week 8 Flashcards
cerebral palsy
motor function disorder caused by nonprogressive brain defect present at or shortly after birth
- symptoms depend on injury severity
- palsy = lack musc control
- more common males
aetiology CP
anything causing damage to immature brain
- some CP is never diagnosed
- “immature” is not defined
types of CP
congenital: 90% of case
prenatal: prior to birth i.e. maternal drug use, alc, toxin, illness
perinatal CP: at or around time of birth
- low birth weight
- preterm birth
- o2 deprivation
acquired CP: 10%, happens 28 days post birth
postnatal CP: infection of brain, injury, cerebrovascular accidents i.e. stroke, heart defect
topographical classification of CP
diplegic CP: both legs affected…sometimes arms
hemiplegic CP: one side of body i.e. L arm and leg
monoplegia: only one limb affected, very rare
triplegic CP: 3 limbs, rare
quadriplegic or tetraplegic CP: whole body…arms, legs, and trunk
- sometimes face and mouth
problematic classification bcs little distinction
hypotonia
laxity of muscles
often diagnosed w CP diagnoses
degree of disability CP classification
mild CP: min impact, fine motor mvmnts
- can go undiagnosed
mod CP: gen musc mvmnts, speech, fine motor skills
- can impact daily life, but good function
severe CP: little to no control, reflexes
clinical types CP
diagnosed according to predominant type
spastic CP: 65%, damage to motor cortex resp for motor commands
- hypertonic musculature: stiff
- co-contraction: agonist and antagonist contract same time
- pigeon-toed scissor gait and hemiplegic gait/lean one side
athetoid CP: 25%, damaged basal ganglia
- unpreditcable and purposeless mvmnt aka CUP mvmnt
- CUP mvmnt bcs musc tone foes b/w hypertonic and hypotonic
- mainly quadriplegic
ataxic CP: 10%, most undiagnosed
- damaged cerebellum, balance and coordiantion
- irregular and imbalanced steps
mixed CP: 2+ types of CP…mult brain areas damaged
GMFCS
gross motor function classification system: kids and youth under 18, classes according to typical abilities and gross motor function
5 pt scale
typical, rather than best function
meaningful activities i.e. wheeling, sitting, walking
- age based desc bcs motor funct changes w age
lvl 1: walks no limits
2: walks w limits
3: walks using handheld device
4: may use powered mobility, self mobile w limits
5: manual wheelchair
ages are “between birthdays” not yrs old
behaviour indicators of CP
neurological soft signs:
- attention deficits
- hyperexcitability, stim reflexes
- rigidity around concepts
- unstable emotions
- poor visual input
complications w CP
contracture: muscs shorten bcs of hyperactive stretch
- joint becomes fixed and causes pain
- prevent i.e. splints, bracing, exercise
scoliosis
spina bifida
2nd most common complex condition after CP
neural tube defect: occurs first 4 wks of conception
affects brain, SC, or coverings
incomplete fev of spinal column
- can be repaired but permanent nerve damage
- limb paralysis
folic acid: can reduce risk by 70%
risks of spina bifida
prior preg w NTD
family history NTD
insling dependent diabetes
obesity
anti seizure meds
symptoms of spina bifida
defective posterior vertebral arch fusion
- causes sac like protrusion which may be exposed
can cause sensation loss and loss of mvmnt
spina bifida occulta
occulta aka hidden, vertebrae covered by skin
minor defect, least commin
does NOT need treatment
meningocele
lower back sac protrusion b/w vertebrae
- bcs of damaged/missing vert
sac does NOT involve SC, no spinal damage
- sac is full of fluid
- min impairment
myelominingocele
most common AND severe
sac b/w missing vert w NERVE inside sac…CSF, spinal cord, vert
damage depends on vertebral damage
hydrocephalus: excess CSF in brain ventricles, can cause ID
primary complications w spina bifida
muscle paralysis assoc w myelominingocele bcs nerve damage
lose sensation, skeletal deformities
hydrocephalus
urinary incontinence
secondary complications SB
low fitness bcs musc paralysis and deformity
- clinical obesity
poor functional strength
respiratory difficulties, pressure sores
LD, seizures, etc.
shunt: drainage system for hydrocephalus
- tube keeps fluid mvmnt in brain
- can cause infection or seizure
PA concerns for developmental conditions
intervention is commonly needed
age 7 motor performance predicts adult performance
- if reflexes not integrated by 7, will likely have reflex forever
pathological reflexes don’t integrate at approp time
can be used in PA
goals for PA w developmental conditions
managed, not treated
- alleviate symptoms and max independence
lots of energy to perfrom ADLs, must conserve energy
dev voluntary musc mvmnt and gross motor skills
- warm water inc ROM
- physio
goals:
1. reduce musc impairments and inc QOL
2. optimal function
3. prevent/limit secondary complications
4. circumvent worsening symptoms
5. promote wellness over lifespan
