Development of the Child with Cerebral Palsy: Difference between revisions
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=== Spastic Hemiplegia === | === Spastic Hemiplegia === | ||
The main characteristic is a reduction of the motor repertoire of the affected side especially in upper limb. Hemiplegic often have associated movements that express the relation and influence among the preserved side. | The main characteristic is a reduction of the motor repertoire of the affected side especially in upper limb. Hemiplegic often have associated movements that express the relation and influence among the preserved side.<br> | ||
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'''Musculoskeletal System:''' | '''Musculoskeletal System:''' | ||
*Child with hemiplegia shows subtle asymmetries in supine position in the 2nd trimester, hemiplegic arm remains in shoulder elevation and extension. | *Child with hemiplegia shows subtle asymmetries in supine position in the 2nd trimester, hemiplegic arm remains in shoulder elevation and extension. | ||
*Children with hemiplegia sits in the non-affected side, so they remain in a shortened position of the paretic trunk side and avoid weight bearing in hemiplegic side. | *Children with hemiplegia sits in the non-affected side, so they remain in a shortened position of the paretic trunk side and avoid weight bearing in hemiplegic side. | ||
*Many children use this posture to scoot about the floor, totally avoiding an all-fours posture. | *Many children use this posture to scoot about the floor, totally avoiding an all-fours posture. | ||
*All fours requires a more symmetrical trunk and extremities weight bearing that are difficult for hemiplegic kids. That’s why most of hemiplegic do not crawl, they use to move around using lateral sitting posture. | *All fours requires a more symmetrical trunk and extremities weight bearing that are difficult for hemiplegic kids. That’s why most of hemiplegic do not crawl, they use to move around using lateral sitting posture. | ||
*When they grow the hemiplegic trunk side is shortened as the cervical spine in early stages. | *When they grow the hemiplegic trunk side is shortened as the cervical spine in early stages. | ||
*Upper limb remains in protraction, elbow in flexion and hand close, maybe thumb adducted. This create big difficulties to integrate the hand in ADL activities. | *Upper limb remains in protraction, elbow in flexion and hand close, maybe thumb adducted. This create big difficulties to integrate the hand in ADL activities. | ||
The child with hemiplegia controls the lower limbs in different ways; | The child with hemiplegia controls the lower limbs in different ways; | ||
*However, there are postures that remain in the 3 different walking patterns. One is the pelvic asymmetry in the 3 planes. In the frontal plane the pelvis is elevated (craneal tilted) in the transverse plane the hemipelvis of the hemiplegic side is rotated posteriorly, in the sagittal plane hip is in flexion. The leg remain in internal rotation, knee in flexion and plantar flexion. | *However, there are postures that remain in the 3 different walking patterns. One is the pelvic asymmetry in the 3 planes. In the frontal plane the pelvis is elevated (craneal tilted) in the transverse plane the hemipelvis of the hemiplegic side is rotated posteriorly, in the sagittal plane hip is in flexion. The leg remain in internal rotation, knee in flexion and plantar flexion. | ||
The differences appear in the way the kid controls the hip and leg from the pelvic position: | The differences appear in the way the kid controls the hip and leg from the pelvic position: | ||
*Functional leg length discrepancy, showing the hemiplegic side shorter because hemipelvis is elevated. In fact it might be true bony size discrepancy due to growth. This happen in stiff kids with severe hip and knee flexion, adduction and internal rotation. | *Functional leg length discrepancy, showing the hemiplegic side shorter because hemipelvis is elevated. In fact it might be true bony size discrepancy due to growth. This happen in stiff kids with severe hip and knee flexion, adduction and internal rotation. | ||
*The shorter leg tends to follow with internal rotation, plantar flexion and inversion with strong pull of tibialis posterior. The hemiplegic foot supinates with weight bearing. | *The shorter leg tends to follow with internal rotation, plantar flexion and inversion with strong pull of tibialis posterior. The hemiplegic foot supinates with weight bearing. | ||
*Other type are the hemiplegic with less hip flexion and less internal rotation but knee hyperextension with weight bearing and plantar flexion, although the first contact in stance phase is with toes not with heel. | *Other type are the hemiplegic with less hip flexion and less internal rotation but knee hyperextension with weight bearing and plantar flexion, although the first contact in stance phase is with toes not with heel. | ||
*Hip in external or internal rotation, knee mobile with phases of flexion and extension and slight plantar flexion with pronation of foot. Kids with neuromuscular stiffness.<br> | *Hip in external or internal rotation, knee mobile with phases of flexion and extension and slight plantar flexion with pronation of foot. Kids with neuromuscular stiffness.<br> | ||
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'''Neuromuscular System:'''<br> | '''Neuromuscular System:'''<br> | ||
Muscle retractions and early or late bone growth alterations are more or less frequent according to the severity. | Muscle retractions and early or late bone growth alterations are more or less frequent according to the severity. | ||
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'''Sensory and Perceptual System:''' | '''Sensory and Perceptual System:''' | ||
*Tactile, thermal, pain, proprioceptive… occur more in adults is not frequent in childhood hemiplegia. Although stereognosia disorders are quite frequent. | *Tactile, thermal, pain, proprioceptive… occur more in adults is not frequent in childhood hemiplegia. Although stereognosia disorders are quite frequent. | ||
*Motor impairment, perceptive alteration, neurophysiological aspects, epilepsy are all factors that affect direct with the child learning ability.<br> | *Motor impairment, perceptive alteration, neurophysiological aspects, epilepsy are all factors that affect direct with the child learning ability.<br> | ||
Revision as of 14:12, 4 September 2016
Original Editor - Lorena Perez as part of ICRC Cerebral Palsy Content Development Project
Top Contributors - Naomi O'Reilly, Kim Jackson, Simisola Ajeyalemi, WikiSysop, 127.0.0.1, Tony Lowe, Rucha Gadgil, Lucinda hampton, Jess Bell and Chelsea Mclene
Introduction[edit | edit source]
Knowledge of typical development is essential to compare the atypical development of children with Cerebral Palsy at all stages of their development, but even more so during the early stages where imparments are often not so evident
http://www.cdc.gov/ncbddd/actearly/milestones/index.html
Depending on the type of the Cerebral Palsy and Neurodevelopment Disorders, we will observe different patterns including positions and movements and different impairments.
The symptoms and function of each person with Cerebral Palsy varies. Cerebral Palsy is non-progressive so does not get worse over time, but the exact symptoms and function can change over a person's lifetime. From Birth to 5 years of age, a child should reach specific movement goals or developmental milestones - e.g. rolling, sitting up, standing, and walking which are often delayed or absent in the child with Cerebral Palsy.
Lets examine the development related to each type of Cerebral Palsy. Different body systems can influence the development milestones in children with Cerebral Palsy.
Musculoskeletal System:[edit | edit source]
Bony structures deformities or impairments are secondary due to:
- Impact of gravity on a body that has poor alignment and moves abnormally
- Abnormal muscle contraction during growth
- Lack of variety of movements and strategies e.g. weight-bearing postures.
Neuromuscular System;[edit | edit source]
In relation to Spasticity and Muscle Fibre, the literature supports the notion that, although spasticity is multifactorial and neural in origin, significant structural alterations in muscle also occur. An understanding of the specific changes that occur in the muscle and extracellular matrix may facilitate the development of new conservative or surgical therapies for this problem. ( see Annexe 1)
Sensory and Perceptual System;[edit | edit source]
In many children with Cerebral Palsy vision is compromised in relation to postural control and movement, proprioceptive, tactile and vestibular functioning, which creates pathologic patterns and strategies to move and orient the body in space.
Respiratory System:[edit | edit source]
Many children with Cerebral Palsy have difficulty to maintain respiration while at the same time supporting posture and movement. Infants breathe primarily with the diaphragm which sits high in the thoracic ribcage, with each inspiration, it contracts, pushing down on the abdominal contents. In the infant, the abdominal muscles are not yet working to oppose this force of the diaphragm, and the belly expands. This is called belly breathing. In addition the ribcage is elevated and the ribs horizontally positioned, making the ribcage a fairly rigid structure. This is why the ribcage remains elevated and the spine in flexion in many children with Cerebral Palsy. They have difficulty to expand the rib cage for air exchange and difficulties in exhalation of air to control the speech. The abdominal muscles fail to be used posturally to support lower trunk stability in children with Cerebral Palsy.
Associated Conditions:[edit | edit source]
Other impairments that children with Cerebral Palsy can develop are skin and digestion problems, motivation, nutrition and growth, deficit of attention, learning difficulties. You can read more about these conditions on the Physiopedia Page Cerebral Palsy Associated Conditions.
Typical Postures and Movement Strategies[edit | edit source]
This information is based on clinical observation and clinical reasoning from the evaluation and assessment of the impairments, and describes the atypical features for children with spasticity, athetosis, hypotonia and ataxic cerebral palsy.
Quadriplegia[edit | edit source]
Upper Limb Observation | Lower Limb Observation |
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Neuromuscular System:
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Neuromuscular System:
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Musculoskeletal Feature: The child will adopt pathologic patterns in the attempt to see or play:
Note: This pattern will correspond to a kid with a normal development of 1 month, but babies developing normally change this position by controlling the head with in 3 planes; extension, flexion, lateral flexion and rotation while pushing the surface against gravity. |
Musculoskeletal Feature:
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Sensory and Perceptual System:
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Prognosis: We have to differentiate between; Antigravity Quadriplegia
Vertical Trunk Antigravity Sitting Position: On Tacrum with Trunk in Kyphosis and Knees Semi-Extension Upright Standing: Possible with Upper Limbs Devices Crawling: Possible Pathological Creeping or Crawling Manipulation: Possible with Difficulties Food: Effective Cognition: Usually Preserved |
Diplegia[edit | edit source]
The child with diplegia will have control of the head, neck, tongue and eyes. Some have more compromise of the upper limb than others. Those with more severe involvement of the limbs may develop similar to the quadriplegic vertical trunk antigravity forms, with similar general features.
Musculoskeletal System:
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Neuromuscular System:
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Sensory and Perceptual System:
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Prognosis:
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Spastic Hemiplegia[edit | edit source]
The main characteristic is a reduction of the motor repertoire of the affected side especially in upper limb. Hemiplegic often have associated movements that express the relation and influence among the preserved side.
Musculoskeletal System:
The child with hemiplegia controls the lower limbs in different ways;
The differences appear in the way the kid controls the hip and leg from the pelvic position:
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Neuromuscular System: Muscle retractions and early or late bone growth alterations are more or less frequent according to the severity. |
Sensory and Perceptual System:
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Recent Related Research (from Pubmed) [edit | edit source]
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References [edit | edit source]
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