Cerebral Palsy

Question 1

How are gait deformities treated in cerebral palsy?

Answer 1

1) toe walking- AFO for flexible, TAL for rigid
2) crouched- hip, knee and ankle releases
3) stiff knee- distal rectus transfer

Question 2

Where is the acetabular deficiency a/w cerebral palsy?

Answer 2

Posterosuperior

Question 3

What is the treatment options for cerebral spastic hip dysplasia?

Answer 3

1) younger than 4 and/or Reimers index less than 40% can do soft tissue releases (adductor, psoas) and abductor braces
2) older than 4 or Reimers index >60% perform bony procedures (VDRO, pelvic osteotomies)
3) chronic hip dislocation- abduction osteotomy or Girdlestone

Question 4

What are the three gait disorders a/w cerebral palsy?

Answer 4

1) Toe-walking and Jump gait
2) Crouched gait
3) Stiff-knee gait

Question 5

Define cerebral palsy?

Answer 5

Nonprogressive upper motor neuron disease (static encephalopathy) due to injury to immature brain

Question 6

In a CP patient what is the most reliable predictor for ability to walk?

Answer 6

Independent sitting by age 2

Question 7

What are the Gross Motor Function Classification Scale?

Answer 7

I- normal gross motor func
II- walks indecently with difficulty over uneven surfaces
III- uses additive device
IV- uses mostly wheelchair
V- completely dependent in all aspect of daily living

Question 8

What is the MOA of botulinum toxin sometimes used in the tx of CP contractures?

Answer 8

competitive inhibitor of presynaptic cholinergic receptors with a finite lifetime (usually lasts 2-3 months)