4.4 - Cerebral Palsy

cerebral palsy

____________ is a non-progressive neurological difference of lesion that occurs in the early developing CNS, “catch all term”

posture; motor control

cerebral palsy causes differences in _________ and _________ creating different permanent disorders

T (could be wheelchair, running, etc)

T/F: cerebral palsy has a WIDE variety of presentations

• neurological insults

• hypoxic/ischemia

• infections

• CVA

what are the 4 main causes for the many reasons for why cerebral palsy occurs

perinatal (43%) → prenatal (34%) → undetermined (16%) → postnatal (6%)

list in order the timing periods of when CP occurs/diagnosed

F

T/F: neuroimaging will always diagnosis CP

• low birth weight

• maternal infection

• neonatal seizures

what are the 3 poor prognostic risk factors for CP

• tone

• asymmetries

• atypical development and reflexes

• lack of developmental progression

what findings are you expected to find during an initial PT assessment with someone who has CP

spastic (velocity dependent)

___________ presentation of tone:

hypertonic

hypotonic (floppy)

___________ presentation of tone:

low tone

dystonic (more common with low tone trunk posture and spasticity in extremities)

___________ presentation of tone:

mixed tone with awkward joint angles

ataxic

___________ presentation of tone:

uncoordinated and unbalanced

athetoid

___________ presentation of tone:

writhing movements

• diplegic

• hemiplegic

• triplegic

• quadriplegic

**note: this “plegic” not “paralysis” so talking about the cound involved

what the 4 distributions of involvement for CP

gross motor functional class system (GMFCS)

the _______________ is a method to describe the child’s level of independent functioning

• least severe = 1

• most severe = 5

what is the scoring for gross motor functional class system (GMFCS)?

• least severe =

• most severe =

• before 2nd birthday

• between 2nd and 4th birthday

• between 4th and 6th birthday

• between 6th and 12th birthday

• between 12th and 18th birthday

(we will mostly stay with the 6th to 18th range for this class)

what age bands does the GMFCS cover

1

level ______ of the GMFCS:

Walks without restriction; limitations in more advanced gross motor skills

2

level ______ of the GMFCS:

Walks without assistive devices; limitations walking outdoors, and in the community

3

level ______ of the GMFCS:

Walks with assistive mobility devices; limitations walking outdoors, and in the community

4

level ______ of the GMFCS:

Self-mobility with limitations; children are transported or use power mobility outdoors, and in the community

5

level ______ of the GMFCS:

Self-mobility is severely limited even with the use of assistive technology

assistive device = can leave it behind

gait trainer = strapped in

what’s the difference between an assistive device (lvl 3) and a gait trainer (lvl 4)… the big ticket question

• GMFCS - gross motor function classification system

• MACS - manual ability classification system

• CFCS - communication function classification system

what are the 3 different outcome measures for people with CP

F (the graph shows a decline but it is not due to degeneration, the decline is the effect of growth; ex. rapid growth spurts creates longer level arms and physics takes over, if muscles are spastic they can’t keep up with growth so they get tighter)

T/F: CP is a progressive disease

3, 4, 5

what levels of the GMFCS do we typically see a decline in during adolescence

normal to shortened

what is the life expectancy with someone with CP

cognition

the better someone moves, the better their ___________

• hamstrings

• adductors

• plantar flexors

what are 3 common muscle groups to go through muscle tendon releases and transfers with someone who has CP

7-10 years

if a child with CP has a surgery before the ages of ____-_____, the odds of them getting another surgery is high

baclofen

people with CP are often prescribed _________ to decrease their spasticity

ordal

taking (oral or intrathecal) baclofen causes systemic effects

intrathecal

taking (oral or intrathecal) baclofen causes more regional effects

• BSF = fitness

• activity = functioning

• participation = friends

• environmental factors = family

• personal factors = fun

what are the ICF framework F words

include info on test and measures, slide 23 after asking buck question

5 mo - 21 years

what age range does the gross motor function measure (GMFM) cover

• Lying and rolling

• Sitting

• Kneeling

• Standing

• Walking, Running, and Jumping

what are the 5 categories of the gross motor function measure (GMFM)

higher

the (lower or higher) the score on the gross motor function measure (GMFM), the more functional the child

66

gross motor function measure (GMFM) 66 or 88:

shorter

88

gross motor function measure (GMFM) 66 or 88:

longer version

66

gross motor function measure (GMFM) 66 or 88:

valid for children with CP and without AFOs of adaptive equipment

88

gross motor function measure (GMFM) 66 or 88:

valid for children with down syndrome, OI, and in process for other neuro progressive disorders

88

gross motor function measure (GMFM) 66 or 88:

does not give any norm references

66

gross motor function measure (GMFM) 66 or 88:

does have norm references for ages and GMFCS levels

88

gross motor function measure (GMFM) 66 or 88:

gives % of function, the higher they are the more functional

• hypertonia assessment tool (HAT)

• early childhood assessment of balance (ECAB)

• modified ashworth scale

• tardieu scale

what are test and measures used to assess PRIMARY body structure and function for CP

• spinal alignment and range of motion measure (SAAROMM)

• functional muscle strength

what are test and measures used to assess SECONDARY body structure and function for CP

tardieu (measures the distance from the R1/first catch to R2/end range = therapeutic zone)

the __________ test tells you the therapeutic zone of spasticity which you can use when considering casting

spinal; functional

when assessing a child’s body structure and function, look at their _________ alignment and ROM as well as ___________ muscles strength

she’s sneaky like that

i would look at the links to the outcome measures in canvas for scoring