Cerebral Palsy

Question 1

Cerebral Palsy: defenintion

Answer 1

“A group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”

Question 2

Comorbidities often occurring with CP

Answer 2

Sensation and sensory processing involvement
Perception
Cognition
Communication and speech issues

Question 3

Issues with diagnosis of CP

Answer 3

Difficult due to the plasticity of the developing brain
Can use MRI and cranial ultrasound
Often won’t be diagnosed until age 3

Question 4

Presentation of CP

Answer 4

Abnormal muscle tone
Atypical posture
Movement with persistent reflexes
Non-progressive lesion

Question 5

Diagnoses which mimic CP

Answer 5

Metabolic disorders
Mitochondrial disorders
(rule out with family history)

Question 6

Intraventricular hemorrhages (IVH)

Answer 6

bleeding INTO the ventricles

Question 7

Germinal matrix hemorrhages (GMH)

Answer 7

bleeding into the tissues AROUND the ventricles

Question 8

Periventricular Intraventricular hemorrhages (PIVH)

Answer 8

bleeding into ventricles AND surrounding tissue

Question 9

Periventricular cyst (PVC)

Answer 9

may form in the area where the bleed occurred once the acuteness has resolved

Question 10

Known risk factors for development of CP

Answer 10

Injury during critical periods of brain development

Periventricular white matter is most sensitive to insult/injury between 24-34 wks of gestation

Question 11

Spastic CP

Answer 11

Increased resistance to passive movements, spasticity increases with increased velocity and movement
Associated with lesion in cerebral cortex
Hemi, Di, and Quad

Question 12

Hypotonic CP

Answer 12

Infants can present with hypotonia and transition to spasticity or ataxia

Question 13

Dyskinetic CP

Answer 13

Uncontrolled movement
Athetoid and Dystonic
Deep gray matter lesions
Sometimes periventricular white matter lesions

Question 14

Athetoid CP

Answer 14

Slow, writhing movement

Associated with lesion in basal ganglia

Question 15

Ataxic CP

Answer 15

Balance and control disorder
Weakness, incoordination, wide based gait, noted tremor
Associated with cerebellar infarct

Question 16

Diplegia

Answer 16

Most common form of spastic CP
Primarily affects LEs
Infarct in white matter of periventricular area caused by hypoxia
Usually normal cognition

Question 17

Hemiplegic

Answer 17

UE and LE on same side of body affected
Cognitive function normal
Social and emotional deficits
Minimal equipment requirements

Question 18

Quadriplegic

Answer 18

Volitional muscle control of 4 extremities severely impaired
Periventricular white matter lesions
Variable cognitive affects
Requires significant equipment through life span

Question 19

GMFC level I

Answer 19

Independent

Question 20

GMFC level II

Answer 20

Walks without assistive devices

Limited in outdoor and community level ambulation

Question 21

GMFC level III

Answer 21

Walks with assistive devices

Limited in outdoor and community level ambulation

Question 22

GMFC level IV

Answer 22

Self-mobility with limitations

Children are transported or use power mobility outdoors and in community

Question 23

GMFC level V

Answer 23

Difficulty controlling all movements

Self mobility severely limited even with use of assistive technology

Question 24

4 main brain lesions resulting in hemiplegic CP

Answer 24

Periventricular white matter abnormalities
Cervical-subcortical lesions
Brain malformations
Nonprogressive postnatal injuries

Question 25

4 components of comprehensive assessment

Answer 25

Motor attainments Neurologic signs Primative reflexes Postural reactions

Question 26

Gait abnormalities in Spastic Diplegia

Answer 26

Limited mobility in L-spine and pelvic girdle Compensate with more movement of trunk, head, neck and UEs. Feet can be in valgus outside lateral dimensions of trunk or in narrow BOS with heels off floor in plantarflexion

Question 27

Gait abnormalities in Hemiplegia

Answer 27

Asymmetry! Brief/incomplete weight shift on uninvolved LE UE swing on uninvolved side, Involved shoulder in hyperextension and elbow flexion Toe walking common, tight gastroc

Question 28

Gait abnormalities in Athetosis

Answer 28

Initiates gait with head High flexion of hip initially during stepping LE placed into extension with adduction, IR and PF Thoracic spine excessively flexed with rotation of cervical spine

Question 29

Gait deviations in Diplegia

Answer 29

``` Equinovarus Planovalgus Crouch Jump knee Stiff knee Recurvatum Idiopathic toe walking ```

Question 30

Quadriplegic gait

Answer 30

usually not community ambulators | Encourage gait/standing

Question 31

Ataxic gait deviations

Answer 31

Widened BOS Increased double-limb support time Balance is primary goal in PT