Cerebral Palsy

Cerebral Palsy

permanent and non-progressive disorder

primarily impacts motor function

characterized as a developmental disability

Pyramidal

spastic 70-80% of all forms of CP (increased muscle tone, stiff)

classified by paresis (weakness) or plegia (paralysis)

Extrapyramidal

the aspect of the CNS that allows for modulation of muscle tone, posture, and movement

dyskinetic, ataxia, mixed

Pyramidal: Monoplegia

affects one limb (usually an arm)

rare; typically impacts hands or feet

fingers may curl towards the body

Pyramidal: Hemiplegia

affects one side of the body (arm, leg, and trunk)

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

asymmetrical hand use

Pyramidal: Diplegia

affects symmetrical parts of the body (legs or arms)

involves both LE’s

Pyramidal: Quadriplegia

affects on all four limbs

impacts all limbs symmetrically

more likely to have cognitive impairments

Extrapyramidal: Dyskinetic

involuntary and uncontrolled movement (athetosis)

Extrapyramidal: Ataxia

unsteadiness; difficulty with balance

controlled movements challenging

Extrapyramidal: Mixed

common; diffuse brain damage

dystonia with spasticity

Functional Classification of CP

Gross Motor Functional Classification System (GMFCS)

GMFCS: One

can perform gross motor skills

balance and coordination limited

GMFCS: Two

may walk with physical assistance

minimal ability to perform gross motor skills such as running

GMFCS: Three

mobility device needed

can climb stairs with physical assistance

GMFCS: Four

physical assistance or powered mobility needed

GMFCS: Five

transported in a manual wheelchair in all settings

poor head and trunk control

Etiology of CP

only small percentage of cases are the result of birth complications

85-90% of cases occur in utero

presence of risk factors does not equate to a diagnosis; strongest risk factor is prematurity and low birth weight

Signs and symptoms of all forms of CP

abnormal muscle tone, reflex/posture abnormalities, delayed motor development, atypical motor performance

Associated disorders: Cognitive Impairment

most significant impact; more common in severe cases; may be masked

Associated disorders: Orthopedic conditions

due to spasticity → contractures

hip displacement and dislocation are primary concern

scolosis

What are other associated disorders with CP?

seizure disorder

visual impairments (nystagmus/strabismus)

oral motor/communication (dysphagia/dysarthria)

GI (GERD and constipation)

pulmonary (aspiration PNA)

Diagnosis

typically between 12-24 months

developmental screening is critical; failure to meet milestones

also screen for cognitive, visual, and hearing impairments due to high incidence of associated conditions

CP: Course Prognosis

the survival rate is lower than the general population

higher in more severe cases, risk of respiratory dysfunction

Medical and Surgical Management: Pharmacologic

diazepam, dantrolene, baclofen, and botox (severe spasticity)

decreases spasticity/dystonia

Medical and Surgical Management: Surgery

joint fusions, tendon lengthening, tendon transfers

Medical and Surgical Management: Rehabilitation

reduce negative effects of abnormal movement

improve functional use of arms, hands, legs

develop independence in occupations

CP’s effect on occupational performance

virtually all body functions, impacted; consider associated disorders and impact