Cerebral Palsy: GMFCS, Spasticity & Physiotherapy Management

Cerebral Palsy (CP)

Cerebral Palsy is a non-progressive Upper Motor Neuron (UMN) disorder caused by damage to the immature brain. It manifests as disorders of movement and posture.

1. Classification

• Physiological: Spastic (Cortex), Athetoid (Basal Ganglia), Ataxic (Cerebellum).
• Topographical:
  • Hemiplegia: One side (Arm > Leg).
  • Diplegia: Legs > Arms (Prematurity is common cause).
  • Quadriplegia: All 4 limbs affected.

2. GMFCS Levels (Gross Motor Function)

The gold standard for prognosis:

• Level I: Walks without restrictions.
• Level II: Walks without aids but limited outdoors.
• Level III: Walks with assistive devices (crutches/walker).
• Level IV: Self-mobility with power wheelchair (mostly non-ambulatory).
• Level V: Dependent manual wheelchair.

3. Management

• Spasticity Management: Stretching, Baclofen, Botox (Botulinum Toxin A) injections.
• Surgery: SEMLS (Single Event Multi-Level Surgery) is preferred over multiple small surgeries to correct lever arm dysfunction.
• Gait: Address Scissoring (Adductors), Crouch (Hamstrings), and Equinus (Achilles).

25 Practice MCQs

Q1. Cerebral Palsy is defined as a disorder that is:

Answer: A). The brain lesion doesn't grow, but musculoskeletal deformity can worsen.

Q2. Spastic Diplegia typically affects:

Answer: A). Common in premature infants (Periventricular Leukomalacia).

Q3. Scissoring gait is caused by tightness of:

Answer: A). Legs cross over each other.

Q4. GMFCS Level III implies:

Answer: A). Needs support.

Q5. Botulinum Toxin A (Botox) works by:

Answer: A). Effects last 3-6 months.

Q6. Crouch Gait involves:

Answer: A). Often due to weak soleus or tight hamstrings.

Q7. Athetoid CP is associated with damage to the:

Answer: A). Involuntary writhing movements.

Q8. The most common type of CP is:

Answer: A). ~70-80% of cases.

Q9. Hip subluxation in CP is due to muscle imbalance between:

Answer: A). "Windswept" hips. Requires surveillance.

Q10. SEMLS stands for:

Answer: A). Correcting all deformities in one go to reduce rehab time.

Q11. Silfverskiold test differentiates:

Answer: A). If dorsiflexion improves with knee flexion, Gastroc is tight.

Q12. Selective Dorsal Rhizotomy (SDR) involves:

Answer: A). Interrupts the reflex arc.

Q13. Which reflex is persistent in CP?

Answer: A). Sign of UMN lesion and lack of inhibition.

Q14. Equinus deformity is treated by lengthening the:

Answer: A). Z-plasty or Hoke's procedure.

Q15. Baclofen pump delivers medication to:

Answer: A). For severe generalized spasticity.

Q16. Hemiplegic CP usually presents with:

Answer: A). Unilateral involvement.

Q17. Ashworth Scale measures:

Answer: A). Modified Ashworth Scale (MAS) 0-4.

Q18. Stiff Knee Gait is caused by:

Answer: A). Treated with Rectus transfer.

Q19. Ataxic CP is due to damage in the:

Answer: A). Poor balance and coordination.

Q20. Jump Gait involves:

Answer: A). Looks like the child is about to jump.

Q21. Reimer's Migration Index is used to assess:

Answer: A). >30% is "Hip at Risk".

Q22. Serial casting is most effective for:

Answer: A). Often combined with Botox.

Q23. Quadriplegic CP has the highest risk of:

Answer: A). Full body involvement.

Q24. Constraint-Induced Movement Therapy (CIMT) is used for:

Answer: A). Neuroplasticity training.

Q25. AFO stands for:

Answer: A). Prevents foot drop and controls ankle.