Cerebral Palsy Flashcards

1
Q

Define Cerebral Palsy

A

An umbrella term that encompasses a group of permanent movement and posture disorder that limit activity
Most commonly results in spasticity, but can also incorporate disorders of sensation, perception, cognition, communication, and behaviour.

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2
Q

What are the types of cerebral palsy

A

Spastic (70%): hemiplegia, diplegia, quadriplegia (UMN)
Dyskinetic (Basal ganglia + substantia nigra)
Ataxic (Cerebellar)
Mixed

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3
Q

What causes cerebral palsy

A

Acquired pathology within the developing brain
Centrally-mediated abnormal muscle tone → spasticity

Hypoxic ischaemic encephalopathy (40% of cases)
Prematurity
Multiple gestation
Maternal infection, congenital infection
Congenital brain malformation
Postnatal meningitis or sepsis
Intraventricular haemorrhage

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4
Q

What are the prenatal, perinatal, and postnatal risk factors for cerebral palsy

A

Pre: multiple gestation, maternal infection, placental abruption

Peri: preterm birth, low birth weight, HIE, sepsis, resp. distress, intraventricular haemorrhage

Post: head injuries, meningitis

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5
Q

What are the symptoms of cerebral palsy

A

Early:
Unusual fidgety movements, asymmetry, paucity
Hypotonia, spasticity, dystonia (fluctuating)
Motor development delayed (head control, rolling, crawling)
Feeding difficulties: poor weight gain, choking while eating, long meal times
Recurrent chest infection (aspiration)
Drooling

Later:
Delayed motor milestones
Delayed speech development
Delayed cognitive/intellectual development
Persisten toe-walking
Spasticity when they attempt activities

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6
Q

What are the differentials for cerebral palsy

A

Brain tumour
Dystonia
Muscular dystrophy
Myelodysplasia
Spinal stenosis

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7
Q

What are the signs of cerebral palsy on examination

A

General examination - Pay attention to movement and muscle tone
Newborn head circumference
Excessive stiffness or floppiness
Absent or abnormal fidgety movements
Exaggerated amplitude, speed, jerkiness
Persistent cramped synchronous movements <3yo
Absence of fidgety movements at 3-4 months
Response to visual stimuli and sounds, level of arousability

Neurological
Spasticity (after 2yo)
Clonus
Excessive plantar flexion (spastic hemiplegia)
Reflexes
Lack of parachute reaction
Lack of foot placement reaction

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8
Q

What investigations are done for cerebral palsy

A

The Hammersmith Infant Neurological Examination (HINE) for children 2-24 months
Prechtl’s Assessment of General Movements (GMs)
GMFCS (Gross motor function classification system)

± MRI head: white matter damage, basal ganglia/deep grey matter damage, focal infarcts

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9
Q

What is the overall management for cerebral palsy

A

Refer to child development service for multidisciplinary assessment: Risk factors + abnormal motor features | delayed motor milestones | persistent toe walking

MDT management (paediatric, nursing, physiotherapy. occupational, SALT, dietician, psychologist)

Priorities:
○ Parent education
○ Seating, positioning
○ Ambulation
○ Education: Education Health Care Plan (EHCP)
○ Feeding/nutrition
○ Social/emotional well-being

+ regular review of: eating, drinking, swallowing, SAL, height and weight, drooling, pain, sleep, mental health, GORD, epilepsy, constipation

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10
Q

What treatments can be used for the motor symptoms of cerebral palsy

A

Hydrotherapy (heated pool + exercise)
Physiotherapy
Botulinum toxin A (help walking)
Selective dorsal rhizotomy (SDR) - surgical procedure
Intrathecal baclofen therapy (muscle relaxant given into the spinal fluid)
Orthopaedic surgery (resistant contracture or bony deformity)
Oral diazepam (for significant spasticity from mid-childhood)

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11
Q

How are the following features of Cerebral palsy managed: drooling, pain, sleep disturbance, speech issues, nutrition issues

A

Excessive drooling → Glycopyrronium bromide (oral or enteral tube)
* High-dose botulinum toxin A injection to the salivary glands
* Salivary gland surgery

Pain → step-wise pain management

Sleep disturbance → 1. optimise sleep hygiene 2. Trial melatonin (off licence)

Speech issues → sign language, speech boards, laptops, tablets

Nutrition issues →NG tube, jejunostomy, gastostomy considerations

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12
Q

What are the complications of cerebral palsy

A

Feeding difficulties (50%) → poor growth
Sialorrhoea/drooling - can be affected by positioning, medication history, reflux, dental issues
Aspiration and recurrent chest infection
Vomiting, regurgitation, gastro-oesophageal reflux
Osteopenia, osteoporosis ( vit D deficiency or compromised nutritional status)
Constipation
Incontinence - impaired motor control of bladder muscles
Visual impairment
Hearing impairment - 1 in 10
Epilepsy - 1 in 3 people to 1 in 2 people
Learning disability - IQ <70 in 1 in 2 people
Communication difficulties
Behavioural difficulties
Sleep-disturbance
Pain

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13
Q

What is the prognosis for cerebral palsy

A

Permanent condition where the functional and neurological manifestations of the condition evolve over time, despite the underlying brain lesion being non-progressive
The more severe the physical, functional, or cognitive impairment, the greater likelihood of reduced life expectancy
The majority of children survive into adulthood (20 year survival rate 87-94%)

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