Medical-Surgical Foundations: Cerebral Palsy
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Questions and Answers

What is the overall prevalence rate of cerebral palsy in live births?

  • 2.11 per 1000 live births (correct)
  • 3.5 per 1000 live births
  • 5 per 1000 live births
  • 1.5 per 1000 live births

    • Which of the following is NOT considered a maternal risk factor for cerebral palsy?

  • History of stillbirth
  • Intellectual disability
  • Maternal seizures
  • Advanced paternal age (correct)

    • Which subtype of hypoxic-ischemic brain injury is characterized by damage due to a lack of oxygen?

  • Focal and multifocal ischemic brain necrosis (correct)
  • Periventricular leukomalacia
  • Status marmoratus
  • Selective neuronal necrosis

    • What dramatic increase in prevalence rate is observed in children with very low birth weight?

    <p>59.6 per 1000 live births</p> Signup and view all the answers

    Who was the first to propose that cerebral palsy may be caused by abnormal development before birth?

    <p>Dr. Sigmund Freud</p> Signup and view all the answers

    Which pattern of cerebral palsy is specifically characterized by muscle stiffness affecting both legs?

    <p>Diplegic Pattern</p> Signup and view all the answers

    What is the leading cause of childhood disability?

    <p>Cerebral Palsy</p> Signup and view all the answers

    Which of the following is a classification of cerebral palsy?

    <p>Diplegic Pattern</p> Signup and view all the answers

    What is the most common antecedent of cerebral palsy?

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

    Which of the following describes the impact of selective neuronal necrosis?

    <p>Affects specific vulnerable neurons</p> Signup and view all the answers

    What is the primary manifestation of periventricular leukomalacia?

    <p>Bilateral white matter necrosis</p> Signup and view all the answers

    Which classification system assesses gross motor function in children with cerebral palsy?

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

    What type of injury is associated with hypoxic-ischemic cerebral injury?

    <p>Loss of blood supply and oxygen</p> Signup and view all the answers

    What system is used to classify communication function in children with CP?

    <p>Communication Function Classification System</p> Signup and view all the answers

    What does a positive hip assessment indicate?

    <p>Possibility of hip contracture</p> Signup and view all the answers

    Which type of cerebral palsy is characterized by hypertonic deficits primarily in the lower limbs?

    <p>Diplegic pattern</p> Signup and view all the answers

    What common issue is experienced by 50% of individuals with cerebral palsy?

    <p>Epileptic seizures</p> Signup and view all the answers

    What is a known long-term consequence of status marmoratus?

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

    What typically occurs to muscle stretch reflexes in neonates after severe brain injury?

    <p>They may be difficult to elicit</p> Signup and view all the answers

    What is the impact of prematurity on the incidence of cerebral palsy?

    <p>Is a major contributing factor</p> Signup and view all the answers

    Which area of the brain is most commonly affected by focal and multifocal ischemic brain necrosis?

    <p>MCA (Middle Cerebral Artery) area</p> Signup and view all the answers

    What anatomical points are used to measure tibial torsion?

    <p>Anterior-superior iliac spine to the medial malleolus</p> Signup and view all the answers

    What is measured to test for hamstring contracture?

    <p>Popliteal angle by extending the lower leg</p> Signup and view all the answers

    To evaluate the position of the patella, what specific measurement is relevant?

    <p>Line drawn through the malleoli</p> Signup and view all the answers

    What does the term 'CP' signify in the diagnosis context?

    <p>Cerebral palsy reflecting a description of clinical findings</p> Signup and view all the answers

    Which test is specifically associated with assessing for perinatal asphyxia?

    <p>Blood pH measurement</p> Signup and view all the answers

    Which imaging technique is beneficial for checking intraventricular hemorrhage in a premature infant?

    <p>Cranial ultrasound</p> Signup and view all the answers

    What is emphasized in the Phelps method of therapy?

    <p>Self-help skills and balance sense development</p> Signup and view all the answers

    What is the primary goal of stretching in relation to contractures?

    <p>To reduce the risk of contracture from muscular imbalance</p> Signup and view all the answers

    Which of the following is used to assess anatomic pathways in auditory and visual pathways?

    <p>Evoked potentials</p> Signup and view all the answers

    What does the Robotic and Partial Body Weight-Supported Treadmill Training focus on?

    <p>Achieving a more normalized gait pattern through repetitive tasks</p> Signup and view all the answers

    What is a reported benefit of strength training programs in CP?

    <p>Increased strength</p> Signup and view all the answers

    Which approach is utilized to activate muscles through sensory receptors?

    <p>Bobath method</p> Signup and view all the answers

    What exercise regimen is suggested to improve aerobic fitness effectively?

    <p>45 minutes of high-intensity activities four times a week</p> Signup and view all the answers

    What does the Silfverskiold test evaluate?

    <p>Ankle dorsiflexion to assess gastrocnemius/soleus contracture</p> Signup and view all the answers

    Which neurological assessment is important for children with CP?

    <p>Postural and reflex assessment</p> Signup and view all the answers

    What does functional electrical stimulation (FES) do?

    <p>Elicits muscle contraction during functional activity</p> Signup and view all the answers

    In what way does constraint-induced movement therapy aim to improve motor function?

    <p>By limiting the unaffected limb's use</p> Signup and view all the answers

    What potential side effect is common with oral medications for spasticity management?

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

    What is the primary goal of using ankle-foot orthosis in children with CP?

    <p>Prevent contracture and promote alignment</p> Signup and view all the answers

    What is a significant limitation of using baclofen for treating hypertonia in children?

    <p>It can lead to sedation and dizziness</p> Signup and view all the answers

    What does the Overhead Harness System help with during therapy for children with CP?

    <p>Supports body weight during treadmill activities</p> Signup and view all the answers

    What challenge is commonly faced when treating generalized secondary dystonia in CP children?

    <p>It poorly responds to oral medications</p> Signup and view all the answers

    Which of the following is a characteristic of aerobic exercise for children with CP as per systematic reviews?

    <p>Improved physiological measures without adverse effects</p> Signup and view all the answers

    What is a function of functional electrical stimulation (NMES) during therapy?

    <p>It causes muscle contraction</p> Signup and view all the answers

    What type of devices can support mobility in children with CP?

    <p>Wheelchairs and mobility aids</p> Signup and view all the answers

    What is one of the key purposes of using orthotic devices in CP management?

    <p>To prevent contractures and provide optimal alignment</p> Signup and view all the answers

    What is a common adverse event related to Botulinum toxin (BoNT) injections?

    <p>Injection site pain</p> Signup and view all the answers

    What is one of the intricacies involved in neurolysis with alcohol?

    <p>Requires electrical stimulation for guidance</p> Signup and view all the answers

    What is the primary purpose of intrathecal baclofen (ITB) therapy?

    <p>To treat spasticity or dystonia</p> Signup and view all the answers

    Which type of orthopedic surgery is suitable for children aged 3 to 8 with spastic diplegic CP?

    <p>Muscle release and lengthening</p> Signup and view all the answers

    What is a key indication for using intrathecal baclofen therapy?

    <p>Goals defined for spasticity reduction</p> Signup and view all the answers

    What does selective dorsal rhizotomy (SDR) involve?

    <p>Surgical cutting of nerve roots</p> Signup and view all the answers

    Which intervention is suggested for children with dysphagia to prevent aspiration?

    <p>Modifying feeding consistencies</p> Signup and view all the answers

    What is the function of deep brain stimulation (DBS) in treating dystonia?

    <p>To provide pulsed electrical stimulation to the brain</p> Signup and view all the answers

    What can contribute to malnutrition in children with cerebral palsy (CP)?

    <p>Feeding inefficiency</p> Signup and view all the answers

    What is the typical prescriptive interval for Botulinum toxin (BoNT) injections?

    <p>3-4 months</p> Signup and view all the answers

    Which feeding issue is commonly seen in children with CP?

    <p>Excessive sialorrhea</p> Signup and view all the answers

    What is the relationship between GMFCS levels and medical comorbidities in children with CP?

    <p>Higher GMFCS levels correlate with more severe comorbidities</p> Signup and view all the answers

    What can modified feeding consistencies help manage in children with CP?

    <p>Reduced airway obstruction risk</p> Signup and view all the answers

    What distinguishes the effects of alcohol neurolysis compared to BoNT-A?

    <p>Alcohol neurolysis duration lasts longer</p> Signup and view all the answers

    What is essential when utilizing early intervention programs for children with disabilities?

    <p>Evaluate children for potential delays</p> Signup and view all the answers

    Study Notes

    Cerebral Palsy Overview

    • Cerebral Palsy (CP) is a neurological disorder caused by abnormal brain development or damage occurring before, during, or shortly after birth.
    • Dr. Sigmund Freud was one of the first to propose that CP may originate from abnormal prenatal development.

    Epidemiology

    • CP is the leading cause of childhood disability.
    • The overall prevalence rate of CP is approximately 2.11 per 1000 live births.
    • There is a significant increase in prevalence among children with very low birth weight (59.6 per 1000 live births).
    • Extremely premature infants show even higher rates, with 111.8 cases per 1000 live births.

    Etiology/Risk Factors

    • Various maternal health issues pose risks, including:
      • Maternal seizures.
      • Intellectual disabilities in mothers.
      • Thyroid diseases, such as hyperthyroidism and hypothyroidism.
      • Previous history of stillbirth or neonatal death.

    Prenatal Hypoxic-Ischemic Cerebral Injury

    • This type of injury can be categorized into several subtypes based on affected brain areas.

    Volpe's Subtypes of Hypoxic-Ischemic Neuropathology

    • Parasagittal Cerebral Injury: Typically affects areas near the midsagittal line of the brain.
    • Periventricular Leukomalacia: Damage to the white matter around the ventricles; often seen in preterm infants.
    • Focal and Multifocal Ischemic Brain Necrosis: Localized death of brain tissue due to lack of blood flow.
    • Status Marmoratus: A complex pattern of brain injury related to severe hypoxia.
    • Selective Neuronal Necrosis: Specific death of certain neurons without widespread damage to other brain areas.

    Classifications of Cerebral Palsy

    • Various classifications exist to categorize CP based on movement patterns and affected body parts, aiming to guide treatment approaches and outcomes.### Overview of Cerebral Palsy
    • Motor disorders in cerebral palsy (CP) often include sensory, cognitive, communication, and behavioral disturbances.
    • 70-80% of CP cases arise prenatally, with prematurity being a significant risk factor.
    • Associated issues may include epilepsy and secondary musculoskeletal problems.

    Pathophysiology

    • Premature infants have immaturity and fragile brain vasculature, leading to compromised cerebral blood flow and potential intraventricular hemorrhage (IVH).
    • Outcome from IVH is dependent on the extent of associated brain injury.
    • Prenatal hypoxic-ischemic events are the primary cause of cerebral injury.

    Types of Cerebral Injury

    • Selective Neuronal Necrosis: Most common injury type, impacting specific vulnerable neurons and linked to oxygen deprivation.
    • Volpe’s Subtypes:
      • Parasagittal Cerebral Injury: Bilateral damage resulting in spastic quadriplegia.
      • Periventricular Leukomalacia: Associated with prematurity, leads to spastic diplegia or quadriplegia and visual/cognitive deficits.
      • Focal and Multifocal Ischemic Brain Necrosis: Results in spastic hemiplegia or quadriplegia; most commonly affects the middle cerebral artery (MCA).
      • Status Marmoratus: Rare form with neuronal injury in basal ganglia, resulting in choreoathetosis.

    Clinical Patterns

    • Neonatal Pattern: Hypotonia followed by spasticity; difficulty with reflex elicitation.
    • Diplegic Pattern: Primarily affects lower limbs with scissoring and equinovarus deformities.
    • Hemiplegic Pattern: Affects one side with loss of range of motion and limb asymmetry.
    • Quadriplegic Pattern: Diffuse spasticity with significant functional limitations.

    Associated Problems

    • Mental retardation occurs in approximately 50% of cases, especially in severe forms.
    • Seizures also affect about half of CP patients, more common in hemiplegic and spastic quadriplegic cases.
    • Oromotor issues include difficulties with sucking, swallowing, and drooling, particularly in spastic quadriplegia.
    • Gastrointestinal concerns may arise, along with dental and visual impairments.

    Classification and Assessment

    • Gross Motor Function Classification System (GMFCS): Ranges from independent walking to those requiring a wheelchair.
    • Manual Ability Classification System (MACS): Assesses upper extremity function in daily activities.
    • Communication Function Classification System (CFCS): Classifies communication abilities across different interactions.
    • International Classification of Functioning: Focuses on the interplay of body function, structure, activity, and participation.

    Evaluation Techniques

    • Leg and Hip Assessment: Various tests (Thomas, Ely, Staheli) evaluate for hip contractures and movement limitations.
    • Gait Assessment: Observations of hip, knee, and foot mechanics during walking are essential for functional evaluations.

    Summary

    • Understanding CP's multifaceted classification and varied impacts on movement, cognition, and behavior is crucial for effective diagnosis and intervention.
    • Early identification and tailored assessments can significantly improve mobility and quality of life for individuals with CP.### Assessment Techniques
    • Tibial torsion is assessed from anterior-superior iliac spine to medial malleolus.
    • Knee contractures evaluated via popliteal angle and assessment of medial joint space.
    • Pelvifemoral angles measured from greater trochanter to medial malleolus; asymmetry indicates potential issues.
    • Hamstring contracture is determined by extending the leg against resistance after flexing the hip to 90 degrees.

    Knee Assessment

    • Position of the patella is evaluated for alignment and dysfunction.
    • Test posterior capsular tightness with legs extended until resistance is noted.

    Diagnosis of Cerebral Palsy

    • CP does not refer to a specific cause; it's a diagnosis of exclusion based on clinical findings.
    • Initial assessment of suspected CP includes diagnosis confirmation, necessary tests, symptom etiology, comorbidity identification, and treatment planning.

    Diagnostic Testing

    • Assess for metabolic and genetic disorders: thyroid function, lactate, pyruvate, organic and amino acids, chromosomal analysis.
    • Tests for perinatal asphyxia include blood pH, CSF protein, and lactate-to-pyruvate ratio.
    • Imaging options: cranial ultrasound for premature infants (intraventricular hemorrhage), cranial CT, cranial MRI for insights after 2-3 weeks, PET for blood flow/glycolysis assessment, and SPECT for cerebral perfusion.

    Therapeutic Techniques

    • Early intervention is key for optimal outcomes in children with CP.
    • Therapeutic exercises must be age-appropriate and integrate developmental sequences.
    • Various methods (Rood, Bobath, Vojta) focus on muscle activation, normalizing tone, and postural development.
    • Conductive education aims for independent functioning without external aids.

    Stretching and Contracture Management

    • Stretching aims to prevent muscle tightening due to hypertonicity, implemented through various devices and casting.
    • Evidence indicates stretching has minimal impact on joint mobility in neurologically impaired subjects.

    Strengthening and Exercise

    • Strength training improves strength without increasing spasticity; indirect benefits include enhanced self-esteem and participation.
    • Aerobic exercise is beneficial for physiological fitness without adverse effects.

    Orthopedic Devices

    • Ankle-foot orthoses are commonly used for controlling gait deviations and maintaining joint alignment.
    • Mobility supports include wheelchairs, adaptive seating, and standing frames for enhanced independence.

    Spasticity Management

    • Management strategies include therapeutic exercise, casting, splinting, electrical stimulation, and pharmacological interventions.
    • Common medications: baclofen, diazepam, dantrolene sodium, tizanidine, clonazepam, with side effects requiring careful monitoring.

    Advanced Interventions

    • Transcranial magnetic stimulation and direct current stimulation show potential in enhancing proprioception and balance in CP.
    • Constraint-induced movement therapy focuses on improving motor function in hemiplegic limbs through structured therapy after limb immobilization.
    • Functional Electrical Stimulation (FES) aids in muscle contraction during activities, enhancing functional gains.

    Neurolytic Techniques

    • Alcohol neurolysis is used for primary dystonia treatment, though it requires complex procedural techniques due to discomfort and potential complications.

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    Description

    This quiz covers key concepts related to cerebral palsy, focusing on medical-surgical foundations for managing adult physical dysfunction. It is designed for healthcare professionals to enhance their understanding and application of these concepts in clinical practice.

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