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Cerebral palsy Flashcards

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1
Q

What is cerebral palsy?

A

Permanent neurological problems resulting from bran damage at birth
Not progressive but changes due to growth and development
Huge range of severity

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2
Q

Antenatal causes of cerebral palsy

A

Maternal infections
Trauma during pregnancy

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3
Q

Perinatal causes of cerebral palsy

A

Birth asphyxia
Pre term birth

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4
Q

Post natal causes of cerebral palsy

A

Meningitis
Severe neonatal jaundice
Head injury

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5
Q

Type sof cerebral palsy

A

Spastic/pyramidal
Dyskinetic/athetoid/extrapyramidal
Ataxic
Mixed

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6
Q

What is spastic CP?

A

Hypertonia (increased tone) and reduced function due to UMN damage

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7
Q

Symptoms of dyskinetic CP

A

Problems controlling muscle tone
Hyper/otonia both
Causes atheotid movements and oro=motor problems

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8
Q

What part of brain is damages in dyskinetic CP

A

Basal ganglia

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9
Q

What is damaged in spastic CP

A

UMNs

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10
Q

Sympotms of ataxic CP + where damaged

A

Coordinated movement problems
Cerbellum

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11
Q

Patterns of CP

A

Monoplegia, hemiplegia, diplegia quadriplegia

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12
Q

What is differnece between diplegia and quadraplegia

A

Four limbs affected in both
Diplegia - four limbs are affected but mostly legs
Quadraplegia - four limbs are affected more severely often with seizures, speech disturbacnes and other impairments

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13
Q

Monoplegia vs hemiplegia

A

ONe limb affected -mono
Hemi - one side of body affected

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14
Q

What is hypoxic ischaemic encephalopathy

A

Perinatal asphyxia causing acute brain injury due to systemic hypoxia and decerased cerebral blood flow

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15
Q

Signs and sympotms of cerebral palsy during development

A

Failure to meet milestones
Increased or decreased tone, generally or in specific limbs
Hand prefernece below 18 months
Problems with coordination speech or wlaking
Feeding or swallowing problems
Learning difficulties

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16
Q

What does a high stepping gait suggest is damaged?

A

Foot drop or LMN lesion

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17
Q

What does a waddling gait suggest?

A

Indicates pelvic muscle weakness due to myopathy

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18
Q

Anatalgic gait (limp) suggests?

A

Localised pain

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19
Q

What lesion does a broad based gait/ ataxic gait suggest?

A

Cerebellar lesion

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20
Q

Muscle bulk LMN vs UMN

A

Bulk preserved in UMN
Reduced bulk with fasciculations

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21
Q

What causes hypertonia?

A

UMN lesion

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22
Q

What causes hypotonia?

A

LMN lesion

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23
Q

LMN vs UMN which more dramatically reduces power?

A

LMN

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24
Q

Reflexes UMN vs LMN

A

UMN - brisj
LMN - reduced

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25
What causes hemiplegic/diplegic gait
Increased muscle tone and spasticity in the lefs
26
What happens in a hemiplegic/diplegic gait?
Leg extended with plantar flexion of feet and toes -> swing leg large semicircle when moving leg behind to front
27
What will people with CP typically have>
UMN lesion signs, good muscle bulk, increased tone, brisk reflexes and slightly reduced or normal power
28
Complications and ass conditions in CP
Learning disability Epilepsy Kyphoscoliosis Muscle contractures Hearing and visula impariment Gastro-oeophageal reflux
29
What should first response be when asked how to manage cerebral palsy?
Management will involve a multidisciplinary team approach
30
What healthcare workers are involved in the care of someone with cerbral palsy>
Physio Occupational therapy Speech and language therapy Dieticians Orthopaedic surgeons Paediatricians Social workers Charities and support grouos
31
What is physiotheraoy used for in cerebral palsy?
Stretch and strengthen muscles Maximise function Prevent muscle contractures
32
Occupational therapy how help cerebral palsy
Manage ADLs eg dressed, bathrom Techniques to perform takss ADAPTATIONS AND SUPPLY EQUIPMENT eg rails for assistance, hoist if wheelchair bound
33
What can do if patient cant reach nutritional requirements due to swallowing difficulties
NG PEG tube
34
What can orthopaedic surgeons do for people with cerebral pasly?
Tenotomy to release contractures or lengthen tendons
35
What medications may people with cerebral palsy be on?
Muscle relaxants Anti-epileptic drugs Glycopyrronium bromide
36
What is baclofen used for?
Muscle spasticity and contractures
37
What is glycopyrronium bromide usedd for>
Excessive drooling
38
Support organisations for cerebral palsy
Action Cerebral Palsy Association of Paediatric Chartered Physiotherapists Royal College of General Practitioners (RCGP) Royal College of Nursing (RCN) Royal College of Paediatrics and Child Health
39
Antenatal risk factors for cerebral palsy
Preterm birth Chorioamnionitis Maternal respiratory tract or GU infection treated in hospital
40
Perinatal risk factors for cerbreal pasly
Low birth weigh t Chorioamnionitis Neonatal encephalopathy Neonatal sepsis Maternal resp tract or GU tract infeciton
41
What parts of brain cause CP most often?
white matter damage: 45% * basal ganglia or deep grey matter damage: 13% * congenital malformation: 10% * focal infarcts: 7%.
42
What is Chorioamnionitis?
43
What is periventricular leukomalacia?
a softening of white brain tissue near the ventricles. trouble with vision and with eye movements trouble with movement, and tight muscles developmental delay that is increasingly apparent over time Ventricels not enough blood, PROM, infection
44
What condition is white matter damage most likey to occur in?
More common in spastic than dyskinetic CP Can be of any functional level or motor subtype
45
What damage is most ass with dyskinetic CP?
Grey matter/basal ganglia
46
What type of CP is most likely to be related to perinatal hypoxic-ischaemic injury?
dyskinetic
47
What is the extent of long term functional impact determined by when CP caused by perinatal hypoxic-ischaemic injury?
The severity of the initial encephalopathy
48
When offer MRI to investigate CP?
To explore aetiology of sus or known CP if not clear form * antenatal, perinatal and postnatal history * their developmental progress * findings on clinical examination * results of cranial ultrasound examinations
49
How assess children 0-3 months who are at increased risk fo CP?
General movement assessment during routine neonatal follow ups
50
What are early motor features of CP?
Unusual fidgety movements or other abnormalities of movement incl asymmetry or paucity of movement Abnormalities of tone incl hypotonia, spasticity or dytonia (fluctuating tone) Abnormal motor development incl late head control, roll and crawling Feeding difficulties
51
What are the most common delayed milestones in children with CP?
Not sitting by 8 months Not walking by 18 months Early asymmetry of hand function before 1 year
52
Red flags for other neurological disorders?
absence of known risk factors * family history of a progressive neurological disorder * loss of already attained cognitive or developmental abilities * development of unexpected focal neurological signs * MRI findings suggestive of a progressive neurological disorder * MRI findings not in keeping with clinical signs of cerebral palsy
53
What are the determinants at 2 years old of how well they'll be able ot walk?
If a child can sit at 2 years of age it is likely, but not certain, that they will be able to walk unaided by age 6. * If a child cannot sit but can roll at 2 years of age, there is a possibility that they may be able to walk unaided by age 6. Cerebral palsy in under 25s: assessment and management * If a child cannot sit or roll at 2 years of age, they are unlikely to be able to walk unaided.
54
What children are more likely to have speech and language problmes with CP?
bilateral spastic, dyskinetic or ataxic cerebral palsy Unilateral spastic CP
54
What children are more likely to have speech and language problmes with CP?
bilateral spastic, dyskinetic or ataxic cerebral palsy Unilateral spastic CP
55
What can you use as treatment for drooling after anitcholinergics if ineffective>
Botulinum toxin A injections
56
What should monitor for in children with CP bone wise?
Low bone mineral density
57
How to prevent low bone mineral density?
an active movement programme * active weight bearing * dietetic interventions as appropriate, including nutritional support and calcium and vitamin D supplementation * minimising risks associated with movement and handling.
58
What can cause oain in CP?
MSK - scoliosis, hip subluxation, dislocation Increased muscle tone Muscle fatigue and immobility Constipation Vommitting GORD
59
What can cause sleep disturbances in children with CP?
sleep-induced breathing disorders, such as obstructive sleep apnoea * seizures * pain and discomfort * need for repositioning because of immobility * poor sleep hygiene (poor night-time routine and environment) * night-time interventions, including overnight tube feeding or the use of orthoses * comorbidities, including adverse effects of medication.
60
What extra qs should you ask about in a CP consultation?
Pain Sleep Distress
61
What mental health related conditions are more common in children with CP?
Mental health and psychological problmes Behaviours that challenge - may be triggered by pain, discomfort or sleep disturbances Neurodevelopmental disorders - ASD, ADHD
62
What eye conditions are related to CP?
Problems controlling eye movements Strabismus Refractive errors Problems of eye function incl retinopathy of prematurity IMpaired cerebral visual info processing Visual field defects
63
What other areas can children with CP have problems in?
Behavioural difficulties LD Hearing impairment Visual impairment Vommitting, regurgitation and reflux Constipation Epilepsy
64
What is athetoid movements
low, involuntary, writhing muscle movements random and unpredictable changes in muscle movement worsening symptoms with attempts at controlled movement worsening symptoms with attempts at improved posture inability to stand

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