CP- NueroDysfunction Week 8

CP

Walks without limitations; only limited in advanced motor skills

GMFCS level I

Walks with limitations; Limitations in walking outdoors and in the community (duration and surface dependent)

GMFCS level II

Walks using a handheld mobility device; Limitations in walking outdoors and in the community (duration and surface dependent)

GMFCS level III

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

GMFCS level IV

Transported in manual wheel chair; Self mobility is severely limited even with the use of assistive technology

GMFCS level V

Children walk at home, school, outdoors, and in the community. They can climb stairs without the use of a railing. Can perform gross motor skills such as running and jumping, but speed, balance, and coordination are limited

GMFCS level I

Children walk in most settings and climb stairs while holding on to the railing. May experience difficulty walking long distances and balancing on uneven surfaces or in crowded/confined areas. Children only have minimal ability to perform gross motor skills such as running and jumping.

GMFCS level II

Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding on to the railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.

GMFCS level III

Children use methods of mobility that require physical assistance or powered mobility in most settings. They may walk for short distances at home with physical assistance or use powered mobility/body support walker when positioned. At school, outdoors, and in the community children are transported in a manual wheel chair or use powered mobility

GMFCS level IV

Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control arm and leg movements. Child is totally dependent.

GMFCS level V

velocity dependent response to stretch

spasticity

What neuromuscular movement system Dx are seen in CP

Fractionated movement deficit (poor selective control)

What sensory movement system Dx are seen in CP

sensory detection

What MSK movement system Dx are seen in CP

force production

what are the secondary MSK issues seen in CP (3)

• contractures

• muscle weakness

• decreased endurance

what is the overarching goal of PT for children with CP

participation (especially walking)

How does CP occur

damage to the developing brain

Body structure and function of CP (4)

• spasticity

• increased tone

• muscle hypo-extensibility

• decreased selective control

secondary impairments of CP (6)

• muscle weakness

• contractures

• poor alignment

• bony torsion

• hip displacement

• spinal deformity (scoliosis)

How has the prevalence of CP been trending in the last 40 years?

unchanged

Antenatal causes of CP

• infection

• brain malformation

• poor prenatal maternal care

• unknown CNS issues

• genetics

• baby too small/large

Perinatal causes of CP

• placenta vascular issues

• brain insults in premature infant

• ischemic brain injury

• complications from premature birth (breech, preeclampsia, infection, apnea, etc.)

Postnatal causes of CP

• encephalitis/ infection

• cerebral vascular hemorrhage (first 28 days)

• accidents/injuries (MVA, drown)

Diagnosing CP before what age is difficult

2 years