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 1.75 kg, length of 43 cm, and head circumference of 29 cm. 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, movement, and balance that result from a defect or anomaly of the developing brain and is one of the top diagnoses of childhood disability, affecting 2 to 3 of every 1000 live births.1 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. Like 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.1 An estimated 760,000 people in the United States have CP with 65% under age 18.2
CP may occur when there is an interruption of blood flow or damage to the developing brain, 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.1 Injury to the developing brain results in changes to otherwise predictable brain formation, growth, and maturation, as described in Chapters 8 and 19. However, it should be noted that CP can occur in those without known risk factors or obvious cause and is, then, referred to as idiopathic (without known cause). ...