Cerebral palsy

• CP

• 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

• 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

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

Description

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

Essentials of Diagnosis

• 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)

General Considerations

• 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
  • Seizure disorder (in 50% of cerebral palsy cases)
  • Cognitive impairment (in 53% of cerebral palsy cases)
  • Orthopedic deformities
  • Sensory integration dysfunction
  • Speech and language deficits
  • Difficulty feeding
  • Microcephaly
  • Respiratory distress
  • Bronchopulmonary dysplasia
  • Hydrocephalus
  • Retinopathy of prematurity
  • Visual impairment
  • Auditory impairment
  • Gastroesophageal reflux

Demographics

• Present in 0.2% of the population

Signs and Symptoms

• 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

Functional Implications

• 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 ...