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Questions and Answers

What is the effect of Intraventricular Hemorrhage (IVH) on cerebral palsy in preterm infants?

  • IVH primarily affects the visual system.
  • The risk of cerebral palsy increases with the severity of IVH. (correct)
  • IVH does not affect motor performance.
  • IVH only causes cognitive impairment.

    • Periventricular leukomalacia (PVL) is a type of brain damage that only affects grey matter.

    False

    Name one permanent disorder associated with cerebral palsy.

    Activity limitation

    Cerebral palsy results from disturbances in the developing ________ or infant brain.

    <p>fetal</p> Signup and view all the answers

    Match the following motor symptoms associated with cerebral palsy:

    <p>Spasticity = Muscle stiffness and tightness Ataxia = Lack of muscle coordination Dystonia = Involuntary muscle contractions Hypotonia = Decreased muscle tone</p> Signup and view all the answers

    Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?

    <p>Spastic CP</p> Signup and view all the answers

    Ataxic CP involves unsteady movements and difficulties with coordination.

    <p>True</p> Signup and view all the answers

    What are two common difficulties that individuals with Spastic CP face?

    <p>Getting dressed and manipulating objects.</p> Signup and view all the answers

    The form of cerebral palsy that involves twisting and abrupt movements is called ______.

    <p>Dyskinetic CP</p> Signup and view all the answers

    Match the type of cerebral palsy with its characteristic feature:

    <p>Spastic CP = Increased muscle tone Ataxic CP = Unsteady shaky movements Dyskinetic CP = Abrupt twisting movements</p> Signup and view all the answers

    What is a characteristic movement associated with dystonia?

    <p>Twisting and repeating movements</p> Signup and view all the answers

    A child with cerebral palsy typically has increased muscle tone and stiff movements.

    <p>False</p> Signup and view all the answers

    What are the three classifications systems used to assess severity in cerebral palsy?

    <p>Gross Motor Function Classification System, Manual Ability Classification System, Communication Function Classification System</p> Signup and view all the answers

    Children who can’t walk by _____ months may be showing signs of cerebral palsy.

    <p>18</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Intraventricular Hemorrhage (IVH) = Bleeding into the brain's ventricular system Periventricular Leukomalacia (PVL) = Damage to white matter around the ventricles Cerebral Palsy = Group of disorders affecting movement and muscle tone Developmental Milestones = Key skills children should accomplish by certain ages</p> Signup and view all the answers

    Which of the following signs indicates a baby might have cerebral palsy?

    <p>Does not roll over independently by 6 months</p> Signup and view all the answers

    Children with CP may show feeding or swallowing difficulties.

    <p>True</p> Signup and view all the answers

    List one possible motor symptom of cerebral palsy.

    <p>Low muscle tone, muscle spasms, or poor muscle control</p> Signup and view all the answers

    Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?

    <p>Spastic CP</p> Signup and view all the answers

    All children with spastic cerebral palsy have seizures.

    <p>False</p> Signup and view all the answers

    What are the three classifications of spastic cerebral palsy?

    <p>Hemiplegia, Diplegia, Quadriplegia</p> Signup and view all the answers

    Spasticity is defined as an increase in the physiological resistance of muscle to ______ motion.

    <p>passive</p> Signup and view all the answers

    Match the types of spastic cerebral palsy with their characteristics:

    <p>Hemiplegia = One side of the body is affected Diplegia = Lower extremities are severely involved, arms mildly Quadriplegia = All four limbs are affected</p> Signup and view all the answers

    What is a key characteristic of cerebral palsy?

    <p>Permanent but not unchanging disorders of movement and posture</p> Signup and view all the answers

    The definition of cerebral palsy includes progressive disorders of motor function.

    <p>False</p> Signup and view all the answers

    During which period is brain damage that leads to cerebral palsy likely to occur?

    <p>Prenatal, perinatal, or postnatal periods</p> Signup and view all the answers

    Cerebral palsy is the most common _____ disability in childhood.

    <p>motor</p> Signup and view all the answers

    Match the following classification systems with their purpose:

    <p>GMFCS = Gross Motor Function Classification System MAC = Manual Ability Classification CFCS = Communication Function Classification ICF = International Classification of Functioning</p> Signup and view all the answers

    Which of the following is NOT a cause of cerebral palsy?

    <p>Excessive physical activity</p> Signup and view all the answers

    Cerebral palsy can be completely cured with proper intervention.

    <p>False</p> Signup and view all the answers

    What factors contribute to the rising prevalence of cerebral palsy?

    <p>Improving life expectancies and increased awareness or access to diagnosis</p> Signup and view all the answers

    What percentage of children with spastic cerebral palsy typically have quadriplegia?

    <p>30%</p> Signup and view all the answers

    Dyskinetic cerebral palsy accounts for 20% to 30% of all cases of CP.

    <p>False</p> Signup and view all the answers

    What underlying issue can contribute to dyskinetic cerebral palsy?

    <p>Basal ganglia dysfunction due to hyperbilirubinemia or severe anoxia.</p> Signup and view all the answers

    Children with ataxic cerebral palsy have difficulty with __________ due to loss of balance and coordination.

    <p>movement</p> Signup and view all the answers

    Match the type of cerebral palsy with its characteristic feature:

    <p>Spastic CP = Increased muscle tone and stiff movements Dyskinetic CP = Abnormal, uncontrolled movements Ataxic CP = Loss of coordination and balance Quadriplegia = Involvement of all four limbs and trunk</p> Signup and view all the answers

    Which condition is often associated with spastic diplegia?

    <p>Periventricular Leukomalacia</p> Signup and view all the answers

    Children with dyskinetic CP typically show normal intellectual development.

    <p>True</p> Signup and view all the answers

    What is a common MRI finding in children with quadriplegia?

    <p>Periventricular leukomalacia (PVL).</p> Signup and view all the answers

    Which type of cerebral palsy is characterized by having normal or close to normal muscle tone?

    <p>Ataxic CP</p> Signup and view all the answers

    The classification system that assesses motor function in children with cerebral palsy is known as __________.

    <p>GMFCS</p> Signup and view all the answers

    The diagnosis of cerebral palsy relies on imaging findings.

    <p>False</p> Signup and view all the answers

    Children with hypotonia during the first years of life may have which type of cerebral palsy?

    <p>Ataxic</p> Signup and view all the answers

    Name one classification system used to assess the severity of cerebral palsy.

    <p>GMFCS (Gross Motor Function Classification System)</p> Signup and view all the answers

    In cerebral palsy, children who receive adequate medical care usually have a life expectancy that is considered _____ in comparison to peers.

    <p>normal</p> Signup and view all the answers

    Match the type of cerebral palsy with its characteristic muscle tone variation:

    <p>Spastic CP = Increased muscle tone Dyskinetic CP = Involuntary movements Ataxic CP = Poor coordination Hypotonic CP = Decreased muscle tone</p> Signup and view all the answers

    Which of the following classifications is NOT typically used to assess functional ability in children with cerebral palsy?

    <p>TLCS (Time to Locate Classification)</p> Signup and view all the answers

    Mortality in children with cerebral palsy is consistent across different types.

    <p>False</p> Signup and view all the answers

    What is the primary challenge often faced by children with quadriplegic cerebral palsy?

    <p>Malnutrition, infections, or respiratory problems</p> Signup and view all the answers

    Diagnosis of cerebral palsy can show variability, meaning two paediatricians may _____ on the diagnosis for the same child.

    <p>disagree</p> Signup and view all the answers

    What are the three general classifications based on severity of cerebral palsy?

    <p>Mild, Moderate, Severe</p> Signup and view all the answers

    Topographical distribution only considers the severity of cerebral palsy.

    <p>False</p> Signup and view all the answers

    What is the main focus of intervention for children with cerebral palsy?

    <p>Understanding the child's abilities</p> Signup and view all the answers

    What are the two terms used to describe muscle tone variations in cerebral palsy?

    <p>Hypertonia and Hypotonia</p> Signup and view all the answers

    The Gross Motor Function Classification System (GMFCS) classifies children into _____ ordinal levels.

    <p>five</p> Signup and view all the answers

    Match the classification systems to their focus area:

    <p>GMFCS = Gross motor function MAC = Manual abilities CFCS = Communication function Severity Classification = Scope of impairment</p> Signup and view all the answers

    Which option is not one of the classification systems used in functional classification of cerebral palsy?

    <p>Functional Independence Measurement (FIM)</p> Signup and view all the answers

    Hypertonia is associated with floppy limbs in individuals with cerebral palsy.

    <p>False</p> Signup and view all the answers

    Name one aspect that the functional classification systems assess.

    <p>Cognition, self-care, mobility, or social aspects</p> Signup and view all the answers

    Muscle tone in cerebral palsy can be categorized as increased muscle tone (_____ ) or decreased muscle tone (_____ ).

    <p>hypertonia; hypotonia</p> Signup and view all the answers

    The age bands considered in the GMFCS include children of what age ranges?

    <p>Less than 2 years and 2 to 4 years</p> Signup and view all the answers

    Study Notes

    Cerebral Palsy

    • Cerebral Palsy (CP) is an umbrella term for a group of permanent disorders that affect movement and posture.
    • CP results from non-progressive disturbances in the developing fetal or infant brain.
    • The Australian Cerebral Palsy Register reports on births between 1993 and 2006.

    Cerebral Palsy- Pathophysiology

    • Premature neonatal brains are vulnerable to two main pathologies:
      • Intraventricular haemorrhage (IVH) - Bleeding into the brain ventricles.
        • Increased risk in preterm infants due to underdeveloped periventricular blood vessels.
        • Risk of CP increases with IVH severity.
      • Periventricular Leukomalacia (PVL) - Brain damage affecting white matter causing cell death and empty spaces.
        • Periventricular white matter is involved in controlling motor function.
        • Spasticity, cognitive impairments, and vision issues are frequently associated with PVL.
        • Approximately 60-100% of babies with PVL will be diagnosed with CP.

    Cerebral Palsy Classification

    • Cerebral Palsy is classified based on the type of movement disorder:
      • Spastic Cerebral Palsy: Characterized by hypertonia or increased muscle tone.
        • Upper Limbs (Arms & Hands): Flexion at the elbow, wrist, and fingers.
        • Lower Limbs (Legs): Flexion at the hip, adduction or scissoring of the thighs, flexion at the knee, equinovarus foot posture.
      • Ataxic Cerebral Palsy: Characterized by uncoordinated movements, unsteady gait, and tremor.
        • Individuals with ataxia often experience difficulty with balance due to issues with depth perception.
      • Dyskinetic (Athetoid) Cerebral Palsy: Characterized by difficulty controlling muscle movement, resulting in twisting, abrupt, and repetitive movements.
        • Dystonia: Twisting and repetitive movements that can be painful.
        • Athetosis: Slow, writhing movements.
        • Chorea: Irregular, abrupt movements.

    Cerebral Palsy Signs and Symptoms in Babies and Young Children

    • Babies:

      • Low muscle tone (feels floppy when picked up)
      • Unable to hold up head while lying on stomach or in a supported sitting position
      • Muscle spasms or stiffness
      • Poor muscle control, reflexes, and posture
      • Delayed development (difficulty sitting up or rolling over by 6 months)
      • Feeding or swallowing difficulties
      • Preference for using one side of the body

    • Young Children:

      • Delays in reaching physical milestones:
        • Not walking by 12-18 months
        • Not speaking simple sentences by 24 months
      • Signs of Cerebral Palsy may warrant consultation with an early childhood nurse, general practitioner, or paediatrician.
      • NSW families are provided with a Personal Health Record book (Blue Book) containing information about developmental milestones at birth.

    Cerebral Palsy Severity Classification

    • Cerebral Palsy severity can vary and is classified using three systems:
      • Gross Motor Function Classification System (GMFCS): Classifies the level of gross motor function.
      • Manual Ability Classification System (MACS): Classifies the level of hand function.
      • Communication Function Classification System (CFCS): Classifies the level of communication ability.

    Cerebral Palsy Associated Impairments

    • Cerebral Palsy is often associated with various impairments including:
      • Cognitive Impairments: Learning difficulties, attention-deficit hyperactivity disorder (ADHD), and intellectual disabilities.
      • Sensory Impairments: Visual impairments, hearing loss, and problems with touch, taste, smell, and body awareness.
      • Seizures: Epilepsy or other seizure disorders.
      • Speech and Language Problems: Difficulty with speaking, understanding language, or both.
      • Bowel and Bladder Control Problems: Constipation and incontinence.
      • Feeding and Swallowing Difficulties: Dysphagia, a condition that makes it difficult to swallow.
      • Social and Emotional Challenges: Social isolation, anxiety, and depression.

    Clinical Interventions in Physiotherapy

    • Clinical interventions in physiotherapy for children with Cerebral Palsy were originally based on the developmental sequence for planning treatment.
    • However, it is important to recognize that the child's biological systems are not the sole determinant of motor performance.
    • Motor performance is influenced by a dynamic interplay between three factors:
      • The child
      • The task
      • The environment
    • Clinical interventions must consider child-rearing practices, family involvement, and the influence of the environment.

    Cerebral Palsy Definition

    • Cerebral Palsy (CP) is a disorder affecting movement and posture that begins in early childhood due to brain damage.
    • The brain damage is permanent but early intervention can improve outcomes.
    • Any non-progressive brain injury occurring within the first two years of life (some sources say five) is considered CP.

    Timeframe of Brain Injury

    • CP occurs if the brain damage arises during one of these periods:
      • Prenatal Period: Conception to the onset of labor
      • Perinatal Period: 28 weeks intrauterine to 7 days
      • Postnatal Period: First two years of life (some say five)

    Epidemiology and Aetiology

    • CP is the most common motor disability in childhood.
    • Causes of CP are diverse and include:
      • Congenital Factors
      • Genetic Factors
      • Inflammatory Factors
      • Infectious Factors
      • Anoxic Factors
      • Traumatic Factors
      • Metabolic Factors
    • The brain injury can occur prenatally, during birth, or postnatally.

    Diagnosis of CP

    • CP diagnosis is based on clinical observations.
    • It's not based on specific tests or imaging findings, leading to potential variability in diagnosis.
    • Even medical professionals sometimes struggle to differentiate between certain CP types.

    Life Expectancy

    • Life expectancy is normal for most children with diplegia and hemiplegia with good medical care and family support.
    • Some severely affected children with quadriplegia may die from complications like malnutrition or respiratory issues before reaching adolescence.
    • In resource-limited areas, children with CP may not live past the age of five.

    Classification of CP

    • Classification helps group cases with similar characteristics and set realistic expectations for intervention.
    • Classification considers:
      • Severity: Mild, moderate, or severe
      • Topographical Distribution: Which body parts are affected
      • Muscle Tone: Hypertonia (increased muscle tone) or Hypotonia (decreased muscle tone)

    Functional Classification Systems

    • These systems assess functional abilities in areas like cognition, self-care, mobility, and social aspects.
    • Examples include:
      • Gross Motor Function Classification System (GMFCS)
      • Manual Ability Classification System (MAC)
      • Communication Function Classification System (CFCS)

    Anatomical Classification

    • Unilateral: One side of the body is affected.
    • Bilateral: Both sides of the body are affected.
    • Spastic CP is classified as either unilateral or bilateral.
    • Dyskinetic CP and ataxic CP always involve the whole body (bilateral).

    Spasticity

    • Spasticity is increased resistance to passive muscle movement.
    • It's a component of upper motor neuron damage and is characterized by hyperreflexia, clonus, and abnormal reflexes.
    • Spastic CP is the most common type, accounting for 80% to 90% of cases.

    Types of Spastic CP

    • Hemiplegia (Unilateral): One side of the body is affected, often with the upper extremity more severely involved.
    • Diplegia (Bilateral): Lower extremities are severely affected, with milder arm involvement.
    • Quadriplegia (Bilateral): All four limbs, the trunk, and muscles controlling the mouth, tongue, and pharynx are involved.

    Dyskinetic CP

    • Abnormal involuntary movements occur when the child initiates movement.
    • Often accompanied by:
      • Dysarthria (speech difficulty)
      • Dysphagia (swallowing difficulty)
      • Drooling
    • Intellectual development is typically normal, but communication challenges can create a false perception of intellectual impairment.
    • Accounts for approximately 10% to 15% of all CP cases.

    Ataxic CP

    • Ataxia is loss of balance, coordination, and fine motor control.
    • Ataxic children often have:
      • Hypotonia in the first two years of life, followed by normal muscle tone and ataxia appearing around 2-3 years old.
      • Wide-based gait
      • Intention tremor
      • Poor dexterity and fine motor control
    • Associated with cerebellar lesions and sometimes combined with spastic diplegia.

    Intervention with Cerebral Palsy

    • Early intervention plays a crucial role in improving outcomes.
    • Interventions can address difficulties in:
      • Mobility
      • Communication
      • Self-care
      • Cognitive Functioning
      • Socialization
    • The goal is to support the child's overall well-being and maximize their potential.

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    Description

    Explore the critical aspects of Cerebral Palsy, including its definition and the underlying pathophysiological mechanisms. This quiz covers important factors such as intraventricular hemorrhage and periventricular leukomalacia, highlighting their impact on movement and cognitive functions. Test your knowledge on how these conditions relate to cerebral palsy.

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