Cerebral Palsy
early onset of impaired movement and posture NONPROGRESSIVE
Etiology of CP
preterm birth of ELBW and VLBW and anoxia
Spastic CP
most common, hypertonicity, poor control
Athetoid/dyskinetic CP
involuntary movement
Ataxic CP
rapid movement
Mixed/dystonic CP
spastic and athloid
Possible motor signs of CP
poor head control after 3 months
stiff or rigid limbs
arching back/pushing away
floppy tone
unable to sit without support at 8 months
clenched fist after 3 months
uses only 1 side of the body or only uses arms to crawl
possible behavior signs of CP
excessive irritability
no smiling by age 3
feeding difficulties (tongue thrusting or frequent gagging or choking with feeds)
Associated disabilities and problems of CP
ADHD
seizures
drolling
feeding and speech problems
aspiration
inadequate gas exchange
ortho complication
constipation
dental caries
malocclusion
gingivitis
nystagmus and amblyopia
hearing loss
Management of CP
Surgery (ortho or neuro)
Medication: Baclofen pump, antieleptics, ADHD meds
Neural tube defect diagnosis
Elevated alpha-fetoprotein in amniotic fluid (16-18 weeks)
Uterine ultrasound
C-section to prevent further complications
Anencephaly
-absence of cerberal hemispheres
-most serious NTD
-many are still born
-no resuscitation measures
Spina bifida
failure of the osseous spine to close
Spina bifida occulta
not visible externally, tethered cord, altered gain, bowel/bladder defect
Spina bifida cystica
visible defect, sac like protrusion
Two types: meningocele and myelomeningocele
Meningocele
sac contains meninges and spinal fluid but NO neural elements
Myelomeningocele
neural tubes fail to close, may be anywhere along the spinal column (lumbar and lumbosacaral most common)
*occurs first 28 days of pregnancy
*contains meninges, spinal fluids and nerves
If defect is below the 2nd lumbar vertebra: (myelomeningocele)
-flaccid paralysis
-sensory deficit
Initial management of spina bifida
-prevent infection
-assessment of neuro and associated anomalies
-early closure in 12-72 hours after birth (prevent stretching)
Therapeutic Management of spina bifida
-early closure of the sac
-ortho and musculoskeletal considerations
-manage bowel and bladder with cathing
Spinal Muscular Atrophy
-progressive weakness and wasting of skeletal muscles
-degeneration occurs in spinal cord and brainstem, resulting in atrophy of skeletal muscles
Therapeutic management of SMA
diagnosed by EMG and muscle biopsy
prevent infection and treat infection
treat ortho problems
Infantile SMA (Werdnig- Hoffmann disease)
autosomal recessive
most common paralytic form of floppy infant
death usually happens by 4 yo because of resp. failure or infection
Muscular dystrophies
all have genetic origin with gradual degeneration of muscle fibers, progressive weakness and wasting of skeletal muscles
