Cerebral Palsy Flashcards
1
Q
CP Defenition
A
- Cerebral palsy (CP) describes 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.
- The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems
2
Q
Etiology - Birthweight
A
- Birthweight:
- 1000-1499 grams (2.2-3.3 lbs) highest prevalence of CP
- Below 1000 grams had no more increased risk than 1000-1499 grams
- Lowest risk if birthweight >2500 grams (5.5 lbs) live births
- LBW: infants – periventricular leukomalacia (PVL,) periventricular hemorrhage, cerebral infarct
- Normal weight term infants – hypoxic-ischemic encephalopathy (HIE) most common cause (resulting in dyskinetic or spastic quad CP
3
Q
Etiology – Gestational Age
A
- Gestational age:
- Highest prevalence of CP at 23 weeks GA, lowest after 36 weeks GA
- Biggest risk if born <28 week
- Term infants: ~55-65% of kids with CP were term
4
Q
Genetics
A
- Genetics: some evidence there are phenotypes for increased risk for CP
- Already identified 6 genes
- Single-gene mutations found in some cases
- Familial cases
- 2-5 times more common in consanguinity
5
Q
PVL
A
- Often caused by HIE
- Associated with cognitive impairments
- PVL: >80% develop CP
- Posterior lesions worse than anterior lesions
- Focal cysts associated with spastic diplegia
- Extensive cysts associated with spastic quadriplia
- Non-cystic PVL also associated with CP
6
Q
PVL/ IVH
A
- Grades I-II PVL likely to walk by 2 yo
- Grades III-IV, only 10% walk
- Can also have intraventricular hemorrhage (IVH)
- Grades I-II, minimal risk of neurological impairment
- Grades III-IV, high risk of neurological impairment
7
Q
Maternal risk factors
A
- Seizure disorder
- Thyroid disease
- Cognitive impairment
- Heart disease
- Respiratory disease
- Hypertension
- >40 yo
- Pre-eclampsia
- Chorioamnionitis
- Still birth or neonatal death
- Abnormal amount of amniotic fluid
- Bleeding in 2nd or 3rd trimester
8
Q
CP: Early Diagnosis
A
- Preemie with abnormal MRI and abnormal motor signs on General Movements or Test of Infant Motor Performance useful in identifying the presence and location of an injury in ∼89% of kids with CP
- Doesn’t predict the severity of CP
- (AIMS/TIMP in 4-10 month old for prediction of and ID of CP)
- 25-50% of babies with CP will not show signs of CP as newborns
- Prechtl’s qualitative assessment of general movements (GMs) is the most predictive assessment tool to detect infants, as young as 3 months who have the highest risk of CP…”
9
Q
General Prognosis
A
- “All children with cerebral palsy will have physical challenges. The bigger the child’s brain injury, the more likely the child is to have other co-occurring impairments, diseases, and functional limitations accompanying the physical disability, except for pain and behavior, which are common regardless of the level of physical disability.”
10
Q
Predictors of Independent Walking in Young Children with CP
A
- Sit-to-stand, and stand to sit
- Based on the postural control
- and functional strength needed
- Closed chain exercises mimicking everyday activities has shown to increase strength and functional ability
11
Q
Visual Deficits
A
- Up to 71%
- ROP
- Nystagmus
- Homonymous hemianopsia (25% of hemiplegia)
- Strabismus
- Esotropia: deviation of eye towards midline (more common)
Exotropia: deviation of eye away from midline
- Esotropia: deviation of eye towards midline (more common)
12
Q
Modified Ashworth: Body Structure/Function-Spasticity
(Quantifying Muscle Tone)
A
13
Q
Classification
A
- Anatomic distribution and location
- Diplegia: both lower extremities
- Hemiplegia: UE &LE on one side of body
- Quadriplegia: all 4 extremities
- Trunk can be involved in all
- Movement Disorders
- Gross Motor Function Classification System
14
Q
Movement Disorders
A
- Related to location of brain damage
15
Q
Spastic CP
A
- Spastic: motor cortex or white matter projections to/from cortical sensorimotor
- Produces abnormal patterns of posture and movement
- Increased muscle tone in antigravity muscles
- Abnormal postures and movements with patterns of all flexion or all extension
- Imbalance of tone across jointsà contractures and deformities (hip flexors, adductors, internal rotators; knee flexors; ankle plantarflexors; scapular retractors; glenohumeral extensors and adductors; elbow flexors; forearm pronators
16
Q
Dyskinetic forms:
A
-
Dyskinetic forms (uncontrolled and involuntary movement); basal ganglia involvement
- Results in general instability, abnormal postural patterns, lack of coordinated, rhythmical, and accurate movements
17
Q
Dyskinetic movements can be:
A
- Twisting and repetitive movements – known as dystonia
- Slow, ‘stormy’ movements – known as athetosis
- Dance-like irregular, unpredictable movements – known as chorea.
- Dyskinetic movements often co-occur alongside spasticity.
18
Q
Dystonia
A
- “Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both.” (Sanger et al, 2010, p. 1541)
- More predictable movements than chorea
- Triggered by voluntary attempt to move
- Absent during sleep
19
Q
Chorea
A
- “Chorea is an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments.”
- Movements are brief, jerky, discrete motions appear to constantly move
- “…multiple, repeated, but not rhythmic movements”
- Motions more rapid than dystonia and worsen with movement
- Doesn’t stop with relaxation
- Caused by damage to the cerebral cortex, basal ganglia, cerebellum, or thalamus
20
Q
Ballism
A
- “…ballism as chorea that affects proximal joints such as shoulder or hip. This leads to large amplitude movements of the limbs, sometimes with a flinging or flailing quality.”
21
Q
Athetosis
A
- “Athetosis is a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture.”
- Smooth, “sinuous, continuously…flowing, ongoing, random movement…”
- Snake-like movements
- Same regions of body vs. chorea
- Present at rest as well as when attempting to move
- No sustained movement as in dystonia
- Distal more than proximal; trunk, face, neck
- Use weights distally, weighted belt, weighted vest, weighted walker
- Use approximation
22
Q
Athetoid CP (Dyskinetic)
A
- Decreased muscle tone; floppy baby
- Poor proximal joint stabilityà poor functional stability
- Decreased coordination when child assumes upright
- Poor visual tracking
- Speech delay and oral motor problems/drool
- Tonic (primitive)reflexes persist interfering with functional posture and movement
- (so use sidelying positions to decrease effect
