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Peds Disorder-CP

Cerebral Palsy

QuestionAnswer
Cerebral Palsy non-progressive damage to the CNS during prenatal, birth or postnatal periods
What is involved in CP wide variety of motor & cognitive dysfunction depending on the extent of involvement
What is the tone like in CP initially hypotonic w/decreased head & trunk control (DON'T confuse increased tone w/strength)
When are children referred to therapy 12 months of age due to missed milestones
What does the PT determine for CP abnormal motor patterns to inhibit & normal patterns that should be facilitated/practiced
What pattern of movement due children usually develop for compensatory extensor tone to achieve movement & sustain positions
What do abnormal movement patterns over time create deformities of the soft tissue
Soft tissue deformities result in bony changes, skeletal deformities & dislocations
When should intense treatment be started as early as 4-6 months of age or earlier if identified with delays out of the NICU
What therapies should be involved both school/early intervention & medical based
What does CNS have plasticity to change movement patterns
What are types of CP (named by motor impairment) hypotonicity, hypertonicity, fluctuating
What is CP hypertonicity spastic-most common type, indicates a fixed lesion in the motor portion of the cerebral cortex & Rigidity-severe decerebrate lesion
What is CP fluctuating moving all the time (athetosis/athetoid-involvement w/basal ganglia & diff w/midline movements) & Ataxia/ataxic-cerebellar lesion (diff w/distal movements, balance & coordination) Wide BOS
Types of CP (classified by body involvement) monoplegia, diplegia, paraplegia, hemiplegia, quadriplegia
Monoplegia involvement of only one extremity
diplegia BLE involvement w/mild UE involvement (most common presentation)
paraplegia only BLE involvement
Hemiplegia UE & LE involvement on same side
Quadriplegia equal involvement of BUE's & BLE's
Types of CP (classified by degree of severity) Gross Motor Function Classification System (level I, II, III, IV, V)
Physiologic Differences w/CP Decreased: size of muscle fibers, number of motor units, firing frequency, changes in recruitment order of motor units
Ricks Factors for Developing CP Intraventricular Hemorrhage (IVH), Periventricular Leukomalacia (PVL), Encephalopothy (hypoxia/anoxia) & Malformation of the CNS
Intraventricular Hemorrhage (IVH) bleeding into germinal lateral ventricles, increasing severity grade I-IV & increased risk for CO w/greater severity of bleed
Periventricular Leukomalacia (PVL) softening/death of the white matter, affects descending motor tracts, cystic type=more likely to have UE?LE spasticity
Encephalophy (hypoxia/anoxia) brain infection or swelling
Medical Treatments muscle relaxants, botox, selective dorsal rhizotomy & baclofen pump
Muscle relaxants (oral) diazepam, dantrium, baclofen
Botox injection into the dominant spastic muscle to cause temporary paralysis (lasts 3-6 months)
Selective Dorsal Rhizaotomy invasive surgery, cut sensory roots (gallbladder area)
Baclofen pump continuous intrathecal (under the skin) infusion directly into the spinal cord (most commonly used)
CP Assessment/Treatment Postural control & tone, musculoskeletal, neuromuscular, gross motor skills/functional mobility & orthotics/equipment
Created by: jklincoln