Cerebral Palsy chp 18 Flashcards

1
Q

What causes CP and what exactly is it

A

Permanent but changeable
Caused by non progressive defect or lesion in 1 or multiple locations
Utero/during or shortly after birth
Infectious meningitis and trauma are the most common causes of acquired CP
Produces motor and possible sensory deficits
Involves 1 or more limbs and usually the trunk
Voluntary motor function deficits
Produces multiple symptoms
Anatomic sites of involvement, degree of disability, associated dysfunction and causes are heterogeneous
Cognitive decifits in about 23 -44 percent of the cases and IQ is below 70 percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are auditory issues present
Visual disturbances
Learning disabilites a lot have learning disabilities
seizure disorders

A

Auditory impairments in 25%
Visual disturbances in 40-50%
Strabismus, esotropia, nystagmus, homonymous hemianopsia
Learning Disablities 50-70 percent
Seizure disorders 25-25
Disc Dengeration and cervical spine in stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we classify CP

A

Area of the body exhibiting impairments

Movement abnormalities resulting from brain lesions

Degree of severity of CP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to classify movment differences in CP there are 4 of them.

A
Spastic- motor cortex
hemiparesis, diplegia, quadriplegia
2. Dyskinetic- basal ganglia
athetosis (weird slow withering movement of hands, dystonia, choreiform movements, ballismus, tremor)
3. Ataxia- cerebellar lesion
4. Atonia, hypotonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spastic - usally involves the mnotor cortex hyperreflexia, abnormal movment pattern.

A

showing upper motor neuron involvement (hyperreflexia, abnormal movement patterns, weakness, loss of dexterity) -motor cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe Athetosis, dystonia, choreilform, bailismus, tremor

A

Athetosis- showing signs of extrapyramidal involvement with involuntary movements slow writhing movements of face and extremities

Dystonia -rhythmic, changing tone proximally leading to slow uncontrolled movements with a tendency towards fixed postures -basal ganglia
Choreiform movements- rapid jerky movements of face and extremities
Ballismus – coarse flinging movements of extremities with wide amplitude of motion
Tremor – fine shaking of head and extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rarer types of CP so you have like Hypotonic and ataxic which are usally what type of lesions?

A

Hypotonic- showing severe depression of motor function and weakness
Ataxic- showing signs of cerebellar involvement with ataxia (rare) -cerebellar lesion
Mixed lesions combine characteristics of spastic, athetoid and ataxic groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Characteristics of Hypotonia CP just think along the lines of characteristics describing muscle weakness

A

Flaccidity
Extreme floppiness
Inability to generate muscle force
Transient- reclassified spasticity or athetosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristics describing Spastic CP

A

Dystonia
Resistance to passive stretch
Hyperactive stretch reflexes (hyperreflexia)
Changes in muscle structure & function
Abnormal muscle activity elicited by changes in head or body positions
UE flexion/ LE extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Atheoid CP

A

Without a fixed steady position and may involve choreiform or writhing movements
Maintain fixed dystonic posture
Involuntary movements at rest and during movements
Joints often hyper mobile and dislocations occur especially if spasms are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ataxic CP this one is water on the brain so you cant move.

A

Uncommon
Hydrocephalus, head injury, encephalitis, or cerebellar tumor
Difficulty controlling rate, range, direction and force of movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cortical basal ganglia
Cerebellar lesions
Cerebral Cortex and pryamidal tracts

What impairments do you see if these areas are injuried

A

Cortical Basal ganglia thalamic loop- dyskinesia or athetosis, intermittent muscular tension of extremities or trunk, involuntary movement patterns
Cerebellar lesion- ataxia, general instability of movement
Cerebral cortex & pyramidal tracts- spasticity
Hypotonic classification- diminished resting muscle tone and decreased ability to generate voluntary muscle force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the diffrent GMFSC levels age 6-12

and second 12-18

A

6-12 - Level 1 Children walk at home go up and down stairs without holding onto rails children peform gross motor skills but, speed balance and coordination are off
Level 2- children walk but, still hold onto the rails when climbing stairs may expericence difficulty walking long distances may use wheeled mobliity over longer distances children have minimal ability to perform gross motor skills

Level 3- children use a hand held mobility device in indoor settings. need supervision when climbing the stairs and need wheeled mobility when travleing long distances and may self propel for short distances.

Level 4 - Children need supervision when walking shorter distances. Children need wheelchair when at school or traveling along in the community

Level 5- children are transported in a manual wheelchair. Children are limited in their ability to maintain antigravity head and trunk position and control leg and arm movements

AGES 12-18

samething as above just need more assistance when doing transfers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some secondary impairments people can get with CP

So CP is really not D/x until what

A
Expressed in muscular and skeletal systems
 damage occurred in the CNS
Insufficient force generation
Spasticity   (vel dependent)  tone
Abnormal extensibility
Exaggerated or hyperactive reflexes
Malalignments (femoral anteversion/
femoral & tibial torsion)

D/x usally occurs when the child doesn’t reach motor milestones like other children do. still have abnormal primitve reflexes assymetry
Some tests to help ID CP are the Test of Infant motor performance, Neurosensory Motor Developmental Assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Multi system impairments

A

Expressed in the Neuromuscular system
Poor selective control of muscles
Poor regulation of activity in muscle groups in anticipation of postural changes
Decreased ability to learn unique movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give me some general Assessments that are used to help diagnosis CP

A

Movement Assessment of Infants (MAI) 73.5 % in high risk populations (4 months of age)
Bayley 100% for spastic di and quadriplegia and 75% for spastic hemi at 1 year corrected age
Alberta (AIMS) 6 months
General Movement Assessment- saws few false positives
Test of Infant Motor Performance (TIMP) – early detection

17
Q

How to assess if postural issues are present in the child.

A

Postural activity is noted when the child has muscle activation against the supporting surfaces
Postural preparations are strategies used before a functional movement,
increase stability by changing the base of support or increasing muscle activation around a joint
Changes are in anticipation of a specific task that has been learned previously
Uses fb from completing the task prior in a feedforward manner

18
Q

What are somethings that can go wrong in the shoulder gridel region just think like fixed scapula

What movements are usally limited

A

Poor trunk extension
Results in rounding of the thoracic spine/ tight pectoralis major & rectus abdominus muscles
Dynamic scapula stability fails to develop
Fixed scapulae in a downward rotation with forward tipping resulting in restricted sterno and acromioclavicular joint movements
Limited passive flexion,abd, ext rot of shoulder with the utilization of shoulder elevation
Limited extension of ue distal joint movements

19
Q

Examination of hip and plevis

A

Tight hip flexors, add, internal rot with resultant limitations in hip extension, abd, and ext rot
Thomas test – identify flexion contractures of hip
Ortolani click for congenital hip dislocation or shorter femoral length

20
Q

What about Femoral Anteversion what is the birth or degrees of it at birth and what is the normal angle for an adult.

A

Torsion or internal rotation of the femoral shaft on the femoral neck
Birth 40 degree of anteversion (transcondylar axis of the femur and the femoral axis of the neck)
Adult 15 degrees of femoral anteversion
CP increased anteversion

21
Q

What about the tibial torsion what degree marks are these usally around

A

May have limited knee flexion or extension
Tibial torsion
Birth 4 degrees of ext rot
Adults 14 degrees of ext rot

22
Q

Evaluation of the foot.

A

Subtalar joint in neutral thus preventing forefoot hyper-mobility while ensuring excursion of hindfoot
Longitudinal arch at 3 ½ -4 yrs of age

23
Q

How to measure Leg Length and what is an acceptable difference between the legs and yes we can always use a shoe lift.

A

Anterosuperior iliac spine-distal medial malleolus
1cm-2cm

Should we use a shoe lift? And if yes why?

24
Q

Will my SON walk again

A

et al. 89, predications at 2 yrs of age increased accuracy for early prognosis of walking status
Age of sitting, type of CP, presence of tonic labyrinthine, ATNR, symmetrical tonic neck and Moro reflexes, foot placement and parachute postural reactions significantly correlated with ambulation at 8yrs of age.
High stepping, slow lurching gait, small steps, uneven steps, simultaneous flexion of hip/knee/ankle, limited hip extension/ankle DF, knee hypertension in stance, internal rot & add

25
Q

Name some gait deviations commonly seen with CP

A

Limited asymmetric pelvic tilt or rotation
Use excessive head, neck, upper trunk & UE mobility
Flexed hips during stance
Excessive adduction & internal rotation of hip (Medial aspect of knees may approximate)
Knees either flexed or hyper extended during stance
Feet in valgus
Plantarflexed
Speed of walking is half that of aged matched

Limbs on involved side are retracted or rotated posterior
No arm swing & involved UE held in hyperextension at shoulder with elbow flexion

26
Q

Assessment for Goal Writing

Basically just telling the ABC’s of goal writing again.

A

Remember objectives (short term goals) do not need to be components of long term goals but they need to be logically connected and have…
Subject
An observable action verb
An observable functional performance with a beginning and an end point
Conditions under which the performance will be met (circumstances & environment)
Criteria or how well the client performs this function

27
Q

Some just general interventions to Do with kids with CP

A
Strength progressions
Gravity eliminated movements-against gravity
Alter amount of assistance
Endurance progressions
Increase number of reps
Increase length of time of exercise
Coordination progressions
Dual tasks
28
Q

Things to rememeber during exercise

A

Dissociation or differentiation
External support- PROXIMAL TO DISTAL
Sensory system
Secondary musculoskeletal changes- (myofascial release)
Avoid prolonged holding in static positions
Use graded transitions with brief holding
Impose weight shifts
Vary transitions, speed of movements and ranges
Active movements and repetition for learning

29
Q

Review tables 5.1 -5.4

A

Table 5.1 - 5.4

30
Q

Neurodevelopmental treatment explain

Sensroy intergration

Conductive education

Vojta- proprioceptive info

A

Its a treatment technique that focuses on realating practice activites to real situations as much as possible and hopefully the carryover is seen and treatment is directed toward functional outcomes targets specific impairments that the child has and developing an approach that is both motor and sensory oriented

sensory intergration- providing the oppurtunity to experience a variety of sensory input

Conductive education- it is the cooperation of everything into one treattment (motor, sensory, cognitive, communication, psychosocial, and ADLS) Treatments often include the use of task series, group work, rythimic intention, specific equipment usally 5 times a week for 6t week

The Vojta “method”is for the physician a precious clinic tool for the evaluation of the child development from birth, and a reliable element of diagnosis; it is for the physiotherapist an efficient global therapy which can be used from the first days of life, in a preventive or curative intention.

The treatment based on the reflex locomotion contributes to:
* Modify the reflex activity of the young child and to orient the neuromotor development in a more physiological direction, by the induction of a different central neurological activity that supplies to the patient a new corporal perception. The muscular “proprioception” plays here a very important part.

  • Modify the spinal automatisms in lesions of the spinal cord .
  • Control the breathing in order to increase the vital capacity.
  • Control the neurovegetative reactions , and promote an harmonious growth of the locomotor anatomical system .
  • Prevent the orthopaedic degradation, frequent in severe pathological situations.

Electrical Stimulation- Russian bcasically to strenghten specific muscles or they refer to it as functional electrical stimulation

31
Q

Neuromedical interventionsfocus to delay surgery

A

Oral Muscle relaxant drugs- diazepam, dantrolene, baclofen
? Safety in children and effectiveness
Neuromuscular blocks- dynamic deformity management, alcohol & phenol (muscle), botulinum A toxin & botox (nerve terminals) (overuse of agonist and have difficulty activating antagonist)

Improve function, prevent or treat muscloskeletal complications
increase comfort decrease pain, facilitate case of care and improve appearance

Selective dorsal rhizotomy (SDR / SPR)- select number of dorsal rootlets are sacrificed across L2-S2,
require Muscle stretching, strengthening, & reeducation for 6 -12 months post surgery
Implanting Spinal cord stimulators- C2 & C4
Continuous intrathecal baclofen infusion (CIBI)