Lecture Set 13 - CP.pdf

Sample Exam Question… Regarding ADHD which statement is not true a.Is a type of learning disability b.Is a neurobiological disability c.Interferes with daily activities d.None of the above (they are all true) Cerebral Palsy (CP) Sherrill, C. (2004). Adapted physical activity, recreation, and sport...

Sample Exam Question… Regarding ADHD which statement is not true a.Is a type of learning disability b.Is a neurobiological disability c.Interferes with daily activities d.None of the above (they are all true) Cerebral Palsy (CP) Sherrill, C. (2004). Adapted physical activity, recreation, and sport: Crossdisciplinary and lifespan. Boston: McGraw-Hill. Cerebral Palsy Defined as: • Chronic neurological disorder of movement and posture caused by a defect or lesion on immature brain • Varies in severity Cerebral Palsy • Cerebral means: Brain • Palsy means: Disorder of posture or movement; lack of movement • Primarily a motor deficit Cerebral Palsy • Varies in Severity: • Mild (i.e. general clumsiness may have a slight limp) • Severe (ambulatory difficulty, inability to speak with spoken words, almost no control of motor function) • Differs from person to person • Varying degrees of damage to the brain result in differing degrees of impairment. Cerebral Palsy • Visible Signs Range: • No visible signs TO cognitive, sensory, perceptual difficulties and no motor control with speech difficulties Causes • Prenatal (conception to Birth) • 30% prenatal • Perinatal (20 week of gestation to 28 days after birth) • 60% • Approximately 10% of CP occurs postnatal Causes of Cerebral Palsy PRENATAL PERINATAL POSTNATAL • Fetal anoxia • Poor nutrition • Chemical toxins • Maternal health problems • Premature birth • Difficult delivery • Prolonged labour • Head injury (brain hemorrhages, infections, tumors) • Physical abuse 90% of CP cases occurs during the prenatal and perinatal periods NOTE: • A person who sustain injuries to the motor portion of the brain after age 2-5 exhibit similar motor impairments but are labeled differently • i.e., Stroke, Acquired Brain Injury (ABI) Depends on which area of the brain has been damaged • Muscle tightness or spasm • Involuntary movement • Difficulty with: • gross motor skills such as walking or running • fine motor skills such as writing and speaking • Abnormal physical sensations Classification/Types of CP (CP disorders classified according to two factors) 1. Limb Involvement • • • • • Monoplegia Diplegia Hemiplegia Triplegia Quadriplegia 2. Muscle Tone/Movement Spasticity Athetosis Ataxia People with CP have abnormal muscle tone to varying degrees. • Three major types are recognized BUT most people have mixed types and the diagnosis indicates which is most prominent. • • • • Types of CP - Limb Involvement Types of CP - Limb Involvement Types of CP - Classified according to movement 1. Spastic CP • Most common (50-60%) • Excessive muscle tone, abnormal tightness and stiffness characterized by hypertonic involuntary muscle contractions • Difficulty relaxing muscles when attempting purposeful movement Types of CP - Classified according to movement 2. Athetosis (30%) • Overflow of motor impulses so muscles are characterized by constant, slow, unpredictable and purposeless movement caused by fluctuating muscle tone (hypotonic and/or hypertonic). Types of CP - Classified according to movement 3. Ataxia (10%) • Damage to cerebellum (feedback mechanism of brain and organizes information to coordinate muscle functions) • Poor balance and trunk control • Uncoordinated movement • Involuntary movement of trunk and extremities • Hypotonic • Walk with wide gate CP - Classification according to Severity • Mild • Can walk, speech somewhat affected • Moderate • Difficulty with speech and locomotion • Severe • Use of wheelchair, difficult to understand Associated Medical/Health Concerns • • • • • Oral Dental Speech (35-75%) Visual (55-60%) Sensory deficits Convulsive disorders (25-50%) • ID (30-70%) • Hip dislocation, scoliosis, foot deformities • Major reflex problems (80-90%) Pathological Reflexes • Infant reflexes • Involuntary & predictable • Typically indicative of a mature nervous system • In CP, reflexes are not integrated • Reflexes interfere with smooth, coordinated movement Considerations for Physical Activity • Spasticity • Relaxed atmosphere • Warm water swimming beneficial • Perform slow, prolonged stretches • Work through full ROM Considerations for Physical Activity • Avoid abnormal, involuntary, non-functional muscle patterns • Transport skills (encourage independent movement) • Manipulation skills (make use of functional ability) • Mechanical and muscle inefficiency (a lot of energy is used for movement) • Flexibility – stretch daily Considerations for Physical Activity • Delayed motor development • Limits the physical, mental, emotional stimulation that children require • Suggested that motor performance at age 7 is indicative of motor performance as an adult • Early intervention Considerations for Physical Activity • Adopt principle of keeping body parts in alignment • Avoid abnormal postures and stereotyped patterns • Injury, deviations • If flexion is present place in extension and vice versa Seating someone in their wheelchair… • Must have proper alignment • Hips at 90o and in contact with back of chair • Thighs slightly abducted and in contact with seat • Knees, elbows, ankles at 90 deg flexion • Limit pressure on back of knees • Feet should be flat • Head and neck in midline