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555-3
Cerebral Palsy
| Term | Definition |
|---|---|
| cerebral palsy | Group of permanent disorders if posture & movement development Non-progressive Malformation/ injury to immature brain (2 yrs or younger) Multifactorial disorder Env & genetic mechanisms influence |
| epidemiology of CP | 2/ 1000 live births Most common motor disability in childhood Can lead to progressive MSK deformities |
| spastic unilateral CP | Hemiplegic 38% prevalence Presents: arm & leg turned in & bent, fist, tip toe standing Due to perinatal stroke Good for tertiary care intervention |
| spastic bilateral- diplegia CP | Affects 2 legs 35% prevalence Presents: arms slightly clumsy, legs pressed together & turned in, tiptoe standing Prematurity or in-utero insults |
| spastic bilateral- quadriplegic CP | Entire body 5% prevalence Present: poor head control, arms bent & turned in, fists, legs together & turned in, tiptoe standing Neuronal migration issue or infection |
| dyskinetic CP | Abnormal, involuntary, recurring posture & mvmnt Dystonia & choreoathetosis 15% prevalence Has athetoid movements |
| dystonia vs. choreoathetosis | Increased tone w/ passive mvmnt & low speed. Antagonists fire when agonists fire vs. Hyperkinesia w/ decreased tone tendency. Involuntary movements of limbs, wriggling movements. May be fast or slow |
| rigidity vs. muscle tone | Velocity independent bidirectional resistance to externally imposed movements vs. Ease at which muscle can be stretched. Excludes resistance due to joint, ligament, or other skeletal properties. Tone occurs when they are awake but relaxed. Low in trunk |
| ataxia CP | Presents: Unsteady shaky mvmnts, unsteady walking, poor balance, unsteady gait 5% prevalence Due to metabolic or other genetic disorders |
| spasticity | Velocity dependent muscle resistance, faster the movement the faster the resistance Often undetectable if mvmnt is slow Earlier the catch, more spasticity there is |
| clonus | Oscillating reflex muscle due to stretch response of muscle spindle Directly related to tendon jerk hyperreflexia |
| dystonia results in | Abnormal postures at rest & during voluntary muscle mvmnt Limited active ROM during functional limb use |
| etiologic evaluation of CP | Birth/ pre-natal history Physical exam (HINE) POSTER Neurologic developmental exam Neuroimaging (MRI, standard of care to rule out other pathology) Consider further testing |
| hammersmith infant neurological examination (HINE) vs. POSTER | Neuro exam for babies btwn 2-24mo. Specific cut off scores for predicting CP. Max global score is 78. vs. Posture, oral motor, strabismus, tone, evaluation of milestones, reflexes. Need 4/6 to suspect CP |
| screening hand ax for infants (SHAI) | Initial screening of infants to identify those at risk for developing unilateral CP at 3.5-12 months 85% predictive starting at 3.5 months, 98% when MRI confirms it |
| neuroimaging | 70-90% have image findings Spasticity- white matter lesions Dystonia- basal ganglia/ thalamic lesions Rigidity- diffuse brain lesions Ataxia- cerebellar lesions |
| classification systems of CP | Manual ability classification system (MACS); hand function Gross motor function classification system (GMFCS) Communication function classification system (CFCS) Eating & drinking ability classification system (EDACS) Functional mobility scale (FMS) |
| MACS | Ages 4-18years, mini Macs for 1-4 y/o Both reliable & valid How CP use their hands, based on self-initiated activity Typical manual performance; bilateral use Diff levels of child ability to handle objects & need for assistance Appropriate objects |
| GMFCS level 1 2 3 | 1. Walk, climb stairs w/o physical help. Can run & jum. Hemi 2. Walk in most settings, may use hand held mobility device 3. Walk w/ assistance, may need chair for longer distances |
| GMFCS level 4 5 | 4. Use wheeled mobility most of time, need help transferring 5. Wheelchair all time, limited in posture & limb control, limited self mobility |
| FMS | 1. Uses wc 2. Uses walker 3. Uses crutches 4. Uses canes 5. Independent on level surface (rail for stairs) 6. Independent on all surfaces Rating for 5, 50, 500 meters |
| activity vs. participation | Execution of task or action by individual. Integrated use of body functions vs. Take part in something. Involved in activities & routines of daily life. Passive or active |
| environment vs. setting | Physical, social, attitudinal vs. Home, school, outdoors, community |
| impairments with CP | Ortho (contractures, dislocations, stress fractures) Cognition (executive functioning) Speech & language Vision (visuomotor perception) |
| impairment ax | Strength ROM testing Modified Tardieu, modified ashworth Sensation, stereognosis testing Neuroimaging Visual/ Auditory testing Cognitive testing Gait analysis Balance scales |
| activity ax | Hand function Printing Dressing Feeding Gait GMFM 66 6 minute walk Energy expenditure index Peabody, M-fun Movement ABC |
| participation ax | COPM PEDI-CAT- how it impacts participation GAS (goal setting) Life habits CPCHILD- impacts participation; an activity Abilihands- impacts participation; an activity |
| activity & participation limitations | Printing & writing impairments Limited fine & gross motor activities Limited independence in ADLs & IADLs |
| ages for... 1. HAI 2. mini AHA 3. AHA | 1. 3-12 months 2. 8-18 months 3. 18+ months |
| sensory testing & mirror movement | Monofilaments 2 point discrimination Stereognosis Mirror movement ax (shows difficulty w/ movement discrimination) |
| OT treatment options | Strengthening & stretching programs NM stimulation (FES) Splinting & casting |
| splinting | Prevents contracture in up to 34% kids Use with at least Ashworth 1 Use resting splint at night, stretch to give flexors a break Daytime splints can be used to help with certain tasks |
| activity tx options | Activity analysis & modifications Breakdown tasks (bwd & fwd chaining) Independence/ partial assistance Modifying task Scaffold if cognitively able |
| participation tx options | Adapt env to meet goal Different equipment in different settings Adapt external env, remove barriers Look at QOL measures Include entire family |
| 1. use it or lose it 2. interference 3. age matters 4. use it & improve it | 1. Failure to use specific functions can lead to degradation 2. Plasticity in response to experience can interfere w/ getting other behav 3. More plastic at young age 4. Training that drives specific function can enhance the function |
| 1. specificity 2. repetition matters 3. intensity matters 4. salience matters 5. transference | 1. Nature of training dictates nature of plasticity 2. Need sufficient repetition 3. Need sufficient intensity 4. Sufficiently salient to induce plasticity 5. Plasticity from one experience can enhance getting similar behaviors |
| strategies to harness neuroplasticity | Practice must be structures, repetitive, self generated Voluntary actions & problem solving Withdraw assistance quickly when child shows attention to task Just right challenge Goal related activities |
| constraint induced movement therapy | Constrain limb to force use of affected limb Improved selective motor control Transference & shaping used in protocol Progress skills when successful 7-10 times for shaping Structured, variable, repetitive, self generated Increases spontaneous use |
| hand arm intensive bimanual therapy (HABIT) | Intensive bimanual therapy Theories of motor learning Greater improvement in bimanual hand use & goal attainment Whole task practice & part task practice Includes asymmetric & symmetric movements High duration + freq over short time |
| bimanual therapy (Hoare model) | Complete bimanual hand ax Review w/ family role of dominant & helper hand Functional bimanual goal Diff behaviors are functional depending on severity of impairment 30 min, daily, 8 weeks Toy & task selection is key |
| strategies for learning | Intrinsic feedback helps build independence Model behavior Always have child attend to AH before DH Simple verbal commands Whole or part tasks depends on goal |
| goal based COOP | Problem solving approach Assist with improving motor performance of meaningful activities Client centered Goal-Plan-Do-Check Child generates own strategies & methods Best for cognition 5yr+ |
Created by:
craftycats_
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