Cerebral Palsy (CP) Quiz
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Questions and Answers

Define Equinus Contracture.

Equinus contracture is a condition where there is limited flexibility or extension of the ankle joint, causing the foot to point downwards excessively (plantar flexion).

Match the lower limb problem to the related gait issue in CP:

Excessive hip internal rotation = Anteversion Weakness in Hip Abductor = Trunk lurching gait Hip flexion & adduction, increased Knee flexion & ankle hyper dorsiflexion during stance = Crouch gait

Involuntary or unintentional urination during sleep is known as enuresis.

True

Cerebral palsy results in a group of permanent disorders of the development of ______ and posture.

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

What is cerebral palsy (CP)?

<p>Cerebral palsy describes a group of permanent disorders of the development of movement and posture.</p> Signup and view all the answers

What are the key components to movement impairments in CP?

<p>Pyramidal tract dysfunction</p> Signup and view all the answers

Tertiary impairment in CP is due to brain lesions.

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

Vascular events such as a middle cerebral artery infarct can be a ___ cause of CP.

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

Match the following gait patterns with the corresponding descriptions:

<p>Hemiplegic gait = No hip/knee flexion, ankle dorsiflexion Diplegic gait - Jump gait = Hip flexion &amp; adduction, Knee flexion &amp; ankle plantarflexion Diplegic gait - Crouch gait = Hip flexion &amp; adduction, increased Knee flexion &amp; ankle hyper dorsiflexion during stance Trunk lurching gait = Weakness in Hip Abductor leading to side-to-side walking</p> Signup and view all the answers

Study Notes

Cerebral Palsy (CP)

  • CP is a group of permanent disorders of movement and posture, causing activity limitations, attributed to non-progressive disturbances in the developing fetal or infant brain.
  • Motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, as well as seizures and secondary musculoskeletal problems.

Types of Cerebral Palsy

  • Pyramidal CP: indicates damage to the pyramidal tract, which is a key component of movement impairments.
  • Extrapyramidal CP: indicates injury outside the pyramidal tract, in areas such as the basal ganglia, thalamus, and cerebellum.

Etiology

  • There is no single specific cause of CP; rather, potential causes occur in the prenatal, perinatal, and postnatal periods.
  • Prenatal causes include:
    • Vascular events (e.g., middle cerebral artery infarct)
    • Maternal infections (e.g., rubella, toxoplasmosis)
    • Metabolic disorders
    • Maternal ingestion of toxins
    • Rare genetic syndromes
  • Perinatal causes include:
    • Obstructed labor
    • Antepartum hemorrhage
    • Cord prolapse
    • Other neonatal causes (e.g., hypoxic–ischemic encephalopathy, neonatal stroke, severe hypoglycemia, untreated jaundice, severe neonatal infection)
  • Postneonatal causes include:
    • Metabolic encephalopathy
    • Storage disorders
    • Intermedullary metabolism disorders
    • Metabolic disorders
    • Miscellaneous disorders (e.g., toxicity, infections, meningitis, septicemia, malaria)

Risk Factors

  • Present before pregnancy:
    • Maternal factors (e.g., delayed onset of menstruation, irregular menstruation, long intermenstrual intervals)
    • Medical conditions (e.g., intellectual disability, seizures, thyroid disease)
    • Paternal and sibling factors (e.g., advanced paternal age, motor deficit in sibling)
  • Present during pregnancy:
    • Prenatal conception to the onset of labor
    • Perinatal period (28 weeks intrauterine to 7 days postnatal)
    • Postnatal first 2 years of life

Diagnosis and Prognosis

  • Signs and symptoms of CP may be apparent in early infancy.
  • Infants presenting with abnormal muscle tone, atypical posture, and movement with persistence of primitive reflexes may be diagnosed earlier than 2 years of age.
  • Milder cases of CP may not be diagnosed until 4 to 5 years of age.
  • Evaluation of the child's motor skills, neuroimaging, and evidence that symptoms are not progressing are key elements of diagnosis.

Clinical Findings

  • Dysarthria: a motor speech disorder characterized by weakness or difficulty controlling muscles of the mouth, face, and respiratory system.
  • Enuresis: involuntary or unintentional urination, typically during sleep.
  • FTT: Failure to Thrive, characterized by a child not growing or gaining weight as expected for their age and gender.
  • High Basal Metabolic Rate: an individual burns more calories while at rest compared to others of the same age, gender, and weight.
  • Equinus Contracture: limited flexibility or extension of the ankle joint, causing the foot to point downwards excessively.
  • Fasciculation: involuntary contractions or twitching of small groups of muscle fibers.
  • Biarticular: a muscle that crosses and acts upon two joints.
  • Monoarticular: a muscle that crosses and acts upon only one joint.
  • Contracture: permanent shortening or tightening of a muscle, tendon, or other soft tissues, leading to decreased flexibility and range of motion in a joint.
  • Tightness: a sensation of tension or limited flexibility in muscles or other soft tissues around a joint.

Examination

  • Fasciculation
  • Atrophy
  • Involuntary movement
  • Musculoskeletal examination (PROM):
    • Muscle tone (normal, + hyper, - hypo)
    • Contracture
    • Deformity
  • Primitive reflexes:
    • ATNR (4m)
    • Grasp reflex (5m)
    • Planter reflex (10m)
    • Moro reflex
    • Protective reflex
    • Landau reflex (5m)
    • Parachute reflex (8-9m)

Gait in CP

  • Hemiplegic gait:
    • No hip/knee flexion
    • Ankle dorsiflexion
    • Circumduction
  • Diplegic gait:
    • A. Jump gait:
      • Hip flexion and adduction
      • Knee flexion and ankle plantarflexion
    • B. Crouch gait:
      • Hip flexion and adduction
      • Increased knee flexion and ankle hyperdorsiflexion during stance
    • C. Stiff knee gait:
      • Decreased knee flexion in swing phases due to spastic knee extensor
    • D. Scissoring knee gait:
      • Hip flexion and severe adduction
      • Internal rotation
      • Knee flexion and ankle plantarflexion
  • Trunk lurching gait:
    • Weakness in hip abductor muscles
    • Side-to-side walking
  • Hip rotational profile and pelvic obliquity:
    • Anteversion
    • Retroversion
    • Pelvic obliquity
      • Un-leveled ASIS
      • Scoliosis
      • Leg length discrepancy
      • Hip abductor muscle weakness
  • Knee:
    • Genu varus/ genu valgum
    • Tibial torsion (knee rotation)
    • Tightness muscles (e.g., hamstring, gastrocnemius)
  • Ankle and foot:
    • Equinus
    • Talipes
    • Pes

Cerebral Palsy (CP)

  • CP is a group of permanent disorders of movement and posture, causing activity limitations, attributed to non-progressive disturbances in the developing fetal or infant brain.
  • Motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, as well as seizures and secondary musculoskeletal problems.

Types of Cerebral Palsy

  • Pyramidal CP: indicates damage to the pyramidal tract, which is a key component of movement impairments.
  • Extrapyramidal CP: indicates injury outside the pyramidal tract, in areas such as the basal ganglia, thalamus, and cerebellum.

Etiology

  • There is no single specific cause of CP; rather, potential causes occur in the prenatal, perinatal, and postnatal periods.
  • Prenatal causes include:
    • Vascular events (e.g., middle cerebral artery infarct)
    • Maternal infections (e.g., rubella, toxoplasmosis)
    • Metabolic disorders
    • Maternal ingestion of toxins
    • Rare genetic syndromes
  • Perinatal causes include:
    • Obstructed labor
    • Antepartum hemorrhage
    • Cord prolapse
    • Other neonatal causes (e.g., hypoxic–ischemic encephalopathy, neonatal stroke, severe hypoglycemia, untreated jaundice, severe neonatal infection)
  • Postneonatal causes include:
    • Metabolic encephalopathy
    • Storage disorders
    • Intermedullary metabolism disorders
    • Metabolic disorders
    • Miscellaneous disorders (e.g., toxicity, infections, meningitis, septicemia, malaria)

Risk Factors

  • Present before pregnancy:
    • Maternal factors (e.g., delayed onset of menstruation, irregular menstruation, long intermenstrual intervals)
    • Medical conditions (e.g., intellectual disability, seizures, thyroid disease)
    • Paternal and sibling factors (e.g., advanced paternal age, motor deficit in sibling)
  • Present during pregnancy:
    • Prenatal conception to the onset of labor
    • Perinatal period (28 weeks intrauterine to 7 days postnatal)
    • Postnatal first 2 years of life

Diagnosis and Prognosis

  • Signs and symptoms of CP may be apparent in early infancy.
  • Infants presenting with abnormal muscle tone, atypical posture, and movement with persistence of primitive reflexes may be diagnosed earlier than 2 years of age.
  • Milder cases of CP may not be diagnosed until 4 to 5 years of age.
  • Evaluation of the child's motor skills, neuroimaging, and evidence that symptoms are not progressing are key elements of diagnosis.

Clinical Findings

  • Dysarthria: a motor speech disorder characterized by weakness or difficulty controlling muscles of the mouth, face, and respiratory system.
  • Enuresis: involuntary or unintentional urination, typically during sleep.
  • FTT: Failure to Thrive, characterized by a child not growing or gaining weight as expected for their age and gender.
  • High Basal Metabolic Rate: an individual burns more calories while at rest compared to others of the same age, gender, and weight.
  • Equinus Contracture: limited flexibility or extension of the ankle joint, causing the foot to point downwards excessively.
  • Fasciculation: involuntary contractions or twitching of small groups of muscle fibers.
  • Biarticular: a muscle that crosses and acts upon two joints.
  • Monoarticular: a muscle that crosses and acts upon only one joint.
  • Contracture: permanent shortening or tightening of a muscle, tendon, or other soft tissues, leading to decreased flexibility and range of motion in a joint.
  • Tightness: a sensation of tension or limited flexibility in muscles or other soft tissues around a joint.

Examination

  • Fasciculation
  • Atrophy
  • Involuntary movement
  • Musculoskeletal examination (PROM):
    • Muscle tone (normal, + hyper, - hypo)
    • Contracture
    • Deformity
  • Primitive reflexes:
    • ATNR (4m)
    • Grasp reflex (5m)
    • Planter reflex (10m)
    • Moro reflex
    • Protective reflex
    • Landau reflex (5m)
    • Parachute reflex (8-9m)

Gait in CP

  • Hemiplegic gait:
    • No hip/knee flexion
    • Ankle dorsiflexion
    • Circumduction
  • Diplegic gait:
    • A. Jump gait:
      • Hip flexion and adduction
      • Knee flexion and ankle plantarflexion
    • B. Crouch gait:
      • Hip flexion and adduction
      • Increased knee flexion and ankle hyperdorsiflexion during stance
    • C. Stiff knee gait:
      • Decreased knee flexion in swing phases due to spastic knee extensor
    • D. Scissoring knee gait:
      • Hip flexion and severe adduction
      • Internal rotation
      • Knee flexion and ankle plantarflexion
  • Trunk lurching gait:
    • Weakness in hip abductor muscles
    • Side-to-side walking
  • Hip rotational profile and pelvic obliquity:
    • Anteversion
    • Retroversion
    • Pelvic obliquity
      • Un-leveled ASIS
      • Scoliosis
      • Leg length discrepancy
      • Hip abductor muscle weakness
  • Knee:
    • Genu varus/ genu valgum
    • Tibial torsion (knee rotation)
    • Tightness muscles (e.g., hamstring, gastrocnemius)
  • Ankle and foot:
    • Equinus
    • Talipes
    • Pes

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Test your knowledge on Cerebral Palsy, a group of permanent disorders of movement and posture, and its types such as Pyramidal CP.

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