Developmental Disorders Part 3: Cerebral Palsy

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Questions and Answers

What is a common clinical presentation of Reye’s Syndrome?

Significant increases in serum ammonia levels (correct)

Significant decreases in serum glucose levels

Persistent fever and elevated blood pressure

Severe headaches and vomiting

Which symptom is NOT associated with the onset of encephalitis?

Flaccidity

Mild amnesia

Coma and unresponsiveness

Rash (correct)

What is a key characteristic of Rett Syndrome during the first 6 months of life?

Severe intellectual disability

Rapid growth in head size

Immediate loss of language skills

Normal development (correct)

What medical management is indicated for Reye's Syndrome to prevent permanent neurological damage?

Peritoneal dialysis and controlled ventilation Signup and view all the answers

How is Rett Syndrome typically diagnosed?

Via clinical presentation and symptoms Signup and view all the answers

What is the best predictor of ambulation for a child by age 8 if they achieve independent sitting by 24 months?

Independent sitting by 24 months Signup and view all the answers

What percentage of infants born to chronic alcoholics may have Fetal Alcohol Syndrome (FAS)?

50-75% Signup and view all the answers

Which facial feature is NOT characteristic of Fetal Alcohol Syndrome (FAS)?

Prominent chin Signup and view all the answers

Which of the following is a critical prognostic indicator for determining future potential for independent walking?

Independent sitting by 24 months Signup and view all the answers

What is one of the diagnostic criteria for Fetal Alcohol Syndrome (FAS)?

Growth retardation Signup and view all the answers

Which treatment option is aimed specifically at managing spasticity?

Botox injections Signup and view all the answers

Which synthetic drug is commonly used to assist in managing muscle spasticity?

Dantrolene Signup and view all the answers

What is commonly associated with Reye's Syndrome in children?

Aspirin use after viral infection Signup and view all the answers

What must be present to diagnose FAS based on neurodevelopmental criteria?

Impaired fine motor skills Signup and view all the answers

Which of the following is a significant factor contributing to Fetal Alcohol Syndrome (FAS)?

Genetic predisposition Signup and view all the answers

Which of the following best describes cerebral palsy (CP)?

A category of developmental disabilities with early onset Signup and view all the answers

What is the most common cause of congenital cerebral palsy?

Maternal infection or illness during pregnancy Signup and view all the answers

What percentage of cerebral palsy cases are classified as acquired?

10-20% Signup and view all the answers

Which of the following is NOT classified as a type of muscle tone in cerebral palsy?

Hypertonic Signup and view all the answers

What does the GMFCS classification emphasize primarily?

Self-initiated movement and mobility Signup and view all the answers

Which diagnostic method offers the best predictive validity for diagnosing CP in children younger than 5 months?

General Movement Assessment (GMA) Signup and view all the answers

What kind of motor impairment is most commonly associated with spinal cord injuries, rather than CP?

Paralysis affecting the limbs Signup and view all the answers

Which of the following is a recommended referral indicator for suspected CP?

Hand preference before 12 months of age Signup and view all the answers

In terms of prevalence, which group shows a higher likelihood of being diagnosed with cerebral palsy?

Children born preterm or with low birthweight Signup and view all the answers

What type of muscle tone is characterized by reduced muscle tone and is often seen in children with cerebral palsy?

Hypotonia Signup and view all the answers

Study Notes

Cerebral Palsy

A category of developmental disabilities with early onset; not a disease.
Characterized by non-progressive CNS deficits leading to motor impairments and sensory abnormalities.
Most common motor disability in children; prevalence ranges from 1 to nearly 4 per 1,000 children.
Higher prevalence in children born preterm or with low birth weight.

Causes of Cerebral Palsy

No single cause; requires individual case assessment.
Congenital: Intrauterine factors like maternal infections, anoxic events, or developmental errors.
Acquired: 10-20% due to brain damage in infancy from infections, trauma, or hemorrhages.
Genetic factors also play a role.

Clinical Picture – ICF

Primary Impairments: Muscle tone issues, spasticity, reduced motor control, sensory processing impairment.
Secondary Impairments: Muscle tightness, joint contracture, decreased strength, impaired endurance.
Activity Limitations: Delayed gross motor skills, mobility restrictions, characteristic gait patterns.
Participation Restrictions: Impact on family and community engagement; children with CP participate less in social and physical activities.

Muscle Tone Types and Distribution

Types:
- Spastic: Motor cortex damage.
- Dyskinetic: Basal ganglia damage.
- Ataxic: Cerebellum damage.
- Hypotonic: Cerebellum damage.
Distribution: Monoplegia, diplegia, hemiplegia, quadriplegia/tetraplegia.
Degree of Tone: Mild, moderate, severe.

GMFCS Classification

5-level system based on mobility, need for devices, and quality of movement; focus on usual performance in various settings.
Level 1: walks without limitations.
Level 2: walks with limitations.
Level 3: walks with a handheld device.
Level 4: limited self-mobility; may use powered mobility.
Level 5: requires transport in a manual wheelchair.

Diagnosis of Cerebral Palsy

Best diagnosed through MRI, General Movement Assessment, and Hammersmith Infant Neurological Examination before 5 months.
Referral recommended for early signs like hand preference, stiffness, head lag, or inability to sit unsupported.

Prognosis

Non-progressive; lesions do not worsen, but developmental progress might appear to worsen.
Prognostic factors for ambulation include independent sitting by 24 months; critical timeframe within first 30 months for walking potential.

Medical Management of Cerebral Palsy

Spasticity management through Botox, oral medications, intrathecal baclofen.
Orthopedic interventions include tendon transfers and single-event multi-level surgery.

Fetal Alcohol Syndrome (FAS)

Associated with maternal alcohol consumption during pregnancy; no safe level established.
Incidence: 3-6 per 1,000 live births; 50-75% of infants of chronic alcoholics are affected.
Clinical Picture: Growth deficiencies, facial dysmorphology (e.g., microcephaly, thin upper lip), behavior problems.

FAS Diagnostic Criteria

Must meet all three:
- Characteristic facial features (e.g., short eye slits, thin upper lip).
- Growth retardation (e.g., lower birth weight).
- CNS neurodevelopmental abnormalities (e.g., learning disabilities, fine motor impairment).

Reye’s Syndrome

Associated with acute viral infections; may link to aspirin use.
Clinical picture includes fever, abdominal pain, and neurological symptoms progressing to lethargy.
Diagnosis confirmed with elevated serum ammonia levels.

Rett Syndrome

Possible X-linked dominant condition; primarily affects females.
Clinical picture involves normal early development followed by loss of skills, stereotypical hand movements, and severe ID.
Diagnosis based on clinical presentation; often misdiagnosed.

Medical Management for Rett Syndrome

Focus on seizure control via medication.

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Description

Explore the key concepts of cerebral palsy as part of developmental disorders in this quiz. Understand the implications of this non-progressive CNS deficit and its impact on motor abilities and sensory functions. This material is designed for students in PT 546.