Ch 19 Cerebral Palsy Flashcards
(108 cards)
1
Q
CP is a
A
- neurodevelopmental motor condition
- compromised posture, balance, muscle control, movement
- disturbances of sensation, perception, cognition, communication, behavior by epilepsy and musculoskeletal problems
2
Q
Is CP a permanent disorder?
A
yes
3
Q
Is CP progressive or non progressive
A
non progressive
4
Q
Where did CP occur?
A
developing fetus or infant brain
occurs early in the brain development
5
Q
Onset of CP?
A
before 2 or 3 years
6
Q
How is CP diagnosed
A
formal neurodevelopmental exam
observation
history of activity limitation
MRI
7
Q
Findings on MRI if CP positive?
A
White matter damage
cortical and subcortical lesions (basal ganglia)
brain malformation
postnatal injury
8
Q
Birth asphyxia is the major cause of CP. T or F
A
False
birth aphyxia accounts for minority (10-20%) of cases
9
Q
Where does CP originate?
A
pyramidal and extrapyramidal systems of the brain
10
Q
what is the pyramidal system?
A
the system that connects regions of the cortex involved with motor control to muscle via corticospinal tract
initiates and carries signals that allow for volunary skilled movements
11
Q
Damage to pyramidal system results in…
A
spastic CP (majority of cases - 70-85%)
12
Q
Characteristics of spastic CP? (name 3)
A
abnormally high muscle tone
occurs more frequently in children born preterm than full term
associated with underlying periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH)
13
Q
Pyramidal motor system CP accounts for what percentage of CP?
A
70-85%
14
Q
How many subtypes of CP are there within the pyramidal motor system?
A
3 subtypes
- spastic hemiplegic CP
- spastic diplegic CP
- spastic quadriplegic CP
15
Q
Phenotypes/subtypes of CP are described based on what factor?
A
which limbs are affected
16
Q
1st subtype of pyramidal motor system CP - Spastic hemiplegic CP
A
involves arm and leg of one side
usually more arm than leg affected
most common subtype of CP in full term babies
L hemisphere is affected in 2/3 of cases
17
Q
prognosis of spastic hemiplegic CP
A
almost ALL can learn to walk
more than half have normal IQ
18
Q
MRI finding of spastic hemiplegic CP/neuropathology/cause?
A
unilateral MCA stroke
19
Q
typical time of injury of spastic hemiplegic CP?
A
prenatal
20
Q
Which hemisphere is usually affected in spastic hemiplegic CP
A
Left hemisphere
21
Q
2nd subtype of pyramidal motor system CP - Spastic diplegic CP
A
involves the lower extremities
upper also affected but less (usually clumsy hand movements)
most common subtype of CP in pre term babies
22
Q
MRI findings/ Neuropathology of spastic diplegic CP/cause?
A
white matter damage of prematurity, esp PVL
23
Q
Prognosis of spastic diplegic CP
A
severity of motor disability correlates with severity of cog impairment
24
Q
typical time of injury for spastic diplegic CP
A
prenatal
25
3rd subtype of pyramidal motor systems CP - spastic quadraplegic CP
involves all 4 extremities, trunk, neck (FULL body)
50% happen prenatally
30% happen perinatally
20% happen posnatally
26
MRI finding of spastic quadraplegic CP/neuropathology/cause?
anoxia
| b/l gray matter injury
27
Problems with Spastic quadraplegic CP? Prognosis?
most severe type
epilepsy
impaired IQ
28
What is the extrapyramidal motor system?
comprised of the cerebellum, basal ganglia, brainstem
function: fine tune movements of the pyramidal system by making adjustments to posture and coordination
29
What happens when extrapyramidal system is damaged?
results in non spastic CP (15-30% of cases)
30
What is the percentage of non spastic CP?
15-30%, minority of cases
31
Characteristics of non spastic CP
all extremities affected (more upper than lower)
| normal IQ
32
subtypes of non spastic CP are delineated by what factors?
the kind of abnormal motor movements that occur
33
Two subtypes of non spastic CP
1) dyskinetic CP
| 2) Ataxic CP
34
Characteristic of Dyskinetic CP
variations in muscle tone and involuntary athetoid or dystonic movements
35
trouble with dyskinetic CP?
abnormal movements make it hard to sit comfortably and coordinate muscles for walking and sleeping
36
What is Dyskinetic CP caused by?
underlying hypoxic-ischemic injury
| usually in full term infants
37
Characteristic of Ataxic CP
lack of coordination during voluntary gross and fine motor movements
38
What is ataxic CP caused by
cerebellar dysfunction
39
Problems with Ataxic CP?
poor balance, unsteadiness, wide based gait, shakiness, tremor
40
What % does Mixed CP account for?
20% of cases
41
Characteristics of Mixed CP
abnormalities in pyramidal and extrapyramidal systems
| exhibit mixed motor signs
42
Risk factors for CP
preterm birth - most important RISK FACTOR
| Low birth weight
43
maternal risk factors for CP
IQ
infection, toxic during pregnancy
diseases during pregnancy (epilepsy, thyroid, HTN)
44
Fetal risk factors for CP
```
multiple births
co twin dead in uterus
male
IUGR
developmental brain malformation
thrombophilic disorders
```
45
Perinatal risk factors for CP
```
prematurity, although majority of CP cases are born full term
Low Birth weight
anoxic damage (10-14%)
low apgar scores at 5 minutes
abnormal muscle tone
perinatal stroke
```
46
Postnatal risk factors for CP
infections and brain injury
47
Other risk factors for CP
SES not well established
| black race
48
Prevalence of CP in developed countries
2-2.5/1000
49
Has the prevalence of CP changed?
No, it has remained stable because of IVF, improved survival rates
50
physical morbidity - mobility
33% cannot walk
17% require assistance to walk
50-60% can walk without assistance
51
physical morbidity - musculoskeletal complication
spasticity
52
physical morbidity - pain
75% children and 70% adult have chronic pain
53
epilepsy rate of CP
28-50% incidence
54
physical morbidity - oral motor impairment
affects chewing, swallowing, saliva
feeding tube for failure to thrive
speech articulation problems, may need augmentative communication
55
physical morbidity - visual and occulomotor impairment
28% of children of some form of visual/occulomotor impairment
- 10% blindness
- 10-12% hearing impairment
56
physical morbidity - bladder control
urinary incontinence 25%
57
physical morbidity - sleep
sleep disorder 20-25%
| fatigue
58
physical morbidity - skin
pressure sores
59
Cognitive morbidity
30-35% of kids have IQ score < 70
| 50% of kids have IQ score < 50
60
What predicts cognitive morbidities in CP?
motor impairments and epilepsy
61
Which subgroup has the worst cognitive functions?
spastic quadraplegic
62
Which factor is NOT a reliable indicator of cognitive impairment
motor involvement
63
People with severe CP can have normal IQ. True or False
True
64
People with mild CP cannot experience severe cognitive impairment. True or False
False
65
Social Emotional Morbidity
social difficulties
depression
low self esteem
25% behavioral problems
66
Mortality - increased or decreased life expectancy?
life expectancy increased
survival rates improved
mild CP comparable with general population
67
leading cause of death in severe CP
respiratory infection
68
CP is classified as which types in their severity?
mild, moderate, severe
69
Standardized measure of CP severity in children
Gross motor function classification system (GMFCS)
70
Gross motor function classification system (GMFCS)
5 level ordinal rating based on functional mobility and activity limitation
higher number = more severe
71
GMFCS Level I
Level I = can walk and climb stairs independently and without limitation; some problems with gross motor skills (running, jumping, speed, balance coordination)
72
GMFCS Level V
severe limitations in voluntary control of movement
impaired mobility even with assistance
wheelchair bound
73
Can CP be diagnosed in utero?
No, because it's based on clinically observable motor manifestation
74
Is it hard to detect CP during infancy (1-12 mos)
Yes, because motor patterns change, early motor abnormalities can be transient
precocious motor signs can be a sign of CP
absence of motor abnormalities in infancy does NOT mean there is no CP (50% of kids with CP may have unremarkable pre and perinatal history)
75
precocious motor signs (e.g. early standing before 12 months) can mean
hypertonia (stiffness and rigidity) in legs
76
precocious motor signs (e.g. strong hand preference in 12 - 18 mos) can reflect
weakness in the other hand
77
most kids exhibit full motor signs of CP at what age?
2 years or beyond
78
when can a definitive dx of CP be made?
2-3 years old
79
in mild CP cases, when can definitive diagnosis be made?
4-5 years
80
can children with the CP dx outgrow the disorder (no longer exhibit signs of CP?)
yes! by age 7
81
% of children with CP who outgrow the disorder
50%
82
which types of CP cases are more likely to be outgrown by age 7 in children?
mild
monoparetic (one extremity only)
diplegic
extrapyramidal types
83
will children who outgrow motor symptoms of CP continue to suffer from other neurological problems?
yes! such as seizures, ID
84
Is CP progressive?
No, but motor manifestations can worsen (e.g. caused by stress on the body, osteoporosis, arthritis)
85
NP results for CP
no typical profile BUT
1. Verbal skills better than Visuospatial skills
2. attention and processing speed affected (white matter and subcortical involvement)
3. EF not an issue if motor skills are accounted for
86
IQ in CP
varies from severe ID to giftedness
75% affected
50% borderline to impaired
IQ correlated with degree of motor impairment
87
Learning in CP
SLD 25-30%
88
Attention in CP
affected by periventricular white matter and subcortical damage
epilepsy affects attention
89
Processing speed in CP
hard to measure, but some slowing
90
speech and language in CP
oral motor control affects speech, dysarthria
| verbal, language skills are not mostly normal
91
visuospatial in CP
*impaired*
92
memory in CP
attention, visual impairment contribute to memory problems
93
EF in CP
questionable
94
sensorimotor function in CP
motor abnormalities
28% have visual/ocular-motor impairment
10-12% have hearing impairment
disturbances in sensory, touch, pain, sound...
95
emotion and personality in CP
more behavioral and social problems
96
PVT SVT
fatigue and pain interfere with alertness, engagement
boredom
motivation, frustration tolerance
97
Psychological Treatment of CP
Family centered interventions
98
medication for CP
more effective at treating SPASTICITY than addressing muscle weakness, incoordination, or movement abnormalities
99
Medication for spasticity
muscle relaxant
neuromuscular blocker
benzo
100
How does muscle relaxant work?
e.g. balcofen
works on the brain
inhibits descending excitatory motor pathways that activate reflex
101
How does neuromuscular blocker work
e.g. botox
works on muscle
inject into muscle and extremities to cause focal muscle paralysis and reduce muscle contraction
102
How does benzos work
e.g. diazepam
works on the brain
relax muscles by enhancing effect of GABA (inhibitory NT)
103
Spasticity
muscle tightness and stiffness due to prolonged muscle contraction
increased muscle tone
104
Apgar scores
performed 1 min and 5 min after birth
1 min - see how well baby tolerated birthing process
5 min - see how well baby is doing outside of the womb
105
What does APGAR stand for
```
Appearance
Pulse
Grimace response (reflex irritability when stimulated)
Activity (muscle tone)
Respiration
```
106
What APGAR scores are associated with risk for CP
lower than 3, but not determining factor
107
athetosis
slow and writhing involuntary movement
| repetitive, rhythmic
108
dystonia
involuntary sustained or intermittent muscle contraction that cause repetitive and twisting movement
