Cerebral palsy classifications

cerebral palsy

1. CEREBRAL PALSY

2. WHAT IS CEREBRAL PALSY ? Permanent disorder of movement and posture(motor impairment) due to lesion in developing brain. Non progressive brain lesion resulting in progressive musculoskeletal pathology !!! Spinal cord and muscles are normal

3. Why cerebral prevalence has been increased? Because of increased survival of very low birth weight infants.

4. Causes of cerebral palsy Prenatal causes – TORCH infections , environmental toxins , poor oxygenation , vascular causes , malformations Perinatal causes – birth asphyxia (most common cause) , neonatal jaundice , neonatal hypoglycemia , meningitis, intracranial hemorrhages Postnatal causes – infections, brain injury , asphyxia due to aspiration

5. SPASTICITY VELOCITY DEPENDENT INCREASE IN MUSCLE TONE CAN FELT REMAINS ALL THE TIME TENDONS , BONE AND JOINT SURGERY IS NEEDED DYSTONIA INVOLUNTARY TWISTING MOVEMENTS CAN BE SEEN REDUCES DURING SLEEP AND REST ARTHRODESIS WORKS

6. PHYSIOLOGICAL CLASSIFICATION SPASTIC DYSKINETIC ATAXIC HYPOTONIC MIXED

7. Pyramidal problems are due to ischemic encephalopathy leading to spastic cerebral palsy. Extrapyramidal problems are due to neonatal jaundice causing dyskinesia and choreoathetosis .

8. Geographical classification Monoplegia – only one limb affected. Hemiplegia and double hemiplegia - both upper and lower limbs . But UL>LL Paraplegia – both lower limbs Diplegia – both upper and lower limbs affected but LL> UL. Quadriplegia - both lower and upper limbs equally affected.

9. DIFFERENTIAL DIAGNOSIS HEREDITARY SPASTIC PARAPARESIS CHIARI MALFORMATION DOPAMINE DEFICIENT DYSTONIA CHARCOT MARIE TOOTH DISEASE

10. GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM Firstly described by D r Robert Palisano and D r P eter rosenbaum . it includes description of gross motor function of children on basis of sitting ,walking and wheel chair mobility . Important system to classify functional mobility of child It predicts how the mobility of the child would remain for life long The original GMFCS had some limitations. These limitations included an upper age limit of 12 years and rating of the child based on their best capability rather than their typical performance when forced by the rating scale to choose a single category.

11. GMFCS Help to see walking ability of child Help in managing Help to predict complications like hip subluxation mainly seen in GMFCS 4 and 5

12. Treatment according to GMFCS scoring GMFCS1 – less physiotherapy is needed. GMFCS 2- balance / coordination training GMFCS 3 – balance training , strengthening, prevent/ treat ortho deformity GMFCS 4 – wheelchair training, , look for hip dislocation. GMFCS5- realistic goals.

13. Treatment can change FUNCTIONAL MOBILITY SCORE but not GMFCS.

14. Functional mobility scale Functional mobility scale was designed by Graham and colleagues as a measure of ambulatory performance in children with CP. The FMS is the only existing functional scale that accounts for the fact that children may demonstrate different ambulatory abilities and use different assistive devices to walk various distances. FMS categorizes the assistance needed for a child to walk 3 distances . The distances are not specifically measured but are used as estimates to represent household , school and community ambulation. Ratings are given for each distance category .

15. Like GMFCS , the FMS assesses a childs average performance in daily life rather than their maximum capability. FMS specifically addresses ambulation, and , therefore , is not intended to substitute for the GMFCS , which assesses mobility on a more general level.

16. Functional mobility score

17. The child who ambulates independntly for all distances and on all types of surfaces would be given a rating of 6,6 and 6 . A child who ambulates independently on level surfaces in the home , uses crutches at school, and a wheelchair for shopping trips and family outings would be given a rating of 5,3, and 1 .

18. FUNCTIONAL MOBILITY SCORE FMS 1 – wheel chair bound , stand for transfer FMS 2 – uses walker / frame and needs support FMS 3 – use crutches and walk independently FMS4 – use stick and walk independently FMS 5 – Walk independently on levelled surfaces FMS 6- walk independently on all surfaces.

19. If a child having GMFCS 3 , can walk for 5 meters with help of stick , can walk for 50 meters with help of crutches , can walk in community using wheel chair … Then rating that describes the current function would be 3, 2, 1 .

20. How to check whether there is spasticity /contracture on basis of tardieu scale R1 – angle on fast stretch R2- angle on sustained stretch Spasticity angle = R2- R1 Low spasticity angle means contracture High spasticity angle means spasticity