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731: Pediatrics > Cerebral Palsy (Part 1) > Flashcards

Cerebral Palsy (Part 1) Flashcards

1
Q

Define Cerebral Palsy

A

A group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain

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2
Q

The motor disturbances of CP are often accompanied by disturbances of what?

A
  • sensation
  • perception
  • cognition
  • communication
  • behavior
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3
Q

__% of children with CP have mental retardation, when combined with the slow learners and persons with disabilities that number climbs to __%

A

40

75

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4
Q

Epilepsy occurs in __% of children with CP

A

35

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5
Q

Visual impairments occur in __% of children with CP

A

20

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6
Q

Hydrocephalus occurs in __% of children with CP

A

9

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7
Q

What is a way to distinguish CP from other diagnoses?

A

CP is nonprogressive

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8
Q

True or False

No upper age limit has been determined for postnatal onset of CP

A

True

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9
Q

Why has there been an increase in the prevalence of babies with CP?

A

There is increased survival of preterm and very preterm babies

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10
Q

The incidence of CP is - per every 1000 live births

OR

_ in every 300 babies

A

2-3

1

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11
Q

The prevalence of CP in twins is said to be __ per every 1000 live births

A

15

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12
Q

The prevalence of CP in triplets is said to be __ per every 1000 live births

A

80

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13
Q

The prevalence of CP in quadruplets is said to be __ per every 1000 live births

A

43

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14
Q

75% of all CP cases are due to what?

A

Changes in prenatal brain development

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15
Q

What are some potential prenatal (before birth) causes of CP?

A
  • vascular events such as middle cerebral artery infarct
  • maternal infections during the 1st and 2nd trimesters
  • metabolic disorders
  • maternal ingestion of toxins
  • rare genetic syndromes
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16
Q

What are some potential perinatal (during birth) causes of CP?

A
  • obstructed labor
  • antepartum hemorrhage
  • cord prolapse
  • hypoxic-ischemic encephalopathy
  • untreated jaundice
  • severe neonatal infection
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17
Q

Perinatal asphyxia is though to cause -% of CP

A

6-8

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18
Q

What percentage of CP is thought to be caused postnatally?

A

10-18%

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19
Q

What are some potential postnatal (after birth) causes of CP?

A
  • metabolic encephalopathy
  • infections
  • injuries
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20
Q

What are some maternal characteristics that are associated with a higher likelihood of CP development?

A
  • delayed onset of menstruation
  • irregular menstruation
  • long intermenstrual intervals
  • unusually short or long interval between pregnancies
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21
Q

What paternal characteristic is associated with a higher likelihood of CP development? What specific type of CP?

A

advanced age

athetoid dystonic CP

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22
Q

What are the likely causes of perinatal asphyxia?

A
  • prolapsed cord
  • massive intrapartum hemorrhage
  • prolonged or traumatic birth
  • large baby with shoulder dystocia
  • maternal shock
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23
Q

What APGAR scores are associated with an 81-fold increased risk of CP?

A

0-3 a 5 minutes

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24
Q

Why is the diagnosis of CP so difficult?

A

The immature brain has much more plasticity, which allows for the uninjured part to assume the function of the injured part of the brain

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25
Q

When will a child be diagnosed with CP prior to 2 years of age?

A

The present with:

  • abnormal muscle tone
  • atypical posture
  • movement with persistence of primitive reflexes
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26
Q

Milder cases of CP may not be diagnosed until - years of age

A

4-5

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27
Q

What are the 3 key elements when diagnosing CP?

A
  • evaluation of motor skills
  • neuroimaging
  • evidence that symptoms are not progressing
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28
Q

What neuroimaging studies can show the location and type of brain injury?

A
  • cranial ultrasound
  • CT
  • MRI
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29
Q

What neuroimaging technique is preferred?

A

MRI

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30
Q

When is cranial ultrasound used? Why?

A

In high-risk preterm infants, because it is less invasive then other techniques

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31
Q

When neuroimaging is unremarkable, what should you suspect next?

A

Other disorders that mimic the diagnosis of CP, such as metabolic or mitochondrial disorders

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32
Q

Cerebral hemorrhages may be associated with CP, what are the 3 types of hemorrhages? Describe each

A
  • Intraventricular hemorrhages (IVH): bleeding into the ventricles
  • Germinal matrix hemorrhages (GMH): bleeding into the tissue around the ventricles
  • Periventricular intraventricular hemorrhages (PIVH): bleeding into both areas
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33
Q

What may form in the area where the bleed occurred once the acuteness has resolved?

A

Periventricular cyst (PVC)

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34
Q

What are 2 known risk factors for hemorrhages?

A
  • mechanical ventilation

- injury during critical periods of brain development

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35
Q

When is the periventricular white matter most sensitive to insult? What is the most predominant cause of this?

A

Between 24-34 weeks of gestation

Mother uses drugs

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36
Q

What are the grades of hemorrhages from least to most severe?

A

Grade I
Grade II
Grade III
Grade IV

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37
Q

True or False

The grade of the hemorrhage is enough o predict the development or severity of CP

A

False

38
Q

Prudent obstetrical care can help reduce the risk of CP, what does this include?

A
  • Management of preeclampsia with magnesium sulfate
  • Management of infections with antibiotics
  • Management of preterm labor with corticosteroids
39
Q

What is the major cause of CP in infants born preterm?

A

cystic periventricular leukomalacia (PVL)

40
Q

Other than neuroimaging techniques doctors tend to analyze what 2 things?

A
  • the infant’s “general movements” (GMs)

- cognitive abilities

41
Q

What is the first and the second strongest predictor if survival of the child with CP?

A

1) intellectual ability

2) severity of the physical impairments

42
Q

What are the most common causes of mortality in kids with CP?

A
  • respiratory and circulatory system impairments
  • certain cancers
  • neurologic complications
43
Q

What are the 3 ways in which movement disorders can be classified?

A
  • type of movement disorder
  • anatomic location of the child’s impaired motor function
  • scope of motor dysfunction
44
Q

What are the 5 types of movement disorders?

A
  • spastic
  • hypotonic
  • dyskinetic
  • athetoid
  • ataxic
45
Q

Spasticity occurs in approximately __% of all children with CP

A

75

46
Q

Define spasticity

A

Increased resistance to passive movement which increases with increased velocity of movement

47
Q

What scale is the most widely used scale for assessing spasticity?

A

Modified Ashworth Scale

48
Q

Describe the scoring system for the MAS

A 
00 = hypotonia
0 = normal tone
1 = slight increase in tone manifested by a slight catch and release or min resistance to joint ROM
1+ = slight increase in tone manifested by a slight catch and minimal increased resistance to joint ROM for half of the joint range
2 = more marked increase of tone though most of the whole joint (the affected joint is easily moved)
3 = considerable increase in muscle tone; passive movement difficult but possible
4 = affected joint is stiff and cannot be moved
49
Q

What treatment methods does spastic CP respond to?

A
  • Botox
  • baclofen
  • selective dorsal rhizotomy
  • orthopedic surgery
50
Q

Muscle changes associated with spastic CP can cause what secondary disorders?

A
  • hip dislocation
  • scoliosis
  • knee contracture
  • torsional malalignments of the femur and tibia
51
Q

What are the 3 classifications based on anatomical location of the impaired motor function?

A
  • diplegia
  • hemiplegia
  • quadriplegia
52
Q

What is the most common form of spastic CP?

A

diplegia

53
Q

What leads to spastic CP?

A

white matter infarct in the periventricular areas

54
Q

Describe the presentation of a child with spastic diplegic CP

A
  • increased lumbar lordosis
  • anterior pelvic tilt
  • B hip internal rotation
  • B knee flexion
  • intoeing
  • equinovalgus foot position
55
Q

What is the largest concern for kids with spastic diplegic CP?

A

Gait deficits such as equinus and crouched gait posture

56
Q

Describe spastic hemiplegic CP

A

the child’s upper and lower extremity on the same side of the body are affected

57
Q

What are the 4 main types of brain lesions that result in hemiplegic CP?

A
  • periventricular white matter abnormalities
  • cervical-subcortical lesions
  • brain malformations
  • nonprogressive postnatal injuries
58
Q

Which extremity is more affected in spastic hemiplegia? Is the involvement more proximal or distal?

A

upper

distal

59
Q

Describe the presentation of children with spastic hemiplegic CP

A
  • shoulder protraction
  • elbow flexion
  • wrist flexion and ulnar deviation
  • pelvic retraction
  • hip IR and flexion
  • knee flexion
  • forefoot contact (due to plantarflexed feet)
60
Q

Do children with hemiplegia achieve all gross and fine motor milestones?

A

Yes, but not within the typical time frame

61
Q

When do children with hemiplegia begin to walk?

A

18-24 months

62
Q

What are 2 standardized assessments that are used to evaluate the quality of UE function on children with hemiplegia?

A
  • SHUEE

- Assisting Hand Assessment (AHA)

63
Q

Is cognitive function impaired in children with spastic diplegia or hemiplegia?

A

No, but they tend to have social and emotional deficits

64
Q

What is spastic quadriplegic CP?

A

A subtype of CP in which volitional muscle control of all 4 extremities is severely impaired

65
Q

What are the most common neuroimaging findings in children with spastic quadriplegia?

A

periventricular white matter lesions

66
Q

Typically damage to what spinal tract leads to spastic diplegia? When does it result in quadriplegia?

A

cortical spinal tract

when it extends laterally

67
Q

Is cognition impaired in children with quadriplegic CP?

A

It depends on the child and can range from normal to severely impaired

68
Q

Define dyskinesia

A

Uncontrolled and involuntary movement

69
Q

Dyskinesia typically occurs because there is damage it what brain area?

A

Deep gray matter lesions, and to a lesser extent periventricular white matter lesions

70
Q

What does dyskinesia include?

A
  • athetosis
  • rigidity
  • tremor
  • dystonia
  • ballismus
  • choreoathetosis
71
Q

Describe athetosis

A

involuntary movements that are slow and writhing, abnormal in timing, direction, and spatial characteristics

72
Q

Athetoid movements usually effect what joints?

A

proximal joints

73
Q

Athetosis is often found in combination with what other dyskinetic movement pattern?

A

chorea

74
Q

What sensory and motor feed-forward and feedback circuit results in athetosis when impaired?

A

cortical-basal ganglia-thalamic loop

75
Q

What are older individuals with athetoid CP at risk for acquiring?

A

Devastating neurological deficits owing to IVD degeneration and instability in the C-spine (most notably C5-C6)

76
Q

How do individuals with athetoid CP typically initiate and attempt to control of movement?

A

with the jaw and head

77
Q

Is cognitive function impaired in children with athetoid CP?

A

No, they tend to have normal or above normal intelligence levels

78
Q

What can be defined as a rhythmic movement of small magnitude, that usually affects smaller joints?

A

tremor

79
Q

Tremors are rarely the only isolated disorder in CP, and are more commonly found in combination with what disorders?

A
  • athetosis

- ataxia

80
Q

What can be defined as a slow motion with a torsional element that may involve one limb or the entire body

A

dystonia

81
Q

What is the most rare dyskinetic movement disorder that involves random motion in large, fast patterns usually of a single limb?

A

Ballisnus

82
Q

What dyskinetic movement disorder involves jerky movement, commonly of the digits and varies in ROM?

A

choreoathetosis

83
Q

Describe ataxic CP

A

it is a disorder of balance and control in the timing of coordinated movements along with weakness, incoordination, a wide-based gait, and a noted tremor

84
Q

Damage to what area of the brain results in ataxic CP?

A

cerebellum

85
Q

What do children with ataxic CP have the most difficulty with?

A

transference of skills

May benefit from a specific task-oriented approach to treatment

86
Q

Hypotonia in a child with CP can be permanent, but is often transient in the evolution of what?

A

athetosis or spasticity

87
Q

Hypotonia is commonly seen as part of a mixed tone presentation, what does this mean?

A

Some children with quadriplegia may present with spastic LEs and hypotonic UEs

88
Q

In summary, damage to the cortex tends to lead to what type of CP? Damage to the basal ganglia tends to lead to what type of CP? Damage to the cerebellum tends to lead to what type of CP?

A

spastic (hemiplegia, diplegia, quadriplegia)

dyskinetic (athetoid, dystonic)

ataxic

89
Q

What classification system is based on gross motor function of children with CP?

A

Gross Motor Functional Measure (GMFM)

aka Gross Motor Functional Classification System (GMFCS)

90
Q

The GMFCS helps to measure what?

A

the severity of movement disability

91
Q

Describe the levels of the GMFCS

A
  • Level I: independent
  • Level II: walks without assistive devices; limited in outdoor and community level ambulation
  • Level III: walks with assistive devices; limited in outdoor and community level ambulation
  • Level IV: self-mobility with limitations; children are transported or use power mobility outdoors and in community
  • Level V: difficulty controlling all movements; self mobility is severely limited even with use of assistive technology.

731: Pediatrics (19 decks)

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