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Flashcards in Cerebral Palsy Deck (27):
1

Corrected Age for Development

1. Use: plot growth parameters (don't use past 2 years) and developmental parameters
2. Calculate: (40 weeks - gestational age) = result
- take Age - result = corrected age

2

What patient wants to get out of interview?

make sure the patient gets what they want out of the interview

3

Common questions about walking in toddlers

When should they walk? --> 9-17 months
Pigeon-toed normal? --> YES
Flat feet? --> NORMAL
Use walker? --> NO

4

Developmental categories

Gross motor
Fine motor
Social/communication
Cognitive/language
+/- problem solving
*USE A QUESTIONNAIRE (bright futures)

5

Developmental screening timeline

9 months
18 months
30 months
- document stuff and make sure to ID risks
*tons of questionnaires out there

6

Developmental delays

Autism - primarily social interactions
CP - motor dysfunction and other domains
Genetic/metabolic - global delays
*Psychostressors can cause delays too

7

Autism Spectrum Disorder

0.6% prevalence - mean age of diagnosis is 48 months
- recommended screening at 12 & 24 months
- use M-CHAT to screen for it
- early intervention = best prognosis

8

Risks of developmental delay in preterms?

# and severity of delays correlates with decreasing gestational age
1. Bronchopulmonary dysplasia
2. Retinopathy of newborn
3. Hyperbilirubinemia
4. Periventricular leukomalacia

9

Bronchopulmonary dysplasia

poor growth due to increased caloric requirements, recurrent infections, or CHF

10

Retinopathy of newborn

all premies at risk for this
- extraretinal fibrovascular proliferation = can cause retinal detachment

11

Hyperbilirubinemia

Bilirubin is potential neurotoxin = can lead to kernicterus
- abnormal motor development and sensorineural hearing loss

12

Periventricular leukomalacia

damage of white matter around ventricles --> hypoxia, ischemia, inflammation
- correlated with intraventricular hemorrhage

13

Family pedigree

Determine if there are conditions that run in families and which members have been affected

14

Stressors on kids

can act as regression of milestones, tantrums, sleep problems, eating problems

15

Measuring head circumference

measure around most prominent parts of frontal and occiput
- may need to measure more than once

16

Toddler neuro exam

OBSERVATION IS MOST IMPORTANT
1. Mental Status - interaction, sleepy, arousable
2. CN exam - flashlight, facial symmetry, hearing, voice
3. Muscle tone and strength - watch them walk, feel extremities, note any weakness
4. DTR - note any hyperreflexia or asymmetry
5. Babinski - thumb on bottom of foot (L5-S1)
6. Cerebellar - balance, smooth movements

17

Cerebral Palsy

hetergeneous disorders characterized by motor and postural dysfunction (wide range of severity)
- 2/1000 kids
- need therapy with speech, mobility, and self-care

18

Spastic Quadriplegia

1. entire body involved
2. Global brain abnormalities

19

Spastic diplegia

1. Legs greater than arms
2. periventricular white matter abnormalities

20

Dyskinetic cerebral palsy

1. variable, often entire body
2. basal ganglia, cerebellum, thalamus

21

Spastic hemiplegia

1. arm and leg on one side
2. unilateral UMN abnormalities

22

Ataxic cerebral palsy

1. entire body
2. cerebellar abnormalities

23

Learning 2 languages at once

Probably causes a slight delay in expressive language in kids --> but helps them with language acquisition later in life

24

Risks for CP

1. Prematurity
2. IUGR
3. Perinatal asphyxia
4. Intrauterine infections

25

Assessment of CP

1. Complete H&P
2. Screening for hearing, vision, or speech problems
3. Neuroimaging - MRI for baseline
4. Referral for formal developmental testing

26

MRI findings consistent with CP

- irregularly shaped ventricles and periventricular leukomalacia
- thinned corpus callosum

27

Therapy for CP

The more = the better, earlier = better
PT, OT, speech and language