Cerebral Palsy

Cerebral Palsy

• complex, heterogenous condition that primarily impacts motor function

• can occur at different times during development

  • prenatal (before birth)

  • perinatal (around birth)

  • postnatal

• brain-based, non progressive, permanent condition

  • variability in severity

Features of CP

• motor impairment with accompanying disorders of sensory function, cognition, speech, and sometimes seizures

• disorder in sensorimotor development that is manifested by

  • abnormal muscle tone

  • stereotypical patterns of movement

Causes of CP

• the primary cause is NOT BIRTH COMPLICATIONS

• most are congenital

• risk factors

  • low birth weight

  • premature birth

  • postpartum impact of prematurity/low birth weight

  • maternal infection or infant infection

  • fetal stroke

  • gene mutations

  • TBI

Hypertonicity

muscles are more resistive to sudden, passive movement

• 80% of CP cases have this

Contractures

permanent shortening of a muscle or joint and deformities

Spastic Hemiplegia

involves one entire side of the body, including the head, neck, and trunk

Spastic Diplegia

involves both lower extremities, with mild incoordination, tremors, or less severe spasticity in the upper extremities

Spastic quadriplegia

impacts all limbs symmetricaly

• typically flexor pattern in UE’s and extensor pattern in LE’s

• still may be greater in one area vs. another

Athetosis

slow, writhing, involuntary movements of the face and extremities or the proximal parts of the limbs and trunk

• increases with emotional tension and are not present during sleep

Ataxia

unsteadiness and difficulties with balance, particularly with ambulating

• walk faster to compensate for lack of stability and control

• controlled movements clumsy

Hypotonicity

• low tone, floppy

Mixed

• both low and high tone

Diagnosis

• no definitive test

• usually occurs when motor milestones are not met in infancy and preschool years

• rarely diagnosed at birth-usually takes time to notice symptoms

Differential diagnosis

• types of movement patterns observed in child

• atypical or stereotypical movements

• rules out other diagnoses such as MD

• genetic testing

• MRI, CT: evidence of lesions in the brain

Course and Prognosis

• varies depending on type, severity, and presence of associated problems

• secondary problems occur with severe form

  • contractures

  • musculoskeletal deformities

  • arthritis

• survival is deemed to be good, but lower than general population

• adults with CP are more likely to die from respiratory complications

Motor symptoms

• reflex abnormalities

  • hyperreflexia: overactive reflex response to stimulus

  • clonus: involuntary rhythmic muscle contractions

  • enhanced stretch reflex

  • overflow: extraneous movements

Delayed motor development

• failure to achieve motor milestones

Atypical Motor performance

asymmetrical hand use, unusual crawling or gait, uncoordinated reach, tremors, rigid muscles, oral-motor difficulties

Medical/Surgical Management

• reduce spasticity

  • botox

  • baclofen

  • intrathecal baclofen pump

  • surgical tendon lengthening and tendon transfers

• prevent contractures/increase ROM

  • splinting

  • orthotics

  • positioning

• neurology to address seizures

• ophthalmologist to address visual challenges

• ENT & audiology: hearing