Cours 8 : Cerebral Palsy

Question 1

Is Intellectual Disability more common among individuals with CP?

Answer 1

Yes (50%), it is more common

Question 2

What does cerebral means?

Answer 2

Brain

Question 3

What does Palsy means?

Answer 3

Decrease in muscle control (paralysis of the brain)

Non-progressive but not unchanging (symptoms can change) disorder of movement and/or posture, due to an insult to or abnormality of the developing brain. Speech and sense like hearing and vision can also be impaired.

Question 4

What are the things to remember in Cerebral Palsy?

Answer 4

Is not contagious
Is not hereditary (not transmitted)
Is not life-threatening (life expectancy is similar to able-bodied individuals)

Question 5

Are the people in the picture presented at slide 3 paraplegic, quadriplegic or both?

Answer 5

Paraplegic, we are using the field definition

Question 6

What is the incidence of Cerebral Palsy?

Answer 6

2 to 2.5 cases per 1000 births (incidence has not declined over the last 60 years despite medical advances.

15 000 people in Quebec
50 000 people in Canada
More males than females (1.33 male for 1 female)

Question 7

Why did the incidence not decline over the last 60 years despite medical advances?

Answer 7

Increase of the survival rate of pre-term babies

Question 8

Why are the males more prone to get Cerebral Palsy than the females?

Answer 8

The reasons are uncertain. Males born very preterm also appear to be more vulnerable to white matter injury and intraventricular hemorrhage than females. Sex hormones such as estrogens provide protection against hypoxic-ishemic injury, and the neonatal brain is also influenced by these hormones.

Question 9

What are the CP causes? - 90% before or during birth

Answer 9

Maternal infections (aids, rubella, herpes)

Chemical toxins (alcohol, tobacco, drugs)

Injuries affecting fetal development

Damage to the brain or oxygen

Deprivation during deliveries –>genetic disorders, chromosomal, abnormality, faulty blood supply

Question 10

What are the CP causes? - 10% before or during birth

Answer 10

Brain infections (meningitis)
Cranial traumas (accidents, shaken baby syndrome) and oxygen deprivation (near drowning)

Question 11

What are the other factors of CP causes?

Answer 11

Age of the mother ( under 20 and up 34 years old)

Premature + decrease of birth weight babies

Question 12

What are the early signs of cerebral palsy?

Answer 12

Before 3 years of age

Motor skills not developing normally (coordination + balance)

Abnormal muscle tone : hypotonia (1st), hypertonia )2nd)

Favour one side of the body

Question 13

Which leg was more affected in Sophia’s walking pattern?

Answer 13

Right leg
- Toe walking
- Foot dragging
- Favours left when standing up
- She must have better proprioception and control over their muscles

Question 14

What are the classifications by the number of limbs affected?

Answer 14

Quadriplegia (all 4 extremities)

Diplegia (lower extremities more frequent than upper)

Hemiplegia (the entire left or right side is affected)

Triplegia (3 extremities, usually both legs + 1 arm)

Monoplegia (1 extremity)

Question 15

What are the classification by the movement disorder?

Answer 15

Spastic CP - tug-og-war or co-contraction (muscles are tight)

Athetoid CP - mixed muscle tone, constant motion (muscles move a lot)

Ataxic CP - look unsteady and shaky (ex : Sophia in the video)

Question 16

What are the areas touched in Spastic CP?

Answer 16

Motor cortex
Premotor cortex

Question 17

What are the areas touched in Athetoid CP?

Answer 17

Basal ganglia
Tremors

Question 18

What is the area touched in Ataxia CP?

Answer 18

Cerebellum

Question 19

What is an example of an individual who has Spastic CP?

Answer 19

Quadraplegia : all four limbs and the trunk are affected

Diplegia : all four limbs are affected, the legs more severely than the arms

Because cerebral palsy results from brain damage, it is not uncommon for individuals with cerebral palsy to have associated disorders. Other conditions most frequently associated with CP are reflex disorders; seizures; and speech, hearing, or visual problems. In about 40% of people with CP, some degree of mental retardation also may be present. When working with individuals with cerebral palsy, it is important to determine whether the person has associated disorders so you can modify instruction appropriately. Is is also very important not to assume that speech problems and CP automatically imply mental retardation. Individuals with CP may be of normal or superior intelligence

Question 20

What is Spasticity?

Answer 20

Abnormal muscle tightness + stiffness
- Most common (65% of people with CP)

• Caused damage to the motor cortex + cortical tracts
• If there’s more damage to the basal ganglia + cerebellum than it an exacerbate spasticity
• Spastic muscles interfere with voluntary movements
• Interventions :
  Surgical lengthening of tendon
  Dorsal rhizotomy

Question 21

What is the monosynaptic reflex arc is composed of?

Answer 21

Sensory neutron from muscle and tendon going into the spinal cord and connecting to a motor neurone exiting the spinal cord going to muscle. Stimulating the tendon causes the muscle to contract. The ling tracts represent neurone that pass up and down the spinal cord and modify the action of the reflex arc. Injury to these tracts usually causes the reflex arc to become hyperactive (spastic)

Question 22

What is Athetosis?

Answer 22

Constant, unpredictable, and purposeless movement cased by fluctuating muscle tone (hypertonia-hypotonia)

Damage to basal ganglia

+- 25% of people with CP

Problems with facial expression, eating, speaking, head control, fingers + wrist control

most people with athetosis are quadriplegic

** Poor balance, arms and hand movement, regular shake or as sudden spams. Uncontrolled movements are often worse when the child is excited or tries to do something**

Question 23

What is Ataxia?

Answer 23

Disturbance of balance and coordination characterized by hypotonia + decrease postural tone

Results from disorders of the cerebellum + vestibular system (system located in the ears that provide information of where our body is moving in space)

Question 24

What is the abnormal gait associated with Spastic CP?

Answer 24

Scissors gait
Legs = flexed + inwardly rotated + toe walking

Question 25

What is the abnormal gait associated with SpasCP?

Answer 25

Scissors gait : associated with quadriplegic spastic cerebral palsy. The legs are flexed, inwardly rotated, and adducted at the hip joint, causing them to cross alternately in front of each other. There is excessive knee flexion. Toe walking causes a narrow base. Scissoring and toe walking may be caused also by the positive supporting reflex. The positive supporting reflex is an externsion (plantar flexion) response of the feet to tactile stimuli. Legs = flexed + inwardly rotated + toe walking

Hémiplégie gait : associated with hémiplégie spastic cerebral palsy and stroke. Arm and leg on the same side are involved. Tends to occur with any disorder producing an immobile hip or knee. Individual leans to the affected side, and arm on that side is held in a rigid, semi flexed position. Hip circumduction + toe walking

Question 26

What is the abnormal gait associated with Ataxic CP?

Answer 26

Ataxic or cerebellar gait
Walk with a wide base with irregular steps.
Eyes are down
Arms away from the body
Absence of opposition of arms and legs

Question 27

What is the fitness and cerebral palsy?

Answer 27

Higher heart rate, blood pressure and lactate concentration

Decrease in mechanical efficiency = increase energy

Caused by spasticity + athetosis and poor exercise habits

Support harness for balance and body weight support

Question 28

What are the effects of exercise training?

Answer 28

Improvement in sense of wellness, body image, capacity to perform ADLs, decrease spasticity + athetosis (mild to moderate changes) and resistance training = controversial (they thought that if you trained, you would take the muscles stronger and they would be more spastic = FALSE)

Question 29

According to the latest studies, resistance training increases spasticity (and in turn decrease range of motion by how many percentage?

Answer 29

0%, it does not increase

Question 30

What do we see with resistance training and walking in children with cp?

Answer 30

Study summary :
2 times a week for 60 minutes ; 26 subjects per group aged 6 to 13 y/old
Training group : leg press machine and 3 exercises (sit-to-stand, lateral step-up, half knee rise)
Control group : conventional PT program

They see significant improvement in muscle strength in trained group vs control group

No improvement in walking ability in both groups

No change in muscle spasticity and range of motion in both group

Possible reasons for lack of improvement in walking = lack of specific exercises