Cerebral palsy

diagnostic signs of CP

- *persistent primitive reflexes*: these reflexes diminish as the cortex matures which is usually by 12 months - with CP, the primitive reflex patterns persist *beyond early infancy common ones that do persist are the ATNR+labyrinthine reflexes.* Should be integrated by 6 mos. - *movement reactions*: delayed or absence of these developmental responses (protective reflexes, righting actions) in children with CP contribute to their motor disability. - walking: scissoring or toe walking

CP intervention overview

-interdisciplinary approach is important -OT addresses motor development of the upper extremities, oral motor functions, visual perceptual problems, trunk control and ADLs -PT/OT addresses posture and movement as well as the use of adaptive devices and seating.

neurodevelopment therapy (NDT) for CP intervention

-motor therapy -key method of intervention -provides child with sensorimotor experiences that enhance the development of normal movement patterns -assessment begins with observation of posture at rest and during transitions between positions (how are they moving from lying, to sitting to standing?) -evaluate the tone, range of motion and quality of primitive reflexes and automatic movement reactions GOAL: normalize tone and control of movement during functional activity -use of individualized plan of positioning, therapeutic handling and play

bracing, splinting and positioning for CP intervention

-used for positioning and to maintain ROM, prevent contractures, provide stability and control involuntary movements. 3 types: -ankle-foot-orthosis (AFO): short leg brace that is used to position the foot flat and provide a consistent stretch to the achilles tendon (also known as heel cord) -resting hand splint: used to hold thumb in an abducted position and the wrist in a neutral or slightly extended position -thumb loop/strap: used to inhibit tone in the hand and keeps hand free to engage in play. Helps abduct the thumb to prepare to oppose. [custom made or ordered from book]

what determines a CP diagnosis? (2)

1) age of onset 2) lack of progression

types of CP (6)

1) atonic 2) choreoathetoid 3) dystonia 4) ataxic 5) hemiplegia 6) diplegia

causes of CP (8)

1) exposure to radiation or teratogenic drugs 2) intrauterine infection 3) developmental abnormalities of the brain 4) chromosomal abnormalities 5) abruptio-placenta and other abnormalities in fetal-placental functioning 6) complications during labor and delivery (lack of oxygen to the brain) 7) neonatal illness 8) early childhood disorders, such as meningitis, head trauma, and poisonings

medications used for CP (3)

1) nerve blocks: injections of *denaturing agents into motor nerves to target spasticity in muscle groups.* May cause sensory loss due to damaged sensory nerve fibers 2) motor point blocks: *interrupts nerve supply of spastic muscle without effecting sensation.* Lasts 4-6 months. 3) botulism (botox): *used by blocking the nerve muscle junction.* Weakens the muscle and reduces spasticity for 3-6 months. -temporary types of methods -therapy: maximize ROM

At the age of 16, if a person suffers from a TBI and has symptoms of CP are they diagnosed with CP?

Yes

what is cerebral palsy?

a disorder of movement and posture that is due to a non progressive abnormality of the immature brain. - the brain damage that causes CP may also produce other disabilities, such as MR (mental retardation), seizures, visual and auditory deficits and behavior problems.

Ataxia (ataxic)

abnormalities of voluntary movement involving balance and position of trunk and limbs in space

hemiplegic CP

affects UE and LE on one side of body.

extrapyramidal cerebral palsy

athetoid, dystonic, + ataxic movements. -deep into the cerebral cortex -includes: the corpus callous, substantia nigra and sub thalamic nucleus, and connections with the midbrain -damage occurs to the pathways *outside the pyramidal tracts* -these other tracts pass through the basal ganglia from the cerebellum -*most common type of extrapyramidal CP is choreoathetoid CP*

pyramidal cerebral palsy

can be classified as hemiplegia (on one side), diplegia (just the legs) or quadriplegia (upper and lower extremities) CP. -spastic CP -*damage to the motor cortex or to the pyramidal tract of the brain* -motor strip of the frontal lobe passes its signals for voluntary movement to the spinal cord through the pyramidal tract --damage to any part of this pathway leads to *spasticity*

quadriplegia

diffuse and severe damage to the cerebral cortex. - all four limbs are affected, and prognosis is worse - severe mental retardation, seizures and visual and auditory deficits are common

choreoathetoid cerebral palsy

dyskinetic CP -*abrupt, involuntary movements of the extremities* -difficulty regulating movement and maintaining posture -*lead pipe rigidity*: limb may appear rigid but can be bent with persistent pressure -changes in muscle tone varies from time to time --tone may appear normal -involuntary movements are absent during sleep -variability of tone: contractures less likely to occur -can reduce tone by rapidly flexing and extending the arm or leg -may have more sucking, swallowing, drooling and speaking problems -difficult to develop stability to sit or walk

toe walking

equinus position of feet with increased extensor tone in the legs

T or F: If a person has spastic quadriplegia and absence of postural reactions or persistence of primitive reflexes at 1 y/o there's a poor prognosis for ambulation

false: 2 y/o (if there's absence of postural reactions or persistence of primitive reflexes at 2 y/o and they have spastic quadriplegia)

T or F: for a child with poor head control or feeding difficulties, you could recommend a low backed chair with tilt back

false: high backed chair with tilt back

T or F: a child who was previously healthy and suffered a TBI may show symptoms of Erbs palsy during recovery from a coma

false: they may show symptoms of cerebral palsy

atonic

floppy muscle tone predominates atonic CP NOTE: spastic CP may be present in first months of life with signs of hypotonia, but, choreoathetoid movements are rarely seen before 18 months of age therefore MDs wait to give an actual diagnosis.

spasticity

increased muscle tone with a clasped knife quality. - when arms or legs are moved and the initial resistance is strong, but will give way abruptly as would closing a pocketknife - this increased muscle tone interferes with normal movement

scissoring

increased tone in adductors and internal rotators of hip

Diplegia CP

less UE, greater LE impairment.

If a child suffers from a TBI and shows symptoms of CP after the age of 16, is it called CP?

no, it would be called a neurological deficit.

hemiplegia

one-sided abnormalities - pyramidal nerve fibers cross over before they enter the spinal cord and damage to one side of the brain will cause abnormalities of one side of the body. *Arms* is usually more affected than the legs.

spastic diplegia

part of the tract that passes near the lateral ventricles. Region that includes fibers that control movement of the legs. *legs* are more affected more than the arms.

positioning devices for CP

sidelyers, prone boards, and supine standers are used for skeletal alignment. -scooters, tricycles and wheelchairs with proper trunk support -walkers crutches, lofstrand crutch, posterior walker, standard forward position walker

how to correct scissoring gait

tendon releases of adductors and heel cord for the person to have more of a flat foot.

orthopedic surgery and CP

this is done to *increase range of motion through release, lengthening, or transfer of affected muscles and tendons.* -lengthening of achilles tendon at the ankle improves walking ex. of surgery: Adductor Tenotomy and Obturator Neurectomy: release of hip adductor muscles --> improves scissoring and prevents hip dislocation caused by contractors of adductor muscles in thigh --> some adductors are cut and nerve fibers that lead to them are severed --> casted for 6-8 weeks to maintain open position

Tonic Labyrinthine Reflex

this pattern may dominate posture and movement with CP and can persist throughout life. -when supine the head is extended, and shoulders are retracted with extended legs -in prone the opposite occurs (head and legs are flexed)

wheelchairs and CP

to maximize mobility and function, a w/c with a solid seat and back is recommended. - can add head and trunk supports and try for those children with *lack of postural control* - use of special seating cushions or custom molded inserts that contours the body of the infant for support of orthopedic deformities - joy sticks and switches for control and speed - supportive strollers are alternatives

T or F: if a person has hemiplegic CP or Ataxia and is independently sitting by 2 years of age there's a good possibility that they will ambulate

true

ambulatory prognosis is determined by what?

type of CP, age of independent sitting and postural or tonic reflexes

Rigid and atonic CP (dystonic)

type of extrapyramidal. -dystonia or rigidity characterizes right posturing centered in the trunk and neck