Pediatrics: Interventions: Cerebral Palsy

Question 1

Cerebral Palsy: Pathology

Answer 1

• Non-progressive encephalopathy caused by
• Hemorrhage below the lining of the ventricles
• Hypoxia
• Malformations and Trauma to the CNS

Question 2

Cerebral Palsy: Classifications: One limb

Answer 2

• Monoplegia

Question 3

Cerebral Palsy: Classifications: Two lower limbs

Answer 3

• Diplegia

Question 4

Cerebral Palsy: Classifications: Upper and Lower limbs on one side of the body

Answer 4

• Hemiplegia

Question 5

Cerebral Palsy: Classifications: All four limbs

Answer 5

• Quadriplegia

Question 6

Cerebral Palsy: Classifications: Trunk

Answer 6

• Can be involved in all types

Question 7

Cerebral Palsy: Movement Disorders: Spastic

Answer 7

• Increased tone
• Lesion of motor cortex
• Lesion of projections of motor cortex

Question 8

Cerebral Palsy: Movement Disorders: Athetosis

Answer 8

• Fluctuating muscle tone
• Involuntary slow writhing movements
• Lesion of Basal Ganglia

Question 9

Cerebral Palsy: Movement Disorders: Ataxia

Answer 9

• Instability of movement especially ambulation

- Lesion of cerebellum

Question 10

Cerebral Palsy: Movement Disorders: Dystonia

Answer 10

• Involuntary movements with sustained contractions

Question 11

Cerebral Palsy: Movement Disorders: Hypotonia

Answer 11

• Decreased Muscle Tone

Question 12

Cerebral Palsy: Movement Disorders: Mixed

Answer 12

• Mixture of movement disorders

Question 13

Cerebral Palsy: Impairments

Answer 13

• insufficient force generation
• Tone abnormality
• Poor selective control of muscle activity
• Poor anticipatory postural control
• Decreased ability to learn unique movemnts
• Abnormal patterns of movement in total flexion or extension
• Persistence of primitive reflexes

Question 14

Cerebral Palsy: Spastic Cerebral Palsy

Answer 14

• Increased muscle tone in antigravity muscles

- Abnormal postures and movement with mass patterns of flexion and extension

Question 15

Cerebral Palsy: Spastic Cerebral Palsy: Patterns of Contracture: Upper Extremity

Answer 15

• Scapular Retractors
• Glenohumeral extensors
• Glenohumeral adductors
• Elbow flexors
• Forearm pronators

Question 16

Cerebral Palsy: Spastic Cerebral Palsy: Patterns of Contracture: Lower Extremity

Answer 16

• Hip flexors
• Adductors
• Internal Rotators
• Knee flexors
• Ankle plantar flexors

Question 17

Cerebral Palsy: Spastic Cerebral Palsy: Other

Answer 17

• Visual
• Auditory
• Cognitive
• Oral
  Motor deficits may be seen with spastic CP

Question 18

Cerebral Palsy: Spastic Cerebral Palsy: Crouching Gait

Answer 18

Walks with 
- Hip flexion
- Adduction
- Internal rotation
- Knee flexion
May also toe walk

Question 19

Cerebral Palsy: Athetoid Cerebral Palsy:

Answer 19

• Involuntary, slow, writhing movements
• Generalized decreased muscle tone (floppy baby syndrome)
• This is a result of basal ganglion involvement

Question 20

Cerebral Palsy: Athetoid Cerebral Palsy: Stability

Answer 20

• Functional stability is impaired especially in proximal joints

Question 21

Cerebral Palsy: Athetoid Cerebral Palsy: Ataxia and incoordination

Answer 21

When child assumes upright with

• Decreased base of support
• Muscle tone fluctuations

Question 22

Cerebral Palsy: Athetoid Cerebral Palsy: Other

Answer 22

Deficits to

• Visual tracking
• Speech delay
• Oral motor

Question 23

Cerebral Palsy: Athetoid Cerebral Palsy: Reflexes

Answer 23

Tonic reflexes like
- ATNR
- STNR
- Tonic labyrinthine reflex
May be persistent blocking functional postures and movement

Question 24

Cerebral Palsy: Ataxic Cerebral Palsy

Answer 24

• Low postural tone and poor balance
• Stance and gait are wide based
• Intention tremor of hands
• Movement uncoordinated
• Ataxia follows initial hyoptonia
• Poor visual tracking and nystagmus
• Speech articulation problems
• May occur in conjunction with spastic or athetoid CP

Question 25

Cerebral Palsy: Interventions and Goals: Minimize effects of impairment

Answer 25

- Static positioning and dynamic patterns of movement to habitual abnormal spastic patterns - Symmetry in postures - Elongate spastic Hamstrings and heel cords via stretching or in some cases serial casting

Question 26

Cerebral Palsy: Interventions and Goals: Maximize Gross Motor Functional Level

Answer 26

- Functional motor skills - Postural control - Developmental activities - Weight bearing

Question 27

Cerebral Palsy: Interventions and Goals: Equipment: Seating

Answer 27

- Head neutral - Trunk upright - Hips, knees and ankles at 90 degrees flexion - Wheel chair may be tipped posteriorly to decrease extensor tone and maintain hip flexion

Question 28

Cerebral Palsy: Interventions and Goals: Equipment: Prone or Supine Standers and Parapodium

Answer 28

- Promotes weight bearing through LE - Need at least 5 hours/week for bone mineralization - Tonic Labrynthine Reflex will elicit extensor tone in supine and flexor tone in prone

Question 29

Cerebral Palsy: Interventions and Goals: Equipment: Side Lying

Answer 29

- Will help decrease effect of tonic labyrinthine reflex

Question 30

Cerebral Palsy: Interventions and Goals: Equipment: Rollator Walkers

Answer 30

- Posterior collator helps child maintain upright position and arm position helps decrease extensor tone

Question 31

Cerebral Palsy: Prognosis

Answer 31

- Good prognosis for ambulation if child can sit independently by 2 years of age - If ambulation takes place most often it will take place by 8 years of age