Cerebral Palsy (CP)

CP: Movement Disorders-Spastic

• Hypertonic

• Stiffness when trying to move

• Limited ROM

• AREAS OF THE BODY AFFECTED:

  • Monoplegia: One extremity (arm or leg)

  • Diaplegia: Legs! (No arms)

  • Hemiplegia: One side (UE & LE)

  • Quadriplegia: All extremities

  • Tetraplegia: All extremities & head/neck

CP: Movement Disorders- Dyskinetic

• Excessive, unintentional & abnormal movement

  • Movement Patterns:

    • Athetoid: SLOW, WRITHING w/abrupt jerky. Tone fluctuates from low to abnormal (NO SPASTICITY)

    • Choreoathetoid: Random, UNPREDECTABLE jerky, Involuntary movements triggered by movement (action)

    • Dystonic: STEREOTYPED, predictable twisted postures that are absent at rest and triggered by movement (action)

CP: Movement Disorders-Ataxic

• Poor balance and coordination

• Clumsy

• Involuntary tremors

• Postural instability

• Increased Falls

CP: Movement Disorders- Mixed

• Combination of HIGH and LOW muscle Tone

CP Impairments to KNOW-PRIMARY

• Muscle weakness: HYPOTONICITY

• Muscle tightness: HYPERTONICITY

• Involuntary movements

• Impaired sensation in affected limbs

• Abnormal tone in face

• Weakness of eye muscles

• Possible seizure disorder

CP Impairments to KNOW-SECONDARY

• Contractures, bone deformities, and joint dislocations

• Poor, unsteady gait

• Bladder/bowel control difficulties

• Visual, hearing, or speech impairments

• Intellectual disabilities

• Problems w/breathing due trunk weakness

• Skin integrity

• Feeding, eating, swallowing difficulties

UPPER VS LOWER MOTOR NEURONS

• UMN: Brain and Spinal cord

  • Injury to UMN results in tone, spasticity, involuntary movements

• LMN: Branch out from spinal cord (Carry messages to the muscles)

  • Flaccidity

MNEMONIC To help remember all we can do for CP

“Kids with CP appreaciate their moms so much they all get a mom tatto- CP MOM TAT”

• Constraint- Induced Movement Therapy

• Positioning

• Modalities

• Orthoses

• Medical

• Tone

• Adaptive Equipment

• Taping- Can be part of positioning

CP Assessment

• Occupational Profile

• Structural clinical observations of occupational performance

• Functional cognition

• Task/ activity analysis

• Assessment measures:

  • Cerebral Palsy Quality of Life (CP QOL) Child: 4-12 YO

  • Cerebral Palsy Quality of Life (CP QOL) Teen: 12-18 YO

CP: GROSS MOTOR CLASSIFICATION SYSTEM

• LEVEL I: Walks w/o limitations. Gross motor skills may be impaired

• LEVEL II: Walks w/ limitations

• LEVEL III: Walks using hand-held mobility device or AD (w/c for longer distances)

• LEVEL IV: Self-mobility is limited. Relies primary on power mobility or assistance of caregivers

• LEVEL V: Dependent for mobility. Transported in w/c

CP: MANUAL ABILITY CLASSIFICATION SYSTEM

• LEVEL I: Independent with ADL, handles objects easily and successfully, limitations in speed and accuracy

• LEVEL II: Handles MOST objects w/ SOME difficulty with REDUCED quality/speed. STILL INDEPENDENT with ADLS

• LEVEL III: Handles objects w/ DIFFICULTY needing modification

• LEVEL IV: Handles limited selection of easily managed objects IN ADAPTED SITUATIONS. Requires continuous support and assistance and/or adaptive equipments

• LEVEL V: Requires TOTAL ASSISTANCE. Dosn’t handle objects and severely limited ability to perform

CP: COMMUNICATION FUNCTION CLASSIFICATION SYSTEM

• LEVEL I: Effective sender/receiver w/ familiar and unfamiliar partners

• LEVEL II: Effective but SLOW sender w/ familiar and unfamiliar partners

• LEVEL III: Effective sender/ receiver w/ FAMILIAR PARTNERS ONLY

• LEVEL IV: INCONSISTENT Sender and/or receiver with familiar partners

• LEVEL V: SELDOM effective sender AND receiver even w/ familiar partners

CP: EATING & DRINKING ABILITY CLASSIFICATION SYSTEM

• LEVEL I: Eats and drinks safely and efficiently

• LEVEL II: Eats and drinks safely but w/ SOME LIMITATIONS TO EFFICIENCY

• LEVEL III: Eats and drinks w/ SOME LIMITATIONS TO SAFETY AND EFFICIENCY

• LEVEL IV: East and drinks w/SIGNIFICANT LIMITATIONS FOR SAFETY

• LEVEL V: UNABLE TO EAT AND DRINK SAFELY, tube feeding may be considerate to provide nutrition

INTERVENTION: POSITIONING

• Hypotonia:

  • Poor head control: reclined bath chair w/ seat belt for support

  • Writing task: Slant board and foot support in sitting

• Hypertonia:

  • Extensor flexor: sustained flexion of the trunk, slow trunk rotation in sitting, and knee flexion in Quadruped

INTERVENTION: Orthotics, Splints & Casting

• Prevent joint contractures

  • Serial static splints/cast: reduce tightness and spasticity

    • Continuously for 6+

• Improved hand function

  • Isolate fingers or support wrist

• Educate

  • Purpose and goals

  • Instructions for donning/doffing and cleaning

  • Wearing schedule

  • Skin integrity checkups

INTERVENTION: Constraint-Induced Movement Therapy (CIMT)

• Good for HEMIPLEGIA

• Restrictive use of the unaffected/strong UE

• Intensive, repetitive practice of motor activities

• Up to 6 hours per day, for 2 to 4 weeks

• Use of mitts, casts, splints, and slings

INTERVENTION: Bimanual Therapy

• Repetitive practice using BOTH HANDS

• More than 30 hours/week of intensity

• Transfer items between hands, remove or put on clothing, or carry, or move toys

INTERVENTION: TONE- Handling and NDT

• NDT: Hands-on

• HYPOTONICITY: Facilitation

• HYPERTONIC: Inhibition

INTERVENTION: Adaptive equipment

• Apative/built up utensils : limited grasping patterns

• Non-skid material (Dycem): Control child plates on tabletop

• Large zipper pull: poor motor coordination

INTERVENTION: MODALITIES

• Electrical Stimulation

• HOT: Increase ROM, reduce spasticity, pain reduction

• COLD: pain reduction

Refer to state for regulations!

INTERVENTION: MEDICAL

• Physician prescribed

  • Pharmaceutics:

    • Baclofen

    • Botox

  • Orthopedic surgeries: Tendon transfer, muscle release, osteitomies

    • Immobilization > Early (CONTROLLED) movement > strength & function

INTERVENTION: Taping/Strapping- Major functions of KT

• Support weakened muscles

• Improved circulation

• Reduced pain

• Improve joint alignment

INTERVENTION: TAPING/STRAPPING- Types of KT

• Rigid Tape: Limits movement, stabilizes and provides support

• Flexible, elastic tape: Encourages movement

TEST THE CHILD SKIN FIRST! To check for negative reactions by applying a small “test strip”