Term
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Definition
An umbrella term for a group of disorders of development and posture. |
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Term
What can cerebral palsy be attributed to? |
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Definition
Non-progressive disturbance occurring in the foetal/infant brain. |
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Term
What is the most common classification of cerebral palsy? |
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Definition
Spastic cerbral palsy, 80-90%. |
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Term
What pathophysiology is spastic cerebral palsy associated with? |
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Definition
Damage to the cortex, therefore no inhibition of the reflexes causing hypereflexia. |
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Term
Name the three different types of spastic cerebral palsy? |
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Definition
Quadriplegic (10%)- all four limbs, diplegia (35%)-both legs more commonly than both arms and hemiplegia (40%)-one side of the body. |
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Term
What percentage of cerebral palsy is extrapyramidal? |
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Definition
5-10%- associated with damage to the extrapyramidal system. |
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Term
What are the specific causes of extrapyramidal cerebral palsy? |
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Definition
Acute neonatal hyperbilirubinaemia. Acute neonatal hypoxic ischaemic injury |
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Term
Describe dystonic cerebral palsy as a type of extrapyramidal cerebral palsy |
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Definition
Dystonia - Abnormal sustained contraction of agonists & antagonists. This results in abnormal posture with strongest muscle group out competing. |
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Term
Describe choreo-athetoid cerebral palsy as a type of extrapyramidal cerebral palsy |
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Definition
Atheoid- slow writhing movements Chorea- Rapid sudden involuntary movements. |
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Term
What percentage of cerebral palsy is ataxic? |
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Definition
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Term
Describe ataxic cerebral palsy |
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Definition
Damage to the cerebellum. Ataxia- abnormality in the smooth approach to an object, wide amplitude corrections needed. This may therefore affect walking, speech and movements. |
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Term
Describe hypotonic cerebral palsy |
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Definition
Hypotonia, hyperreflexia and persistance of primary reflexes. |
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Term
What is mixed cerebral palsy and why might this happen? |
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Definition
Mixed picture of all types, due to damage to more than one part of the brain. |
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Term
What co-morbidities can be present with cerebral palsy? |
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Definition
Learning Difficulties (30%), Hearing Impairment (~25%), Visual Impairment (may be due to visual cortex damage or oculomotor process), Epilepsy |
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Term
What are the pre-natal causes of cerebral palsy? |
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Definition
Infection, Toxins, Drugs, Trauma, ↓Foetal movement |
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Term
What are the perinatal causes of cerebral palsy? |
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Definition
Asphyxia, Interventricular Haemorrhage |
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Term
What ate the postnatal causes of cerebral palsy? |
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Definition
Vascular Diseases (CVA), Infection, Trauma, Encephalopathy, Metabolic Disturbance e.g. ↑Bilirubin/Glycaemia |
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Term
What are the prenatal suggestive factors of cerebral palsy? |
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Definition
Infection, Toxins, Drugs, Trauma, ↓Foetal movement |
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Term
What are the perinatal suggestive factors of cerebral palsy? |
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Definition
Prematurity, Difficult birth, Abnormal tone, Post-birth pathology |
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Term
What developmental signs might make you consider a diagnosis of cerebral palsy in infancy? |
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Definition
Delayed motor development and missed milestones. |
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Term
On examintaion, what would make you consider a diagnosis of cerebral palsy? |
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Definition
Abnormal Tone Athetosis/Chorea/Ataxia Reflex Abnormalities: Hyperreflexia Persistence Of Primitive Reflexes e.g.: •Morro Reflex (Startling on dropping backwards) •Asymmetric Tonic Neck Reflexes (Turning head to left (actively or passively) causes extension of left limbs & flexion of right limbs +v-v) |
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Term
What management options are available for cerebral palsy? |
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Definition
Therapy-physio, occupational and SALT. Orthotics Antispasmodics- Baclofen and Botulinum toxin. Surgery- Orthapaedic and selective dorsal rhizotomy. |
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Term
How does baclofen as an antispasmodic for cerebral palsy work? |
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Definition
GABA antagonist (GABA inhibitory neurotransmitter), reduces spasticity with varying effect, PO or IV. |
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Term
How does botulinum work as an antispasmodic in cerebral palsy? |
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Definition
Blocks ACh release, reduced tone for 3-4 months post treatment. Administered via injection. |
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Term
What is selective dorsal rhizotomy? |
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Definition
Cuts sensory fibres reducing muscle stimulus by reducing reflexes. Eliminates spasticity but leaves the patient very weak. |
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Term
What is the current prevalance of autistic spectrum disorders and how has this changed? Why? |
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Definition
100 per 100,000 persons have an autistic spectrum disorder, 4:1 male:female ratio. ~4 per 100,000 classified as autistic in 1960s Due to increased prevalence of autism, or increased diagnosis |
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Term
What are the associated risk factors of autistic spectrum disorders? |
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Definition
Genetic factors- 5-6% chance with older siblings diagnosed. Elderly parenthood- both maternal and paternal. Associated syndromes- <10% of cases foetal alcohol syndrome, phenylketonuria, angelman syndrome. Co-Ocurring disorders- ADHD (20-30%) |
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Term
What are the classical clinical features of autistic triad? |
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Definition
Impairment of social relationships, Impairment of Social Communication, and Impairment of Imagination. |
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Term
How would impairment of social relationships present as a sign of autism? |
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Definition
Social Isolation - Often content to be alone, Find making friends difficult Lack Understanding Of Social Behavior Find social cues difficult to read; lack of empathy Inappropriate behavior – May cause offence & appear insensitive/egocentric |
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Term
How would impairment of social communication present as a sign of autism? |
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Definition
Non-Verbal Communication Verbal Communication - Use formal/pedantic spoken language, lacking in inflexion Interpretation – Take things literally & have difficulty interpreting implied meanings |
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Term
What characteristic signs of autism would you expect to see in childhood? |
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Definition
Echolalia: Child may repeat/mimic chunks of language out of context Absence of Protodeclarative Pointing: Child doesn’t point to declare interest Using Parents/Carers As Tools - Child may grab person’s hand and place it on an object to get person to do something |
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Term
How would impairment of imagination present as a sign of autism? |
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Definition
Preference for repetitive activities – e.g. ordering/lining up/stacking toys, Attention drawn to trivial aspects of environment with lack of appreciation of whole Devotion to routine – e.g. bedtime rituals, following exact routes Devotion to specific topics – e.g. repetition of facts on certain topics |
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Term
How is the differential diagnosis of autism assessed? |
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Definition
The use of multi-disciplinary teams (e.g. Doctors, Psychologists, SALTs, OTs) and multiple sources (e.g. home, school, parents) along-side a semi-structured interview and observation tools. |
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Term
What semi-structured interview schedules and observation tools are used in the assessment of autism? |
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Definition
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Term
What other variables should be considered in the diagnosis of autism? |
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Definition
Pregnancy and birth Developmental milestones- in particular language. |
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Term
In the presentation of autism, what is regression of milestones? |
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Definition
Children have normal developmetn before regressing e.g stopping communication at 18-30 months or losing toilet training. |
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Term
By what age does developmental delay usually become apparent in autism? |
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Definition
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Term
What are the classic language signs of autism? |
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Definition
•Language Delay/Absence •Echolalia - immediately or delayed -‘Parroting’ of parents orders -Repetition of chunks of dialogue from TV/film out of context |
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Term
What are the classic social interaction signs of autism? |
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Definition
Absence of protodeclarative pointing Failure to follow point of other Lack of eye contact Indifference to presence of parents or others |
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Term
What are the classic environmental stimuli signs of autism? |
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Definition
Interest in moving geometric patterns Inappropriate reactions to loud sounds e.g. incessant screaming, suggestion of pain Abnormal responses to physical pain: no crying/running to parent |
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Term
What are the classic play signs of autism? |
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Definition
Absence of symbolic play (tea parties, playing with toy telephone) Repetitive Play e.g. repeatedly tapping objects Ordering objects or dropping from a particular height |
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Term
What are the classic movement signs of autism? |
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Definition
• Patterned, repetitive movements e.g.Hand Flapping - tends to occur when child excited Tics & ‘choreoatheotic’ movements Self injurious behaviours |
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Term
When does aspergers and high functioning autism typically present? |
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Definition
School age rather than pre school. |
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Term
How does aspergers typically present in children? |
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Definition
IQ >70 Impairments in all 3 areas of Autistic triad No delay in language |
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Term
Hows does higher functioning autism classically present in children? |
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Definition
IQ >70 Impairments in all 3 areas of autistic triad Delay in language acquirement +/- Abnormality in language functioning, delay may only be picked up in retrospect |
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Term
What are the classic language and communication signs of both aspergers and higher functioning autism at school age? |
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Definition
Limited use of gestures Awkward body language Absence of facial expression Pedantic speech Poor use of inflexion Socially inappropriate & offensive communication Literal interpretation of orders |
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Term
How might you describe the interests of a school age child with classic aspergers or a higher functioning autism presentation. |
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Definition
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Term
What are the classic relationship signs of both aspergers and higher functioning autism at school age? |
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Definition
Social isolation Difficulty in making friends (+/- lack of interest in doing so), this may lead to depression in teenage years. |
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Term
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Definition
Diagnosis for those who present with subthreshold signs of autism or present with signs of autism after the age of 30 months. |
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Term
What interventions are indicated in autistic spectrum disorders? |
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Definition
Family education & support Language therapy Behavioural therapy Psychological treatment Pharmacological treatment Risperidone - Used for severe aggression- Atypical Antipsychotic Diet |
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