Cerebral palsy

Question 1

Define cerebral palsy (CP)

Answer 1

Abnormality in movement or posture because of a NON PROGRESSIVE brain damage that happened during development, birth or early life

Over 2y/o -not CP and instead aquired brain injury

1 in 400 and most common motor impairment

amazing paces case

Question 2

Causes and risk factors of cerebral palsy (CP)

Answer 2

Causes are very varied-

Risk factors:
Antenatal - Premmie,, multiple babies, maternal infection like chorioamnimonitis (rubella, toxoplasmosis, CMV)
Natal -HIE, Low birth weight, trauma, tools used during delivery
Postnatal - Meningitis, neonate sepsis, jaundice, neonate seizures

80% of CP are antenatal -
vascular occlusions, structural maldevelopment, genetic syndromes, congenital infections
10% are perinatal -HIE during pregnancy (and all the causes of HIE)
10% are postnatal -esp in premature babies with periventricular leukomalacia 2nd to ischemia

Question 3

Signs and Sx of cerebral palsy (CP)

Answer 3

Signs and Sx are usually seperated into categories-spastic (90%), ataxic (6%) and dyskinetic (4%) (they get own card)

General signs -
Development delay -missing milestones in gross motor skills +- persistance of primitive reflexes
NEVER LOSE ANY

abnormal posture/limb movement -depends on type of CP

Abnormal feeding/distrubance (slow, gagging, vomit, micro-aspiration)
abnormal gait
early hand preference

often associated with -learning disabilities, epilepsy, squints and hearing problems

Question 4

Signs and Sx of Spastic cerebral palsy (CP)

Answer 4

Spastic–damage to UMN pathways/pyramidal tracts -leading to hypertonia, hyperreflexia,
“clasp knife reflex” -can resist with flexor until 1 point where it just gives -UMN sign
dynamic catch -faster the muscle used, stronger it is (velocity)

3 main types -

Hemiplegic
Unilateral arm and/or leg, face spared
4-12 month 1st presentation
fisting of affected hand, asymetric movements at birth
walk on tip toes on affected side
Scissor gait -knee looking inwards
flaccid but increase tone on 1 side

PMh and BH can be clear -unclear cause/stroke

quadriplegic
All 4 limbs affected, often severe
hyperflexed back and neck -opisthotonos
Trunk affected
Poor head control
Low central tone -
associated with seizures, micocephaly, big learning disabilities

PMH-often HIE, severe

diaplegic-legs affected more than arms, but still all 4affected
abnormal walking -scissor gait or worse
difficulies with hand use

assocaited with LVP and preterm damage

Question 5

Sign and Sx of Ataxic cerebral palsy (CP)

Answer 5

HYPOtonic CP -
damage to cerebellum
usually very genetic determined

hypotonia, ataxia, coordination issues
delay in development
intension tremors

Question 6

Signs and Sx of dyskinetic cerebral palsy (CP)

Answer 6

Involuntary/uncontrolled abnomral movements
damage to basal ganglia
usually HIE or kernicterus caused

variable muscle tone determined by primitive reflexes -
Chorea- irregular, sudden, non rythmical
athetosis -slow, writhing distal movement -finger fanning
Dystonia -simultaneous flex/extensor action -twisted motion

Question 7

Investigation of cerebral palsy (CP)

Answer 7

have high clinical suspicion with any child not walking by 18 months, not sitting by 8mo, early hand preference
or still tiptoeing walk
or any other sign previously discussed

MRI -will show where and what the lesion is
needed if PMH, BH and Hx not clear enough
if its progressive-not CP
if lose milestones

MDT investigation with paeds, Physio, SALT, Nurse, OT, ortho

Question 8

Management of cerebral palsy (CP)

Answer 8

very MDT related because no treatment
and common in paces ;)

Educate parents about prognosis and what it is
prognosis -those that can sit before 2 probs can walk before 6
speech -50% trouble with talk, 33 with language
Life expect - worse with severe CP

Paeds-medical -epilepsy common (33%)
Physio -encourage movement, improve stengh, reduce loss of ROM
SALT -improve talking and communication capabilites
OT -identify tasks that could be hard and help with

Medication for Sx -
anticonvusltants
Stiffness-diazepam
Constip -movicol
drooling-antocholinergic
sleeping-melatonin

Question 9

PACES mx talk for cerebral palsy (CP)

Answer 9

explain diagnosis (damage to brain that accured early in develop)
Explain it wont progress/get worse, even if Sx might evolve
Refer to MDT, with Paeds/OT/SALT/PT which will all be involved in long term management
medication is available for sx control and help
Social services and support groups for parents