Outpatient exam
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Outpatient exam

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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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