Define cerebral palsy
Nonprogressive neuromotor disorder resulting from brain damage before, during and shortly after birth-it is not inherited and prevalent in 2 out of 1,000 live births
What are some of the causes of cerebral palsy prenataly
-radiation, intrauterine infections, drug usage, metal toxicity, fetal anoxia, cerebral hemorrage, chromosomal abnormalities, abrupted placenta, premature detachment-
What are some of the causes of cerebral palsy post nataly
premature birth, asphysia sepsis, cerebral hemorrhage, inflammatory diseases of the brain and head trauma
What are some of the causes of cerebral palsy perinataly (during birth)
-trauma to child's brain during birth, using forcepts-
How do you classify cerebral palsy
Looking at limb paralysis and neuromuscular characteristics
What is quadriplegia
Paralysis of trunk and all four extemities
What is diplegia
Paralysis of corresponding extremities on both sides of body either arms or legs
What is paraplegia
Paralysis of Lower trunk and both lower extremities
What is hemiplegia
Paralysis of One side of the body such as right arm and leg common in mild forms
What is monoplegia
Paralysis of Single extremity not common
name the characteristics of spastic in cerebral palsy
Increased muscle tone, exaggerated stretch reflex, slow effortful jerky voluntary movements-being started easily happens in 50% of cases
Name the characteristics of athetoid cerebral palsy
Slow writhing involuntary movements when spontaneous or volitional actions are attempted. happens in 10% of cases
Name the characteristics of ataxic cerebral palsy
Disturbed equilibrium resulting in balance problems, reflexes and muscles are normal occurs in 5-10% of cases
Name the characteristics of rigid cerebral palsy
Simultaneous constant contractions of all muscles painful and tiring occurrence of 1%
Name the characteristics of mixed cerebral palsy
Combination of more than one type most common is spastic/athetoid typically there is increase muscle tone and slow movement w/30% occurance
What are the most common speech problems in cerebral palsy
* Articulatory Problems
* Resonatory Problems
* Phonatory Problems
* Respiratory Problems-difficult time controlling breath stream
* Prosodic Problems
What is assessed with cerebral palsy
* Neuromotor Functions
* Motor Development
* Mental Development-they may or may not have mental retardation
* Speech disorders and intelligibility
* Prosodic Problems
* Voice and Respiratory Problems
* Resonance Problems-hypernasality
* Oromotor Dysfuncti
What is spastic encephalopathy?
Neuromuscular disorder of posture and controlled movement occurring secondary to damage to the immature brain before, during or after birth.
What are the normal characteristics of a CP patient?
Decreased functional abilities
Delayed motor development
Impaired muscle tone and movement patterns
What are the two ways to categorize CP?
Congenital and acquired
What are the types of abnormal muscle tone and movements?
Spasticity, rigidity, dyskinesia and ataxia
What is the most common muscle tone in CP patients?
Spasticity
How do you categorize the severity of CP disorder?
Mild, moderate, and severe
What is the typical behavior/activity level of a CP patient?
Passive, stiff, unable to hold head in normal position, and they can't adjust their body positions.
What is dyskinesia?
Disordered movement and fluctuating muscle tone
Ataxia is?
Loss of coordination resulting from damage to the cerebellum
What is the least common muscle tone in CP patients?
Rigidity
CP
Umbrella term used to describe Mvmt disorders due to brain damage that are non-propressive and are acquired in utero, during birth or infancy
Is a CP lesion progressive or non progressive?
The lesion is nonprogressive.
The child changes and the needs of child change.
Prior to what age does the CP lesion occur?
2
What 2 disorders result from CP?
Posture
Voluntary movement
What accompanies these disorders?
everything...impairments in
speech
vision
hearing
perception
CP etiologies?
Can occur before or during birth 2andary to a lock of O2
vascular accidents
hypoxia
infections
congenital CNS abnormalities
Etiologies of acquired CP includes:
Meningitis
CVA
Seizures
BI
Prenatal Etiologies?
Maternal infections/viruses
medical problems during pregnancy
genetic
drugs
Perinatal Etiologies?
prematurity
low birth wt
severe jaundice
traumatic delivery
perinatal stroke
anoxic event
Postnatal etiologies?
aquired infection
TBI
anoxic event
lead exposure
What causes the lesions?
hemmorrhage
hypoxia
malformation of CNS
prematurity
What are the 2 pathogenises caused by prematurity?
(IVH) intraventricular hemorrhage
(PVL) periventricular leukomalacia
What are the intraventricular grades?
1. least serious
2. ok
3. increased chance for CP
4. most likely will have CP
What is it called when the tissue around the ventricles does not receive enough blood and dies?
PVL
periventricular leukomalacia
What is the hallmark sign of CP?
PVL detected by radiograph
Athetoid
Ataxic
Hypotonia
Mixed
Spastic
are all impairments of what?
muscle tone
Motor impairment degrees?
mild
moderate
severe
profound
What gait pattern is associated w diplegia?
bunny hop
Is spastic muscle tone an UMN or LMN lesion?
UMN
What is a 5 level system based on gross motor abilities?
Gross Motor Function Classification System
(p 852 in Path book)
t/f
CP pts experience increased co-contractions
true
What puts CP pts at high risk for a fall?
delayed anticipatory response
t/f
CP pts lack primitive reflexes?
f
primitive reflexes are persistant in CP pts
What are 2 delayed developments in CP pts?
posture
motor
t/f
despite the delay in motor development, their motor performance is normal.
false
Is hydrocephalus a common co-morbidity of CP?
yes
CP pts also have
_________ difficulties
____________problems
_______ restrictions
feeding
musculoskeletal
joint
Is it easy for CP pts to move agst gravity?
no
ATNR
No reciprcocal kicking
mouth always open
inability to roll
elbows to not fully extend
elbow ext w IR
pronated forearms
no hand to mouth or midline
fisting
impaired voluntary release
grasp w 1 hand
excess add, IR, PF when stand
...early signs of what?
hypertonia
What are 4 hypotonia signs?
floppy
head lag
excess ROM
bilateral hip abd >160*
Decreased force production means?
decreased strength
t/f
CP pts are weaker than normal in ALL LE muscles.
true
What 3 gait patterns are assoc w spastic diplegia CP pts?
scissoring
crouched
bunny hop
t/f
CP pts have increased single limb and decreased double limb support time.
false
CP pts have decreased single limb and increased double limb suport.
t/f
CP pts have adductor fixation for stability.
true
t/f
spastic hemi CP pts wt bear primarily on uninvolved side.
true
t/f
ataxic CP pts have a narrow BOS.
false
Wide BOS
All CP pts have what 3 gait impairments?
decreased speed
increased energy expenditure
limited lumbar mobility
LE separation
Lateral Righting reactions
Increased SLS
...will facilitate?
gait improvement
What are 4 ortho impairments w CP?
Primary motor impairments
Abnormal WB and malalignment, which lead to
spinal and extremity defects, which lead to
2ndary ortho impairments (hip dysplasia)
ADs for CP?
adaptive equip (growing standers)
serial splints/casts
orthoses
CP ther ex?
Positioning
ROM
stretching
AROM
strengthening
Pharmacology and surgery for CP pts does ?
reduces spasticity
What is a transectional cut of the dorsal roots that causes loss of sensation/motor in nerves causing spasticity?
Dorsal Rhizotomy
What do botox and Dorsal Rhizotomy have in common?
Window of opportunity for aggressive Rx.
Most common cause associated w CP death?
respiratory compromise
CP life expectancy?
Only a few years less than normal life span.
What does stretching promote?
spinal alignment
SUSTAINED partial contraction of RESTING or RELAXED muscle?
tonicity
excessive tone
increased resistance to passive stretch
hypertonia
loss of tone
stretch beyond normal limits
hypotonia
VELOCITY DEPENDENT increase in tonic stretch reflxes w exaggerated TENDON JERKS.
spasticity
As a component of the UMN syndrome, what results from hyper-excitability of the stretch reflex?
spasticity
Modified Ashworth Scale?
Only way to objectively document tone/spasticity.
Scale of 0 - 4
0 = no increase in tone
1 = slight increase in tone thru 1/2 ROM
2 = marked increase in tone thru most of ROM
3 = considerable increase in tone, passive movement difficult
4 = rigid flex or
What are the 2 types of 1ary motor patters w/ CP?
Spastic
Athetoid
Spastic Motor patters indicate a lesion in what area of the brain?
Motor cortex of the cerebrum: UMND
Athetoid Motor patterns indicate a lesion in what area of the Brain?
Basal Ganglia, Cerebellum and cerebellar pathways
What is Monoplegia?
One extremity is involved
What is Diplegia?
B LE involvement
UE's may also be involved
What is a Hemiplegia CP?
Unilateral involvemeht of the upper and LE
What does it mean to be a quadriplegia CP?
Involves the entire body
What is the Treatment for CP?
Ongoing family/caregiver education
Normalize tone
Stretching
Strengthening
Developmental milestones,
Positioning,
WB'ing activities
Mobility skills
Splinting
Assistive devices and specialized seating
Surgical interventions for orthopedic mngmet or reducti
Cerebral Palsy
- refers to group of disorders with similar disturbances in movement control
- damage to motor areas of the brain that disrupts the ability to control motor function (movement and posture); muscle control and coordination lost
- muscle tightness/spasticit
Spastic CP
- stiff and difficult movement with permanently contracted muscles
- accounts for 80-90% of overall incidence in children
Athetoid/Dyskinetic CP
- involuntary and uncontrolled, slow, writhing movements, usually affecting hands, feet, arms, or legs
- muscles of face and articulators usually involved, resulting in distorted facial patterning, and/or drooling (developmental dysarthria)
- movements of
Ataxic CP
- disturbed sense of balance and depth perception which includes poor coordination, unsteady gait patterns, and difficulty in attempting fast precise movements (writing, buttoning a shirt)
- least common form of CP (5-10%)
- intention tremor may also occu
Mixed CP
- symptoms from more than 1 of the 3 types of CP is present
- most commonly manifests as spastic and athetoid movements