CP - Neuro Flashcards
Demographics
- Occurs in 2 per 1000 live births (increasing because of ability to keep premature babies alive)
- Affects approx 1 million people in the US
- Caused by insult to the immature brain starting from prenatal period to age 2
- Vascular, hypoxic, infectious, metabolic, toxic
- Teratogenic, traumatic, genetic, idiopathic
- One-time event insult, does not progress
- Classified by type and pattern (e.g. spastic hemiparesis, dyskinetic diplegia, spastic quadriplegia)
Definition
- Term covering a group of non-progressive injury, but often changing effects, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development..
- Disorders of movement and posture causing activity limitations
- Non-progressive disturbances of the developing brain
- Underlying lesion is static, but muscular pathology is progressive
Spasticity
- Motor disorder characterized by a VELOCITY DEPENDENT increased resistance to passive stretch
- Velocity – speed – dependent
- Stretch dependent
- NOT muscle overactivity
- One of the upper motor neuron signs
Upper Motor Neuron Syndrome
- Lesion in the Corticospinal Pathway
- Spasticity
- Clonus – static
- Flexor/extensor spasm
- Hyper-reflexia
Secondary Conditions
- Mental Retardation (30-50%): More global problem w/ the brain assoc w/ retardation, More local insult not assoc w/ retardation
- Epilepsy (15-60%)
- Speech Disorders (30-80%): As a result of the amount of muscles needed to carry out speech
History
- Detailed prenatal and perinatal history
- Exposure to drugs, toxins, infections
- Maternal diabetes, endocrine diseases
- Fam Hx of neurologic diseases, previous pregnancy loss, seizures, mental retardation
- Mode of delivery (clues to what was going on around delivery time), birth weight, APGAR score (just after baby is born), complications such as infection, hyperbilirubinemia, apnea, intraventricular hemorrhage, prolonged hospitalization
- Motor, language and social skills birth to present
- Previously NORMAL development followed by REGRESSION, it is not likely CP, but rather a hereditary neurodegenerative disease
Monoplegia or monoparesis
involving one limb
Hemiplegia or hemiparesis
involving one side of the body
Diplegia or diparesis
involving both legs predominantly
Quadriplegia or quadiparesis
involving all four extremities
Types
Spastic
-Most common type (in US)
-Caused by lesion in pyramidal system
-Hyperreflexia, clonus, positive Babinski
Dyskinetic
-Abnormal tone regulation, postural control, and involuntary movements
-Caused by lesion in the extrapyramidal system (basal ganglia)
-Most common etiology kernicterus (high bilirubin) and severe anoxia
-Athetosis: slow, writhing, involuntary movements
-Chorea: abrupt, irregular jerky movements
-Dystonia: slow rhythmic movements w/ abn posture & tone
Hypotonic
-Tone is decreased but hyperreflexia is present
-Usually associated with diffuse brain malformation
-Less common
Ataxic
-Rarest form
-Lesion in cerebellum or its pathways
-Look for head, trunk, limb ataxia
-Sitting/standing/walking may be impaired with frequent falls
-Hands ataxic with difficulty feeding and writing
Musculoskeletal Progression
- Upper Motor Neuron Syndrome
- Spasticity and Weakness
- Failure of longitudinal muscle growth
- Fixed contracture
- Bony torsion
- Joint instability
- Joint dislocation
- Joint and bone degenerative changes
