Cerebral Palsy Flashcards by Emily Renner

a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.

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what is the most common motor disability in children

CP (1-4/1000)

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what factors increase prevalence of CP in children

low birth weight and those born before 28 weeks gestation

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common risk factors for prenatal CP (most common)

vascular events, congenital brain malformations, maternal infections, multiple gestations

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common risk factors perinatal (during birth)

umbilical prolapse, obstructed labor, placental abruption

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common risk factors postnatal

infections, blood disorders, injuries

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are low or high APGAR scores associated with CP

Low (0-3)

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what is the cutoff age to begin to worry about asymmetry

4 m/o

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what are the key elements in diagnosing CP

Motor skills/development
Non-progressive sx
Neuroimaging

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bleeding into the ventricles only

Intraventricular Hemorrhage (IVH)

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bleeding into the tissue around the ventricles only

Germinal Matrix Hemorrhage (GMH)

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bleeding into both the ventricles and tissues around the ventricles

Periventricular Intraventricular Hemorrhage (PIVH)

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may develop in these areas as the hemorrhage resolves

Periventricular Cyst (PVC)

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grading for hemorrhages

I-IV (least to most severe)

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Ischemic lesion in areas adjacent to the lateral ventricles

Periventricular Leukomalacia (PVL)

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major cause of CP in infants born preterm (<32 weeks)

Periventricular Leukomalacia (PVL)

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Focal periventricular necrosis and more diffuse white matter cerebral injury

Periventricular Leukomalacia (PVL)

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where is there damage to in PVL

cortical spinal tracts

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are the LE or UE more affected in PVL and why

LE (spastic diplegia) because LE cortical tract is closest to the ventricles

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what are the 3 ways to classify CP

type of movement abnormality related to tone
anatomical distribution of involved areas
functional abilities (GMFCS)

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3 types of tone related to CP

spastic, ataxic, dyskinetic

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one extremity involved

monoplegia

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UE and LE on same side and trunk involved

hemiplegia

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all extremities and trunk involved with LE more involved than UE

diplegia

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equal involvement of all extremities and trunk

Quadriplegic

Classification based on gross motor function in kids with CP Standardized system to measure severity of movement of the disability

gross motor function classification system (GMFCS)

what is the most prominent type of CP

spastic

velocity dependent hypertonicity characterized by resistance to passive stretch that increases with increased speed of movement; hyperactive stretch reflex

spasticity

how can spasticity lead to histological muscle tissue changes

Decreased longitudinal growth of muscle fibers Decreased muscle volume Change in muscle unit size

most common form of spastic CP

diplegia

White matter infarct in periventricular area caused by hypoxia Primarily affects b/l LE

spastic diplegia

Increased lordosis Anterior pelvic tilt B/L hip IR B/L knee flexion Toe in Equinovalgus foot position

spastic diplegia

Large range of motor function/gat abilities Cognition is usually typical May have social/emotional issues

diplegia

Periventricular white matter abnormalities most common cause UE and LE on same side of the body are affected (UE>LE )

Spastic Hemiplegia/Unilateral

Scapular protraction Elbow flexion Forearm pronation Wrist flexion Ulnar deviation Posterior pelvic rotation Hip IR and flexion Knee flexion Ankle plantar flexion

Spastic Hemiplegia/Unilateral

Usually able to achieve all developmental milestones but with delays Delay of bimanual skills depending on severity of UE involvement Usually have typical cognition/intelligence, may have social/emotional deficits

Spastic Hemiplegia/Unilateral

Impairment of voluntary muscle control of UE, LE, neck/trunk muscles Wide range of cognitive abilities from typical to severe impairment Gross and fine motor delays

Spastic Quadriplegia

PVL lesions most often seen, or lesion of basal ganglia or occipital region >> seizures, visual impairments Function: Wide range from household ambulation or complete dependent care

Spastic Quadriplegia

movement is uncontrolled and involuntary

dyskinetic

dyskinetic typically has abnormalities in the deep gray matter such as

basal ganglia and thalamus

what is the hallmark sign of dyskinetic CP

hypotonia

Infants show little to no antigravity movements in first few months Movement characterized by bursts of activity

dyskinetic

what are the 3 subtypes of dyskinetic CP

athetosis, dystonia, choreoathetosis

means without fixed posture (constant, slow movements)

athetosis

Involuntary movements that are slow and writhing, continuous and prevent sustaining of stable posture Posture is asymmetric extension of trunk Movements are abnormal in timing and direction Often unable to produce speech due to unable to control breathing Cognition is often normal to above-normal intelligence

athetosis

Global decrease in stiffness/tone proximal to distal Inability to grade muscle activation Muscle termination tends to be passive

athetosis

Asymmetry of spine and hips Joint hypermobility Poor ability to produce force (decreased strength)

athetosis

Fluctuations in respiration rate and rhythm Poor breath support

athetosis

Movement disorder characterized by sustained muscle contraction with twisting, repetitive movements and abnormal postures Sustained muscle contraction when trying to move Low tone at rest Often resembles spasticity due to co-contraction and overflow into extraneous muscles Large variability in body position and movement

dystonia

means dance

Choreoathetosis

Involves brief, jerky, random movements Differs from athetosis in duration and continuity of movements In CP, almost never seen in isolation, will usually be classified along with another type of dyskinetic CP

Choreoathetosis

A disorder of balance and control in timing and coordination movements

ataxia

where due lesions occur with ataxia

cerebellum

Often in combination with spasticity and athetosis Often use musculoskeletal system to extremes to support posture Poor processing of sensory information

ataxia

common characteristics of ataxia

weakness, incoordination, wide based gait, tremor, dysmetria, hypotonia

Often correlated to congenital abnormalities Wide range of functional abilities Can be main form of motor dysfunction or as a precursor to athetosis or spasticity

hypotonia

Decreased stiffness/tone throughout trunk and extremities Difficulty sustaining most muscle groups Passive termination of muscle activity

hypotonia

Joint hypermobility Muscle contractures Poor force production

hypotonia

Decreased breath support Poor cough Decreased cardiovascular fitness

hypotonia

Origin in weakness in CNS dysfunction

Force Production Deficit

Inability to fractionate/isolate movement associated with moderate or greater hyperexcitability

Fractionated Movement Deficit

fractionated movement deficit is always associated with what type of deficit

CNS

Slowness in initiating and executing movement

hypokinesia

Inability to grade forces appropriately for the distance and speed aspects of a task Associated with cerebellar dysfunction

Dysmetria

Systemic effect on muscle tone Inhibit the release of excitatory neurotransmitters or increase release of inhibitory neurotransmitters

Oral anti-spasticity medications

Diazepam (Valium) and Baclofen effect the binding and transmission of GABA receptors at what level

spinal level

Dantrolen is an anti-spasticity medication that acts directly on

skeletal muscle

Regional effect on spasticity Neurosurgical implantation of pump into abdomen with catheter inserted intrathecally

Intrathecal Baclofen Pump

ways to treat spasticity

oral medications, intramuscular injections, neurosurgical interventions, botox, selective dorsal rhizotomy (SDR)

increased resting muscle tension

hypertonia

Toe curling, fisting hands, difficulty moving a body part (actively or passively), asymmetric posture, arching

hypertonia

decreased resting muscle tension

hypotonia

Collapse of body segments, loss of postural alignment, inability to sustain a posture against gravity

hypotonia

resistance to passive movement at 2 speeds

tardieu scale

angle of muscle reaction, point of first catch, functional ROM

full PROM

17 parameters assessed on each LE at foot, knee, hip and trunk in sagittal, frontal, and transverse planes

Edinburgh Visual Gait Score (EVGS)

Assesses ability to perform isolated joint movement without using mass flexor/extensor patterns or undesired movement at other joints Selective motor control is a predictive factor of functional ability in children with CP Tests hip, ankle, knee, subtalar joint and toes

Selective Control Assessment of the LE (SCALE)

Cerebral Palsy Flashcards

(78 cards)