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Questions and Answers
What is the effect of Intraventricular Hemorrhage (IVH) on cerebral palsy in preterm infants?
What is the effect of Intraventricular Hemorrhage (IVH) on cerebral palsy in preterm infants?
Periventricular leukomalacia (PVL) is a type of brain damage that only affects grey matter.
Periventricular leukomalacia (PVL) is a type of brain damage that only affects grey matter.
False
Name one permanent disorder associated with cerebral palsy.
Name one permanent disorder associated with cerebral palsy.
Activity limitation
Cerebral palsy results from disturbances in the developing ________ or infant brain.
Cerebral palsy results from disturbances in the developing ________ or infant brain.
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Match the following motor symptoms associated with cerebral palsy:
Match the following motor symptoms associated with cerebral palsy:
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Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?
Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?
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Ataxic CP involves unsteady movements and difficulties with coordination.
Ataxic CP involves unsteady movements and difficulties with coordination.
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What are two common difficulties that individuals with Spastic CP face?
What are two common difficulties that individuals with Spastic CP face?
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The form of cerebral palsy that involves twisting and abrupt movements is called ______.
The form of cerebral palsy that involves twisting and abrupt movements is called ______.
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Match the type of cerebral palsy with its characteristic feature:
Match the type of cerebral palsy with its characteristic feature:
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What is a characteristic movement associated with dystonia?
What is a characteristic movement associated with dystonia?
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A child with cerebral palsy typically has increased muscle tone and stiff movements.
A child with cerebral palsy typically has increased muscle tone and stiff movements.
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What are the three classifications systems used to assess severity in cerebral palsy?
What are the three classifications systems used to assess severity in cerebral palsy?
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Children who can’t walk by _____ months may be showing signs of cerebral palsy.
Children who can’t walk by _____ months may be showing signs of cerebral palsy.
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Match the following terms with their definitions:
Match the following terms with their definitions:
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Which of the following signs indicates a baby might have cerebral palsy?
Which of the following signs indicates a baby might have cerebral palsy?
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Children with CP may show feeding or swallowing difficulties.
Children with CP may show feeding or swallowing difficulties.
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List one possible motor symptom of cerebral palsy.
List one possible motor symptom of cerebral palsy.
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Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?
Which type of cerebral palsy is characterized by increased muscle tone and may affect both upper and lower limbs?
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All children with spastic cerebral palsy have seizures.
All children with spastic cerebral palsy have seizures.
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What are the three classifications of spastic cerebral palsy?
What are the three classifications of spastic cerebral palsy?
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Spasticity is defined as an increase in the physiological resistance of muscle to ______ motion.
Spasticity is defined as an increase in the physiological resistance of muscle to ______ motion.
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Match the types of spastic cerebral palsy with their characteristics:
Match the types of spastic cerebral palsy with their characteristics:
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What is a key characteristic of cerebral palsy?
What is a key characteristic of cerebral palsy?
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The definition of cerebral palsy includes progressive disorders of motor function.
The definition of cerebral palsy includes progressive disorders of motor function.
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During which period is brain damage that leads to cerebral palsy likely to occur?
During which period is brain damage that leads to cerebral palsy likely to occur?
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Cerebral palsy is the most common _____ disability in childhood.
Cerebral palsy is the most common _____ disability in childhood.
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Match the following classification systems with their purpose:
Match the following classification systems with their purpose:
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Which of the following is NOT a cause of cerebral palsy?
Which of the following is NOT a cause of cerebral palsy?
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Cerebral palsy can be completely cured with proper intervention.
Cerebral palsy can be completely cured with proper intervention.
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What factors contribute to the rising prevalence of cerebral palsy?
What factors contribute to the rising prevalence of cerebral palsy?
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What percentage of children with spastic cerebral palsy typically have quadriplegia?
What percentage of children with spastic cerebral palsy typically have quadriplegia?
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Dyskinetic cerebral palsy accounts for 20% to 30% of all cases of CP.
Dyskinetic cerebral palsy accounts for 20% to 30% of all cases of CP.
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What underlying issue can contribute to dyskinetic cerebral palsy?
What underlying issue can contribute to dyskinetic cerebral palsy?
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Children with ataxic cerebral palsy have difficulty with __________ due to loss of balance and coordination.
Children with ataxic cerebral palsy have difficulty with __________ due to loss of balance and coordination.
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Match the type of cerebral palsy with its characteristic feature:
Match the type of cerebral palsy with its characteristic feature:
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Which condition is often associated with spastic diplegia?
Which condition is often associated with spastic diplegia?
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Children with dyskinetic CP typically show normal intellectual development.
Children with dyskinetic CP typically show normal intellectual development.
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What is a common MRI finding in children with quadriplegia?
What is a common MRI finding in children with quadriplegia?
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Which type of cerebral palsy is characterized by having normal or close to normal muscle tone?
Which type of cerebral palsy is characterized by having normal or close to normal muscle tone?
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The classification system that assesses motor function in children with cerebral palsy is known as __________.
The classification system that assesses motor function in children with cerebral palsy is known as __________.
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The diagnosis of cerebral palsy relies on imaging findings.
The diagnosis of cerebral palsy relies on imaging findings.
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Children with hypotonia during the first years of life may have which type of cerebral palsy?
Children with hypotonia during the first years of life may have which type of cerebral palsy?
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Name one classification system used to assess the severity of cerebral palsy.
Name one classification system used to assess the severity of cerebral palsy.
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In cerebral palsy, children who receive adequate medical care usually have a life expectancy that is considered _____ in comparison to peers.
In cerebral palsy, children who receive adequate medical care usually have a life expectancy that is considered _____ in comparison to peers.
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Match the type of cerebral palsy with its characteristic muscle tone variation:
Match the type of cerebral palsy with its characteristic muscle tone variation:
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Which of the following classifications is NOT typically used to assess functional ability in children with cerebral palsy?
Which of the following classifications is NOT typically used to assess functional ability in children with cerebral palsy?
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Mortality in children with cerebral palsy is consistent across different types.
Mortality in children with cerebral palsy is consistent across different types.
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What is the primary challenge often faced by children with quadriplegic cerebral palsy?
What is the primary challenge often faced by children with quadriplegic cerebral palsy?
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Diagnosis of cerebral palsy can show variability, meaning two paediatricians may _____ on the diagnosis for the same child.
Diagnosis of cerebral palsy can show variability, meaning two paediatricians may _____ on the diagnosis for the same child.
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What are the three general classifications based on severity of cerebral palsy?
What are the three general classifications based on severity of cerebral palsy?
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Topographical distribution only considers the severity of cerebral palsy.
Topographical distribution only considers the severity of cerebral palsy.
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What is the main focus of intervention for children with cerebral palsy?
What is the main focus of intervention for children with cerebral palsy?
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What are the two terms used to describe muscle tone variations in cerebral palsy?
What are the two terms used to describe muscle tone variations in cerebral palsy?
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The Gross Motor Function Classification System (GMFCS) classifies children into _____ ordinal levels.
The Gross Motor Function Classification System (GMFCS) classifies children into _____ ordinal levels.
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Match the classification systems to their focus area:
Match the classification systems to their focus area:
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Which option is not one of the classification systems used in functional classification of cerebral palsy?
Which option is not one of the classification systems used in functional classification of cerebral palsy?
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Hypertonia is associated with floppy limbs in individuals with cerebral palsy.
Hypertonia is associated with floppy limbs in individuals with cerebral palsy.
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Name one aspect that the functional classification systems assess.
Name one aspect that the functional classification systems assess.
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Muscle tone in cerebral palsy can be categorized as increased muscle tone (_____ ) or decreased muscle tone (_____ ).
Muscle tone in cerebral palsy can be categorized as increased muscle tone (_____ ) or decreased muscle tone (_____ ).
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The age bands considered in the GMFCS include children of what age ranges?
The age bands considered in the GMFCS include children of what age ranges?
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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.
- Intraventricular haemorrhage (IVH) - Bleeding into the brain ventricles.
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.
-
Spastic Cerebral Palsy: Characterized by hypertonia or increased muscle tone.
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.
- Delays in reaching physical milestones:
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.
