Cerebral Palsy Flashcards
What is Cerebral Palsy?
An umbrella term referring to a non-progressive disease of the brain originating during the antenatal, neonatal or early postnatal period the brain neuronal connections are still evolving. Usually the term given to brain injuries sustained before 2 years of age.
Epidemiology of CP?
1) Most common cause of childhood disability - 9% incidence if born 23-27 weeks.
2) Under developed countries have 3 times the incidence due to poor antenatal care, nutritional concerns and lack of facilities for birth and perinatal services.
3) Antenatal causes responsible for 80% of cases.
Aetiology of CP?
Antenatal:
1) Preterm birth - increasing risk with decreasing gestational age
2) Intrauterine infections - HIV, CMV, Rubella
3) Rhesus disease
4) Toxic/teratogenic agents - alcohol, smoking, cocaine
Perinatal:
1) Birth trauma
2) Hypoxia
3) Foetal distress
4) Neonatal sepsis
Post-natal:
1) Trauma
2) Intraventricular haemorrhage
3) Hypoxia
4) Meningitis
5) Hyperbillirubinaemia
Clinical presentation of CP?
1) Weakness, paralysis, delayed developmental milestones, seizures, speech and language issues
2) Abnormal gait
3) Abnormal limb/trunk posture
4) Abnormal tone
5) Poor feeding - gagging and vomiting, slow feeding, oromotor incoordination
6) Low Apgar score (bash life test 5 mins after birth)
What are the classifications of cerebral palsy?
1) Spastic cerebral palsy (70%)
2) Dyskinetic/athetoid cerebral palsy (20%)
3) Ataxic cerebral palsy
4) Mixed
What are the clinical presentations of spastic cerebral palsy?
Limb tone is persistently increased - spasticity with clasp-knife limbs under pressure.
Hemiplegic - unilateral involvement of arm and leg - early development of hand preference 12 months, delay walking, increased deep reflexes.
Diplegic - involvement of either both legs or both arms (mostly legs), child looks normal until picked up when legs scissor - hip flexion and adduction, and internal rotation with knee extension and plantar flexion.
Quadriplegia - all 4 limbs affected and association with seizures and low IQ.
What are the clinical presentations of dyskinetic/athetoid cerebral palsy?
1) Slow, writhing, involuntary movements of the extremities (athetoid) or proximal parts of limbs and trunk (dystonia) (ATHETOID/DYSTONIA major symptoms).
2) Abrupt, jerky, distal movements (choreiform) with spasticity.
3) Movement increased with emotional tension and stops during sleep.
4) Dysarthria is often severe
5) Kernicterus (due to excess hyperbillirubinaemia)
What is the clinical presentation of ataxia (hypotonic) cerebral palsy?
1) DASHING?
2) Gait and truncal ataxia, nystagmus, hypotonia, intention tremor, poor balance and muscle coordination.
Differential diagnosis for CP?
1) Acute poliomyelitis
2) Beck’s muscular dystrophy
3) Stroke motor disorder
4) Spinal muscular atrophy
Diagnosis for CP?
1) MRI/CT for exclusion
2) Usually clinical - rarely made in infancy - formal diagnosis around 2 years
MDT approach to CP?
No cure, improve capabilities!!
1) Physio - improve motor skills, mobility, muscle strength and balance. Prevent contractures.
2) OT - Equipment required, mobilise, communication aids, improving posture.
3) SALT - Speech, language, communication and swallowing
Medial treatment to CP?
1) Spasticity - Oral Baclofen, or Oral Diazepam
2) Botilinum Toxin injected locally to relax contracted muscles, lasts for 3 months.
3) Orthopaedic surgery in severe spasticity to lengthen muscles and tendons that are too short.
4) Selective Dorsal rhizotomy (SDR) - used in severe spasticity, selectively destroying problematic nerve roots (spastic) in the spine.
