cerebral palsy

Question 1

is ID more common among individuals w CP

Answer 1

yes about 50%

Question 2

what does cerebral and palsy mean

Answer 2

cerebral = brain
palsy = decrease in m control (paralysis in the brain)

Question 3

CP what is it (5)

Answer 3

non-progressive but not unchanging (symptoms can change), disorder of mvt and/or posture, due to an insult to or an abnormality of the developing brain (elocution, hearing and vision difficulties may also accompany the problems of muscular control)

Question 4

remember CP: (3)

Answer 4

not contagious
not hereditary (not transmitted)
not life-threatening (life expectancy is similar to able-bodied individuals)

Question 5

incidence of CP

Answer 5

2 to 2.5 cases per 1000 births (incidence hasn’t declined over last 60 years despite med advances bc of increase in survival rate of pre-term babies)
15 000 people in Qc
50 000 in canada
males > females (1.33 males for 1 female)

Question 6

sex and pathogenesis of CP

Answer 6

males born very preterm slso appear to be more vulnerable to white matter injury and intraventricular hemorrhage than females

sex hormones such as estrogens provide protection against hypoxic-ischemic injury, and the neonatal brain is also influenced by these hormones

Question 7

CP causes

Answer 7

brain lesion

Question 8

CP causes brain lesions subdivisions

Answer 8

90% before or during birth: maternal infections (aids, rubella, herpes), chemical toxins (alcohol, tobacco and drugs)

• injuries affecting fetal development
• damage to brain or O2 deprivation during deliveries (number 1)
• genetic disorders, chromosomal abnormality and faulty blood supply

10% after birth

• brain infections (meningitis)
• cranial traumas (accidents, shaken baby syndrome)
• oxygen deprivation (near drowning, >2min)

Question 9

brain lesions other factors (3)

Answer 9

age of the mother (under 20; maternal infection and chemical toxins or over 34; genetic disorders, …)
premature + under birth weight babies

older moms is more physiological

Question 10

early signs of CP (4)

Answer 10

• before 3 years of age
• motor skills not developing normally (coordination + balance)
• abnormal m tone (hypotonia; 1st, hypertonia; 2nd)
• favour one side of body
• • toe walking, foot dragging, favour left when standing up)

Question 11

types of CP; classification by # of limbs affected (6)

Answer 11

quadra: all 4 extremities
para: 2 lower ext affected
diplegia: lower ext more frequent than upper (2 limbs affected, either legs or arms)
hemiplegia: entire l or r side of body affected
triplegia: 3 ext (usually 2 legs and one arm)
monoplegia: one extremity

Question 12

type of CP: classification by mvt disorder

Answer 12

spastic CP: tug-of-war or co-contraction
athetoid CP: mixed m tone, cte motion (harder to talk or feed themselves; most severe form)
ataxic CP: looks unsteady and shaky (go slow, walking like a child learning to walk)

Question 13

what structures of the brain are affected by spastic, athetoid and ataxic

Answer 13

spastic; motor cortex, premotor cortex, spasticity

athetoid: basal ganglia, athetosis, tremors
ataxic: cerebellum, ataxia

Question 14

characteristics of spasticity (5)

Answer 14

abnormal m tightness + stiffness

• most common (65% of people w CP)
• caused by damage to motor cortex + cortical tracts (basal ganglia + cerebellum) = exacerbate spasticity
• spastic m. interfere with voluntary mvts
• intervention: surgical lengthening of tendon (toe walking and knee flexion), dorsal rhizotomy

Question 15

spastic CP; dorsal rhizotomy

Answer 15

the long tracts represent neurons that pass up and down the sc and modify the action of the reflex arc. injury to these tracts usually causes the reflex arc to become hyperactive (spastic)

Question 16

characteristics of athetosis (5)

Answer 16

• constant, unpredictable, and purposeless mvt caused by fluctuating m tone (hyper/hypotonia)
• damage to basal ganglia
• (+ or -) 25% of people w CP
• problems w facial expressions, eating, speaking, head control, fingers + wrist control
• most people w athetosis are quadraplegic

Question 17

characteristics of ataxia (3)

Answer 17

• disturbance of balance and coordination characterized by hypotonia + decrease in postural tone
• results from disorders of the cerebellum + vestibular system
• 10% of people with CP

Question 18

abnormal gaits associated with spastic CP

Answer 18

scissors gait: leg = flexed +inwards rotated + toe walking

hemiplegic gait: hip circumduction +toe walking

Question 19

abnormal gait in ataxic CP

Answer 19

ataxia or cerebellar gait: eyes down + wide base of support + arms away from body, absence of opposition of arms & legs (if they close their eyes they fall)

Question 20

fitness and CP for same workload as able-bodied individuals (4)

Answer 20

higher HR, BP and [lactate]
decreased mechanical efficiency = increase energy
cause by spasticity + athetosis and poor exercise habits

support harness for balance and BW control

Question 21

effects of exercise training (5)

Answer 21

limited info

improvement of:

• sense of wellness
• body image
• capacity to perform ADL
• less spasticity + athetosis (mild to moderate changes)
• resistance training = controversial

Question 22

according to latest studies, resistance training increases spasticity (and in turn decrease __) by __ in participants with CP

Answer 22

ROM

0%

Question 23

resistance training and walking in children with CP

Answer 23

effects of 12 weeks of progressive resistance training on walking ability

study summary:

• 3x / week for 60 min; 26 subjects /group, aged 6 to 13
• training group: leg press machine and 3 exercises (sit to stand)
• control group: conventional PT program

Question 24

results of the study (4)

Answer 24

• increase in isometric m strength: (knee extensors, hip abductors and total increase)
• no improvement in walking ability in both groups (comfortable walking speed, cadans, step length and fast walking speed)
• no changes in m spasticity (m tone) and ROM in both groups
• possible reasons for lack of improvement in walking