Cerebral Palsy

Question 1

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

Answer 1

Cerebral Palsy

Question 2

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

Answer 2

Cerebral Palsy

Question 3

Is CP progressive or non-progressive?

Answer 3

A non-progressive neuromotor/neuodevelopmentaldisorder caused by anon progressivedefect or lesion in a single or multiple locations in the immature brain.

Question 4

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

Answer 4

CP

Question 5

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

Answer 5

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

(anoxia from meconium inspiration)

Question 6

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

Answer 6

• Spastic
• Dyskinetic or Athetoid
• Ataxic
• Hypotonic

Question 7

Answer 7

Hemiplegia CP

Question 8

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

Answer 8

Greatest in spastic quadriplegic and hemiplegic

Question 9

Most common form of CP

Answer 9

Spastic Diplegia

Question 10

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

Answer 10

2/3

Question 11

Answer 11

Spastic Diplegia

Question 12

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

Answer 12

good

Question 13

Answer 13

Spastic Quadriplegia

Question 14

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

Answer 14

The Gross Motor Function Classification System

Question 15

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

Answer 15

ATHETOSIS

Question 16

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

Answer 16

Level 1 GMFCS

Question 17

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

Answer 17

Level II (GMFCS)

Question 18

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

Answer 18

Level III of GMFCS

Question 19

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

Answer 19

Level IV GMFCS

Question 20

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

Answer 20

Level V GMFCS

Question 21

intellectual disability and learning problems in CP:

Answer 21

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

Question 22

Cerebral palsy children will show classic UMN lesion or LMN?

Answer 22

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

Question 23

Babinski sign:

Answer 23

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.

Question 24

Selective Motor Control in children with CP:

Answer 24

is impaired

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

Question 25

Strength in children with cerebral palsy:

Answer 25

* **WEAKNESS** * Must do strengthening exercises

Question 26

Neuromotor impairments in children with CP:

Answer 26

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

Question 27

Major musculoskeletal impairments in children with CP:

Answer 27

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

Question 28

``` Therapeutic Interventions for CP treatment includes Neurodevelopmental Therapy (NDT). ``` What are the NDT treatment principles?

Answer 28

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

Question 29

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

Answer 29

Strengthening

Question 30

Currently in NDT there is a greater focus on:

Answer 30

``` function and acquisition of skills in a functional context ```

Question 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

Answer 31

The ground-reaction (also known as floor-reaction) AFO ## Footnote **GRAFO**

Question 32

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

Answer 32

GRAFO Ground Reaction

Question 33

Answer 33

**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

Question 34

Answer 34

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

Question 35

Answer 35

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.

Question 36

KAFO

Answer 36

Knee Ankle FO

Question 37

HKAFO

Answer 37

Hip Knee AFO not used anymore

Question 38

Interferes with release of acetylcholine at the neuromuscular junction

Answer 38

Botulinum Toxin local dynamic contractures (not structural)

Question 39

Intrathecal Delivery of Baclofen

Answer 39

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

Question 40

**Intratheca**l delivery of baclofen vs. **Oral**

Answer 40

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

Question 41

Selective Dorsal Rhizotomy (SDR)

Answer 41

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

Question 42

Selective Dorsal Rhizotomy (SDR) complications

Answer 42

possible sensory loss

Question 43

Selective Dorsal Rhizotomy **selection and exclusion criteria**

Answer 43

* 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

Question 44

Treatment Options for Patients with **Spasticity:**

Answer 44

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

Question 45

GROSS MOTOR FUNCTION MEASURE (GMFM)

Answer 45

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

Question 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.

Answer 46

spondylotic myelopathy * MSK issue in aging with cerebral palsy