Cerebral Palsy

speech, language, & swallowing impairments

- Difficulty coordinating breathing & swallowing for speech production - Dysarthria - Aphasias - Dysphagia

communication function classification system (CFCS)

- classify everyday communication performance - 5 levels - usual performance in most settings (not best or worse) - all methods of communication accepted - designed for CP but useful w/ any disability

spastic hemiplegia

- commonly caused by cerebral artery infarct - greater involvement on one side of the body - challenges w/ symmetrical posture & movement behaviors

acquired CP causes

- infection (ie: meningitis) - injury (ie: TBI) - CVA

congenital CP risk factors

- low birth weight - premature birth - multiple birth - infection during pregnancy - jaundice - maternal medical complication - birth complications

spastic diplegia

- often caused by hypoxia - involves primarily the trunk & LEs; UEs generally also involved but to a lesser degree

CP prognosis depends on....

1. severity 2. early detection 3. treatment

Gross Motor Function Classification System (GMFCS)

5 levels of classification based on the child's functional abilities & need for OT (NOT quality of movement)

b. Casting

According to Novak and colleagues (2013), which of the following interventions for CP is best supported by evidence? a. Electrical stimulation b. Casting c. Behavior therapy d. Sensory integration

postural

All types of CP result in impairments in _______________ muscle tone

d. Mixed

Damage to multiple areas of the brain will likely contribute to which type of CP? a. Spastic b. Ataxic c. Athetoid d. Mixed

EDACS level 1

Eats and drinks safely and efficiently

EDACS level 2

Eats and drinks safely but with some limitations to efficiency (eating/drinking will take longer)

EDACS level 3

Eats and drinks with some limitations to safety; there may be limitations to efficiency (need more food textures to be modified in order to reduce risk of choking)

CFCS level 2

Effective but slower paced sender and/or receiver with unfamiliar and/or familiar partners

other impairments

Failure to thrive, inadequate nutritional intake, respiratory complications, orthopedic consequences - deformities & contractures

c. Level III

Fatima is an 8-year-old with spastic cerebral palsy with her left side more affected than her right. She wears a wrist cock-up splint on her left hand throughout the school day to maintain her hand in a functional position. She is able to manipulate most school materials but does this slowly and with limitations. She requires an adult or peer to setup material just the right way before she can use them at all. Using the MACS, indicate the level that describes Fatima's upper extremity motor functioning. a. Level I b. Level II c. Level III d. Level IV e. Level V

severity

Historically: mild, moderate, severe (too subjective)

CFCS level 4

Inconsistent sender and/or receiver with familiar partners

b. Level II

Joey is a ten-year-old with CP. While he gets ready for school, he is able to brush his teeth independently but it takes him a little longer than it takes his younger brother. Joey often skips combing his hair because it takes him too long and he finds it difficult to manipulate the comb. He can feed himself breakfast but uses an adapted spoon to help him maintain his grip. Using MACS, what level BEST describes Joey's motor ability? a. Level I b. Level II c. Level III d. Level IV e. Level V

c. Athetoid

Lenny is one year old with CP who presents with fluctuating muscle tone and involuntary writhing motions of his feet. He also has oral and motor involvement. What type of CP is Lenny diagnosed with? a. Spastic b. Ataxic c. Athetoid d. Mixed

c. Reflex-hierarchic

MNRI is an intervention utilizing which of the following practice models? a. Sensory-integration b. Motor control and motor learning c. Reflex-hierarchic d. Dynamic systems theory

d. Level IV

Natalie is an 8-year-old girl with a motor disability. She is positioned most of the school day in her wheelchair, which has been adapted for one arm propulsion. She is able to join her classmates on the floor during circle time with reminders to position her legs in side sitting. Natalie is able to scoot on floor to return to her wheelchair, but requires physical assistance to get to standing and transfer into the chair. Using the GMFCS, which level BEST describes Natalie's motor ability. a. Level I b. Level II c. Level III d. Level IV e. Level V

a. Cerebral cortex

SPASTIC cerebral palsy is generally caused by damage to which part of the brain? a. Cerebral cortex b. Basal ganglia c. Cerebellum d. None of the above

visual impairments

Strabismus, Trouble with eye tracking, Visual field deficits, Nystagmus, & Refractive errors

false - congenital is more common

T/F: Acquired CP is more common than congenital CP.

true

T/F: Athetosis is made worse by attempts to move.

false - it is a static condition with no cure

T/F: CP is a progressive condition with no cure.

false - nonprogressive, but abilities may deteriorate overtime due to secondary complications

T/F: CP is a progressive disorder.

false - looks at a child using one or both hands, not each hand separately

T/F: MACS looks at a child using each hand separately.

true

T/F: Severity & presentation of CP varies greatly across children, however remain stable within each child

true

T/F: The motor impairments of CP are often accompanied by impairments of sensation, perception, cognition, communication, behavior, epilepsy, & secondary impairments.

a. Fitness, function, fun, family actions, friendships, and future

The F-words in child disability describe a framework to influence how people view disability. The factors that are important to all children's development as described in this framework include the following a. Fitness, function, fun, family actions, friendships, and future b. Fitness, function, fun, family actions, friendships, and feedback c. Fitness, function, fun, frustration, friendships, and future d. Feelings, function, fun, family actions, friendships, and future

quadriplegic

Those with mixed CP are typically _______________________.

EDACS level 5

Unable to eat or drink safely -- tube feeding may be considered to provide nutrition

c. Cerebral palsy

What is the most common motor disability in children? a. Muscular dystrophy b. Angelman syndrome c. Cerebral palsy d. Genetic disorder

c. Spastic cerebral palsy occurs due to damage in the basal ganglia.

Which of the following is FALSE about CP? a. Someone with spastic hemiplegia may have weakness in all 4 limbs. b. Ataxia is characterized by poor coordination and balance. c. Spastic cerebral palsy occurs due to damage in the basal ganglia. d. An individual with dyskinetic athetosis would show slow, involuntary, writhing movements.

c. Difficulty navigating a room in the dark

Which of the following is NOT a common functional issue associated with nystagmus? a. Difficulty with balance b. Reduced target accuracy when reaching c. Difficulty navigating a room in the dark d. Compensatory head movements

b. The prevalence rate of CP has remained stable since the 1950s.

Which of the following is TRUE about CP? a. An individual with CP will also have a cognitive impairment. b. The prevalence rate of CP has remained stable since the 1950s. c. A difficulty with bowel and bladder control is a primary impairment in individuals with CP. d. Trauma after birth is a prenatal cause of CP.

a. An individual with a level 5 classification would have trouble handling objects independently and performing simple actions.

Which of the following is TRUE about the MACS a. An individual with a level 5 classification would have trouble handling objects independently and performing simple actions. b. The test is highly reliable for all ages of individuals with CP. c. An individual with a level 1 classification would need adaptations to handle objects successfully. d. Both level II and level III classifications indicate a need for assistive devices to walk.

c. The severity of CP is unrelated to the severity of a potential cognitive deficit

Which of the following is TRUE of CP and cognitive deficits? a. Individuals with CP also have an intellectual disability b. Cognitive deficits are more common when the individual has concurrent epilepsy c. The severity of CP is unrelated to the severity of a potential cognitive deficit d. Lesions affecting the temporal lobe affects attention and judgmen

c. SIPT- Sensory Integration and Praxis Test

Which of the following is not an assessment commonly used for CP? a. PEDI- Pediatric Evaluation of Disability Inventory b. QUEST- Quality of Upper Extremity Skills Test c. SIPT- Sensory Integration and Praxis Test d. DisDAT- Disability Distress Assessment Too

d. All of the above

Which of the following is/are true about the possible cause of motor disabilities in children? a. Genetic condition b. Environmental causes c. Accident or trauma d. All of the above

c. Impairments in postural muscle tone

Which of the following symptoms is found in all types of CP? a. Hypertonia b. Asymmetrical writhing movements c. Impairments in postural muscle tone d. Cognitive deficits

d. A and B

Which statement are correct about motor disabilities in children? a. Can be static conditions, do not get worse over time b. Can be progressive conditions, gets worse over time c. Always improves with intervention d. A and B

b. Diplegia

Which term BEST describes a child with cerebral palsy who shows spasticity that affects the legs more than the arms? a. Hemiplegia b. Diplegia c. Quadriplegia d. Dystonia

ataxic

__________ CP is often seen in conjunction w/ spasticity & athetosis because the Cb's inputs & outputs are connected to the motor cortex & BS

ataxic

______________ CP is the least common type.

spastic

_______________ CP is the most common type.

cerebral palsy

a form of brain damage that occurs in children before, during, or shortly after birth; a group of permanent disorders of the development of movement & posture, that are attributed to non progressive disturbances that occurred early in development.

nystagmus

a reflex response of the eyes to movement of the head

types of dyskinetic CP

athetosis, chorea, & dystonia

ataxic CP

cerebellar origin - involved muscle stiffness, motor timing & sequencing, coordination, & force gradation - Hypotonia - Uncoordinated/jerky movements; difficulty targeting movements - Poor balance - Shifts in muscle tone, typically quadriplegic distribution - Able to direct voluntary movement but clumsily - Involuntary tremor - proximal hypotonicity is common

severe spasticity

child moves slowly & with great effort movement in mass patterns & difficulty isolating movement -- poor control of voluntary movement

Manual Ability Classification System (MACS)

classification system for children with CP which describes 5 levels of handling objects placed within easy reach and everyday functional task; looks at the child's typical performance, not max capacity

epilepsy

cognitive impairments are more likely when CP is associated with __________________

mixed CP

combination of high & low muscle tone problems - When there is more than one motor type, usually one will appear more dominant

acquired

congenital or acquired CP? Brain injury happened day 28 to 1 year of age

congenital

congenital or acquired CP? Brain injury happened before or during birth

athetosis

continuous stream of slow, writhing movements typically of hands & feet -- combo with abrupt, irregular, jerky movements - May be present at rest - Fluctuation of muscle tone from low to normal w/ little or no spasticity & poor coactivation of muscle flexors & extensors

sensorineural hearing loss

damage to neural receptors of inner ear - poor balance & dizziness

conductive hearing loss

damage to the structures of outer/middle ear

eating & drinking ability classification system (EDACS)

describes 5 distinct levels of eating & drinking ability using the key features of safety and efficiency

Strabismus

deviation of the alignment of 1 eye in relation to the other eye

CP diagnosis

diagnosed clinically based on history & physical exam findings - delays in motor development (from 1wk to 36 months) - physical exam: hyperreflexia, persistent primitive reflexes (Babinski, startle, atonic neck reflex), and/or tonal abnormalities (hypo/hypertonicity) - MRI, CT, EEG, EMG - gross motor function classification system (GMFCS) & pediatric evaluation of disability inventory(PEDI)

Dysarthria

difficulty articulating words

hemiplegia

difficulty primarily on one side of the body

dysphagia

difficulty with swallowing which may impact ability to eat

MACS level 5

does not handle objects and has severely limited ability to perform even simple actions

EDACS level 4

eats and drinks with significant limitations to safety (need close attention given to a number of different factors to swallow food & drink safely b/c of the significant aspiration & choking risk)

CFCS level 3

effective sender and receiver with familiar partners

CFCS level 1

effective sender and receiver with unfamiliar and familiar partners

comorbidities

epilepsy, global developmental delay, learning disabilities, cognitive impairments, hearing loss, vision loss, perceptual deficits

quadriplegia

greater or equal involvement of the upper limbs in comparison with lower limbs

MACS level 4

handles a limited selection of easily managed objects in adapted situations

MACS level 2

handles most objects but with somewhat reduced quality and/or speed of achievement

MACS level 1

handles objects easily and successfully

MACS level 3

handles objects with difficulty; needs help to prepare and/or modify activities

cause of CP

hypoxic event leading to death of brain cells, but often actual cause is unknown

aphasias

impairment in ability to speak, write, or comprehend the meaning of words

dystonia

involuntary sustained or intermittent muscle contractions, abnormal postures, or both

monoplegia

involvement in 1 extremity

chorea

irregular, spasmodic, involuntary movements of the limbs or facial muscles - Fluctuations from low to high tone - Jerky involuntary movement (proximal to distal) - Sustained twisted postures that are absent at rest; triggered by movement - hyperkinesia, hypotonia, & fluctuating muscle tone

diplegia

legs are more affected than arms

distribution

monoplegia, hemiplegia, diplegia, quadriplegia

primary impairments

motor & postural functions - atypical motor development and may not walk independently

Dyskinetic CP (Athetoid)

often result of damage to the basal ganglia & thalamic region; excessive/abnormal movement; atypical/unintentional movements - Hypotonia, retained primitive reflexes, significant facial & oral involvement

CFCS level 5

seldom effective sender and receiver even with familiar partners

GMFCS level 5

self-mobility is severely limited even with the use of assistive technology

GMFCS level 4

self-mobility with limitations; children are transported or use power mobility outdoors and in the community

hearing impairments

sensorineural hearing loss and conductive hearing loss

4 types of CP

spastic, dyskinetic, ataxic, mixed

sensory processing impairments

tactile & proprioceptive; hypersensitivities

spastic quadriplegia

total body involvement, LE>UE, but many asymmetries

motor disability

total or partial loss of a person's body function (neuromusculoskeletal & movement-related functions) and/or body structure (structures related to movement or nervous system)

classification of CP

type, severity, and distribution within the body

GMFCS level 3

walks with assistive mobility devices; limitations walking outdoors and in the community

GMFCS level 2

walks without assistive devices; limitations walking outdoors and in the community

GMFCS level 1

walks without restrictions; limitations in more advanced gross motor skills

spastic CP

when both hypertonia & hyperreflexia exist; results from damage to the cortical areas of the brain; varying distribution & severity; diminished sensation is common; clonus; persistent primitive reflexes; abnormally stiff muscles