CP Flashcards

1
Q

CP
what is it
Etiology

A

Cerebral Palsy (CP)
- a continuum of disorders of the movement, posture and coodination

Etiology
- caused by non-progressive disturbances that effect the brain during early development (fetal, infantile or early childhood)
- Increased risk of CP for… young gestational age at birth (premature) , low birth weight & serious illness in early years (meningitis and infantile stroke)

What Causes CP?
- in many cases - there is no cause found
- when the cause is identief - usually remlated to perinatal and prenatal events

Other Less Common Causes
- perinatal: chorioamnionitis (infection of the amnionic sac)
- low birth weight
- periventricaulr leukomalacia: damanged white matter
- congenital malformations
- encephalopathy as newborn

  • postnatal: infections (sepsis, meningitis)
  • asphyia
  • accidental injury (breif accidental event)

hydrocephalus at any age
can be acquired (infantile stroke, near drowning, trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is CP Classified

A

CP Classification: to determine the type and related symptoms

Classifications according to
- Type (spastic, dyskinetic or mixed)
- spastic = motor pyramidal tract affect: stiffness
- diskinetic = extrapyramidal tract affects: uncontrolled movements
- Severity
- Distribution

Quadriplegia
- all four limbs affected
- often seen with hypotonia of trunk and neck
- more liekly associated with intellectual disabilities

Diplegia
- lower limbs involved
- arms spared

Hemiplegia
- one side of the body affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of CP
dependent on type
Spastic Hemiplegia
Spastic diplegia
Spastic Quadraplegia
Atehtoid/extrapyramindal

A

always some motor component to CP

Spastic= UMN lesion (hyperreflexia!)

Spastic Hemiplageia
- circumductive gait: swinging leg outward to walk because reduced flexion ability
- early handedness: preferr one side over the other much earlier than normal

Spastic Diplegia (lower limbs)
- Scissor gait: increased tone in hip adducors makes them have to cross midline to walk
- commando crawl: crawl fine with ahnds but legs drag behind

Spastic Quadraplegia
- affect all limbs and swallowing
- high likelihood of seizures and cognitive impairment

Athetoid/Etxpyramidal
NOT AN UMN lesion: they will have hypotonia with increase tone later in life
- involuntary contraction of muscle groups; probelms swallowing and with speech
- normal intelligence; low seizure risk
- UE more affected than LE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Spasticity & Dyskinesia with CP

A

Spasticity
- assocaited with most CP cases
- the velocity dependent resistance of muscle stretch
- UMN: hyperreflexia and clonus
- co-contraction of muscles
- persistant primitive reflexes
- stiff moving, fisting hands, sicssor gait, toe walking and poor posture

Dyskinesia
- involuntary movements = athetosis and chorea
- dystonia: sustained muslce contraction leading to abnormal posturing
- dysarthia and feeding issues
- ataxia

the severity of gross motor function = GMFCS 5 point scale
- done by OT and PT to assess motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how can CP be prevented

A

Adequate Antenatal Care
- prevent infection
- possible mag sulfate to mom
- delayed cord clamp to reduce hemorrhage

Postnatal Care
- immedaite recussitaion
- hypothermia to protect brain
- get good ventilation
- maintain metabolic state
- control seizures
- treat encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some Manifestations of CP you can note on exam

A
  • spacticity
  • dyskinesia
  • ataxia
  • joint contractures (toe walking because achilles too tight)
  • newborn: ventral suspentions to test reflexes : strength of trunk tone if low muscle tone: could be CP
  • delayed or too early milestones (shouldnt be rolling)
  • persisting primitive reflexes
  • opsthotonic posturing (spastic contracture of muscleS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Primitive reflexes
Tonic Labrinthine Reflex

A

TLR
- tilting head back when baby is laying donw: causes arch back with legs strightening and toes pointing, hands fist
- gone at 6 months

Asymmetric Tonic Reflex
- extension of UE and LE to the side the neck is turned and flexion on opposite
- shouldnt ever be at rest
- gone at 3-4 months

Galant Reflex
- bab on tummy; stroke next to vertebrae in thorax to lumbar = baby turns toward the side you stroked
- gone at 1-2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Comorbidities of CP

A
  • chronic pain: especially in those with spasticity (since its stiffness and abnormal posutring)
  • inability to walk, speak, incontinence
  • hip displacement
  • epilepsy is common
  • behvaioral and sleep issues

Psychiatric
- ADHD, depression, anxiety and conduct disorder are all common
- early CBT can help
- and medications if neede

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

History Taking to determine if CP

how is a dx. made

A

prenatal and birth history

family history of the following
- development disorders and congenital
- seziures
- CP
- movement disorders
- joint contractures
- vascualr accidents
- infertilit or stillbirths
- adult onset neurodegener d/o

Pt. speciifcal
- early or late milestone
- signs of spasticity or dyskinesia

a diagnosis requires serial examinations
- can be dx. at age 2 (earliest at 5-6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Additional Dx. tools for CP along with hx taking

A

Imaging
- MRI: to see potential cause and exclude other conditions
- CRANIAL US: is the standard of care in premies: evaluate for intraventricaulr disease
- reveiw placenta if possible

Genetic
- genetic and molecular testing can be done for some types
- mostly done to R/O other conditions that mimic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment of CP
screen for what otehr conditions

A

Screen for
- intellectual disability
- seizures
- vison and hearing issues
- speech and alangugae
- nutrtional

Technological support: wheelchairs, communication devices
- family psych support

manage motor function: OT, PT, orthotics
manage spasticity: baclofen intrathecal pump or onabotulism A into muscles directly ( or surgery)
Dystonia: DA agonists

Hand Dysfunction: constraints or bimanual thearpy

Equinas Deformity: ankle orthotics are first line, then surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of CP: Impaired Oral Function

A

can result in lots of other complications
- difficult to manage secretions, aspiration, pneumonia, poor nutrtion, etc.

Manage
- soft/puree diet
- NG tube or G tube
- Salivary treatment = scopolamine, glycopyrolate or onobotulism A into the salivary gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of CP: Pressure Ulcers

Osteoporosis

A

prevention
- alterate postions
- prophylatic dressing
- pressure mattresses
- wheel cahir cushions
- sheepskin

Osteoporosis
- due to: lackof use, poor nutrtion, lack of Vit D, late puberty, anticonvusants
- FRAX assessment and DEXA at age 18 and Q18-24 months
- calcium, Vit D and bisphosphonates as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Continued Care

A
  • normal lifespan
  • check and screen for all other disesae processes you would for other populations (DM, obestiy, done density, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly