Card Set Information
What is the most common cause of motor impairment in children?
What is cerebral palsy?
Disorder of motor function due to a NON PROGRESSIVE (static) lesion of the developing brain
How do the symptoms compare to the lesion?
Although the lesion is non-progressive, the symptoms EVOLVE as the nervous system develops
What are the 2 areas of motor function that CP affects?
What are the other problems that children with CP suffer from?
Visual impairment from errors of refraction and cortical damage
SAL problems – hearing loss, oro-motor incoordination, LD
Joint contractures, hip subluxation, scoliosis
What are the DEVELOPMENTAL problems in CP – think of the 4 domains
Fine motor and vision
: visual impairment due to refractive error and cortical damage
Hearing, speech, language
Gross motor – spasticity
What are the problems with eyes in CP?
Cortical damage – affecting vision
What are the musculoskeletal problems in CP apart from spasticity?
What is a joint contracture?
High resistance to passive stretch of a muscle
Resulting from fibrosis of the tissue supporting the muscles or joints
How do you divide the causes of CP? And what % each?
What are the antenatal causes of CP?
Cortical migration disorder
Structural maldevelopment of the brain during gestation
: rubella, CMV, toxoplasmosis
What is the main intrapartum cause of CP?
Birth asphyxia – Hypoxic Ischaemic injury
What are the post natal causes of CP?
: HIE, PVL from ischaemia / intraventricular haemorrhage
Hyperbilirubinaemia (kernicterus in basal ganglia – choreoathetoid CP)
: meningitis, encephalitis
What are the early features of CP?
Abnormal limb tone/posture
Delayed motor milestones
Slowing of head growth
Feeding difficulties – oromotor incoordination (slow feeding, gagging, vomiting)
Asymmetric hand function before 12 months of age
What happens to primitive reflexes in normal babies and in CP?
Normally – need to disappear for motor development to progress
CP – may persist and become obligatory
How is the diagnosis of CP made?
Pattern of tone in limbs and trunk
What are the 3 main clinical types of CP?
Where is the damage in spastic cerebral palsy?
UMN (corticospinal tract)
What are the features of spastic CP?
: increased limb tone (clasp knife fashion)
Brisk deep tendon reflexes
Extensor plantar responses
What are the 3 types of spastic CP?
: unilateral involvement of arm and leg (arm>leg), face spared
If an infant has fisting of the hand, a flexed arm and pronated foream, asymmetric reaching and tiptoe walk what type of CP is that?
What may happen initially to the tone in the arms in spastic CP?
Hypotonia and flaccid then becomes spastic later
What can spastic hemiplegia sometimes be caused by?
What are the features of quadriplegia CP?
All 4 limbs affected
Arms > legs
: extensor posturing
Poor head control
Low central tone
Scissoring of the legs – due to excessive adduction
What may there have been a history of in quadriplegic spastic CP?
HIE after birth
What else is quadriplegic spastic CP associated with?
What is deplegia?
Both legs affected – walking is abnormal
Arms may be affected to certain degree
What are the 4 features of ataxic hypotonic CP?
Trunk and limb hypotonia
Delayed motor development
Where is the brain damage in ataxic hypotonic CP?
Cerebellum – so remember all cerebellar signs eg incoordination, intention tremor, ataxic gait
what is dyskinetic CP due to? – where is damage?
Basal ganglia or extra pyramidal pathways
Eg in kernicterus
What is the clinical presentation of dyskinetic CP?
Delayed motor development
Abnormal INVOLUNTARY movements appear later:
Chorea- abrupt, jerky movements
Athetosis – slow writhing continuous movements
Dystonia – sustained abnormal postures
What is the management of CP?
What must be done for parents?
Accurate diagnosis and prognosis
How can increased tone be treated?
Muscle relaxants – diazepam, baclofen
Botulinum toxin injections to specific muscle groups
What gastro problem do CP children get?
What is common presentation to hospital in a child with CP?
Chest infection as they are less mobile, and less able to clear secretions