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Flashcards in Cerebral Palsy Deck (46):
1

Can occur in utero, during or shortly after birth and produces motor as well as other impairments
 

Cerebral Palsy

2

____________ refers to a constellation of disorders and impairments. It is not a homogenous pattern of dysfunction. 

Cerebral Palsy

3

Is CP progressive or non-progressive?

A non-progressive neuromotor/neuodevelopmental disorder caused by a non progressive defect or lesion in a single or multiple locations in the immature brain. 

4

Infants with very low birth weight and are very premature are at highest risk of _____

CP

5

In pre-terms can be related to many factors including _______

  • anoxia & IVH (Intraventricular Hemorrage) .
  • Lower weight and very pre-mature.

(anoxia from meconium inspiration)

6

C.P. can be classified or described by the types of impairment or motor disturbance seen
 

  • Spastic
  • Dyskinetic or Athetoid
  • Ataxic
  • Hypotonic

7

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Hemiplegia CP

8

In which type of CP many children may have seizures disorders (35-43%)?

Greatest in spastic quadriplegic and hemiplegic 

9

 Most common form of CP

Spastic Diplegia

10

In spastic diplegia CP, _____ of the cases are caused by prematurity

2/3

11

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Spastic Diplegia

12

In spastic diplegia CP, the Prognosis for independent ambulation is _____

good

13

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Spastic Quadriplegia


 

14

A 5 level system based on descriptions of functional motor abilities with focus on posture and mobility

The Gross Motor Function Classification System

15

These are slow, wriggly, or sudden quick movements of the child's feet, arms, hands, or face muscles

ATHETOSIS

16

Walks without restrictions; limitations in  more advanced gross motor skills i.e.. balance, coordination.
 

Level 1 GMFCS

17

 Walks without assistive devices; limitations in walking outdoor and in the community

Level II (GMFCS)

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18

Walks with an assistive mobility devices (including crutches and wheelchairs); limitations walking outdoors and in the community

Level III of GMFCS

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19

Self-mobility limitations; walk short distances, are transported or use power mobility outdoor and in the community.
 

Level IV GMFCS

20

Self-mobility is severely limited, even with the use of assistive technology

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Level V GMFCS

21

intellectual disability and learning problems in CP:

  • 50-75% 
  • Communication disorders: 25%, related to oral-motor function, central language dysfunction, hearing and cognitive deficits 

22

Cerebral palsy children will show classic UMN lesion or LMN?

  • Classic UMN lesion
  • Spasticity
  • Clonus
  • BabiskBabinski
  • Increased DTR

23

Babinski sign:

where the big toe is raised (extended) rather than curled downwards (flexed) upon appropriate stimulation of the sole of the foot. The presence of the Babinski sign is an abnormal response in adulthood. 

24

Selective Motor Control in children with CP:

is impaired

e.x. can't dorsiflex the ankle with the knee extended 

25

Strength in children with cerebral palsy:

  • WEAKNESS
  • Must do strengthening exercises 

26

Neuromotor impairments in children with CP:

  • Muscle tone (spasticity)
  • Selective motor control
  • Balance
  • Strenght (weakness)
  • Alignment and WB

27

Major musculoskeletal impairments in children with CP:

  • Contractures
  • Hip subluxation / dislocation
  • Torsional Deformities: femoral anteversion, tibial torsion 
  • Scoliosis
  • Back Pain
  • Patello-femoral dysfunction
     

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28

Therapeutic Interventions for CP treatment includes 
Neurodevelopmental Therapy (NDT).

What are the NDT treatment principles?

  • Use of Facilitation of effect “Tone”
  • Use of Reflex Inhibiting Postures
  • Use of Key Points of Control
     

29

 Currently ____________ regimes for
individuals with CP have been proven to
be highly effective and have been shown
not to increase spasticity (Daminano)
 

Strengthening

30

Currently in NDT there is a greater focus on: 

function and acquisition of skills in a
functional context 

31

________________ is an orthosis commonly prescribed for ambulatory children who walk with excessive dorsiflexion and knee flexion (crouched gait) during the stance phase of gait

The ground-reaction (also known as floor-reaction) AFO

GRAFO

32

  • Moderate to severe crouched gait
  • Heavier child that solid AFO does not provide enough stability

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GRAFO

Ground Reaction 

33

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Posterior Leaf Spring AFO

PLS

Hemiplegia (some flexibility for DF)

strong enough to prevent plantar flexion during swing and stance but flexible enough to allow some anterior tibial translation and dorsiflexion from midstance to the beginning of terminal stance

34

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Supramalleolar Orthoses

SMO

The SMO is typically indicated for the child with good ankle plantarflexion and dorsiflexion control but who needs control of planovarus or planovalgus foot position

35

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SAFO

A solid AFO with anterior tibial strap and anterior ankle strap is a common orthotic design to provide ankle and foot stability , giving a stable base for children to stand. 

36

KAFO

Knee Ankle FO

37

HKAFO

Hip Knee AFO

not used anymore

38

Interferes with release of acetylcholine at the neuromuscular junction 

Botulinum Toxin
local dynamic contractures

(not structural)

39

Intrathecal Delivery of Baclofen
 

  • Acts as GABA  receptor agonist
  • GABA (gamma-amino butyric acid) is an inhibitory CNS neurotransmitter 
  • impedes release of excitatory neurotransmitters 

40

 Intrathecal delivery of baclofen  vs. Oral

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  • Intrathecal:
    • Lower doses
    • fewer SEs
  • Oral:
    • Low BBB penetration
    • SE
    • Lack of preferential SC distribution

41

Selective Dorsal Rhizotomy (SDR)

  •  Dorsal sensory nerve roots are severed
  • Often performed on children between ages of 7 and 10 years 

42

Selective Dorsal Rhizotomy (SDR) complications

possible sensory loss
 

43

Selective Dorsal Rhizotomy selection and exclusion criteria 
 

  • Spastic CP, at least 2 years of age
  • Adequate strength
  • Motivation and ability to participate in P
  • Exclusion: Non-CP, Mixed tone, Rigidity, Severe scoliosis, no potential for functional gains 

44

Treatment Options for Patients with Spasticity:
 

  1. Intrathecal Baclofen Therapy
  2. Oral medications: SEs
  3. Injection therapy: botox
  4. Neurosurgery: SDR
  5. Orthopedic surgery 
  6. Rehab Therapy

45

GROSS MOTOR FUNCTION MEASURE (GMFM) 

  • around 5 y/o children with cerebral palsy
  • criterion-referenced
  • can be used for Down syndrome
  • can give one dimension

46

______________ is a neck condition that arises when the spinal cord becomes compressed—or squeezed—due to the wear-and-tear changes that occur in the spine as we age. The condition commonly occurs in patients over the age of 50.

 spondylotic myelopathy

  • MSK issue in aging with cerebral palsy