Week 6 Flashcards
What is cerebral palsy?
A group of permanent disorders of the development of movement and posture, causing
activity limitations that are attributed to nonprogressive disturbances that occurred in the
developing fetal or infant brain
How is cerebral palsy diagnosed?
A clinical diagnosis is made when a child does not reach early motor milestones and exhibits abnormal muscle tone or qualitative differences in movement patterns
Even though the cause of cerebral palsy is not completely understood, what is it associated with?
Prenatal, post natal, and peri-natal events that may include hypoxic, ischemic, infectious, congenital, or traumatic brain insults
What are somethings that may contribute to cerebral palsy?
- Premature birth
- Atypical uterine growth
- Multiple birth and genetic factors
What are somethings that we look at when diagnosing cerebral palsy?
- Assessment of symmetry
- Involuntary movements
- Abnormal primitive reflexes
- Late development of postural reflexes
At what age do most clinicians diagnose a child with cerebral palsy and why?
Most diagnosis get made between the age of 2-3, because alot of the presentations can disappear or can be associated with something else. Can be made in 6 months or younger
The classification of cerebral palsy is based on what?
- Impaired area of the body
* Movement abnormality
What are the types of cerebral palsy that falls under the impaired area of the body classification?
- Monoplegia: one limb affected (rare)
- Diplegia: all limb affected, but legs are more affected than arms
- Hemiplegia: one side of the body is affected
- Quadriplegia: all limbs are affected
What are the types of cerebral palsy that falls under the movement abnormality classification?
- Spastic: spasticity of the muscles (most common)
- Dyskinetic/athetoid: fluctuating tone/writhing movements. Low tone in the trunk and high in the arms
- Ataxic: balance and coordination problems are common
- Hypotonic: low muscle tone
What part of the brain is usually affected in the case of spastic cerebral palsy?
Injury to the motor cortex or white matter projection
What part of the brain is usually affected in the case of dyskinetic/athetoid cerebral palsy?
Injury of the basal ganglia
What part of the brain is usually affected in the case of ataxic cerebral palsy?
Injury to the cerebellum
What part of the brain is usually affected in the case of hypotonic cerebral palsy?
Not a single site is affected
What is the frequency at which we see cerebral palsy?
- Spastic diplegia (38%)
- Spastic hemiplegia (30%)
- Ataxia (11%)
- Dystonia (9.5%)
- Spastic quadriplegia (5.5%)
- Athetosis (5.5%)
- Mixed (2%)
____ is the more contemporary way of classifying cerebral palsy.
*Gross Motor Function
Classification System* is the more contemporary way of classifying cerebral palsy.
What is the Gross Motor Function Classification System?
A 5 level, age categorized system that places children with CP in categories of
severity based on performance in functional motor skills such as sitting, walking, and wheeled mobility. Highly reliable, and children usually don’t switch levels that they are in
At what age is the Gross Motor Function Classification System highly reliable and valid?
Particularly at preschool age and older
Around what age does a child being classified on the Gross Motor Function Classification System plateau?
Around the age of 5
Between what age does a child with cerebral palsy reach about 90% of their gross motor potential?
Between the age of 3 and 6
What are the body function/structure impairments seen in children with cerebral palsy?
- Muscle tone(high or low, spasticity) & extensibility
- Muscle strength
- Skeletal structure
- Selective control, postural control, motor learning
- Pain
What are the muscle tone presentations seen in children with cerebral palsy?
- Gets worse over time
- Muscle tone might not relax with activity
- Muscle growth often doesn’t keep up with bone growth
- Chronic muscle imbalance
- Abnormal posture/weakness
- Abnormal reflex activity
What are the muscle strength presentations seen in children with cerebral palsy?
- Unable to generate normal muscle forces
* Activity limitation such as: poor walking speed, poor gross motor function
What are the selective control, postural control, motor
learning presentations seen in children with cerebral palsy?
• Impairments in muscle strength and extensibility can result in abnormal bio-mechanical forces that affects the bones and joints
- Scoliosis
- Hip subluxation and dislocation
What are the selective control, postural control, motor
learning presentations seen in children with cerebral palsy?
- Children will have difficulty isolating their muscle and selected pattern
- Difficulty responding to postural changes/challenges
- Problems learning new movements
- Limitations in cognition and perceptual motor skills and a lack of opportunity to practice said skills
What are the interventions to be done with an infant with cerebral palsy?
- Educate family/caregivers (most important)
- Handling/positioning: encourage active movements, and normal movements and postures
- Facilitate optimal sensorimotor development: well aligned postural stability, smooth mobility
What are the interventions to be done with a preschooler with cerebral palsy?
- Prevent secondary impairment
- Promote play self-care, social skills and communication skills
- Optimize gross motor skills: encourage movement exploration, child initiated solutions to motor task, adaptations to changes in the environment, and repetitive practice of goal related functional task that are meaningful to the child
- Promote mobility
What are the interventions to be done with a school age child with cerebral palsy?
- Maintain achieved level of activity, prevent deterioration
- Promote participation in age-appropriate activities
- Start thinking of transition planning: which is characterized by self determination, enhanced knowledge of self and community, problem solving, decision making skills, identification of support system and supportive environment
What are the researched benefits of a backwards walker in a preschooler with cerebral palsy?
- Encourage a more upright posture
- Promote a better quality gait
- Decreased energy expenditure
What is myelodysplasia?
Defective development of any part (especially the lower segments) of the spinal cord. AKA spin bifida
What are the classifications of spina bifida?
- Spina bifida aperta: visible/open
* Spina bifida occulta: closed or not visible
What is spina bifida occulta?
A closed lesion, which can refer to a lipoma. A tuft of hair is commonly seen
What is a lipoma?
A small or large subcutaneous masses of fat, which are often associated with abnormal pigmentation of the skin, skin appendages, and dimples above the gluteal cleft
What are the different forms of spina bifida occulta?
- Lipomyelomeningocele with paralysis
- Lipomyelomeningocele w/out paralysis
- Lipoma of the filum terminale, usually with no paralysis
- Lipoma of the cauda equina or the conus medullaris with or w/out paralysis at birth
What are the different forms of spina bifida aperta?
- Spina bifida with meningocele
- Spina bifida with meningomyelocele
- Spina bifida with myeloschisis (most severe)
What is a meningomyelocele?
Open spinal cord defects, that usually protrude dorsally and are not skin covered, and are associated with spinal nerve paralysis.
What is a meningocele?
Skin covered spinal cord defect, which is initially associated with no paralysis and usually contain only membranes or non-functional nerves that end in sac wall. So paralysis might be developed overtime
What causes spina bifida?
It is thought to occur during neural tube formation, which happens in the 1st couple of weeks after conception
What are the parts of neural tube formation?
- Neurulation: the folding of the ectoderm on each side of the primitive spinal cord to form a tube that extends from the hindbrain to S2. Occurs before gestational day 28
- Canalization: when nerve cells fuse together to become the distal end of the spinal cord (distal to S2)