[MND] Cerebral Palsy

Question 1

Epidemiology: Cerebral Palsy

Answer 1

2 to 2.5 / 1000 live births in NZ

Approximately 7000 people have a degree of cerebral palsy in NZ (1/3 are under 21 years old)

Question 2

Pathophysiology of CP?

Answer 2

The initial neurological lesion the child sustains is non-progressive as it remains unchanged; however the effects of the lesion on other systems such as the musculoskeletal system can be progressive

Question 3

The clinical presentation of Cerebral Palsy is dependent on

Answer 3

The area and extent of the CNS affected

Question 4

Prognosis?

Answer 4

A reduced life expectancy (90% survival rate into teens and 20s)

Immobility and severe learning difficulties are considered influencing factors

Question 5

Ataxic Cerebral Palsy?

Answer 5

@ the cerebellum

• Affects 5-10% of the cases
• Characterised by low muscle tone and poor co-ordination of movements
• Affects the sense of balance and depth perception (resulting in poor co-ordination, unsteady, wide based gait)

Question 6

The Gross Motor Function Classification System (GMFCS) is an outcome measure for..

Answer 6

cerebral palsy; it is a classification tool with five levels based on the child’s ability to perform gross motor skills and assistance required when mobilising in a variety of conditions (i.e. stairs, distances, altered terrain)

Question 7

Cerebral Palsy can be described as

Answer 7

A group of disorders primarily affecting the development of movement and posture causing limitation of activity

Question 8

In CP, what percent does hemiplegia account for?

Answer 8

30%

Question 9

Dyskinetic Cerebral Palsy is a lesion located @? What are the movements like?

Answer 9

The basal ganglia (10-20% of cases)

Movements are uncontrolled, purposeless, slow, writhing movements

Question 10

Diagnosis?

Answer 10

Based on patient history and physical examination. CT and MRI can be useful when the aetiology (cause) has not been established

Question 11

Constraint-Induced movement therapy can improve functional ability in the affected upper limb and aid cortical reorganisation and can be useful for

Answer 11

hemiplegia

Question 12

What are some causes / risk factors for CP?

Answer 12

Multiple Pregnancy (i.e. twins/triplets)
Low and very low birth weight (50% of cases, 30% increase in risk)
Vascular Accidents
Infection
Damaged placenta 
Foetal malformation syndromes

Question 13

About 10% cases of CP is ‘Mixed Cerebral Palsy’ which means

Answer 13

Several areas of the brain are involved

Question 14

Spasticity in the arm, leg and trunk on one side, underdevelopment of the affected side (smaller limbs/leg shortening), equines of foot and ankle, flexion of elbow, wrist and fingers

All this sounds like what kind of CP?

Answer 14

Spastic Hemiplegia

Question 15

In CP, symptoms are developed before or during the…

Answer 15

First year of birth

Question 16

Orthotics can be used to ….

What are a some types of CP this might be useful for?

Answer 16

maintain leg length, prevent further deformity, improve joint alignment, improve biomechanics and function
(can be useful for spastic diplegia / hemiplegia / quadriplegia)

Question 17

Lesion locations of CP

Answer 17

Premotor / motor cortex = Spastic

Cerebellum = Ataxic

Basal Ganglia = Dyskinetic

Question 18

What guidelines can we use for strength training for CP?

Answer 18

ACSM guidelines - 3x8-12 reps; 2x a week; light to moderate load

Question 19

What are the guidelines for Serial Casting and what is it effective for?

Answer 19

Effective in lengthening shortened muscles

Guidelines: short periods, frequent reapplication over 6 weeks