Cerebral Palsy

Question 1

Risk Factors for CP

Answer 1

Prematurity
Low birth weight
Low maternal education
Poor prenatal care
Maternal or fetal infection or inflammation
Multiple pregnancy
Perinatal asphyxia
Brain malformation
Genetic disorders

Question 2

Diagnosis of CP

Answer 2

12-18 months
History and physical
Neuroimaging studies, e.g., MRI, CT scan
Metabolic and genetic screening
Coagulation studies
Developmental surveillance, i.e., motor, speech and language, cognition, vision, hearing
Nutritional and growth status

Question 3

Clinical Signs of CP

Answer 3

Qualitative movement differences
Muscle tone differences
Hypertonia
Hypotonia
Failure to attain, or asymmetrical development of, motor milestones
Decreased muscle strength for transitional movements
Deficits in postural control development
Deficits in voluntary motor control

Question 4

Prenatal Causes of CP

Answer 4

Congenital problems causing defects in the developing brain
Maternal infections: rubella, cytomegalovirus, toxoplasmosis
Metabolic disorders
Rare genetic syndrome

Question 5

Congenital problems causing defects in the developing brain

Answer 5

Microcephaly
Schizencephaly-cleft defect
Lissencephaly- smooth brain

Question 6

Classification by Topography

Answer 6

Hemiplegia (33%) 
Diplegia (44%)
Triplegia
Quadriplegia (6%)
Monoplegia

Question 7

Diplegia

Answer 7

primary motor impairment of lower limbs, limited involvement of upper limbs

Question 8

GMFCS Level I:

Answer 8

Walks without restrictions; limitations in more advanced gross motor skills

Question 9

GMFCS Level II:

Answer 9

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

Question 10

GMFCS Level III:

Answer 10

Walks with assistive mobility devices; limitations walking outdoors and in the community

Question 11

GMFCS Level IV:

Answer 11

Self-mobility with limitation; children are transported or use power mobility outdoors and in the community: most likely to have power wheelchair

Question 12

GMFCS Level V:

Answer 12

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

Question 13

GMFCS 0-2 Age Band

Level I

Answer 13

• -Sits on floor with hands free­
• -Moves in and out of floor sitting
• ­‐Crawls on hands and knees
• ­‐Pulls to stand and takes steps holding onto furniture
• ­‐Walks between 18-­‐24 months without assistive mobility devices, AMD

Question 14

GMFCS 0-2 Age Band

Level II

Answer 14

• ­‐Maintains balance in floor sitting but may use hands for support
• ­‐Creeps on stomach or crawls on hands and knees
• ­‐May pull to stand and take steps holding onto furniture

Question 15

GMFCS 0-2 Age Band

Level III

Answer 15

Maintains floor sitting with low back support

-­‐Rolls and creeps forward on stomach

Question 16

GMFCS 0-2 Age Band

Level IV

Answer 16

Head control but trunk support required for floor sitting

-­‐Rolls to supine, may roll to prone

Question 17

GMFCS 0-2 Age Band

Level V

Answer 17

Limited voluntary control of movement

• ­‐Unable to maintain head and trunk postures in prone and sitting
• ­‐Requires assistance to roll

Question 18

GMFCS 2-4 age band

Level I

Answer 18

• Sits on floor with hands free
• Requires assistance to move in and out of floor sitting and standing
• Walks without AMD as preferred mobility method

Question 19

GMFCS 2-4 age band

Level II

Answer 19

May have balance difficulty in hands free sitting on floor

• Requires assistance to move in and out of sitting on floor
• Pulls to stand on stable surface
• Crawls using reciprocal pattern
• Cruises holding onto furniture
• Walks using AMD as preferred mobility method

Question 20

GMFCS 2-4 age band

Level III

Answer 20

Maintains floor sitting, often by “W-sitting”; may require assistance to assume

• Creeps on stomach or crawls on hands and knees, often without reciprocal leg movements as primary means of mobility
• May pull to stand on stable surface and cruise short distances
• May walk short distances indoors using AMD and assistance for steering and turning

Question 21

GMFCS 2-4 age band

Level IV

Answer 21

Floor sits when placed but uses hands support to maintain alignment and balance

• Frequently requires adaptive equipment for sitting and standing
• Self-mobility for short distances in room through rolling, creeping on stomach, or crawling on hands and knees without reciprocal leg movement

Question 22

GMFCS 2-4 age band

Level V

Answer 22

Restricted voluntary control of movement and ability to maintain antigravity head and trunk postures

• Limited motor function including sitting and standing that are not fully compensated for through use of adaptive equipment and assistive technology
• No independent mobility and are transported; some achieve self-mobility using

Question 23

Manual Ability Classification System, MACS

Answer 23

observed ability to handle objects in daily activities, e.g., eating, dressing, playing, drawing, writing
5 levels, 4-18 years

Question 24

MACS Level I

Answer 24

handles objects easily and successfully

Question 25

MACS Level II

Answer 25

handles most objects but with somewhat reduced quality and/or speed of achievement

Question 26

MACS Level III

Answer 26

handles objects with difficulty; needs help to prepare and/or modify activities

Question 27

MACS Level IV

Answer 27

handles a limited selection of easily managed objects in adapted situations

Question 28

MACS Level V

Answer 28

does not handle objects and has severely limited ability to perform even simple actions

Question 29

Primary Impairments

Answer 29

due to pathophysiology

Question 30

Secondary Impairments

Answer 30

develop over time as a result of other impairments, activity limitations, participation restrictions, contextual factors, i.e., environmental, personal

Question 31

Primary Impairments in

Children with Cerebral Palsy

Answer 31

Muscle tone and extensibility
Muscle strength
Postural control
Selective motor control

Question 32

Muscle Stiffness

Answer 32

abnormally high tone or muscle hypoextensibility requiring more force to produce length changes.

Question 33

Differences between spastic muscle and normal muscle

Answer 33

decreased number of muscle fibers.
shorter resting sarcomere length.
increased collagen concentrations.
poor organization and quality of
     extracellular material

Question 34

Children with CP have:

Answer 34

decreased muscle strength
Decreased EMG activity due to neuronal drive, co-activation of antagonist muscles, secondary myopathy, altered tissue properties.
Biomechanical changes reducing torque, may also impact joint structures.
More weakness in distal musculature, concentric contractions, faster movement speeds

Question 35

Selective voluntary motor control:

Answer 35

the ability to isolate muscle activation that is a primary impairment

Question 36

Poor SVMC is characterized by

Answer 36

reduced movement speed or mirror movements, i.e., reciprocal activation on the opposite side of the body. Co-activation of antagonist muscle groups may also be evident when moving a limb

Question 37

Difficulties with SVMC result in

Answer 37

coupled flexion or extension patterns or abnormal movement synergies, sometimes described as posturing.

Question 38

What is whole task practice recommended for:

Answer 38

discrete tasks, e.g., reaching and grasping for an object, and for continuous tasks that require longer movement duration and cyclical repetition of limb movements, e.g., walking or cycling

Question 39

What is part task practice recommended for:

Answer 39

serial tasks that involve a combination of discrete tasks, i.e., wheelchair transfer training.