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  • CP

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  • 343 Infantile cerebral palsy
  • 343.0 Congenital diplegia
  • 343.1 Congenital hemiplegia
  • 343.2 Congenital quadriplegia
  • 343.3 Congenital monoplegia
  • 343.4 Infantile hemiplegia
  • 343.8 Other specified cerebral palsy
  • 343.9 Infantile cerebral palsy, unspecified

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  • G80.0 Spastic quadriplegic cerebral palsy
  • G80.1 Spastic diplegic cerebral palsy
  • G80.2 Spastic hemiplegic cerebral palsy
  • G80.3 Athetoid cerebral palsy
  • G80.4 Ataxic cerebral palsy
  • G80.8 Other cerebral palsy
  • G80.9 Cerebral palsy, unspecified

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Description

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  • Non-progressive damage to cerebral cortex (and other parts of the brain, such as cerebellum) that occurs during prenatal, perinatal, or post-natal period

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Essentials of Diagnosis

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  • 4 types of muscle tone (and percentage occurrence in children with cerebral palsy)
    • Hypotonia
    • Hypertonia (70 to 75%)
    • Ataxia (10 to 15%)
    • Athetosis (20%)
  • Distribution of muscle tone
    • Quadriplegia: all 4 limbs involved, arms more than legs; cervical area, oral area
    • Diplegia: primarily legs involved
    • Hemiplegia: primarily ipsilateral arm and leg involved
    • Monoplegia: only one limb involved
    • Triplegia: only 3 limbs involved
    • In athetosis and ataxia, most often total body distribution: no hemiplegia, diplegia
  • Gross motor function classification system
    • Level I (least involved)
    • Level II
    • Level III
    • Level IV (most involved)

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General Considerations

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  • Muscle tone often presents as hypotonia but changes before 12 months of age, most often to hypertonia depending on the type of cerebral palsy
  • Infants (under age 12 months) can also have “transient” muscle tone within first year of life; may initially present as hypertonic but resolves spontaneously without development of cerebral palsy
  • Associated disorders

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Demographics

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  • Present in 0.2% of the population

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Signs and Symptoms

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  • Delays in
    • Gross motor skills
    • Fine motor skills
    • Oral motor skills
    • Perceptual motor skills
    • Social-emotional skills
    • Speech and language skills
  • Abnormal muscle tone (decreased, increased, fluctuating)
  • Arching neck or back into extension
  • Scissoring legs (hip adduction) when held in standing
  • Describe classic rotary, writhing characteristic of movement in athetosis
  • Ataxia: hypotonia and tremulousness, unsteadiness in gait

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Functional Implications

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  • Abnormal movement postures
    • Capital hyperextension
    • Scapular retraction
    • Fisted hands
    • In supported standing
      • Hip adduction (scissoring)
      • Excessive knee flexion (“crouching”)
      • Plantarflexion (standing on toes)
      • Pronation (eversion)
  • Refusal to bear weight on feet or hands
  • Inability to move against gravity in prone position
  • Poor head/trunk control
  • Inability to sit independently
  • Inability to commando crawl or creep on hands and knees
  • Inability to transition from one position to another, such as from prone to sitting
  • Inability to ...

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