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CONDITION/DISORDER SYNONYM

  • Cerebral palsy (CP)

ICD-9-CM CODES

  • 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

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERN

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-–Congenital Origin in Infancy or Childhood1

PATIENT PRESENTATION

A 3-month-old infant referred to outpatient physical therapy following discharge from neonatal intensive care unit with diagnosis of CP. Infant was born at 27-week gestational age with Apgars of five at 1 minute and seven at 5 minutes. Past medical history includes respiratory distress syndrome, seizure disorder, and gastroesophageal reflux. Upon examination, infant exhibits poor head control, fisted hands, and inability to achieve prone on elbows.

KEY FEATURES

Description

  • Nonprogressive damage to cerebral cortex (and other parts of the brain, such as cerebellum) that occurs during prenatal, perinatal, or postnatal period2

Essentials of Diagnosis

  • Four types of muscle tone (and percentage occurrence in children with CP)3

    • Hypotonia

    • Hypertonia (70%–75%)

    • Ataxia (10%–15%)

    • Athetosis (20%)

  • Distribution of muscle tone

    • Quadriplegia: All four limbs involved, arms more than legs; cervical area, oral area

    • Diplegia: Primarily legs involved4

    • Hemiplegia: Primarily ipsilateral arm and leg involved4

    • Monoplegia: Only one limb involved

    • Triplegia: Only three limbs involved

    • In athetosis and ataxia, most often total body distribution: No hemiplegia, diplegia

  • Gross motor function classification system5

    • Level I (least involved)

    • Level II

    • Level III

    • Level IV (most involved)

FIGURE 232-1

Schematic representation of surgical options for muscle release or lengthening in cerebral palsy. A: Myotomy; B: tenotomy; C: aponeurotomy. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

General Considerations

  • Muscle tone often presents as hypotonia but changes before 12 months of age, most often to hypertonia depending on the type of CP

  • 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 CP

  • Associated disorders

    • Seizure disorder (in 50% of CP cases)3

    • Cognitive impairment (in 53% of CP cases)

    • Orthopedic deformities

    • Sensory integration dysfunction

    • Speech and language deficits

    • Difficulty feeding

    • Microcephaly3

    • Respiratory distress

    • Bronchopulmonary dysplasia6

    • Hydrocephalus3

    • Retinopathy of prematurity7

    • Visual impairment

    • Auditory impairment

    • Gastroesophageal reflux8

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