Peds

Pediatric Disorders

Cerebral Palsy (CP)

Description/Overview

"Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain."¹

CP may result in spastic, athetoid, ataxic, hypotonic or mixed tone. The distribution of CP includes diplegia, quadriplegia, and hemiplegia.

• Diplegia involves all four limbs with greater involvement in the lower limbs

• Hemiplegia involves the limbs, neck, and trunk of one side of the body

• Quadriplegia involves changes in tone in the entire body

Complications may include cognitive impairment, mental retardation and learning disabilities; seizures; feeding and communication difficulties; respiratory compromise; gastrointestinal abnormalities contributing to digestive problems; bladder and bowel control problems; dental issues; and hearing and vision problems.

Medical Red Flags

Immediate medical attention should be sought for:

• A sudden or rapid change in function or tone because CP is considered to be non-progressive

• Onset of seizure or uncontrolled seizure

Medical Yellow Flags

In the neonate, physiological and behavioral responses to painful and noxious stimuli should be carefully observed. Pain can be manifested by changes in blood pressure, oxygen saturation, heart rate, and respiration as well as change in tone and facial expression.

Precautions

The immobility and lack of weight-bearing activities is associated with reduced bone mass, osteopenia, osteoporosis, and fracture.

Physical Therapy Examination

History

• A review of complications of pregnancy and delivery, birth weight, gestation, and any neonatal and perinatal difficulties; discussion of medical issues, feeding problems, and other health-related problems

• Developmental milestones (Refer to Tab 2)

Tests and Measures

Aerobic Capacity/Endurance

Assessment

• Energy Expenditure Index (Refer to Tab 2)

• Six-Minute Walk Test (for children 5 years and older)

Potential findings

• The level of involvement will affect aerobic capacity; generally people with CP have considerably lower levels of cardiorespiratory fitness than their non-disabled peers.²

Anthropometric Characteristics

Assessment - Assess

• Girth of limbs for asymmetry

• Limb-length measurement of the upper and lower limbs should be taken periodically

Potential findings

• Limb underdevelopment or shortening are common especially in a more affected side

Assistive and Adaptive Devices

Consideration

• Infant walkers should not be used; the American Academy of Pediatrics has called for a ban on infant walkers, stressing that they can result in serious injury, offer no benefits, and may delay motor development;³...