Cerebral Palsy

what is CP?

• group of permanent disorders of the development of movement and posture

• activity limitations attributed to non-progressive disturbances that occurred in the developing fetal or infant brain

what prenatal events that cause CP? prevalence?

• 80%

• cerebral hypoxia

• hypothyroidism

• infections

• diabetes

• chromosome abnormalities

what perinatal events cause CP? prevalence?

• 8%

• asphyxia

• low birth weight

• breech delivery

• placenta abruption

• prolapsed cord

what post natal events cause CP? prevalence?

• 10-14%

• CVA (especially if occurs in first month of life)

• head trauma

• neonatal infection

• brain tumor

how is CP diagnosed?

• MRI recommended to confirm diagnosis

• supported with pre-natal risk factors and developmental delay

• typically diagnosed by neurologist to r/o progressive neuromotor diagnoses

what are clinical findings that lead to diagnosis?

• typically first indicator is not reaching early motor milestones

• atypical muscle tone

• poor qualitative movements in muscle tone

• abnormal primitive reflexes

what type of imaging can be used for diagnosis?

• US

• CT

• MRI

what does an US look for to diagnose CP?

• intraventricular hemorrhage

• periventricular cyst

• periventricular leukomalacia

what is known risk factor for intraventricular hemorrhage?

ventilators

how does a periventricular cyst form?

develop in areas where an acute hemorrhage resolves

what is periventricular leukomalacia?

• white matter injury

• commonly seen in infants born pre-term

when is a fetus most sensitive to insult and injury causing periventricular leukomalacia?

24-34 weeks gestation

how is CT used to diagnose CP?

• helps to identify

  • congenital malformations

  • intracranial hemorrhage

  • periventricular leukomalacia

  • early craniosynostosis

what is craniosynostosis?

cranial sutures fuse too early

how is MRI used to diagnose CP?

• preferred imaging for diagnosis

• defines cortical and white matter structures and abnormalities more clearly

• determines if whether appropriate myelination is present for given age

what prediction tests are used for CP?

• general movement assessment

  • predictor in the first few months of life

• AIMS

  • predictive of CP in later months

• HINE

how is CP classified?

• type of movement disorder

• anatomical location of the child’s impairment

• severity of motor dysfunction

what is the classification based on movement disorder?

• spastic

• hypotonic

• dyskinesia

• ataxic

spastic CP

• most common

• caused by motor cortex or white matter damage

• described by what parts of the body are affected

define lissencephaly

don’t have all the gyri and sulci of the brain (smooth brain)

what is dyskinesia?

• caused by basal ganglia dysfunction

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

types of dyskinesia

• dystonic

• athetosis

• choreoathetoid

define dystonic dyskinesia

• involuntary sustained or intermittent muscle contraction with repetitive movements

• often twisting

• slow or fast

define athetosis dyskinesia

• slow, continuous, writhing movements that prevent stable posture

• abnormal timing

• large motions of the proximal joints

define choreoathetoid dyskinesia

• jerky movements

• common in digits

hypotonic CP

• diminished resting tone

• decreased ability to generate voluntary muscle force

• correlated with congenital abnormality such as lissencephaly

ataxic CP

• damage to cerebellum and/or sensory structures

• inability to generate normal or expected movement trajectories that are not d/t weakness or involuntary muscle activity

• increased oscillations/tremor with increased challenge

• difficulty with carryover

classifications of CP based on location

• monoplegia

• hemiplegia

• diplegia

• quadriplegia

classification models used to classify severity of dysfunction (PT, OT, ST)

• PT

  • Gross Motor Functional Classification Scale (GMFCS)

• OT

  • Manual Ability Classification Scale (MACS)

• ST

  • Communication Function Classification System (CFCS)

what does the GMFCS focus on?

self-initiated movements with emphasis on sitting and walking

age bands for GMFCS

• 2-4 years

• 4-6 years

• 6-12 years

• 12-18 years

level 1 GMFCS

can run and jump, but speed balance and coordination are limited

GMFCS level 2

• walks in most settings

• limited ability for running

• long distances may use w/c

GMFCS level 3

• need handheld device to be mobile

• can climb stairs with railing or assist

• w/c for longer distances, but can sel

GMFCS level 4

• need some form of walker/gait trainer for therapeutic walking

• primarily use powered chair to maintain independence

GMFCS level 5

• limited in any antigravity movement

• need head control strap in w/c

• not able to self propel a power chair