Cerebral palsy-clinical presentation

Mind Map by v.djabatey, updated more than 1 year ago
Created by v.djabatey about 6 years ago


paeds-community paeds and psychiatry Mind Map on Cerebral palsy-clinical presentation, created by v.djabatey on 01/10/2014.

Resource summary

Cerebral palsy-clinical presentation
1 during neonatal period
1.1 babies IDed if at risk
2 early features
2.1 infancy
2.1.1 abnormal limb &/or trunk posture & tone
2.1.2 delayed developmental milestones
2.1.3 +/-slowing of head growth
2.2 feeding difficulties w/
2.2.1 oromotor incoordination
2.2.2 slow feeding
2.2.3 gagging
2.2.4 vomiting
2.3 abnormal gait once walking achieved
2.4 asymmetric hand function before 12 months old
3 persistence of primitive reflexes (pathological)
3.1 normal role of primitive reflexes
3.1.1 aid appearance of normal patterns of movement
3.1.2 to disappear for motor development to progress
4 diagnosis
4.1 by clinical exam w/ attn to
4.1.1 posture & pattern of tone in limbs & trunk
4.1.2 hand function
4.1.3 gait
5 3 main clinical subtypes
5.1 spastic
5.1.1 damage to upper motor neurone pathway pyramidal/corticospinal tract
5.1.2 persistently increased limb tone (spasticity) velocity dependent spastic tone the faster muscle stretched, the greater resistance it'll have -> dynamic catch characteristic of spasticity clasp knife increased limb tone suddenly gives way under Pa
5.1.3 brisk deep tendon reflexes
5.1.4 extensor plantor responses (upgoing)
5.1.5 unilat or bilat limb involvement
5.1.6 early presentation even as neonate
5.1.7 3 main types hemiplegia unilat arm & leg involvement 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 initially affected limbs flaccid & hypotonic increased tone then emerges as dominant sign past med hx normal unremarkable birth hx neontal stroke can be the cause hemianopia ipsilat side as affected limbs due to larger brain lesions (strokes) quadriplegia all 4 limbs affected often severely truncal involvement tendency to opisothonus (extensor posturing) poor head control low central tone more severe CP assoc microcephaly seizures moderate/severe intellectual impairment hx of perinatal hypoxic-ischaemic encephalopathy diplegia all 4 limbs legs>arms affected relatively normal hand funcn arm motor difficulties most visible on using hands abnormal walking assoc preterm birth periventricular brain damage
5.2 dyskinetic
5.2.1 movements involuntary uncontrolled stereotyped (sometimes) more evident w/ active movement or stress
5.2.2 variable muscle tone
5.2.3 primitive motor reflex patterns predominate
5.2.4 description chorea irreg, sudden & brief non-repetitive movements athetosis slow writhing movements occurring distally e.g. fanning of fingers dystonia simultaneous contracn of agonist & antag truncal & prox mm twisting appearance
5.2.5 relatively unimpaired intellect
5.2.6 presentation infancy floppiness poor trunk control delayed motor development abnormal movements can show only toward end of 1st year of life
5.2.7 pathology damage/dysfunction basal ganglia extrapyramidal pathways
5.2.8 cause kernicterus (hyperbilirubinaemia) commonest cause in past due to Rh disease of newborn hypoxic-ischaemic encephalopathy @ term current commonest cause
5.3 ataxic (hypotonic)
5.3.1 cause genetically determined acquired brain injury to cerebellum or its connections signs ipsilat to lesion but rel symmetrical
5.3.2 early trunk & limb hypotonia
5.3.3 poor balance
5.3.4 delayed motor developments
5.3.5 features appearing later incoordinate movements intention tremor ataxic gait
6 description of functional ability
6.1 Gross Motor Function Classification
6.1.1 Level I walks w/o limitations
6.1.2 Level II walks w/ limitations
6.1.3 Level III walks using a handheld mobility device
6.1.4 Level IV self-mobility w/ limitations; may use self-powered mobility
6.1.5 Level V transported in a manual wheelchair
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Cerebral palsy
Abnormal motor development
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