in childhood?

Question: Approximately, what percentage of children diagnosed with CP are born prematurely?

Question: What is mentioned as the cause of CP for most babies born at term?

Question: What percentage of CP cases is attributed to complications at birth, such as asphyxia or lack of oxygen?

Question: Is CP more prevalent in prematurely born children or those born at term?

Question: What is emphasized as an unknown factor in the cause of CP for most term-born babies?

Question: Besides prematurity, what is mentioned as a potential cause of CP in a small percentage of cases?

Question: At what stage of development does CP occur?

Answer 3

CP is the most common physical disability in childhood

About 45% of children diagnosed with CP are born prematurely

For most babies born at term with CP, the cause remains unknown.

Only a small percentage of CP is due to complications at birth (e.g. asphyxia or lack of oxygen).

Answer: CP is due to damage to the developing brain before, during, or after birth.

Question 4

State the antenatal risk factors for cerebral palsy.

Answer 4

Some risk factors for cerebral palsy have been identified. These include:

*Premature birth (less than 37 weeks)

*Low birth weight (small for gestational age)

*Blood clotting problems (thrombophilia)

*An inability of the placenta to provide the developing foetus with oxygen and nutrients

*Bacterial or viral infection of the mother, foetus or baby that directly or indirectly attacks the infant’s central nervous system

*Prolonged loss of oxygen during the pregnancy or birthing process, or severe jaundice shortly after birth.
*Multiple gestation

Question 5

State the perinatal risk factors for cerebral palsy.

Answer 5

*Birth asphyxia
*Prolonged and complicated labor
*Hypoglycemia
*Hyperbilirubinemia

Question 6

State the postnatal risk factors for cerebral palsy.

Answer 6

*Meningitis
*Encephalitis
*Head trauma
*Cardiopulmonary arrest
*Non-accidental injury

Question 7

State the maternal/ obstetric risk factors for cerebral palsy.

Answer 7

*Hypoxia
*Maternal infection
*Folic acid deficiency
*Brain abnormalities

Question 8

Diagnosis

CP can sometimes now be diagnosed early, so interventions can start as soon as possible.

State the tools used for diagnosing cerebral palsy.

Answer 8

Babies can now be assessed as being at ‘high risk of cerebral palsy’ as early as 3-5 months of age.

The most sensitive tools are:

*General Movements Assessment in babies <20 weeks (corrected) - 95% predictive

*Neuroimaging

*Hammersmith Infant Neurological Assessment (HINE) - 90% predictive

Question 9

Describe the following types of spastic cerebral palsy.

1. Spastic
2. Dyskinetic
3. Ataxic
4. Mixed

Answer 9

1. SPASTIC: 80-90%
   *Most common form of CP. Muscles appears stiff and tight due to hypertonia.
   *Arises from damage to the Motor Cortex.
2. DYSKINETIC: 6%
   *Characterized by involuntary movements such as dystonia, athetosis and/or chorea.
   *Arises from damage to the Basal Ganglia.
3. ATAXIC: 5%
   *Characterized by shaky movements.
   *Affects balance and sense of positioning in space. *Arises from damage to the Cerebellum.
4. MIXED TYPES
   A number of children with CP will have two motor types of presents, e.g. spasticity and dystonia.

Question 10

Parts of the body

Cerebral palsy can affect different parts of the body. For example, for people with spasticity:

Describe the following:
1. Quadriplegia/Bilateral Spasticity
2. Diplegia/Bilateral Spasticity
3. Hemiplegia/Unilateral Spasticity

Answer 10

1. Quadriplegia/Bilateral Spasticity
   Both arms and legs are affected.
   The muscles of the trunk, face and mouth are often also affected.
2. Diplegia/Bilateral Spasticity
   Both legs are affected. The arms may be affected to a lesser extent.
3. Hemiplegia/Unilateral Spasticity
   One side of the body (one arm and one leg) is affected.

Question 11

Gross motor skills

The gross motor skills of children and young people with cerebral palsy can be categorized into 5 different levels using a tool called the Gross Motor Function Classification System (GMFCS) Expanded and Revised, available from Can Child in Canada.

Answer 11

GMFCS Levels:
*Level I - Walks Without Limitations:

Children and young people at Level I can walk independently and without limitations. They may have some limitations in speed and coordination, but their mobility is not significantly restricted.

*Level II - Walks With Limitations:

Individuals at Level II can walk without the need for assistive devices indoors but may require assistive devices or mobility aids for longer distances or in challenging environments. They may face challenges with coordination and balance.

*Level III - Walks Using a Handheld Mobility Device:

At Level III, individuals use handheld mobility devices, such as crutches or a walker, for walking. They may walk short distances without assistance but rely on these devices for greater mobility.

*Level IV - Self-Mobility With Limitations:

Individuals at Level IV have limited self-mobility and often use powered mobility devices like wheelchairs for most activities. They may be able to stand with support but have challenges with walking.

*Level V - Transported in a Manual Wheelchair:

Level V represents the most significant motor impairment. Individuals at this level are transported in a manual wheelchair and typically have limited independent mobility. They may require assistance with activities of daily living.

Question 12

Manual ability

At least two thirds of children with cerebral palsy will have movement difficulties affecting one or both arms. Almost every daily activity can be impacted.

The ability of children from 4–18 years old with cerebral palsy to handle objects in everyday activities can be categorised into 5 levels using the Manual Ability Classification System (MACS). More details at www.macs.nu/index.php

Answer 12

MACS Levels:
Level I - Handles Objects Easily and Successfully:

Children at Level I can handle objects easily and successfully in all daily activities. They can manipulate objects with precision and have no limitations in their manual abilities.

Level II - Handles Most Objects but with Reduced Quality and/or Speed:

Individuals at Level II can handle most objects but may experience limitations in the quality and/or speed of their manual abilities. They may require more time or effort compared to peers.

Level III - Handles Objects With Difficulty:

At Level III, individuals can handle certain objects but experience difficulty, particularly with more complex tasks. They may need adaptations or assistance to complete certain activities.

Level IV - Handles a Limited Selection of Easily Managed Objects:

Children at Level IV have limitations in their ability to handle objects and can only manage a limited selection of easily handled items. They may require substantial adaptations or assistance.

Level V - Does Not Handle Objects and Has a Severe Limitation in the Ability to Perform Even

Question 13

State some of the treatment considerations for cerebral palsy.

Answer 13

1. Pain
2. Hip displacement
3. Seizures
4. Intellectual disability
5. Non-verbal
6. Non-ambulant
7. Behavioral disorder
8. Bladder incontinence
9. Blindness
   10.sleep disorder
10. Deafness
11. non-oral feeding

Question 14

State some of the complications requiring inpatient management in cerebral palsy.

Answer 14

Complications requiring inpatient management include seizures, aspiration pneumonia, UTIs, pressure sores, and contractures.