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