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Peds Disorder-CP
Cerebral Palsy
| Question | Answer |
|---|---|
| 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
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