473623
Description
Mind Map by v.djabatey, updated more than 1 year ago
|
Created by v.djabatey
almost 11 years ago
|
|
Cerebral palsy-clinical
presentation
- during neonatal period
- babies IDed if at risk
- babies IDed if at risk
- early features
- infancy
- abnormal limb &/or
trunk posture & tone
- delayed
developmental
milestones
- +/-slowing
of head
growth
- abnormal limb &/or
trunk posture & tone
- feeding
difficulties
w/
- oromotor
incoordination
- slow
feeding
- gagging
- vomiting
- oromotor
incoordination
- abnormal
gait once
walking
achieved
- asymmetric hand
function before 12
months old
- infancy
- persistence of
primitive
reflexes
(pathological)
- normal role
of primitive
reflexes
- aid
appearance of
normal
patterns of
movement
- to disappear for
motor development
to progress
- aid
appearance of
normal
patterns of
movement
- normal role
of primitive
reflexes
- diagnosis
- by clinical
exam w/ attn
to
- posture &
pattern of tone
in limbs & trunk
- hand function
- gait
- posture &
pattern of tone
in limbs & trunk
- by clinical
exam w/ attn
to
- 3 main clinical subtypes
- spastic
- damage to upper
motor neurone
pathway
- pyramidal/corticospinal
tract
- pyramidal/corticospinal
tract
- persistently
increased limb tone
(spasticity)
- velocity dependent spastic tone
- the faster muscle stretched, the greater
resistance it'll have
- -> dynamic catch
- characteristic of spasticity
- characteristic of spasticity
- -> dynamic catch
- the faster muscle stretched, the greater
resistance it'll have
- clasp knife
- increased limb tone suddenly gives way under Pa
- increased limb tone suddenly gives way under Pa
- velocity dependent spastic tone
- brisk deep tendon
reflexes
- extensor
plantor
responses
(upgoing)
- unilat or bilat
limb
involvement
- early
presentation
- even as
neonate
- even as
neonate
- 3 main types
- hemiplegia
- unilat arm &
leg
involvement
- arm > leg
affected
- arm > leg
affected
- face
spared
- present @ 4-12
months old
- fisting of
affected
hand
- a
flexed
arm
- asymmetric
reaching/hand
funcn
- subseq tiptoe walk
- toe-heel
gait on
affected
side
- toe-heel
gait on
affected
side
- fisting of
affected
hand
- initially affected
limbs flaccid &
hypotonic
- increased tone
then emerges as
dominant sign
- increased tone
then emerges as
dominant sign
- past med hx
- normal
- unremarkable
birth hx
- unremarkable
birth hx
- neontal stroke
- can be
the
cause
- can be
the
cause
- normal
- hemianopia
- ipsilat side as affected limbs
- due to larger brain lesions (strokes)
- ipsilat side as affected limbs
- unilat arm &
leg
involvement
- quadriplegia
- all 4 limbs affected
- often severely
- often severely
- truncal involvement
- tendency to
opisothonus (extensor
posturing)
- poor head
control
- low
central
tone
- tendency to
opisothonus (extensor
posturing)
- more
severe CP
- assoc
- microcephaly
- seizures
- moderate/severe
intellectual
impairment
- microcephaly
- hx of perinatal
hypoxic-ischaemic
encephalopathy
- all 4 limbs affected
- diplegia
- all 4
limbs
- legs>arms affected
- relatively
normal hand
funcn
- arm motor
difficulties
most visible
on using
hands
- arm motor
difficulties
most visible
on using
hands
- relatively
normal hand
funcn
- legs>arms affected
- abnormal
walking
- assoc
- preterm birth
- periventricular
brain damage
- periventricular
brain damage
- preterm birth
- all 4
limbs
- hemiplegia
- damage to upper
motor neurone
pathway
- dyskinetic
- movements
- involuntary
- uncontrolled
- stereotyped
(sometimes)
- more
evident w/
active
movement
or stress
- involuntary
- variable
muscle
tone
- primitive
motor reflex
patterns
predominate
- description
- chorea
- irreg, sudden & brief
non-repetitive movements
- irreg, sudden & brief
non-repetitive movements
- athetosis
- slow writhing
movements occurring
distally
- e.g. fanning of fingers
- e.g. fanning of fingers
- slow writhing
movements occurring
distally
- dystonia
- simultaneous contracn of
agonist & antag truncal & prox
mm
- twisting appearance
- twisting appearance
- simultaneous contracn of
agonist & antag truncal & prox
mm
- chorea
- relatively
unimpaired
intellect
- presentation
- infancy
- floppiness
- poor trunk control
- delayed motor
development
- abnormal movements
can show only toward
end of 1st year of life
- floppiness
- infancy
- pathology
- damage/dysfunction
- basal ganglia
- extrapyramidal
pathways
- basal ganglia
- damage/dysfunction
- cause
- kernicterus
(hyperbilirubinaemia)
- commonest cause in past
- due to Rh disease of newborn
- commonest cause in past
- hypoxic-ischaemic
encephalopathy @ term
- current commonest cause
- current commonest cause
- kernicterus
(hyperbilirubinaemia)
- movements
- ataxic (hypotonic)
- cause
- genetically
determined
- acquired brain
injury to
cerebellum or its
connections
- signs ipsilat to lesion
- but rel
symmetrical
- but rel
symmetrical
- signs ipsilat to lesion
- genetically
determined
- early trunk & limb
hypotonia
- poor balance
- delayed motor
developments
- features
appearing
later
- incoordinate movements
- intention tremor
- ataxic gait
- incoordinate movements
- cause
- spastic
- description of functional ability
- Gross Motor Function Classification
- Level I
- walks w/o limitations
- walks w/o limitations
- Level II
- walks w/ limitations
- walks w/ limitations
- Level III
- walks using a handheld mobility device
- walks using a handheld mobility device
- Level IV
- self-mobility w/ limitations;
may use self-powered
mobility
- self-mobility w/ limitations;
may use self-powered
mobility
- Level V
- transported in a manual wheelchair
- transported in a manual wheelchair
- Level I
- Gross Motor Function Classification
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