Cerebral Palsy

Question 1

Definition of CP

Answer 1

neurodevelopmental impairment caused by a non-progressive defect or lesion in single or multiple locations in the immature brain.

Question 2

When does the lesion need to occur for it to be CP?

Answer 2

in utero, during or shortly after birth.

Question 3

What does the lesion produce?

Answer 3

motor impairment, and possible sensory deficits that are usually evident in infancy or early childhood.

Question 4

What is CP characterized by?

Answer 4

Sensorimotor dysfunction - abnormal muscle tone, abnormal posture and movement

Question 5

Etiology of CP: Prenatal

Answer 5

Hereditary/genetic, prenatal infections, fetal anoxia, metabolic disorders, developmental deficits

Question 6

Etiology of CP: Perinatal

Answer 6

prolonged or difficult labor, asphyxia

Question 7

Etiology of CP: Postnatal

Answer 7

Vascular accidents, intracranial hemorrhage, head trauma, infections

Question 8

Neonatal Encephalopathy (NE): Parasagittal cerebral injury

Answer 8

Major ischemic lesion in term infants (perinatal) lies at the vascular watershed of the anterior/middle/posterior cerebral arteries. May have d/c perfusion during periods of stress, manifests as weakness in proximal extremities > legs
spastic quadriparesis

Question 9

Neonatal Encephalopathy (NE): Periventricular leukomalacia (PVL)

Answer 9

major ischemic event in preterm infants especially SGA infants- can be prenatal or postnatal injury- necrosis of white matter adjacent to the lateral ventricles- often seen in premature infants who have survived major hypoxic/ischemic insults such as cardiac arrest
spastic diplegia

Question 10

Neonatal Encephalopathy (NE): Intraventricular hemorrhage

Answer 10

area adjacent to ventricles (germinal matrix) is very susceptible to episodes of ischemia or hypertension - often seen in premature infants
spastic diplegia

Question 11

Neonatal Encephalopathy (NE): Selective neuronal necrosis

Answer 11

injury and death of cerebral and brain stem neurons which may occur in focal or widespread distribution during the postnatal period- injury pattern seems to mirror glutamatergic neurons-
spastic quadriparesis

Often occurs with other varieties of NE

Question 12

Neonatal Encephalopathy (NE): Status marmoratus

Answer 12

more common in term infants- postnatal onset- affects the basal ganglia
neuronal loss
glial scarring
Hypermyelination: makes brain have marbled appearance.
symptoms may take several months to develop
athetoid or spastic-athetoid cerebral palsy

Question 13

Neonatal Encephalopathy (NE): Focal and multifocal ischemic brain necrosis

Answer 13

most common in term infants- postnatal- destruction (necrosis) of all cellular elements in the distribution of a single vessel or several vessels- cavitation - neonatal seizures seen in 80%-
may result in hemiparesis or quadriparesis

Question 14

What is spastic CP (70%) characterized by?

Answer 14

increased muscle tone, stereotyped and limited patterns of movement, decreased AROM and PROM, tendency to develop contractures and deformities, persistence of primitive and tonic reflexes and poor development of the postural reflex mechanism

Question 15

Effects of malnutrition

Answer 15

Diminished muscle strength
Increased circulation times
Diminished cardiac work capacity
Diminished immune function
Diminished cerebral growth
Delayed cognitive development
Decreased energy-  may result in decreased social interaction, apathy
In children with CP- increased severity of GER
Impaired wound healing

Question 16

Early identification of CP

Answer 16

Asymmetrical movement
Delays in milestones
Tone abnormalities
MRI to confirm abnormal findings