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Week 8: Cerebral Palsy, Worsening of cerebral palsy - Coggle Diagram

- - - - Perinatal hypoxic ischemic injury
      - Prematurity
      - Antepartum hemorrhage
      - Intrauterine infection
      - intracranial haemorrhage/stroke
      - Multiple pregnancy
      - Genetic susceptibility
      - Other factors (Listed in slides)
        
        Low birth weight
        
        Damaged placenta which may interfere with fetal growth
        
        Sexually transmitted infections diseases eg AIDS, herpes, Syphilis, Gonorrhea
        
        Poor Nutrition
        
        Exposure to toxic substances, including nicotine, alcohol and drugs
        
        Development of brain starts in early pregnancy and continues until about age three
        
        Damage to the brain during this time may result in cerebral palsy
  - - - Symptoms
        
        Tremors
        
        Hypertonicity
        
        Scissor gait
        
        because cortex being affected leading to stiffness in limbs - hence case scissor gait (other muscles working more than others)
        
        Limb weakness
      - Parts of the brain affected: Cortex (Pyramidal)
      - Characteristics
        
        Stiffness and difficulty moving
        
        have increased resistance to being stretched
        
        co-contraction of muscles leading to movement to become very tight
        
        Become overactive when used and produce clumsy movements
        
        Usually normal muscles work in pairs - when one group of muscles contract the other group of muscle relaxes to allow free movement in desired direction
        However, spastic muscles become active together and block the effective movement
      - Most common type of cerebral palsy
    - - Symptoms
        
        Abnormally slow movements
        
        Writhing movement
        
        Movement is exacerbated during stress or when there is no sleep
      - Parts of the brain affected: Basal ganglia (extrapyramidal) - not part of conscious control
      - Characteristics
        
        Involuntary and uncontrolled movements (link to parkinson's disease where basal ganglia is also affected)
    - - Symptoms
        
        wide based gait
        
        intention tremor - causing unsteady hands
      - Part of brain affected: cerebellum (extrapyramidal) - not part of conscious control
        
        Cerebellum is very important for balance and coordination
      - Characteristics
        
        Disturbed sense of balance and depth perception
        
        They usually have poor muscle tone (hypotonic), a staggering walk and unsteady hands
    - - Causes
        
        When areas of the brain affecting both muscle tone and voluntary movement are affected
    - - Characteristics
        
        Difficulty in controlling and co-ordinating movement
        
        Children may have involuntary movements (which frequently cease while they sleep)
        
        Difficulty with skills that required coordinated movements such as speech or reaching and grasping objects smoothly
        
        What it is related to
        
        Dystopia: Twisting movements and postures of the trunk or limbs
  - - - When the child has a generalized low tone, the child cannot look up and the head actually falls forward.
      - But the child has a basic intention to explore - therefore the child will fix his head in hyperextended position (which can be seen in the second picture)
      - He/she might try to hold the head up in hyperextended position, therefore the neck starts to become fixed and stiff, which leads to a secondary impairment
    - - Characteristics
        
        High tone (can be in total flexion or total extention)
        
        Problems in initiating any movement when the child has very high tone
        
        Poor alignment when starting any movement
        
        Joint contractures msc shortness from neuromuscular impairment
        
        Bony changes in spine and rib cage, hip, knee, ankle and feet
        
        Bony changes: in fixed elbow flexion, wrist flexion, fisted hand, tilted head, probably scoliosis, probably hip dislocation, lat abduction, knee flexion, fixed deformities and ankle flexion
        
        Typical hand which is in wrist flexion, thumb in palm and radial ulnar deviation
        
        Abnormal sensory feedback received due to abnormal patterns (the child's limbs are in abnormal position)
        
        Therefore e.g normal way of weightbearing on hands - the child is suppose to receive tactile and proprioceptive feedback, which is necessary for hand development
        
        However it does not take place for the client with cerebral palsy
    - - Observation: Hand just reaches out and grabs air, touches ear, would stick out tongue and head will just move about
- - - - Young children participation and environment measure
      - Miller’s function and participation scales
      - Pleads QL
      - School Function Assessments
      - Children’s assessments of participation and Enjoyment
    - - Paediatric Evaluation Of Disability Inventory
      - The Roll Evaluation Of Activities Of Life - Skills that are used for cerebral palsy clients
      - Gross Motor Function Classification System (GMFCS)
      - Manual Ability Classification System (MACS)
      - Functional Communication System (FCCS)
    - - Student Vocational Profile
      - Client Assessment Form
  - - - NDT - Assessment for this is most commonly used for CP clients
      - Observe typical development VS cerebral palsy clients
      - e.g picture: normally developing child crawling - both legs are dissociated during crawling( not moving together) and arms are also moving one at a time
      - e.g video: cerebral palsy client - both the legs are moving together (cannot be called crawling - more like bunny hopping) in order to move forward and also both hands moving together - not alternate pattern of moving observed.