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Cerebral Palsy A collection of diverse syndromes characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. A change in muscle tone at rest and in activity.
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Manifestations Floppy infant/Increase tone Delayed motor development Poor sucking Persistent primitive reflexes
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per 1,000 live births Incidence 1 - 2.3 Prevalence 5.2
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Factors that Increase Incidence Low birth weight: <2,500g Gestational age: <32 weeks Maternal Factors – Mental retardation – Seizure disorder – Hypothyroidism – 2 or more prior fetal deaths – Siblings with motor deficits – 3rd trimester bleeding
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Most Common Antecedent Fetal bradycardia Fetal growth retardation Low placental weight Fetal malformation Neonatal seizures Premature placental separation Newborn encephalopathy
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Etiology Brain injury that occurs prenatal, perinatal or postnatal period. Premature infants (immaturity in fragile brain vasculature, physical stress). Watershed zone next to the lateral ventricles are particularly vulnerable.
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Clinical Diagnosis High risk history - “POSTER” clinical presentation Posture – FSP, ESP, opisthotonus, scissoring Oral Motor - tongue thrust, tonic bite Strabismus Tone (While awake and not struggling) Evolution of Postural Reactions Reflexes – MSRs, clonus, Babinski
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Diagnosis Confirmed by MRI Other tests - Metabolic, biochemical, genetic testing - Developmental assessment and screening tests - Denver Developmental Screening, Beyley Scale - Intellectual evaluation - Standford Binet scale - Motor function measures - GMFM, Pedi, weeFim, Quest
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Classification By limb affectation 1. Monoplegia 2. Diplegia 3. Hemiplegia 4. Quadriplegia
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Classification By muscle tone 1. Spastic - The most common type - Increased in muscle tone - Affects ¾ of all CP - Sometimes presents as lead pipe rigidity - Signs of UMN Lesion (Babinski, hyperactive reflexes)
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2. Dyskinetic - With involuntary movements - Impairments in postural stability - Fluctuating tone a. Athetoid - Slow writhing posturing - Basal ganglia damage - Hyperbilirubinemia (Rh and ABO incompatibility) - Severe anoxia
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b. Choreiform c. Ballistic d. Ataxic - Rare - Mimic cerebellar dysfunction 3. Hypotonic - Needs to be differentiated from other causes of neonatal hypotonia (SMA, metabolic, genetic syndromes) - Most often is the initial presentation of Cerebral Palsy spastic and extrapyramidal type
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4. Mixed - Most often spastic plus athetoid type
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Gross Motor Functional Classification Level 1 Walks without Restriction Limitation in high level skill Level 2 Walks without assistive devices Limitation in walking outdoors Level 3 Walks with devices Limitation in walking outdoors Level 4 Limited mobility Power mobility outdoors Level 5Very limited mobility even with assistive technology
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