Cerebral Palsy
Name the 3 types of CP.
Spastic
Ataxic
Dyskinetic
Which levels require total assistance?
Levels 1, 2, and 3
This level requires total assist, responds to repeated auditory stimuli by increasing or decreasing activity, may have non-purposeful verbalizations, physiological changes, or gross body movement to a stimuli, generalized reflex to pain, delayed response.
Level 2: Generalized Response Total Assist
Name the level associated with each stitch.
Running: level 3
Whip: level 4
Cordovan: level 5
Level 3: Mild Cognitive Decline
This type of CP causes spasticity, hypertonicity, and hyperreflexia.
Spastic CP
Level 4- Confused Agitated Maximum assist
This client can shift between tasks for 2 hours, uses memory devices and may occasionally ask for assistance with this, is aware of her impairments if they interfere with the task but needs assist to anticipate the problem, has depression, easily irritated, and can think about the consequences to their actions with assist as needed.
Level 9: Purposeful Appropriate Stand-by on request
Kristen can live alone safely, but is impulsive and occasionally needs someone to check in on her due to her poor judgement.
ACL 5: New learning and Exploratory
This level is a normal, age associated change, and causes you to forget names or misplace items.
Level 2: Very mild cognitive decline
Name 3 co-morbidities common with CP.
Language and cognitive deficits: 50-75%
seizures: 50%
visual impairments: 40-50%
feeding disturbances
diminished sensation: spastic hemiplegia
The client is now oriented to person and place. He can do familiar tasks with minimal assist for 30 minutes, is unaware of his specific impairments, overestimates his abilities, and is uncooperative.
Level 7: Automatic Appropriate Minimal Assist
This client requires total assist, will track objects, will blink from a bright light stimulus, may respond to some people but not others, pulls at tubes, inconsistently responds to simple commands, and withdrawals or vocalizes with pain.
Level 3: Localized Response Total Assist
Judy has a caregiver to help her with toileting and needs supervision as she has been wandering more. The occupational therapist treating her has been dancing with her to music and doing tasks that require less than 3 minutes of attention.
Level 2: Postural Action and gross body movement
At this level you cannot survive without assistance. STM loss, some assistance, and lack of orientation to place/time/date.
Level 5: Moderately severe cognitive decline
What is chorea, and which type of CP does this occur?
Chorea: involuntary movements, purposeless, typically in the distal extremities and face.
Dyskinetic CP
The client can do multiple tasks at the same time, is aware of his abilities, anticipates his impairments and how it will impact his task, and gets irritable if he is sick/fatigued/emotionally stressed.
This client is inconsistently oriented to person, place, and time. They are able to recognize some staff now, and can use a memory device with max A. They can attend to highly familiar tasks for 30 minutes with moderate redirection, and are showing carryover for relearned familiar tasks but require max A for new learning and no carryover.
Level 6: Confused Appropriate Moderate Assist
Alishia is still living alone and works at a library re-stocking books, with support from the owner. She works 1 hour shifts and uses signs placed on each row to help her find the right stack. She takes the bus back to her home she has lived in for the last 53 years.
ACL 4
At this level there is a loss of speech, difficulty moving/eating/swallowing, loss of bowel/bladder control, and needs assistance with daily activities. It is known for the disconnect between the body and brain.
Level 7: Very severe cognitive decline.
What age range is the Gross Motor Functional Classification System used for to determine a child with CP's motor performance?
Bonus! Can you briefly describe the 5 levels of the GMFCS?
Ages 6-12
Level 1: walking independent
Level 2: walks without device, limitation walking outdoors and in community
Level 3: walking with adaptive device, limitation walking outdoors and in community
Level 4: use of power w/c or are transported
Level 5: self-mobility is severely limited even with use of assistive tech
This client is alert and wandering, not oriented to person/place/time, is not goal-directed, unable to learn new information, able to converse on a social, automatic level with structure and cues, and confabulates stories.
Level 5: confused inappropriate, nonagitated max A
This client is self-centered and consistently oriented to person, place, and time. They can attend to familiar tasks for 1 hour even if distracted. They can recall and integrate past and recent events. They use a memory device with SBA. No assistance is needed once the new task is learned. They overestimate and underestimate their abilities, and have become depressed and irritable.
Level 8: Purposeful appropriate stand by assist
Nicole lives with her son who lets her be as independent as she can by providing ADL set up and giving her tactile cues. He sets her up to do familiar jobs such as folding towels, but likes to make sure each task is less than 30 minutes.
ACL 3
This level causes a lack of awareness to surroundings, may need ADL assist, start of bowel/bladder issues, sleep disturbance, personality changes, behavior changes, unable to count to 10 without assistance. It is common to forget their spouses name at this stage.
Level 6: Severe cognitive decline.