Cerebral Palsy

Hemiplegia

-1 side of the body is affected -limbs are most affected (leg and arm) -trunk is affected to a lesser degree

Diplegia

-2 sides of the trunk are affected -legs are most affected -arms are affected to a lesser degree

Quadriplegia

-4 limbs are affected the most -trunk is affected to a lesser degree

Acquired CP

-brain damage in the first few months or years of life -about 10% of cases *some question if, after the first few months, it is really CP or a head trauma

Congenital CP

-brain injury or abnormality during intra-uterine life -present at birth (may not be detected for months) -70% of CP cases -20% of CP cases due to brain injury during the birthing process (a lot of controversy over this, some say only 10%)

A child over 6 months with CP might...

-continue to have a hard time controlling head when picked up -reach with only one hand while keeping the other in a fist

A child over 10 months with CP might...

-crawl by pushing off with one hand and leg while dragging the opposite hand and leg -not sit by himself or herself

Ataxic CP

-decreased coordination, muscle control, and balance -unsteady, staggering, wide based gate -dysmetria (under or over shooting) -low tone in trunk and high tone distally -lack point of stability influences equilibrium and righting reactions -use more gross patterns -decreased performance of fine and gross motor skills -eyes- difficulty with depth perception or nystagmus (rapid involuntary movements of the eyes) -oral motor control compromised (feeding/speech) -may have cognitive issues -ROM not of concern

Dyskinetic CP Neuromotor Classification

-extrapyramidal, damage to the basal ganglia -fluctuations in tone or uncontrolled, slow, writhing movements (twisting, squirming, or jerky movements) -10%-20%

Ataxic CP Neuromotor Classification

-extrapyramidal, damage to the cerebellum -poor coordination and balance -5%-10%

Dyskinetic CP (ex: Athetoid)

-fluctuations in tone -involuntary writhing or jerky movement (increase during stress and disappear during sleep) -often underlying hypotonia (low tone) -difficulty mainting posture, sitting, and walking -difficulty UE and LE use -difficulty with speech (articulation) -hyperactivity in the muscles of the face (grimacing; a twisted expression on a person's face, typically expressing disgust or pain, OR drooling) -may have problems hearing and breathing -intelligence rarely affected

A child over 2 months with CP might...

-have difficulty controlling head when picked up -have stiff legs that cross or "scissor" when picked up

Acquired Main Causes

-head injury (car accident, fall, child abuse) -infections of the brain (meningitis, viral encephalitis)

Spastic CP

-hypertonicity: flexors, internal rotators, and adductors are most affected -limbs are rigid and stiff -hyperreflexia: exaggerated reflex responses -movements are jerky and awkward -tend to move in mass patterns -often speech, feeding, breathing, and swallowing issues can occur -ROM decreased -contractures (shortening and hardening of muscles, tendons, or other tissues) -intellectual disability are more likely -seizures are more likely

Psychosocial Adaptation

-inability to explore and master environment -limitations of educational, recreational, and social opportunities during early childhood -impact of primary physical impairments and secondary cognitive and communicative impairments -parental and peer reactions, stereotyped negative attitudes

Associated Issues with CP

-intellectual disability = 50% -increased risk of a learning disability -somatosensory -visual impairment = 40% -hearing impairment = 25% -seizure disorders = 40% -mouth, tongue, and pharynx muscles =40%

Congenital Main Causes

-intracranial hemorrhage -hypoxia (loss of oxygen) -congenital abnormality of the brain -placental issues -delivery complications -etiology unknown -risk increases with multiples and pre-maturity

Interventions

-no clinical meaningful interventions that can successfully repair existing damage to the brain areas that control muscle coordination and movement -several interventions available to diminish the degree of impairment (ex: muscle spasticity) and to increase participation in ADL

A child over 12 months with CP might...

-not crawl -not be able to stand with support

Medical and Considerations

-orthopedic and neromuscular (contractors, hip subluxation, scoliosis, bone density) - nutritional -GERD (Gastroesophageal reflux disease) and constipation -skin breakdown -dental -sleep -sensory issues -bladder control -respiratory and aspiration (inhaling small particles of food or drops of liquid into the lungs) -occupations and performance areas -psychological

Surgical and Rehab Interventions

-orthotics, casting, splinting -ROM and stretching -NDT and biomechanics -HABIT and CIMT -MEDICATIONS: oral, botulism injection, and baclofen pump (delivering a liquid form of baclofen into the spinal fluid) -SURGERY: spinal surgery, tendon transfers, selective dorasl rhizotomy (considered due to pain, greater impact over time, impact on joint integrity, and functional implications) -considerations (age, type, severity, walk or not walk, depends on the muscle groups affected)

Parent and Peer Interactions

-overprotection: leads to dependency and slows development of adaptive coping strategies -stereotyped negative attitudes of others -physical appearance, sexual drives, and demands of pending adult role functions can impact adolescent development negatively

Spastic CP Neuromotor Classification

-pyramidal tract (motor pathway from the brain the spinal cord) -hypertonicity -muscle stiffness and permanent contractions -70%-80%

Cerebral Palsy

-umbrella term for a brain injury (or abnormal brain development) that occurs prior to, during, or just after birth -disorders of posture and movement -causes activity impairments -often have disturbances in sensation, cognition, communication, perception behavior, and/or seizure disorder -due to damage in the brain

Is Cerebral Palsy progressive?

CP is NOT progressive, but the issues that present themselves in different performance areas change with age, occupations, and contexts

What is CP?

CP is caused by problems with the motor skill areas of the brain. These areas may develop abnormally or get damaged. The brain's ability to control movement and posture is disrupted.

GMFCS

gross motor function classification system

MACS

manual ability classification system

Dyskinetic CP is caused by damage to...

the basal ganglia

Ataxic CP is caused by damage to...

the cerebellum

Spastic CP is caused by damage to...

the cortex