Young Adult Cerebral Palsy Fictional Case Study

Introduction

Cerebral palsy (CP) arises from damage or malformations to the brain during development and is one of the most common paediatric onset physical disability (Whitney et al., 2019). CP can lead to a variety of neurological and neuromuscular alterations which prevent optimal motor function capacity and mechanical loading (Whitney et al., 2019). CP is a non-progressive disorder of posture and movement pathology (Bromham et al., 2019). It is typically associated with an impairment of the developing fetal brain or an infant brain, typically up till 2 years old (Bromham et al., 2019). This is typically the age where these malformations occur as the brain is rapidly growing during this time which increases the risk for damage (Bromham et al., 2019). The prevalence of CP is approximately 2-3 individuals per every 1000, most affecting children but continues into adulthood (Bromham et al., 2019).

There are many different types of CP which are often classified in terms of whether it is a unilateral or bilateral disorder, the motor subtype (spastic, dystonia, dyskinesia, etc.) and the severity (Bromham et al., 2019). Spastic diplegia affects 35% of children diagnosed with CP, making it one of the most common types of CP (Patel et al., 2020). This form of CP typically involves muscle stiffness bilaterally in the lower limbs, however, individuals will have normal cognitive function and a good prognosis for independent ambulation (Patel et al., 2020). The severity can be categorized by a the Gross Motor Function Classification System (GMFCS) which has been approved and validated for individuals with CP ages 0-18 at the time of diagnosis (Bromham et al., 2019). Although it is not validated in adults, it can provide a good indication of what their functional mobility will be like into adulthood. This classification system describes the gross motor function based on self-initiated movement abilities, with level I representing individuals who are most able and level V representing individuals most dependent on others for all mobility needs (Bromham et al., 2019).

Gross Motor Function Classification System (GMFCS)

(Bromham et al., 2019)

Level	Limitation
Level I	Walks without restrictions; limitations in more advanced gross motor skills
Level II	Walks without assistive devices; limitations walking outdoors and in the community
Level III	Walks with assistive devices; limitations walking outdoors and in the community
Level IV	Self-mobility with limitations; the person is transported or uses power mobility outdoors and in the community
Level V	Self-mobility is severely limited even with the use of assistive technology

See the link below for additional Information on the GMFCS:

Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER)

There is not as much research and evidence behind CP one individuals reach adulthood. However, adults with CP may experience decreased mobility because of a number of factors, including muscle tone, weakness, and pain (Bromham et al., 2019). Adults with CP have a wide range of abilities from full independence to 24 care needed (Bromham et al., 2019). Although CP is a non-progressive disorder, adults may experience new symptoms and difficulties due to progressions of musculoskeletal disorders and comorbidities that are associated with their CP diagnosis (Bromham et al., 2019). Additionally, young adults, ages 18-30 years old, with CP have been shown to have approximately ten times more of a risk for musculoskeletal conditions compared to young adults without CP (Whitney et al., 2019). Some common comorbidities that have been identified in adults with CP are hypertension, depression, epilepsy, osteoarthritis, and many more (Whitney & Kamdar, 2021). There is also a variability in the services for adults with CP and how they are provided, and there is not as much focus in the health care system on long term needs of adults with CP (Bromham et al., 2019).

The purpose of this case presentation is to explore the effects of CP on a young adult who is independent but experiencing new symptoms with her CP in adulthood. The case presentation will take place in an outpatient setting and will discuss all necessary components of a comprehensive physiotherapy exam. This case presentation will then discuss the analysis and plan for this individual and will also touch on some newer technologies available for CP treatment, and how an interdisciplinary team can be beneficial to treating adults with CP. The overall goal of this case presentation is to bring awareness to CP in adulthood as there is not a lot of evidence and information out there for how to care for these individuals. As CP is a non-progressive disease this case study will focus on maintaining function while creating new management and treatment strategies for new symptoms that may arise in adulthood.

Bellow is a brief video with additional information about cerebral palsy:

Brief Overview of Cerebral Palsy