1) Understand the pathophysiology of cerebral palsy
2) Identify the common risk factors for cerebral palsy
3) Identify the typical characteristics of cerebral palsy
4) Identify common classification systems of cerebral palsy
5) Identify and choose optimal treatment interventions for children with cerebral palsy post-stroke
CASE A, PART I
Alejandro Lobo was born at 30 weeks gestation with a birth weight of 1.75kg, length of 43cm, and head circumference of 29cm. He spent 7 weeks in the Neonatal Intensive Care Unit (NICU). On day of life 25, he had an ultrasound, which revealed a grade IV periventricular hemorrhage (PVL). He was born to Carmen and Paul Lobo and has an older sister Carla (2 years old, when he was born). Carmen is a physical education teacher at a local high school and Paul is a software developer.
Cerebral palsy (CP) is a term that describes a collection of disorders of posture and movement that result from a defect or anomaly of the developing brain and is one of the top diagnoses of childhood disability, affecting 1–2.5 out of every 1000 live births. CP is nonprogressive, which means that there was an event (or discrete series of events) that caused damage to the brain by disrupting typical brain structure and function, but the brain damage does not worsen over time. Similar to brain injury in adults, CP presents with a disturbance of motor function but also may be accompanied by sensory dysfunction, cognitive impairments, language delay/dysfunction as well as medical disorders such as epilepsy and malnutrition. Although the lesion is nonprogressive, the presentation of CP may change as the child goes through developmental stages, and secondary musculoskeletal conditions are common as the child grows. An estimated 800,000 people in the United States have CP, and more than 450,000 are children less than 18 years of age.1
CP may occur when there is an interruption of blood flow or damage to the brain during the fetal, perinatal, or neonatal periods, resulting in a permanent lesion with diverse consequences, depending on the location, severity, and time of insult. It should be noted that brain injury, during fetal development and early infancy, may not be immediately obvious, and therefore, the exact cause or timing of the insult may not be known. These events are typically single or a discrete series and not active at the time of diagnosis. Risk factors and the incidence of certain types of brain lesions are known, but the cause is often unknown. Injury to the developing brain results in changes to otherwise predictable brain formation, growth, and maturation, as described in Chapters 8 and 18. However, it should be noted that CP can occur in those without known risk factors or obvious causes and is, then, referred to ...