Peds: Neurologic Conditions (CP, SCI and Spina Bifida, Autism and Down Syndrome, TBI and stroke, Brachial Plexus, CF and CHD)

A group of permanent disorders of movement and posture causing activity limitations due to nonprogressive disturbances in the developing fetal or infant brain

Cerebral palsy (CP)

Is the brain lesion in CP progressive?

No, although signs, symptoms, and functional abilities can change as the child ages

When can the brain injury causing CP occur?

Prenatally, during birth, or postnatally up to approximately 2 years of age

What is a major risk factor for CP?

Prematurity, particularly delivery before 37 weeks

What birth weight is associated with increased CP risk?

Less than 2.5 kg (5.5 lb)

What three areas contribute to the diagnosis of CP?

Neurological assessment, neuroimaging, and assessment of posture/movement

What clinical findings may suggest CP?

Failure to reach early motor milestones, abnormal muscle tone, and qualitative differences in movement patterns

What are the 3 major ways CP is classified?

Functional ability

Distribution of motor disability

Type of muscle tone/motor control disorder

What are the major motor-control types of CP?

Spastic, dyskinetic, ataxic, and mixed

Spastic CP is associated with dysfunction in what area?

Motor cortex/cortical sensorimotor areas

What characterizes spastic CP?

Spasticity, exaggerated reflexes, and abnormal patterns of posture and movement

Dyskinetic CP is associated with dysfunction of what structure?

Basal ganglia

What characterizes dyskinetic CP?

Atypical patterns of posture and involuntary, uncontrolled, recurring, and sometimes stereotyped movements

Dystonic: involuntary, sustained or intermittent muscle contraction with repetitive movements and abnormal postures

Athetoid: slow, continuous, twisting movements

Ataxic CP is associated with what area?

Cerebellar lesion/dysfunction

What characterizes ataxia?

Lack of coordination of voluntary movements

What is mixed CP?

Combination of movement disorders, such as spasticity and dyskinesia

Early signs of CP

Early hand dominance

Delayed motor milestones

Persistent primitive reflexes

Scissored legs below 6 mths

Floppiness

Stiffness

What does the GMFCS classify?

A child's gross motor functional abilities

At which GMFCS levels is spasticity generally higher?

Levels IV and V

What does MACS classify?

How a child uses their hands in daily activities

What does CFCS classify?

Communication abilities, including sender/receiver roles, pace, and familiarity of the communication partner

What does EDACS classify?

Eating and drinking ability in individuals with CP

What does VFCS classify?

Visual function

GMFCS Level I

Walks without limitations. Can climb stairs without a railing; running and jumping are possible but speed, balance, and coordination may be limited

GMFCS Level II

Walks in most settings but may need a railing on stairs and have difficulty with uneven surfaces, inclines, crowds, or confined spaces

GMFCS Level III

Walks using a hand-held mobility device in most indoor settings

GMFCS Level IV

Uses mobility methods requiring physical assistance or powered mobility in most settings

GMFCS Level V

The child is transported in a manual wheelchair in all settings

What early findings may occur with spastic diplegia at 3-6 months?

Decreased neck control, stiffness/floppiness, back arching, LE stiffness, and leg crossing

What may be seen after 10 months in infants with spastic diplegia?

Abnormal crawling

Approximately what percentage of children with CP have spastic hemiplegia?

20-30%

What functions are especially affected in spastic hemiplegia?

Hand functions

What LE posture is common with spastic hemiplegia?

Plantarflexion and inversion, often with forefoot adduction → equinovarus

What other problems may accompany spastic hemiplegia?

Sensory abnormalities, seizures, and visual problems

What is associated with spastic quadriplegia?

Severe motor/sensory deficits, cognitive deficits, seizures, and vision problems

What 5 major movement characteristics should be examined in CP?

Muscle tone, muscle strength, skeletal structure/integrity, selective motor control, and postural control

How does CP affect muscle strength?

Children may be unable to generate normal voluntary muscle force or joint torque

Is CP weakness generally greater proximally or distally?

Distally > proximally

What should be prioritized first during the CP examination?

Functional movement assessment of activities important to the child and family

After examining function, what should the PT assess?

Potential body structure/function causes of activity and participation restrictions

What is the major goal of PT for CP?

Improve motor ability for activity and participation at home, school, and in the environment

What oral medications may be used for CP spasticity?

Diazepam, dantrolene, baclofen, and tizanidine

What are other spasticity-management options?

Intrathecal baclofen, Botox injections, and selective dorsal rhizotomy

What are general resistance-training recommendations in the lecture?

1-3 sets × 6-15 reps at 50-85% RM, 2-4×/week on nonconsecutive days