CP
Bayley age
1 - 42 months
What limbs are affected with monoplegia
1 limb
When should you assess the child's ability to perform writhing movements
1 month
Sitting by what age is a good predictor of walking?
2 years
When are children most vulnerable to IVH?
2nd trimester
When should you assess the child's ability to perform fidgety movements?
3 months
TIMP age
32 weeks - 4 months
NBAD age
37-44 weeks
What tests are used for later testing? 3
AIMS; Bayley; Peabody
WITH CP WHAT ARE MUST NOTS!! (5)
Cranio-sacral therapy; hip bracing; hyperbaric oxygen; NDT; sensory integration
What limbs are affected with diplegia
LE & trunk
What tests are used for early testing? 2
NBAD & TIMP
Mother/infant risk factor
RH incompatibility
What is mixed CP
S&S that don't fit just 1 CP type
GMFCS IV
Self mobility with limitations (may use power mobility)
What limbs are affected with hemiplegia
UE & LE on one side & trunk
With hemiplegia is UE or LE more involved?
UE > LE
How do CP pts sit?
W sit; sit with WBOS; prolonged sitting to one side
GMFCS III
Walks with hand held mobility device
What limbs are affected with quadriplegia?
all 4 & trunk
What are 3 factors that determine life expectancy?
amount of mobility; respiratory system status; ability to feed
How does dyskinetic CP present?
atypical patterns of posture & involuntary uncontrolled recurring movements
What does ataxic CP affect
balance & depth perception (uncoordinated)
What area is damaged with dyskinetic (dystonia & athetosis)
basal ganglia
AIMS age
birth - 19 months
Peabody age
birth - 6 years
Impairment of body structure or function: decreased endurance
body function
Impairment of body structure or function: decreased strength
body function
Impairment of body structure or function: pain
body function
Impairment of body structure or function: poor selective motor control & impaired postural control
body function
Impairment of body structure or function: impaired skeletal alignment
body structure
Impairment of body structure or function: impaired skin integrity
body structure
What are interventions to reduce muscle spasticity? (3)
botox, diazepam, selective dorsal rhizotomy
What is an intervention to improve ankle range?
casting
What area is damaged with ataxic CP
cerebellar
What is the purpose of the functional mobility scale?
classifies mobility in pts with CP according for need of assistance for 5, 50 & 500 m
How might you help train symmetry in an pt with hemiplegia
constrain the unaffected side
What are some interventions to improve motor activity? (4)
constraint induced movement therapy; goal directed functional training; context focused therapy; HEP
How are CP children's endruance
decreased
What occurs with ROM in CP pts
decreased (hypo-extensibility)
Types of spastic CP
diplegia, hemiplegia, triplegia, quadriplegia
What accompanies CP (5)
disturbances in sensation; cognition; communication; perception & behavior
What types of CP are less likely to walk?
dyskinetic & bilateral
Types of dyskinetic CP
dystonia & athetosis
What occurs with DTRs in CP pts
exaggerated
Does the ability to walk come easier or get harder with age?
gets harder
What is CP
group of permanent disorders of the development of movement & posture
What type of CP pts typically have leg length discrepancies
hemiplegia
What types of CP are likely to walk?
hemiplegia & ataxic
What type of CP pts typically have femoral ante-torsion & tibial torsion
hemiplegia & diplegia
What type of CP pts typically have joint deterioration
hemiplegia & diplegia
Contractures from spastic CP occur where in the LE
hip flexors, hip adductors, hip IR, hamstrings, PF
What type of abnormal muscle tone impairments are possible? (3)
hypotonia; hypertonia; spasticity
Perinatal risk factors (4)
infection (measles, CMV, CNS); lack of oxygen during birth; severe jaundice; labor delivery complications
5 dimensions of Gross Motor function measure
lying; sitting; standing; walking ; running
When is CP diagnosed?
may not occur until ~ 2 years
Abnormal muscle tone tests & measures (4)
modified ashworth; tarrideu scale (R1/R2); barry-albright dystonia scale; hypertonia assessment tool
Orthopedic surgical options (4)
muscle lengthening; tendon transfers; deterioration osteotomies; spinal fusions
What are some Tone/ROM clinical manifestations of CP
muscle spasticity; exaggerated DTRs; hypo extensibility of muscles; persistence of primitive reflexes
What is spasticity
neural resistance to externally imposed movement that increases with increasing speed & varies with direction
Are chaotic large amplitude movements normal?
no
Do children with CP have adequate force generation?
no
Is it normal for children to perform movements & contract & relax simultaneously
no
Is ataxic CP common?
no - rare
Do diplegia pts have appropriate balance?
no poor balance -> falls & delay walking
What causes CP
non-progressive disturbances that occur in fetal/infant the brain [brain injuries]
What are other associated problems with CP?
o Visual-Perception & Motor impairments o Sensory Processing & Tactile Sensory Problems o Hearing impairments, Oral-motor (feeding & communication) & Speech deficits o Respiratory complications o Seizures o Cognitive disorders/delays o Behavior & learning problems o Urinary/Constipation issues
How do CP pts typically walk?
on toes
What is FLACC for? when should it be used?
pain measurement - good for nonverbal pts
Contractures from spastic CP occur where in the UE
pecs, IR of shoulder, elbow flexors, forearm pronators, wrist & finger flexors
Prenatal infant risk factors (4)
prematurity; VLBW; intrauterine growth retardation
What are CP pts balance activation strategies
proximal to distal activation
What area is damaged in spastic CP
pyramidal motor tracts (cortex)
Postnatal risk factors (3)
seizures (febrile); BPD; infection (meningitis)
What causes HIE (hypoxic ischemia encephalopathy) 1 main reason & 6 causes for that
significant hypo perfusion & reduced oxygen (compressed umblicial cord; placental detachment; maternal hypotension; intrauterine growth retardation; failure to expand lungs after birth)
What is mixed CP often a combo of
spastic & dyskinetic
What type of CP is periventricular leukomalacia predominately found in?
spastic diplegia
What type of CP pts typically have scoliosis
spastic: hemiplegia especially
What are the different types of CP? (4)
spastic; dyskinetic; ataxic; mixed
What should you be sure to encourage with hemiplegia?
symmetry (use of unaffected side); stretching
Prenatal maternal risk factors (4)
teratogen exposure; drugs; malnutrition; placental inadequacy
What occurs with primitive reflexes in CP pts
they stay
What LE muscle is not activated enough during gait in CP pts?
tib anterior
GMFCS V
transported in manual wheelchair
If a child had head control ~ 9 months what are they likely to be able to do
walk
GMFCS II
walks with limitations (needs railing for stairs; difficulty with long distances & balance with uneven terrain)
GMFCS I
walks without limitations
What occurs with PVL (periventricular leukomalacia)
white mater necrosis in areas next to ventricles
What part of the body does ataxic CP affect?
whole body
What part of the body is affected with Dyskinetic CP (dystonia & athetosis)
whole body
Are fluid/smooth movements normal?
yes
Do CP pts have difficulty with selective control & preventing co-contraction
yes
GMFCS is it CP specific?
yes
Is CP permanent?
yes
does CP increase energy expenditure?
yes (AD needed)
What does athetosis look like?
• Fluctuating tone, constantly moving • Slow continuous writhing movements • Involuntary movement
Primary impairments of spastic CP
• Increased tone/stiffness distally • Decreased tone proximally • Impaired selective motor control • Exaggerated reflexes • Synergetic movement patterns • Muscle weakness • Decreased ROM • Decreased proprioception, kinesthesia & body awareness • Impaired balance & postural reactions
Neurological surgical options (3)
• Intrathecal Baclofen pump • Selective Dorsal Rhizotomy • Deep Brain Stimulation
What does dystonia look like?
• Involuntary sustained/intermittent muscle contractions • Repetitive movements • Abnormal postures • Twisting and repetitive movement
