CP Flashcards
CP
what is it
Etiology
Cerebral Palsy (CP)
- a continuum of disorders of the movement, posture and coodination
Etiology
- caused by non-progressive disturbances that effect the brain during early development (fetal, infantile or early childhood)
- Increased risk of CP for… young gestational age at birth (premature) , low birth weight & serious illness in early years (meningitis and infantile stroke)
What Causes CP?
- in many cases - there is no cause found
- when the cause is identief - usually remlated to perinatal and prenatal events
Other Less Common Causes
- perinatal: chorioamnionitis (infection of the amnionic sac)
- low birth weight
- periventricaulr leukomalacia: damanged white matter
- congenital malformations
- encephalopathy as newborn
- postnatal: infections (sepsis, meningitis)
- asphyia
- accidental injury (breif accidental event)
hydrocephalus at any age
can be acquired (infantile stroke, near drowning, trauma)
How is CP Classified
CP Classification: to determine the type and related symptoms
Classifications according to
- Type (spastic, dyskinetic or mixed)
- spastic = motor pyramidal tract affect: stiffness
- diskinetic = extrapyramidal tract affects: uncontrolled movements
- Severity
- Distribution
Quadriplegia
- all four limbs affected
- often seen with hypotonia of trunk and neck
- more liekly associated with intellectual disabilities
Diplegia
- lower limbs involved
- arms spared
Hemiplegia
- one side of the body affected
Symptoms of CP
dependent on type
Spastic Hemiplegia
Spastic diplegia
Spastic Quadraplegia
Atehtoid/extrapyramindal
always some motor component to CP
Spastic= UMN lesion (hyperreflexia!)
Spastic Hemiplageia
- circumductive gait: swinging leg outward to walk because reduced flexion ability
- early handedness: preferr one side over the other much earlier than normal
Spastic Diplegia (lower limbs)
- Scissor gait: increased tone in hip adducors makes them have to cross midline to walk
- commando crawl: crawl fine with ahnds but legs drag behind
Spastic Quadraplegia
- affect all limbs and swallowing
- high likelihood of seizures and cognitive impairment
Athetoid/Etxpyramidal
NOT AN UMN lesion: they will have hypotonia with increase tone later in life
- involuntary contraction of muscle groups; probelms swallowing and with speech
- normal intelligence; low seizure risk
- UE more affected than LE
Spasticity & Dyskinesia with CP
Spasticity
- assocaited with most CP cases
- the velocity dependent resistance of muscle stretch
- UMN: hyperreflexia and clonus
- co-contraction of muscles
- persistant primitive reflexes
- stiff moving, fisting hands, sicssor gait, toe walking and poor posture
Dyskinesia
- involuntary movements = athetosis and chorea
- dystonia: sustained muslce contraction leading to abnormal posturing
- dysarthia and feeding issues
- ataxia
the severity of gross motor function = GMFCS 5 point scale
- done by OT and PT to assess motor function
how can CP be prevented
Adequate Antenatal Care
- prevent infection
- possible mag sulfate to mom
- delayed cord clamp to reduce hemorrhage
Postnatal Care
- immedaite recussitaion
- hypothermia to protect brain
- get good ventilation
- maintain metabolic state
- control seizures
- treat encephalopathy
What are some Manifestations of CP you can note on exam
- spacticity
- dyskinesia
- ataxia
- joint contractures (toe walking because achilles too tight)
- newborn: ventral suspentions to test reflexes : strength of trunk tone if low muscle tone: could be CP
- delayed or too early milestones (shouldnt be rolling)
- persisting primitive reflexes
- opsthotonic posturing (spastic contracture of muscleS)
Primitive reflexes
Tonic Labrinthine Reflex
TLR
- tilting head back when baby is laying donw: causes arch back with legs strightening and toes pointing, hands fist
- gone at 6 months
Asymmetric Tonic Reflex
- extension of UE and LE to the side the neck is turned and flexion on opposite
- shouldnt ever be at rest
- gone at 3-4 months
Galant Reflex
- bab on tummy; stroke next to vertebrae in thorax to lumbar = baby turns toward the side you stroked
- gone at 1-2 months
Comorbidities of CP
- chronic pain: especially in those with spasticity (since its stiffness and abnormal posutring)
- inability to walk, speak, incontinence
- hip displacement
- epilepsy is common
- behvaioral and sleep issues
Psychiatric
- ADHD, depression, anxiety and conduct disorder are all common
- early CBT can help
- and medications if neede
History Taking to determine if CP
how is a dx. made
prenatal and birth history
family history of the following
- development disorders and congenital
- seziures
- CP
- movement disorders
- joint contractures
- vascualr accidents
- infertilit or stillbirths
- adult onset neurodegener d/o
Pt. speciifcal
- early or late milestone
- signs of spasticity or dyskinesia
a diagnosis requires serial examinations
- can be dx. at age 2 (earliest at 5-6 months)
Additional Dx. tools for CP along with hx taking
Imaging
- MRI: to see potential cause and exclude other conditions
- CRANIAL US: is the standard of care in premies: evaluate for intraventricaulr disease
- reveiw placenta if possible
Genetic
- genetic and molecular testing can be done for some types
- mostly done to R/O other conditions that mimic
Treatment of CP
screen for what otehr conditions
Screen for
- intellectual disability
- seizures
- vison and hearing issues
- speech and alangugae
- nutrtional
Technological support: wheelchairs, communication devices
- family psych support
manage motor function: OT, PT, orthotics
manage spasticity: baclofen intrathecal pump or onabotulism A into muscles directly ( or surgery)
Dystonia: DA agonists
Hand Dysfunction: constraints or bimanual thearpy
Equinas Deformity: ankle orthotics are first line, then surgery
Treatment of CP: Impaired Oral Function
can result in lots of other complications
- difficult to manage secretions, aspiration, pneumonia, poor nutrtion, etc.
Manage
- soft/puree diet
- NG tube or G tube
- Salivary treatment = scopolamine, glycopyrolate or onobotulism A into the salivary gland
Treatment of CP: Pressure Ulcers
Osteoporosis
prevention
- alterate postions
- prophylatic dressing
- pressure mattresses
- wheel cahir cushions
- sheepskin
Osteoporosis
- due to: lackof use, poor nutrtion, lack of Vit D, late puberty, anticonvusants
- FRAX assessment and DEXA at age 18 and Q18-24 months
- calcium, Vit D and bisphosphonates as needed
Continued Care
- normal lifespan
- check and screen for all other disesae processes you would for other populations (DM, obestiy, done density, etc.)
