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Lifespan > Week 9 - Cerebral palsy > Flashcards

Week 9 - Cerebral palsy Flashcards

1
Q

List 4 main factors associated with CP

A

UPMD

  1. umbrella term for group of UMN disorders
  2. Condition that is permanent but not unchanging
  3. Involves disorder of mov’t and/or posture and of motor fx
  4. due to non-progressive disturbances (interference, lesions, or abnormality) in the development of foetal or infant brain)
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2
Q

Define Dyskinesia

A

a state of abnormal muscle tone resulting in muscle spasm and abnormal posture (damage to basal ganglia)

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3
Q

List the long term sequel of spasticity and dystonia and effects physical properties of muscle and soft tissue

A
  1. weakness
  2. motor control
  3. fatigue
  4. contracture
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4
Q

List 4 factors to diagnose CP

A
  1. Abnormal imaging
    2 Risk factors
  2. Abnormal neuro exam
  3. Abnormal motor ax
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5
Q

What is the most common age of diagnosing CP?

A

7-12 months

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6
Q

list the 4 ways to classify CP movement disorder

A
  1. Spastic
  2. Dyskinetic
  3. Mixed
  4. ataxic
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7
Q

List the 3 different topographic classifications of CP

A
  1. Diplegia
  2. hemoplegia
  3. Quadriplegia
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8
Q

List the 2 scales used for functionally classifying CP

A
  1. Gross motor function classification system (GMFCS)

2. Fx mobility scale (FMS)

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9
Q

Describe the distinctions between levels of the gross motor functional classification system GMFCS (5)

A
  • range from good-worse
  • ISWPN
    L1. Walks independently on most surfaces, run & jump (35% of CP pop.)
    L2. Walks independent but difficult uneven surfaces, climb stairs holding railing (24%)
    L3. Assistive mobility for walking, wheelchair, sits independently and independent floor mobility (11%)
    L4. Power mobility outdoors, sitting supported, limited mobility, transfer/standing assisted (13%)
    L5. No independent mobility, carer transported, Poor antigravity head and trunk postures, tilt in space/seating system (15%)
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10
Q

Describe the functional mobility scale (FMS)

A

Looks at functional mobility over 3 distances (5m, 50m, 500m)

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11
Q

Describe the distinctions between levels of FMS (6)

A

IRSCWW (I Run So Controlled With Wind)

  1. no walking aids needed
  2. no walking aids need for walking but requires rail for stairs
  3. Sticks (one or two) without help for walking
  4. Uses crutches without help
  5. Uses walker or frame without help
  6. Uses wheelchair and may stand for transfer, stepping supported
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12
Q

What are the main aims of medical treatment for CP? (3)

A

RCP
1. reduce spasticity and movement problems
2. correct deformity
3. decrease pain
include - injections, surgery, medication

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13
Q

What are the main aim of therapy tx? (2)

A

IPCC
1. Increase independence and participation in community
2. Improve ease of care and comfort
include - activity, exercise, devices

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14
Q

List and describe the types of Dyskinetic CP

A
  1. Myoclonus - sudden involuntary jerking of muscle or muscle groups (muscle twitching followed by relaxation)
  2. Athetosis - slow, involuntary, non-sterotypical, non-purposful, writing mov’t, propensity effect UL
  3. Dystonia - Involuntary muscle contractions that cause slow repetitive mov’t or abnormal postures (may be painful and have tremor)
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15
Q

What are the medical & physio interventions in Mx and treatment of spasticity?

A
  1. Botox
  2. Intrathecal Baclofen (medication) - dampens reflexes (severe Level 4 or level 5)
  3. Selective dorsal rhizotomy (surgery) - severing dorsal routes (30%-50% of L2-S1)
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16
Q

What is required protocol for administration of Botox? (7)

A

ax, goal, prep, sed, stim, inject, review

  1. ax
  2. goal setting
  3. preparation
  4. sedation
  5. stimulation
  6. injections
  7. review
17
Q

What is the criteria for selection for selective dorsal rhizotomy (SDR)? (6)

A

ADMOES

  1. Age (2 and over)
  2. Diagnosis - spastic diplegia
  3. Mobility - some form of in dependent mobility with or without assitive device
  4. Outcome - patients need to exhibit potential for improvement in functional skills
  5. Exclusion - no damage to basal ganglia on MRI
  6. Support - motivated family (18-2 years rehab)
18
Q

List the reversible Mx of spasticity (2)

A
  1. Intrathecal Baclofen

2. Botox

19
Q

What are ways to improve ROM and reduce contractors? (4)

A
  1. Serial casting - effective
  2. Single event multi-level surgery (ie. achilles lengthening) - effective short-term
  3. Stretching - ineffective
  4. Active hip surveillance - effective
20
Q

What causes hip displacement in CP

A

caused by development of muscle imbalances pulling hips and causing dislocation

21
Q

What is migration percentage of femur out of acetabulum be considered hip displacement

A

30%

22
Q

According to the GMFCS, what percentage of displacement are associated with each level?

A
  1. 0%
  2. 15%
  3. 45%
  4. 70%
  5. 90%
23
Q

What is the aim of hip surveillance?

A

To reduce the incidence of painful hip dislocation and need for orthopaedic surgery (using X-rays, botox, good seating positions and interventions)
- improve strength, ROM & decrease contracture, improve bone density, improve fx

24
Q

What are ways to improve strength for CP according to active hip surveillance guidelines

A
  1. hydrotherapy
  2. electrical stimulation
  3. progressive resistance training
25
Q

What are ways to improve bone density for CP according to active hip surveillance guidelines

A
  1. standing - social factors involved
  2. bisphosphonates
  3. Whole body vibration
  4. Vitamin D
    * Insufficient evidence
26
Q

What are ways to improve bone function for CP according to active hip surveillance guidelines

A
  1. context focused therapy
  2. Goal directed training
  3. Home program
  4. assistive technology
  5. conductive education (routine, task)
  6. taping/therasuits
  7. hippo therapy (riding horse)
  8. orthotics
  9. fitness training (effective)
    For upper limb:
  10. Bimanual training (effective)
  11. constraint induced movement therapy (effective)
27
Q

List the ways to assess CP

A
  1. Spasticity (tardieu scale)
  2. ROM (goniometre)
  3. Motor fx (GMFM, FMS)
  4. Gait analysis
28
Q

Main factors for standard care for CP?

A
  1. Regular assessment
  2. Spasticity Mx
  3. Combined with
  4. early intervention
  5. community therapy with expertise in CP mx (hip surveillance)
  6. Family focused therapy that is goal directed

Lifespan (11 decks)

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