Cerebral Palsy

Question 1

Primary lesion is located in the:

Answer 1

CNS

Question 2

Who gets CP?

Answer 2

50% of diagnoses in full-term infants

33% pre-term

Question 3

How is CP diagnosed?

Answer 3

eval of mvmnt and ID of mvmnt dysfxn; generally followed by MRI for baseline assessment

Question 4

CP incidence?

Answer 4

2/1000 live births

Question 5

Define CP:

Answer 5

group of mvmnt disorders occurring as a result of lesion in motor areas of the developing, immature brain

Question 6

What systems are involved in addition to CNS?

Answer 6

Cognitive
Vision
Hearing
Seizures
GI
Orthopedic
Oral motor
Respiratory
Endocrine
Integumentary
G-U

Question 7

What factors are considered in CP classification?

Answer 7

1. location
2. type of mvmnt disorder
3. functional level

Question 8

Locations:

Answer 8

diplegia
hemiplegia
quadriplegia

Question 9

Type of mvmnt disorders:

Answer 9

spastic
dystoni
athetotic
ataxic
mixed

Question 10

How is CP classified based on function level?

Answer 10

GMFCS

5 levels: reflects child’s current abilities and limitations in gross motor function; focused on sitting/walking fxns

Question 11

Goals for infants and toddlers with CP?

Answer 11

facilitate normal mvmnt for achievement of developmental milestones

Question 12

Goals for older children with CP?

Answer 12

maintain and increase strength/flexibility to optimize fxn; develop habits for life long health and wellness

Question 13

Intervention in infancy:

Answer 13

educate!
promote parents’ ease in handling/care
facilitate optimal sensorimotor development for motor skill achievement with well aligned postural stability
monitor for positioning (prevent deformities in children and more severely involved)

Question 14

Intervention in toddler-preschool years:

Answer 14

Optimize mobility and access to environment.
Assistive devices for ambulation
Seating systems
Consider power mobility
Self care equipment

Question 15

Intervention in adolescence:

Answer 15

Health Maintenance- contractures, cardiovascular
Continued access to school and community. Consider ways to foster independence including home modifications, adaptive equipment.
Participation continues to present challenges for high school aged children
Find Mechanisms for involvement in fitness activities to promote health

Question 16

Intervention in school-aged children:

Answer 16

Allow for continued access to school, home and play.
Develop programs to prevent secondary deformities
Encourage participation by modification of environment or activity as needed.

Question 17

What causes joint contracture in individuals with CP?

Answer 17

abnormal forces on bones that create bony deformity
capsular tightness due to abnormal mvmnt patterns and lack of normal joint excursion
tightness of muscle-tendon unit due to weakness, hypotonicity (which inhibits muscle growth)

Question 18

Contracture tend to form in predictable patterns and joints. Describe both UE and LE:

Answer 18

Upper extremities: Shoulder flexors and adductors, pectoralis major, biceps, pronators, FCU, thumb adductors.
Lower extremities: Hip adductors, +/- anteversion, knee flexors, plantar flexors and everters

Question 19

What causes limited flexibility/ in CP patients?

Answer 19

Limited movement of 2 joint muscles is common.

Weakness, and poor selective motor control also play a big part.

Question 20

What motor control deficits are expected?

Answer 20

abnormal tone (hyper or hypotonicity)
lack of selective control
athetoid or ataxic mvmnts

Question 21

What strength deficits are expected?

Answer 21

spastic muscles are week (antagonists not strong enough to overpower spastic muscles)
disturbances in length-tension relationships also impair force generation

Question 22

What aerobic capacity factors need to be considered?

Answer 22

Ambulatory children have a much less efficient gait than their peers so to perform the same level of work, they need to work harder.
Many are sedentary

Question 23

How would you assess aerobic capacity?

Answer 23

6 min or 3 min walk tests

can be done both walking and propelling manual wheel chair

Question 24

What standardized tests are commonly performed?

Answer 24

PEDI
COPM
CAPE
GMFM
GMFCS

Question 25

Describe the GMFM:

Answer 25

A standardized instrument designed to measure change in in motor function in children with cerebral palsy:
Has predictive value in determination of ultimate highest motor function

5 Domains for testing (Rolling, sitting, crawling and kneeling, standing and Walking running and jumping)

Question 26

Why family centered intervention?

Answer 26

Best practice in pediatric PT bc takes into consideration the child and families needs, goals and priorities in the settings where children work, learn and play.
Collaboration since frequent practice which is done under a variety of environments which are part of the child’s daily routines enhances motor learning.

Question 27

Whats the current consensus on stretching?

Answer 27

To maintain muscle length over time: 
prolonged stretching (>30min)
consider position changes, standing, bracing, night splints etc

Question 28

Whats the current consensus on strengthening?

Answer 28

functional utilization of strength > isolated muscle strength