Cerebral Palsy Flashcards
(41 cards)
What is the definition of cerebral palsy?
- static encephalopathy which is non-progressive(once off insult)
- it is a disorder of motion or posture,secondary to an insult to the developing brain
What are the 5 motor abnormalities that we can expect from cerebral palsy
1, spastic (77-93% most common)
- Dyskinetic (2-15% abnormal movements)
- Ataxic (2-8% unsteadiness)
- Hypotonic (uncommon 0,7-2,6%)
- Mixed (spasticity with movement disorder)
What are the characteristics of dystonia?
- involuntary, sustained and intermittent movement
- abnormal postures at res or with activity
- same postures are repeated
- exacerbated by anxiety
- resolves with sleep
- tone generally increased
What do we use to classify the severity of cerebral palsy?
Gross motor function classification system
What are the causes of cerebral palsy?
- Prenatal
- infection(TORCHES)
- intracranial cerebral malformations
- toxins(tik)
- chromosomal abnormalities
- cerebrovascular incidents
What are the perinatal causes of cerebral palsy?
- Perinatal
- birth asphyxia -usually spastic quadriplegia
- prematurity -usually spastic diplegia
- birth trauma
- metabolic-hypoglycaemia
- kernicteris
- hypoxic/ischaemic encephalopathy
What are the post-natal causes of cerebral palsy?
- infection(meningitis, encephalitis)
- vascular malformations (thrombosis, embolism, strokes)
- toxins/drugs
- trauma (head injury)
- post-cardiac arrest
- metabolic (hypocalcaemia, hypoglycaemia, hyponatraemia, hypernatraemia)
What are the most NB questions to ask on history?
- Developmental hx
- Social and family hx-how this is affecting them
- Birth hx-moms previous birth hx, delivery, neonatal
- Developmental status, milestones, communication, speech, feeding, seizures
What do we focus on on general examination?
- General exam-dysmorphism+anthropometry
- Neuro: posture, movement, asymmetry, behaviour, eye signs(nystagmus,squint)
- Respiratory: recurrent chest infections-unable to cough and because of aspiration pneumonia
- Abdomen: constipation, fecal impaction
- Musculoskeletal: contractures, hip dislocation
What is the management of CP patients?
- Multi-disciplinary team NB NB
- social worker, physio, dietician,orthopedic surgeon, occupational therapy - Manage spasticity
- baclofen, Botox, oral diazepam - Manage constipation and reflux
- Control seizures
- Optimize vision and hearing
-baby usually presents with central hypotonia even if they have peripheral hypertonia
When does CP usually occur?
Between birth and 5 years old
Which parts of the brain are usually involved?
- The motor cortex
- Basal ganglia
- Cerebellar cortex
- Brain stem
What is the incidence of cp?
2-5 per 1000 worldwide
What are the spastic CP’sbroken up into?
- Tonic
2. Phasic
What is tonic CP?
- This is due to prolonged contraction of the muscles that it causes contractures
- type 1 muscle fibers are involved
- tonic and phasic can co-exist but tonic overrides eventually
What is phasic CP?
This is when the type 2 muscle fibers stretch from their usual short and relaxed state
-causes brisk tendon reflexes, clonus, clasp knife response
What is spastic hemiplegia?
- subdivision of spastic hemiplegia
- only one side is affected
- strong association with prematurity, birth asphyxia and placental insufficiency
- usually left side affected most
- 99% should be able to walk
Is language affected in spastic hemiplegia?
No-the neonatal brain is plastic
What is spastic diplegia?
-subdivision of spastic CP
-affects the legs more than the arms
Cerebral in origin
What is dyskinetic CP?
- involves the basal ganglia and the subsequent pathways
- chorea and athetosis
- the mature motor cortex and basal ganglia usually inhibit primitive responses like the asymmetrical tonic neck reflex, primitive walking and primitive swimming but when these are damaged the reflexes still exist
- the movements are usually slow and laboured
There are different types of dystonia:
- Flexor
- Extensor-most common
- the arms are usually extended and internally rotated, the wrists are flexed and the fingers extended
- extension of the feet (equinous deformity of the feet and big toe pointing up) - Alternating
- Hemiplegia dystonia
At what age do we start to see dystonia?
At 4 months of age
What part of the brain is involved in hypotonia?
Cerebellum and the pathways
How does hypotonia CP present?
- involves motor learning, fine motor movements like picking up a glass of water
- may present with/without ataxia
- may be caused by genetic factors that pre-dispose a child to a hypotonic cerebellum
