Cerebral Palsy

What is Cerebral Palsy

A group of permanent disorders of movement and posture causing activity limitations, attributed to non-progressive disturbances in the developing fetal or infant brain.

what are 3 key characteristics of cerebral palsy

permanent, non-progressive, appears early in life

What other areas can be affected in cerebral palsy

sensation, perception, cognition, communication, and behavior

what percentage of people with cerebral palsy have accompanying seizures and some intellectual disabilities

35-50%

what are some additional difficulties associated with cerebral palsy?

feeding/swallowing, bladder control, vision, speech, and dental problems

What are the 3 main physical characteristics of cerebral palsy?

Muscle weakness, balance issues, and gait issues

what contributes to muscle weakness in cerebral palsy

Reduced central nervous system activation, reduced ability to regulate motor-unit activation frequency, and deficits in synergist/antagonist balance.

what muscle characteristics contribute to weakness

smaller muscles, smaller muscle fibers, fewer sarcomeres, less optimal myosin-actin overlap, and decreases elasticity.

what contributes to excessive sway during balance exercises?

weak spastic muscles and abnormal sequencing of muscles involved in balance

what spinal deformaties may contribute to balance problems

kyphosis and scoliosis

what are common gait characteristics of cerebral palsy?

increases hip/knee flexion, increased ankle equinus, hindfoot valgus, toe flexion, increased cadence, and increased movement in all planes

what does increased ankle equinus lead to

toe walking

what causes about 90% of cerebral palsy cases

noxious events that cause damage to the brain

what are typical causes before 20 weeks?

hemorrhage and leuokmalcia, which can cause with matter damage

what are typical causes during the 3rd trimester/neonatal period

hypoxia and ischemia, which can cause gray matter damage

what accounts for about 10% of cerebral palsy cases

imporoper brain development during the 1st and or. 2nd trimester,

what are important prenatal risk factors?

prematurity/low birth wirght, hyperbilirubinemia, trauma during birth, intracranial hemorrhage, and infection of the fetus or mother

what is the most significant prenatal risk factor listed?

prematurity and low birth weight

What are postnatal risk factors, and how long can they occur?

They can occur up to 2 years of age and include meningitis, traumatic brain injury, anoxia, cerebrovascular accidents, tumors, surgical complications, toxins, and hyperbilirubinemia.

How common is cerebral palsy?

About 2–5 infants per 1,000 births.

How does prevalence differ by gestational age?

Highest in infants under 28 weeks and lowest in infants over 36 weeks.

What is the prevalence difference between boys and girls?

higher in boys with a ratioo of 1.4:1

What percentage of children with cerebral palsy develop the ability to walk?

70%

What percentage survive to adulthood?

90%

What additional issues can adults with cerebral palsy experience?

Cervical disc degeneration, decreased bone mineral density, poor joint alignment, fatigue, and pain.

What percentage of adults with cerebral palsy have reduced ability to perform activities of daily living?

35%.

By what age do 75% discontinue ambulation?

By age 25.

What are the 4 ways cerebral palsy can be classified?

Physiological, clinical presentation, anatomical, and functional.

What are the physiological classifications?

• Pyramidal: cerebral cortex

• Extrapyramidal: basal ganglia/thalamus

• Mixed: combination

What is spasticity?

A velocity-dependent increase in resistance to passive movement.

What is dyskinesia?

Involuntary contractions resulting in atypical postures.

What are the 3 types of dyskinesia listed?

• Athetosis: slow, continuous, repetitive torsions

• Chorea: sudden, short, irregular movements

• Dystonia: intermittent contractions following a pattern

What is ataxia?

Loss of full control of body movements.

What are the anatomical classifications?

• Monoplegia: one limb

• Diplegia: both arms or both legs

• Hemiplegia: one side of the body

• Triplegia: three limbs

• Tetraplegia: all four limbs

What does the Gross Motor Function Measure (GMFM) assess?

Changes in functional abilities over time.

What are the 5 GMFM dimensions?

• Lying and rolling

• Sitting

• Crawling and kneeling

• Standing

• Walking, running, and jumping

What do GMFM Levels I–V represent?

• 
  

• I: Walks without support

• II: Walks with some support; minimal running/jumping

• III: Uses assistive mobility devices

• IV: Ambulation severely limited; wheelchair most of the time

• V: Severe physical impairments restricting voluntary movement

What happens to cardiovascular and metabolic responses at a given submaximal workload in people with CP?

They are higher, including heart rate, blood pressure, and lactate concentrations.

How are peak physiological responses affected?

They are generally 10–20% lower, with reduced mechanical efficiency and physical work capacity.

What can happen to physical work capacity?

It can be 50% lower.

Why are peak physiological responses lower in cerebral palsy?

Increased local muscle fatigue, high muscle tone, involuntary movements, high muscle coactivation, poor exercise habits, weakness/reduced muscle mass, lower breathing efficiency, and a greater ratio of type I to type II muscle fibers.

What happens to energy expenditure during submaximal exercise because of high muscle coactivation?

Energy expenditure increases.

Why is anaerobic exercise negatively impacted?

People with CP have an increased ratio of type I to type II muscle fibers.

What are the aerobic training recommendations listed for people with CP?

Walking/running, 2–4 times/week, at 60–75% HRpeak or 50% VO₂peak, with sessions over 30 minutes per week.

What improvement in aerobic capacity can exercise training produce

About 15–40%.

What can 9 months of aerobic exercise, 4 times/week for 45 minutes/session improve?

Peak aerobic power by 32%.

What are the main cardiorespiratory exercise-testing options?

Wheelchair ergometry, arm ergometry, leg cycle ergometry, and treadmill testing.

What are useful tests for musculoskeletal fitness?

Repetition maximum testing and handheld dynamometry.

What does handheld dynamometry measure well?

Isometric muscle strength.

What does the sit-and-reach test assess?

Low back and hip flexibility.

What does the Apley's Scratch test assess?

Shoulder flexibility.

what are aerobic exercise intensity recommendations for severe vs. less severe CP?

• Severe: 40–50% heart rate reserve or VO₂ reserve

• Less severe: 50–80% heart rate reserve or VO₂ reserve

What do anti-seizure medications do, and what is a major risk?

They suppress rapid, excessive neuron firing; a major risk is central nervous system depression.

What do antispasmodic medications do?

They decrease muscle tone, but they act systematically and may cause drowsiness and lethargy.

What is the purpose of orthopedic surgery?

To correct muscle/joint contractures and torsional deformities in long bones.

What does Botulinum Toxin A do?

Reduces spasticity by paralyzing the muscle and preventing acetylcholine release.

speech impairment shouldnt be confused with

cognitive disability?