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CEREBRAL PALSY
o Untreated jaundice, may lead to Medical Conditions
kernicterus (Infiltration of bilirubin into o Intellectual disability
 A group of permanent disorders of the the BG and other parts of the brain and o Seizures
development of movement and posture SC) o Thyroid disease
causing activity limitations that are attributed o Severe neonatal infection  Paternal and sibling factors
to non-progressive disturbances of sensation, o Placenta abruptio – sudden detachment o Advanced paternal age (often in
perception, cognition, communication and of the placenta from a normal uterine athetoid dystonic CP)
behavior as well as seizures and secondary site of implantation, associated c o Motor deficit in sibling
musculoskeletal problems pregnancy-induced HTN During Pregnancy
Etiology o Placenta pravia – placenta implanted in  Preeclampsia
 Perinatal Asphyxia – 6-8%, underlying cause is the lower uterine segment, risk factor  Multiple pregnancies associated c:
unpreventable for placenta abruptio o Preterm delivery
 Schizencephaly – segmental defect that causes Postneonatal o Poor intrauterine growth
a cleft in the brain  Metabolic encephalopathy o Birth defects
 Lissencephaly – decreased cerebral gyri; o Storage disorders
o Intrapartum complications
results in a smooth brain o Intermedullary metabolism disorders
During Labor
 Microcephaly o Metabolic disorders
 Perinatal Asphyxia
 Megalocephaly o Miscellaneous disorders o Prolapsed cord
 Cortical agenesis o Toxicity e.g. alcohol o Massive intrapartum hemorrhage
 Apoptosis ~50% of neurons during  Infections o Prolonged/traumatic delivery
midgestation o Meningitis o Large baby c shoulder dystocia
Prenatal – accounts for ~80% o Septicemia o Maternal shock
 Vascular events e.g. MCA infarct (m/c) o Malaria (esp in developing countries)
 Causal Factors
 Maternal infections during 1st and 2nd  Injuries o Prolonged second-stage labor
trimesters o CVA o Emergency Cesarean section
o Toxoplasmosis o Following surgery for congenital o Premature separation of placenta
o Others (HIV/AIDS) malformations o Abnormal fetal position
o Rubella o Near-drowning
 Preterm
o Cytomegalovirus o Trauma
o Meconium-stained fluid
o Herpes o MVA
o Tight nuchal cord
 Less common: metabolic disorders, maternal o Child abuse
At Birth and Newborn Period
ingestion of toxins, genetic syndromes Risk Factors
 ↓ BW, age at birth
Perinatal Before Pregnancy
 Poor intrauterine growth
 During Labor and Delivery  Maternal
 Low placental weight and Apgar scores (0-3
o Obstructed labor o Delayed onset of menstruation
have 81x ↑ risk of CP)
o Antepartum hemorrhage o Irregular menstruation
 Neonatal seizures
o Cord prolapse o Long intermenstrual intervals
 Sepsis
 Other neonatal causes o Unusually short/long intervals between
 Respiratory disease
o Hypoxic-ischemic encephalopathy pregnancies
Preterm Infants
o Neonatal stroke (usually MCA) o Low social class
 Patent ductus arteriosus
o Severe hypoglycemia – common in o Parity of three or more in preterm
 Hypotension
neonates c poor suck infants
 Blood transfusion
o Relationship c previous fetal deaths
 Prolonged ventilation
 Pneumothorax Classification o Affected side: shoulder protraction,
 Sepsis Type of movement disorder elbow flexion, wrist flexion and ulnar
 Hyponatremia  Spastic deviation, pelvic retraction, hip IR and
 Total parenteral nutrition  Hypotonic flexion, knee flexion, foot plantarflexion
 Seizures  Dyskinetic  Quadriplegia
 Parenchymal damage c appreciable ventricular  Ataxic o Periventricular white matter lesions
dilation Anatomical location of limbs affected o Extensive lesions to BG and occipital
Diagnosis  Hemiplegia area lead to visual impairments and
 Earlier than 2 y/o, infants c abnormal muscle  Diplegia seizures
tone, atypical posture, persistent primitive  Quadriplegia  Modified Ashworth Scale
reflexes Severity of Motor Function Sco Description
 4-5 y/o for mild cases  Gross Motor Function Classification System re
 Key Elements: (GMFCS) – Palisano and colleagues, 1997 00 Hypotonia
o Motor skills Lev 0 Normal tone, no increase
o Neuroimaging el 1 Slight ↑ manifested by slight catch and
I Walks without restrictions, limitation in more release/minimal ↑ resistance to ROM
o Non-progressive symptoms
advanced gross motor skills 1+ Slight ↑ manifested by slight catch and
 Imaging: minimal ↑ resistance to ROM for more than
o Cranial US – high-risk infants II Walks s AD; limitations in walking outdoors
and in community half of range
o MRI – 70-90% show abnormalities 2 More marked ↑ through most of ROM. But
III Walks c AD; limitations in walking outdoors
 Cerebral Hemorrhages and in community affected jt easily moved
o Intraventricular Hemorrhage (IVH) – IV Self-mobility c limitations; transported/use 3 Considerable ↑, passive movement difficult
bleeding into the ventricles power mobility outdoors and in community but possible
o Germinal Matrix Hemorrhage (GMH) – V Self-mobility severely limited even c 4 Affected jt is stiff and cannot be moved
bleeding into tissue around the assistive technology  Tx:
ventricles Bimanual Fine Motor Function Classification (BFMFCS) o Botulinum toxin
o Periventricular Intraventricular  Fine motor and gross motor involvement in o Baclofen
Hemorrhage (PIVH) – bleeding in both children c CP are often the same o Selective dorsal rhizotomy
areas above Spastic (Pyramidal) – 75% of children c CP Dyskinetic (Extrapyramidal) – Generally uncontrolled
o Periventricular cysts (PVC) may form as  M/c neurologic abnormality in pts c CP and involuntary movement
hemorrhages resolve  Hypertonia in which resistance to passive  Deep gray matter lesions, less periventricular
o Periventricular white matter is most movement increases with increasing velocity white matter lesions
sensitive to insult and injury between of movement  Athetosis – slow and writhing involuntary
24-34 wks of gestation  Diplegia – m/c form of spastic CP movements, large motions of the more
o Periventricular leukomalacia (PVL) is the o White matter infarct in periventricular proximal jts
major cause of CP in preterm infants areas caused by hypoxia o Commonly a secondary movement
o Localized damage to corticospinal tracts o ↑ lumbar lordosis, APT, (B) hip IR, (B) disorder in conjunction c spasticity
often leads to spastic diplegia, when knee flexion, intoeing, equinovalgus  Chorea – jerky, abrupt movements of the limb
lesions extend laterally, quadriplegia  Hemiplegia or facial muscles
often results o Periventricular white matter  Choreoathetosis – jerky movements, commonly
 General movements (GM) are the best abnormalities – m/c dx finding of the digits
expression of functional motor development o Cervical-subcortical lesions, brain  Rigidity – resistance to both passive and active
 Intellectual disability is the strongest malformations, non-progressive movement, not velocity dependent
predictor of survival of a child c CP, severity postnatal injuries  Tremor – rhythmic movement of small
of physical impairments is second magnitude, usually of smaller jts
 Dystonia – slow motion c torsional element
 Ballismus – rarest; random motions in large,
fast patterns usually in a single limb
Ataxic – disorder of balance and control in timing of
coordinated movements
 Deficits in the cerebellum
Hypotonic – often transient and might not represent a
specific type of CP

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