Pam Angelakis Tietta Gowans Sarah Peagler Kara Trachtenberg Mariah Valentine

- Define Spastic Cerebral Palsy- Describe Types of Cerebral Palsy- Understand the causes- Explain the gross motor functionality and affected areas- Analyze the gait analysis- Describe treatments

Neurodevelopmental condition starting in early childhood and persisting through the lifespan. -Affects development of movement and posture-Disturbances of: sensation                            communication                            perception                            and/or behavior                            and/or seizuresBax, Martin, et al. "Proposed Definition and Classification of Cerebral Palsy, April 2005". Developmental Medicine and Child Neurology. 47 (2005). 571-576.

What is it?    - form of hypertonia    -Muscles receive the signals to contract continuously    - Might produce contractures due to a marked loss of sarcomeres in the muscle, increased stiffness in the spastic muscle, and changes in the connective tissues within the muscle. Ostensjo, Singrid. "Motor Impairments in Young Children With Cerebral Palsy: Relationship to Gross Motor Function and Everyday Activities".

Developmental Medicine and Child Neurology. 46:9 (2004). 580-589. 

 

http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe002g/dwe00211g20.gif

Brain lesions in the upper motor neuron system

Effect nervous systems ability to receive certain neurotransmitters responsible for movement

McNeil, M. R. Clinical Management of Sensorimotor Speech Disorders. New York: Thieme Medical, 2007. Print

Periventricular leukomalacia (PVL) Cerebral atrophy Post-hemorraghic porencephaly Middle cerebral artery infract Multicystic encephalomalcia Congenital brain malformations Polymicrogyria

Kulak, W., et al. "Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy." Advances in Medical Sciences. 53:1 (2008). 42-48.

http://www.scielo.br/scielo.php?pid=S0004-282X2001000100007&script=sci_arttext

www.indianjournals.com

www.cerebralpalsysymptoms.org

Grey & White Matter

Beginning of 3rd Trimester-White Matter

End of 3rd Trimester- Grey Matter

themindperspective.files.wordpress.com

Krageloh-Mann, Inberg,MD, et al. "The Role of Magnentic Resonance Imaging in Elucidating the Pathogenesis of Cerebral Palsy: a Systematic Review." Developmental Medicine and Child Neurolology. 49:2 (2007). 144-151.

Bilateral Spastic CPIn-term: maldevelopments, PVL, grey matter lesions

Pre-term: 89% PVL

Unilateral Spastic CPIn-tem: PVL, grey matter lesions

Pre-term: 85% PVL

www.neonatalagy.ucsf.edu

Krageloh-Mann, Inberg,MD, et al.

Low birth weight Multiple births Infections during pregnancy Blood type incompatibility Exposure to toxic substances Mothers with thyroid abnormalities Complications during labor & delivery Breech Presentation Small for gestational age Low apgar score Jaundice Unknown

www.ninds.nih.gov

- Decrease Spasticity, Increase functionRoss, Sandy A., et al. "Relationships Between Spasticity,

Strength, Gait, and the GMFM-66 in Persons With Spastic Diplegia Cerebral Palsy". Archives of Physical Medicine and Rehabilitation. 88:9 (2007). 1114-

1120.  -Children walking unaided had significantly less leg spasticity, fewer deviations in ROM, and better selective dorsiflexion (Ostensjo, Singrid, et al.).

-As deviations in ROM increase, the level of spasticity increased (Ostensjo, Singrid, et al.). - In gait, children using mainly the tibialis anterior for dorsiflexion seemed to have less leg spasticity than children using mainly the toe extensors (Ostensjo, Singrid, et al.).

Wiley, Mary Elizabeth, et al. "Lower-Extremity Strength Profiles in Spastic Cerebral Palsy" studied spastic hemiplegia and diplegia. Developmental Medicine and Child Neurology. 40:2 (1998). 100-107.

The findings: - Muscle tightness can prevent a muscle for achieving an effective length for generating force.                       - stronger knee extensors are more likely to perform better on gross motor skills, walk quicker, crouch, and have greater energy economy when walking.                    - Children with hemiplegia had diminished power generation during gait compared to those with no pathology.                     - Knee extensor and flexor strengths of the involved side were respectively 42 and 52% of the uninvolved side in hemiplegia.                    - The weakest muscles were: hip extensors, ankle dorsiflexors, and plantar flexors.

 - The weakness of the hip extensors, hip flexors (1 side), and plantar flexors (1 side) points to the need for increased power of the uninvolved plantar flexors for propulsion (Wiley et al.)

-Muscle tightness can prohibit a muscle from achieving an effective length for generating force.

Hemiplegic Gait

Diplegic Gait

Gross Motor Function Measure-developed to document motor status and to measure change over time (-5 dimensions    lying and rolling    sitting    crawling and kneeling    standing    walking, running, jumpingThere are five levels of classification, children in level I have the fewest limitations in gross motor function and mobility, and children in level V have the greatest number limitations, meaning that very little voluntary movements are possible.

Damiano, Diane. "Relation of Gait Analysis to Gross Motor Function in Cerebral Palsy." Developmental Medicine and Child Neurology. 38: (1996) 389-396Hanna, Steven E., et al. "Reference Curves for the Gross Motor Function Measure: Percentiles for Clinical Description and tracking over time among children with cerebral palsy".  Journal of Physical Therapy. 88:5 (2008). 596-607

used to discover the precise gait problems and to better facilitate ambulation

identifies the specific walking pattern that is causing the person to have difficulty walking

results of the gait analysis are than used to predict what type of muscle, tendon, and joint surgery would be most benefit, evaluate the success of previous orthopedic surgery, and suggest changes in a person’s exercise program

"Types of Cerebral Palsy.", "Gait Analysis of Cerebral Palsy" 4MyChild- Help and Hope for Life. 4MyChild, Web. 20 Oct 2009. http://www.cerebralpalsy.org/.

spasticity is unilateral (occurring on one side)

The most common accepted classification is that reported by Winters et al. (1987)

patterns are divided into 4 types based on the sagittal plane

Rodda, J. and Graham, H.K. "Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm". European Journal of Neurology 8: (suppl. 5) (2001). 98-108.

Type I◦ During Stance phase, dorsiflexion is normal◦ During Swing phase, there is drop foot present

Type II◦ Equinus is present in all phases of gait

Type III ◦ Equinus in ankle◦ Flexed, stiff knee

Type IV ◦ Equinus in ankle◦ flexed-stiff knee◦ flexed hip ◦ an anterior pelvic tilt

Rodda, J. and Graham, H.K. "Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm". European Journal of Neurology 8: (suppl. 5) (2001). 98-108.

Winters, Thomas F., et al. "Gait Patterns in Spastic Hemiplegia in Children and Young Adults". The Journal of Bone and Joint Surgery. 69:3 (1987). 437-441.

http://chestofbooks.com/health/anatomy/Human-Body-Construction/images/Fig-598-Talipes-equinus.jpg

http://www.foot-care.org/images/dropfoot.jpg

http://www.emergingp.com/images/CerebralPalsy3.jpg

http://hb3.seikyou.ne.jp/home/t-matsu2/Efig25a_copy.jpg

ankle is equinus the knee and hip are in flexion there is an anterior pelvic tilt There is an increase in knee flexion in the

early stance phase of gait, with the correction of the knee to normal or near normal extension in mid- and late stance.

Rodda, J. and Graham, H.K. "Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm". European Journal of Neurology 8: (suppl. 5) (2001). 98-108.

Becher, J.G. MD,PhD. Pediatric Rehabilitation in Children with Cerebral Palsy: General Management, Classification of Motor Disorders". Journal of Prosthetics and Orthotics. 14:4 (2002). p 143.

Excessive dorsiflexion at the ankle Excessive flexion at the knee and hip

◦ Excessive hip flecion causes a pelvic tilt in the anterior position

Overactivity of the rectus femoris, iliopsoas, and hip adduction

Rodda, J. and Graham, H.K. "Classification of gait pattern in spastic hemiplegia and spastic diplegia: a basis for a management algortihm". European Journal of Neurology 8: (suppl. 5) (2001). 98-108.

The foot deformities are varus and valgus

Torsional deformities is when either the femur or tibia are turned inside or outside so that the toes of the feet do not point straight ahead.

Wiley, Mary Elizabeth, et al. "Lower-Extremity Strength Profiles in Spastic Cerebral Palsy". Developmental Medicine and Child Neurology. 40:2 (1998). 100-107.

www.healthforcevictoria.com/therasuit.asp

Strengthens trunk muscles used in posture Increases mobility of the pelvis, lubar spine,

and hip

http://www.equestrianzone.org/services

-100% oxygen at 1.5-1.75 atmospheres-constricts blood vessels-optimal environment for new tissue growth-reactivates dormant cellsAdverse effects-ear pain, bleeding-seizures-myopia

www.hhi-kc.com/whatis.htm

Commonly called Bo-tox Injected into muscle Denervation muscle

paralysis Adjunctive therapy Minor side-effects

http://www.youtube.com/watch?v=VTkwv-Izb-E&feature=related

http://www.youtube.com/watch?v=UDgxjRyPe2w&feature=related