Cerebral Palsy Physical Therapy Examination and Management

Comprehensive vocabulary flashcards covering the etiology, pathophysiology, functional classification, examination, and interventions for cerebral palsy.

Cerebral Palsy (CP)

An early-onset lifelong neurodevelopmental condition characterized by activity limitations due to impaired development of movement and posture, manifesting as spasticity, dystonia, choreoathetosis, and/or ataxia resulting from non-degenerative maldevelopment or injury to the fetal or infant brain.

Periventricular Leukomalacia (PVL)

White matter damage in the periventricular region of the brain due to hemorrhagic infarction in premature infants, damaging sensorimotor pathways and the motor homunculus, commonly correlating with spastic diplegia.

Intraventricular Hemorrhage (IVH)

Germinal matrix hemorrhage occurring within the lateral ventricles in premature infants; categorized into four grades, where grades 1 and 2 often resolve without permanent injury, while grades 3 and 4 present the highest risk of CP and brain injury.

Hypoxic-Ischemic Encephalopathy (HIE)

A widespread, typically bilateral brain injury caused by oxygen deprivation affecting both cortical white matter pathways and deep gray matter structures (such as the basal ganglia and thalamus), often resulting in severe motor impairment across the trunk and all four limbs.

Congenital Brain Malformations

Non-degenerative structural alterations of in utero brain tissue development (such as polymicrogyria and schizencephaly) seen predominantly in full-term infants, frequently presenting with microcephaly.

Prechtl Qualitative Assessment for General Movements (GMA)

An observational screening assessment conducted in supine to identify absent or abnormal spontaneous movement patterns, which is highly predictive of cerebral palsy by approximately 3 months post-term age.

Hammersmith Infant Neurological Exam (HINE)

A 26-item clinical evaluation assessing cranial nerve function, movements, reflexes, protective reactions, behavior, and motor milestones, utilizing independent left and right scoring to detect limb asymmetry.

Clinical Red Flags for CP Referral

Key early indicators prompting diagnostic work-up: hand preference before 12 months, lower extremity stiffness at 6 to 12 months, and persistent fisted hands, persistent head lag, or consistent postural asymmetry after 4 months.

Topographic Classification

A clinical classification of CP determined by anatomical limb involvement: Hemiplegia (20-25%), Diplegia (30-35%), Quadriplegia/Tetraplegia (15-20%), and Dyskinetic, Ataxic, or Mixed (20%).

Gross Motor Function Classification System (GMFCS)

A 5-level system categorizing children with cerebral palsy based on self-initiated movement and functional motor performance rather than anatomical distribution.

GMFCS Level I

Children walk without limitations in home, school, outdoors, and community settings and climb stairs without using a railing, but show limitations in speed, balance, coordination, and advanced gross motor tasks.

GMFCS Level II

Children walk in most settings and negotiate stairs holding a railing, but have difficulty walking long distances, on uneven surfaces, or in crowded spaces, with minimal ability to run or jump.

GMFCS Level III

Children walk using a hand-held mobility device in most indoor environments, climb stairs holding a rail with supervision or assistance, and utilize wheeled mobility for long-distance travel.

GMFCS Level IV

Children require physical assistance or powered mobility in most settings, may walk short household distances with body support walkers, and rely on manual wheelchair transport or powered mobility in community settings.

GMFCS Level V

Children experience severe limitations in antigravity head/trunk posture and limb control even with assistive technology, requiring transport in a manual wheelchair across all settings.

Athetoid CP (Neuroimaging Findings)

Atypical neuroimaging findings characterized by high intensity signaling in the globus pallidus (basal ganglia), thalamic nuclei, subthalamic nucleus, substantia nigra, hippocampus, and hypothalamus.

Ataxic CP (Neuroimaging Findings)

Atypical neuroimaging findings characterized by cerebellar volume loss, hypoplasia, or cerebellar infarcts.

Disorganized Muscle Recruitment (Postural Control)

A motor control deficit seen in CP where postural muscles are recruited in an atypical top-down (cranial-to-caudal) sequence instead of the normal bottom-up (caudal-to-cranial) sequence, accompanied by excessive antagonist co-activation.

Sarcopenia (in Cerebral Palsy)

A condition characterized by accelerated loss of muscle mass, diminished strength, and reduced muscle performance occurring prematurely before adulthood in CP, eliminating functional strength reserves.

Galeazzi Test

A musculoskeletal screening test performed in supine with hips and knees flexed to screen for unilateral hip dislocation or congenital shortening of the femur by evaluating knee height.

Selective Control Assessment of the Lower Extremity (SCALE)

A standardized physical therapy clinical tool that grades selective voluntary motor control (SVMC) at individual joints of the lower extremities in patients with spastic CP.

Popliteal Angle Test

A clinical examination measuring distal hamstring muscle length, executed in supine with the test hip flexed to $90^\circ$ while the contralateral limb rests extended flat on the table.

Thomas Test

A clinical examination assessing hip flexor contracture; considered negative when at least $10^\circ$ of hip extension is obtained while the contralateral lower limb is flexed to $>80^\circ$.

Ryder's Test

A musculoskeletal assessment performed in prone or sitting to quantify femoral torsion or version by palpating the greater trochanter during hip rotation (also known as Craig's Test or Trochanteric Prominence Angle Test).

High Velocity Training

A strength training method consisting of resistance exercises performed at increasingly faster speeds to improve movement velocity, muscular power, and walking capacity in ambulatory individuals with CP.

Motor Capacity vs. Motor Performance

Capacity refers to an individual's maximal ability to execute a task within a controlled environment, whereas performance describes the actual execution of tasks within real-world, everyday contextual settings.

GMFM-66 Motor Growth Curves

Prognostic trajectory curves demonstrating that children with CP attain roughly 90% of their gross motor potential in early childhood: Level I at 4.8 years, Level II at 4.4, Level III at 3.7, Level IV at 3.5, and Level V at 2.7 years.

Single-Event Multilevel Surgery (SEMLS)

An orthopedic surgical strategy where multiple operative procedures are performed at two or more anatomical levels simultaneously during a single operation to reduce repeated surgeries.

Botulinum Toxin A (Botox)

An injected pharmacological agent that reduces focal spasticity by blocking acetylcholine release at the neuromuscular junction, temporarily decreasing involuntary muscular contraction.

Selective Dorsal Rhizotomy (SDR)

A neurosurgical procedure involving selective deafferentation of sensory rootlets at L1-S2 to diminish reflex hyperreflexia and spasticity, typically indicated for children aged 3 to 8 years in GMFCS levels I-III with spastic diplegia.

Intrathecal Baclofen (ITB) Pump

A surgically implanted continuous delivery system infusing baclofen directly into the spinal subarachnoid space to act on dorsal horn receptors, most effective for lower extremity spasticity and generalized dystonia.

Thigh-Foot Angle Test

A pediatric orthopedic examination executed in prone or sitting to measure the degree of tibial torsion by comparing the foot axis to the longitudinal thigh axis.