from posture and movement of the child with cerebral palsy ... · spastic diplegia, 93, 96, 99,...

AAbdominals

exhalation and, 25hypotonia, 47, 57infants with typical development, 232–233, 234spastic diplegia, 97, 134spastic quadriplegia, 89

Abnormal range of joints and muscle, 23Accompanying impairments classifi cation, 2, 4Acetabulum, 119Activity

capacity, 17defi ned, 7examples, 8individual and specifi c, 17performance, 17positive/negative aspects, 9

Activity limitationsataxic cerebral palsy, 202, 204–205, 207, 209characteristics, 12dyskinetic cerebral palsy, 164–165, 168, 172hypotonia, 41, 45, 50–51impairments, 13postural control and movement, 12, 13spastic diplegia, 93, 96, 99, 101–102spastic hemiplegia, 103, 105, 106, 108spastic quadriplegia, 89–90

Alignment, hypotonia studies, 59–60Anatomical and neuroimaging classifi cation, 2, 4Ankle, spastic cerebral palsy, 120, 121Anticipatory control

ataxic cerebral palsy, 199diplegia and, 81dyskinetic cerebral palsy, 184–185hemiplegia and, 81spastic cerebral palsy, 82–83

Anticipatory postural adjustments, 10Antigravity postural control. See Infants with typical development

Arms. See Upper extremitiesArousal, defi ned, 25. See also Physiological arousal and attention

Asymmetrical tonic neck refl ex (ATNR), 161Ataxia

defi ned, 197postures, 100sensory processing impairments, 22stiffness, 78

Ataxic cerebral palsy, 197–223 activity limitations, 202, 204–205, 207, 209body structures and functions, 210–215

joints, 212–213musculoskeletal system, 213–214neuromuscular system, 210–211physiological arousal and attention, 214respiratory system, 214sensory/perceptual systems, 211–213swallowing, digestion, elimination, 215walking, 202, 203, 205, 209

causes, 197–198eyes, 200–203, 211–212, 215–217, 220feeding, 200, 202–203, 205, 213intervention case studies, 219–223intervention strategies, 215–218motor learning, 209–210pathophysiology, 197–198postural control and movement, 198–209

characteristics, 198–199drooling, 200, 202eyes, 200–203feeding, 200head, neck, tongue, and eyes, 200–203lower trunk, 205–207muscle synergies, 199–200neck, 200–203participation restrictions, 202pelvic girdle and lower extremities, 207–209thoracic spine, ribcage, and upper extremities,

203–205tongue, 200–203

sitting, 203, 206speech-language, 203, 207, 214, 221–222standing, 199, 208, 209, 219–220symptoms, 3synergies, 199–200, 204, 210, 211vision, 211–212

Athetosischaracteristics, 155hip dislocation, 169

index

243

From Posture and Movement of the Child With Cerebral Palsy, 2nd Ed., by M. Stamer, 2015, Austin, TX: PRO-ED. Copyright 2015 by PRO-ED, Inc.

244 Index

kinesthetic sense, 175lower trunk, 167musculoskeletal system, 178, 179neuromuscular system, 173, 174reaching, 161, 162, 164, 173, 184sitting, 170standing, 171symptoms, 3

Attention, defi ned, 25. See also Physiological arousal and attention

Audition, purpose of, 9Auditory processing in ataxia, 213

BBalance

defi ned, 9infants with typical development, 237

Ball. See Therapy ballBasal ganglia, 153–154Belly breathing

ataxic cerebral palsy, 204defi ned, 24hypotonia, 57

Bilateral spasticity, 92Bimanual task using interlimb coordination, 68Body structures and functions

ataxic cerebral palsy, 210–215 musculoskeletal system, 213–214neuromuscular system, 210–211physiological arousal and attention, 214respiratory system, 214sensory/perceptual systems, 211–213swallowing, digestion, elimination, 215

defi ned, 7dyskinetic cerebral palsy, 173–181

cardiorespiratory and muscle endurance, 180–181

musculoskeletal system, 177–180neuromuscular system, 173–174respiratory system, 180sensory/perceptual systems, 174–177swallowing, digestion, elimination, 181

examples, 8hypotonia, 51–59

cardiorespiratory and muscle endurance, 58elimination, 59musculoskeletal system, 54–57neuromuscular system, 51–53physiological arousal and attention, 58respiratory system, 57sensory/perceptual systems, 53–54swallowing and digestion, 58–59

impairments, 18–28 cardiorespiratory and muscle endurance, 26musculoskeletal system, 22–24

neuromuscular system, 19physiological arousal and attention, 25–26primary vs. secondary, 18–19respiratory system, 24–25sensory/perceptual systems, 21–22skin condition, 28swallowing, digestion, elimination, 27–28

positive/negative aspects, 9spastic cerebral palsy, 108–124

cardiorespiratory and muscle endurance, 123musculoskeletal system, 114–122neuromuscular system, 108–111physiological arousal and attention, 123respiratory system, 122–123sensory/perceptual systems, 112–113swallowing, digestion, elimination, 123–124

Body system impairments, 11–12Bones, spastic cerebral palsy, 121Breath holding

hypotonia, 47, 67spastic cerebral palsy, 123

Breathingspastic quadriplegia, 87and swallowing coordination study, 11

Bronchopulmonary dysplasia, 26

CCapacity, defi ned, 17Cardiorespiratory and muscle endurance

body function and structure impairments, 26dyskinetic cerebral palsy, 180–181hypotonia, 58spastic cerebral palsy, 123

Case studiesataxic cerebral palsy, 219–223dyskinetic cerebral palsy, 188–192hypotonia, 69–75spastic diplegia, 137–139spastic hemiplegia, 142–145spastic quadriplegia, 131–133

Causation and timing classifi cation, 2, 4. See also Pathophysiology

Causes of cerebral palsy, early theories, 1Central nervous system

control of muscle activity, 20–21impairments caused by lesions, 1joint stiffness and, 19lesions, impact of, 21lesions causing spasticity, 78

Cerebellumattention impairments, 214damage during preterm birth, 197–198functions, 210motor learning, 218proprioception perception, 212


Index 245

respiratory system disruptions after surgical resection, 214

sensory feedback loops, 211Cerebral palsy

classifi cations, 2–4 accompanying impairments, 2, 4anatomical and neuroimaging, 2, 4causation and timing, 2, 4functional, 2, 4motor type, 2–3

defi ned, 1–2Cervical spine

dyskinetic cerebral palsy, 157, 178hypotonia, 38–39spastic quadriplegia, 84

CFCS (Communication Function Classifi cation System), 4

Chin tuckdyskinetic cerebral palsy, 183hypotonia, 40, 45, 60, 74

Choreacharacteristics, 155symptoms, 3

Choreoathetosisbasketball, dribbling, 191–192cardiorespiratory and muscle endurance, 180–181defi ned, 155lower extremities, 168musculoskeletal system, 177neuromuscular system, 173–174postural control and movement, 157, 161proprioception, 213quieting themselves, 184tactile discrimination, 176timing and ordering of movements, 173

Classifi cations of cerebral palsy, 2–4 accompanying impairments, 2, 4anatomical and neuroimaging, 2, 4causation and timing, 2, 4functional, 2, 4motor type, 2–3

Cocontractionataxic cerebral palsy, 208–209, 210–211compensatory, 109defi ned, 19graded activity, 20hypotonia, 20, 51limb or joint stiffness, 19–20neuromuscular system control of, 19new skills and, 20purpose of, 19–20spastic cerebral palsy, 108–109spasticity, 20

Communication Function Classifi cation System (CFCS), 4

Compensatory cocontraction, spastic cerebral palsy, 109

Compensatory lateral fl exion, 103Compensatory postural adjustments, 10Compensatory responses in sitting, 80Constipation. See also Elimination

hypotonia, 59spastic quadriplegia, 124tube-fed children and, 27

Cooling after birth, 154Core sets, 8

DDefi nition of cerebral palsy, 1–2Depth perception

hypotonia, 40spastic diplegia, 138spastic quadriplegia, 84

Development of children with cerebral palsy, 28–29Development of infants. See Infants with typical development

Development predictability of children with cerebral palsy, 28–29

Diaphragmfunctions, 24–25hypotonia, 43spastic diplegia, 97spastic quadriplegia, 87

Digestionataxic cerebral palsy, 215dyskinetic cerebral palsy, 181esophagus, 27hypotonia, 58–59nutrition and oral motor skills, 28spastic cerebral palsy, 123–124

Diplegia. See also Spastic diplegiadefi ned, 77sitting, 170

Direction-specifi c activitycompensatory postural adjustments, 10spastic diplegia and, 80

Domains in the ICF model, 7, 9Down syndrome

excessive joint mobility, 56similarities to hypotonia, 37subluxation and dislocation, 55

Drug use causing hypotonia and lethargy, 58Dyskinetic cerebral palsy, 153–192

athetosis, 155. See also Athetosisbasal ganglia injury, 153–154body structures and functions, 173–181

cardiorespiratory and muscle endurance, 180–181

musculoskeletal system, 177–180neuromuscular system, 173–174


246 Index

respiratory system, 180sensory/perceptual systems, 174–177swallowing and digestion, 180, 181

causes, 153–154characteristics, 153, 156chorea, 155choreoathetosis, 155defi ned, 153dystonia, 155. See also Dystoniaeyes, 157, 167, 174–175feeding, 159, 185–186intervention case studies, 188–192intervention strategies, 181–188pathophysiology, 153–154postural control and movement, 156–172

activity limitations, 164–165, 172asymmetry, 156–159eyes, 157, 167head, 156–159, 161hips, 157, 169–170, 177–178jaw, 158joints, 160, 162, 180lower extremities, 168–172lower trunk, 166–168neck, 156–159, 161overview, 156participation restrictions, 168pelvic girdle, 168–172ribcage, 162, 163scooting backward in supine, 163sitting, 160, 163, 170, 172thoracic spine, 160, 163tongue, 158trunk control, 187upper extremities, 159–162, 164walking, 171–172

reaching, 162, 183simulating a function, 210speech-language, 180, 187–188standing, 159, 160, 166, 170–171, 172, 185symptoms, 3synergies, 174vision, 163, 174–175

Dysmetria, 198Dystonia

as cause of hypertonia, 78cervical spine instability, 178characteristics, 155hypotonia, 62, 155intervention strategies, 183lower extremities, 168musculoskeletal system, 180neuromuscular system, 173–174postural control and movement, 157, 163, 166reaching, 166, 173standing, 172symptoms, 3

tactile discrimination, 176trunk control, 187vision, 175

EEating. See FeedingEating and Drinking Ability Classifi cation System (EDACS), 4

EDACS (Eating and Drinking Ability Classifi cation System), 4

Eliminationataxic cerebral palsy, 215constipation

hypotonia, 59spastic quadriplegia, 124tube-fed children and, 27

hypotonia, 59spastic cerebral palsy, 124tube-fed children and, 27

Endurance, cardiorespiratory and muscle. See Cardiorespiratory and muscle endurance

Environmental factorscharacteristics, 12defi ned, 7hypotonia, 45positive/negative aspects, 9

Esophagus, 27Excessive range of joints and muscle, 23Extremities. See Lower extremities; Upper extremitiesEye extension

dyskinetic cerebral palsy, 157postural control and movement, 21spastic cerebral palsy, 112spastic quadriplegia, 84

Eyes. See also Visionataxic cerebral palsy, 200–203, 211–212, 215–217,

220downward gaze therapy, 74dyskinetic cerebral palsy, 157, 167, 174–175hypotonia, 40, 41, 53infants with typical development, 227, 228position, 9spastic diplegia, 92–93, 137spastic hemiplegia, 102–103spastic quadriplegia, 84strabismus, 92, 174

FFeeding. See also Swallowing

ataxic cerebral palsy, 200, 202–203, 205, 213breathing and swallowing coordination, 11dyskinetic cerebral palsy, 159, 185–186dyskinetic cerebral palsy intervention, 188–192Eating and Drinking Ability Classifi cation

System, 4food choices, hypotonia intervention, 69–71hypotonia, 65, 69–71


Index 247

infants with typical development, 228respiratory system and, 25spastic hemiplegia, 142spastic quadriplegia, 84, 130swallowing, digestion, elimination, 27–28tube-fed children and elimination, 27

Femur, 119, 121Food choices, hypotonia intervention, 69–71Foot, spastic cerebral palsy, 120, 121Forces, defi ned, 78Freud, Sigmund, 1Functional classifi cation

Communication Function Classifi cation System, 4deterioration and worsening of skills, 18Eating and Drinking Ability Classifi cation

System, 4Gross Motor Functional Classifi cation System, 4hypotonia, 38hypotonia intervention, 62–63Manual Ability Classifi cation System, 4overview, 2, 4postural control and movement, 21

Functional limitationsataxic cerebral palsy, 204dyskinetic cerebral palsy, 172spastic hemiplegia, 104–105, 106

GGait analysis, hypotonia, 47. See also WalkingGAS (goal attainment scaling), 8Gastroesophageal refl ux (GER)

cause of, 27dyskinetic cerebral palsy, 181spastic quadriplegia, 124

General Movement Assessment, 10Generalized hypotonia. See HypotoniaGMFCS (Gross Motor Functional Classifi cation System), 4

Goal attainment scaling (GAS), 8Graded activity, cocontraction, 20Graded control, hypotonia, 52, 64–65Grasp, dyskinetic cerebral palsy, 162, 165Graviception, 9Gross Motor Functional Classifi cation System (GMFCS), 4

HHamstings, 180Hand movement studies, 11Head control

ataxic cerebral palsy, 200–203dyskinetic cerebral palsy, 156–159, 161hypotonia, 38–40, 41, 60–62infants with typical development, 227–229joint approximation, 61lack of, 11purpose of, 9

spastic diplegia, 92–93spastic hemiplegia, 102–103spastic quadriplegia, 83–84thoracic extension therapy, 70

Health conditiondefi ned, 7ICF diagram, 8pathophysiology, 17positive/negative aspects, 9

Hemianopia, 102Hemiplegia

causes, 79defi ned, 77postural synergies, 80

Hips. See also Pelvic girdleathetosis, 169dyskinetic cerebral palsy, 157, 169–170, 177–178hypotonia, 47, 56infants with typical development, 235joint development, 23spastic cerebral palsy, 118–120spastic diplegia, 97, 100, 135–136spastic hemiplegia, 107spastic quadriplegia, 88, 90–91subluxation and dislocation, 118–119

Holistic treatment, 1Humerus, 121Hydrocephalus, 37Hyperbilirubinemia, 176–177Hyperlordosis, 118Hypermobility of joints and muscles, 23Hypertonia

causes, 78defi ned, 77–78, 155dystonia and, 62, 155postural control and movement, 165reaching, 176spastic quadriplegia and dystonia, 79stiffness, 78voicing, 187wheelchair control, 184

Hypomobility of joints, 23Hypotonia, 37–75

body structures and functions, 51–59 cardiorespiratory and muscle endurance, 58elimination, 59hips, 47, 56musculoskeletal system, 54–57neuromuscular system, 51–53physiological arousal and attention, 58respiratory system, 43, 45, 57sensory/perceptual systems, 53–54swallowing and digestion, 58–59vision, 53–54

case studies, 69–75cocontraction, 20defi ned, 37


248 Index

feeding, 65, 69–71graded control, 52, 64–65intervention strategies, 59–68

alignment, 59–60food choices, 69–71gaining function, 62–63graded control, 64–65head and trunk control, 60–62movements requiring change in direction,

66–67, 72–73occupational therapy, 68seating systems, 69, 184speech-language, 65, 67trunk control, 60–62, 63walking, 66writing, 68

pathophysiology, 37postural control and movement, 38–51

abdominals, 47, 57characteristics, 38diaphragm, 43environmental factors, 45eyes, 40, 41, 53head, 38–40, 41lower extremities, 49–51lower trunk, 45–49neck, 38–39, 41participation restrictions, 41, 45, 50–51pelvic girdle, 49–51ribcage, 41–45, 57shoulders, 39, 42, 44, 55–56sitting, 43, 49standing, 42, 46, 50thoracic spine, 39, 41–46tongue, 40, 41upper extremities, 41–45

spastic quadriplegia vs., 90–91speech-language, 45, 63, 65, 67synergies, 111

Hypoxic-ischemic injury, 154

IICD (International Classifi cation of Diagnosis), 7ICF. See International Classifi cation of Functioning, Disability and Health (ICF)

ICF-CY (International Classifi cation of Functioning, Disability and Health, children and youth version), 8

ICHI (International Classifi cation of Health Intervention), 7

Impairments of body functions and structures, 18–28 activity limitations, 13body system, 11–12cardiorespiratory and muscle endurance, 26deterioration and worsening of skills, 18dyskinetic cerebral palsy, 174hypotonia, 56musculoskeletal system, 22–24

neuromuscular system, 19physiological arousal and attention, 25–26primary vs. secondary, 18–19respiratory system, 24–25sensory/perceptual systems, 21–22skin condition, 28spastic cerebral palsy, 109–111swallowing, digestion, elimination, 27–28

Implants, 28In vivo ultrasound technology, 114Infants with typical development, 227–237

abdominals, 232–233, 234carrying with front pack carrier, 230eyes, 227, 228feeding, 228head control, 227–229hips, 235lower extremities, 234–237lower trunk, 232–234neck, 227–228pelvic girdle, 234–237ribcage, 229–231shoulders, 229, 230sitting, 231speech-language, 233standing, 231, 236, 237thoracic spine, 229–231, 233tongue, 228trunk control, 235walking, 237

Intercostal musclesdyskinetic cerebral palsy, 163exhalation and, 25hypotonia, 62

Interlimb coordination, 68, 74Internal intercostals, 25International Classifi cation of Diagnosis (ICD), 7International Classifi cation of Functioning, Disability and Health (ICF)

children and youth version, 8core sets, 8domains, 7, 9health condition diagram, 8postural control and movement in children

developing typically, 9–11postural control and movement in children with

cerebral palsy, 11–13 activity limitations, 12. See also Activity

limitationsbody system impairments, 11–12environmental barriers, 12. See also

Environmental factorsineffective postural control and movement, 12.

See also Postural control and movementparticipation restrictions, 12. See also

Participation restrictionspersonal barriers, 12


Index 249

purpose of, 7terms, 7, 9uses for, 7

International Classifi cation of Health Intervention (ICHI), 7

Interventionataxic cerebral palsy, 215–218ataxic cerebral palsy case studies, 219–223attentional costs of, 26basketball, dribbling, 191–192benefi ts of, 1cardiorespiratory and muscle endurance, 26central nervous system lesions, 1dyskinetic cerebral palsy, 181–188dyskinetic cerebral palsy case studies, 188–192dystonia, 183early treatments, 1feeding impairments, 27holistic, 1hypotonia, 59–68

alignment, 59–60food choices, 69–71gaining function, 62–63graded control, 64–65head and trunk control, 60–62movements requiring change in direction,

66–67, 72–73occupational therapy, 68seating systems, 69, 184speech-language, 63, 65, 67trunk control, 63walking, 66writing, 68

International Classifi cation of Health Intervention, 7

occupational therapycutting with scissors, 73–75dyskinetic cerebral palsy feeding, 188–190hand therapy, 142–145writing, 68

organized plan to teach new functions, 29orthopedia treatment approach, 1pulse oximetry during, 26reassessment of the child, 29spastic diplegia, 133–139spastic hemiplegia, 140–145spastic quadriplegia, 124–130, 131–133therapist skills needed, 29with therapy ball. See Therapy ballvisual intervention and motor performance, 22

Intracranial hemorrhages, 78

JJaw

dyskinetic cerebral palsy, 158oral motor skills, 27

Joints. See also Hips

abnormal range, 23ankle and foot, 120, 121ataxic cerebral palsy, 212–213dyskinetic cerebral palsy, 160, 162, 180equinus, 120full fl exion, 56hyperextension, 56joint approximation

ataxic cerebral palsy, 212–213repetitive, 61spastic quadriplegia, 126

knee, spastic cerebral palsy, 120spastic cerebral palsy, 118–121stiffness, 19. See also Stiffnesstemporomandibular joints, 158

Jumping, spastic diplegia, 136

KKernicterus, 176–177Kinesthesia, 113Knee, spastic cerebral palsy, 120Kyphosis

defi ned, 116hypotonia, 54spastic cerebral palsy, 116, 118

LLanguage. See Speech-languageLegs. See Lower extremitiesLesions

central nervous system lesionscausing spasticity, 78impact of, 21impairments caused by, 1

cerebrum, and spastic diplegia, 78dyskinetic cerebral palsy, 153, 154motor performance dysfunction caused by brain

lesions, 2Little, William, 1Little’s disease, 1Lordosis

infants with typical development, 232, 233spastic cerebral palsy, 118spastic quadriplegia, 88, 89

Lower extremitiesataxic cerebral palsy, 207–209dyskinetic cerebral palsy, 168–172dystonia, 168femur, 119, 121foot, spastic cerebral palsy, 120, 121functions, 234, 236hamstrings, 180hypotonia, 49–51infants with typical development, 234–237spastic diplegia, 99–102spastic hemiplegia, 106–108spastic quadriplegia, 90–92


250 Index

Lower trunkataxic cerebral palsy, 205–207dyskinetic cerebral palsy, 166–168hypotonia, 45–49infants with typical development, 232–234spastic diplegia, 96–99, 133–139spastic hemiplegia, 105–106spastic quadriplegia, 87–90

Lumbar extension. See LordosisLumbar fl exion, spastic quadriplegia, 89Lycra splinting use in dyskinetic cerebral palsy, 176

MMACS (Manual Ability Classifi cation System), 4Manual Ability Classifi cation System (MACS), 4Manual vibration

ataxic cerebral palsy, 221–222spastic cerebral palsy, 110spastic diplegia, 135spastic quadriplegia, 125

Motor control, selectivedefi ned, 21spastic cerebral palsy, 111

Motor performance dysfunction, 2Motor type classifi cation

hypotonia, 37, 52learning differences, 209–210overview, 2–3

Motor units, fast- and slow-twitch, 121Movement

defi ned, 10postural activity, 10postural control and movement in children with

cerebral palsy, 11–13. See also Postural control and movement

spontaneous general movements, 10studies, 10–11

Muscle biopsies, 114Muscle tone, 19Muscles. See also Neuromuscular system

controlled by central nervous system, 20–21endurance. See Cardiorespiratory and muscle

endurancepostural activity, 9shortened, 114–115synergies, 21

Musculoskeletal system, 22–24 acetabulum, 119ataxic cerebral palsy, 213–214athetosis, 178, 179dyskinetic cerebral palsy, 177–180dystonia, 180endurance. See Cardiorespiratory and muscle

enduranceextensibility of muscles, 23femur, 119growth factors, 22

hip joint. See Hips; Pelvic girdlehypermobility, 23hypomobility, 23hypotonia, 54–57impairments, 22–23for mobility functions, 48spastic cerebral palsy, 114–122for stability functions, 48strength

force production, 23–24hypotonia, 57

NNDT (Neuro-Development Treatment), 28–29Neck

asymmetrical tonic neck refl ex, 161ataxic cerebral palsy, 200–203dyskinetic cerebral palsy, 156–159, 161hypotonia, 38–39, 41infants with typical development, 227–228spastic diplegia, 92–93spastic hemiplegia, 102–103spastic quadriplegia, 83–84symmetrical tonic neck refl ex, 161

Neural activity, 19Neuro-Developmental Treatment (NDT), 28–29Neuroimaging classifi cation, 2, 4. See also Pathophysiology

Neuromuscular synergies, 21Neuromuscular system

ataxic cerebral palsy, 210–211athetosis, 173, 174cocontraction, 19–20. See also Cocontractiondyskinetic cerebral palsy, 173–174dystonia, 173–174functional postural control and movement, 21hypotonia, 51–53impairments, 19muscle activity control, 20–21reciprocal activation, 19refl exive (muscle) tone, 19selective motor control, 21spastic cerebral palsy, 108–111voluntary motor control, 19

OOccupational therapy

cutting with scissors, 73–75dyskinetic cerebral palsy feeding, 188–190hand therapy, 142–145writing, 68

Oral motor skills, 27–28Orthopedic treatment approach, 1

PParticipation

defi ned, 7


Index 251

examples, 8, 17–18positive/negative aspects, 9

Participation restrictionsataxic cerebral palsy, 202characteristics, 12dyskinetic cerebral palsy, 168hypotonia, 41, 45, 50–51

Patent ductus arteriosus, 26Pathophysiology

ataxic cerebral palsy, 197–198dyskinetic cerebral palsy, 153–154health condition, 17hypotonia, 37spastic cerebral palsy, 78–79

PEDI (Pediatric Evaluation of Disability Inventory), 8Pediatric Evaluation of Disability Inventory (PEDI), 8Pelvic girdle. See also Hips

ataxic cerebral palsy, 207–209dyskinetic cerebral palsy, 168–172functions, 234, 236hypotonia, 49–51infants with typical development, 234–237spastic diplegia, 99–102spastic hemiplegia, 106–108spastic quadriplegia, 90–92

Perceptual systems. See Sensory/perceptual systemsPerformance, defi ned, 17Perinatal hypoxia-ischemia, 153Periventricular hemorrhagic infarction, 78Periventricular leukomalacia, 78, 154Personal barriers, 12Phelps, Winthrop, 1Physiological arousal and attention

arousal, defi ned, 25ataxic cerebral palsy, 214attention, defi ned, 25classifi cations, 25–26hypotonia, 58spastic cerebral palsy, 123

Plantar fl exorsspastic cerebral palsy, 120spastic diplegia, 100–101

Postural activityanticipatory postural adjustments, 10defi ned, 9direction-specifi c compensatory postural

adjustments, 10movement, 10purpose of, 9

Postural control and movementactivity limitations, 12, 13ataxic cerebral palsy, 198–209

characteristics, 198–199drooling, 200, 202eyes, 201–202feeding, 200head, 201

head, neck, tongue, and eyes, 200–203lower trunk, 205–207muscle synergies, 199–200pelvic girdle and lower extremities, 207–209thoracic spine, ribcage, and upper extremities,

203–205body system impairments, 11–12dyskinetic cerebral palsy, 156–172

activity limitations, 164–165, 172asymmetry, 156–159eyes, 157head, 156–159, 161jaw, 158lower extremities, 168–172lower trunk, 166–168neck, 156–159, 161overview, 156pelvic girdle, 168–172ribcage, 162, 163thoracic spine, 160, 163tongue, 158upper extremities, 159–162, 164

dystonia, 157, 163, 166environmental barriers, 12functional classifi cation, 21head control, lack of, 11hypertonia, 165hypotonia, 38–51

characteristics, 38eyes, 40, 41head, 38–40, 41lower extremities, 49–51lower trunk, 45–49neck, 38–39, 41pelvic girdle, 49–51ribcage, 41–45thoracic spine, 41–45tongue, 40, 41upper extremities, 41–45

ineffective postural control and movement, 12, 13infants with typical development

eyes, 227, 228head control, 227–229lower extremities, 234–237lower trunk, 232–234neck, 227–228pelvic girdle, 234–237ribcage, 229–231thoracic spine, 229–231tongue, 228

participation restrictions, 12personal barriers, 12postural control, defi ned, 9spastic cerebral palsy, 79–108

anticipatory control, 82–83characteristics, 79–80compensatory responses in sitting, 80


252 Index

reaching, 82–83spastic diplegia, 81, 92–102spastic hemiplegia, 80–81, 102–108spastic quadriplegia, 83–92walking, 82, 83

voluntary motor control, 19–20Postural extension used fi rst in new skills, 20Prader-Willi, 37Premature birth

ataxia, 197–198basal ganglia injury, 154cardiorespiratory and muscle endurance, 26diagnosis of cerebral palsy, 29hemiplegia and, 79hypotonia and lethargy, 58intervention strategies, 29intracranial hemorrhages, 78periventricular leukomalacia, 78, 154respiratory impairments, 25skin condition, 28spastic diplegia and, 78–79

Primary impairmentsdyskinetic cerebral palsy, 174hypotonia, 51, 52secondary impairments vs., 18–19spastic cerebral palsy, 112spastic diplegia, 101

Primitive refl exes, 161Proprioception

ataxic cerebral palsy, 212–213dyskinetic cerebral palsy, 186hypotonia, 54purpose of, 9for sensory feedback, 22spastic cerebral palsy, 113

Pulse oximetry, 26

QQuadriplegia

defi ned, 77spastic. See Spastic quadriplegia

RReaching

athetosis, 161, 164, 173, 184dyskinetic cerebral palsy, 162, 183dystonia, 166, 173hypertonia, 176spastic cerebral palsy, 82–83spastic hemiplegia, 142spastic quadriplegia, 128

Reading, spastic quadriplegia, 84Reciprocal activation, 19Refl exive (muscle) tone, 19Respiratory system, 24–25

abdominals, 25. See also Abdominals

ataxic cerebral palsy, 214belly breathing

ataxic cerebral palsy, 204defi ned, 24hypotonia, 57

breath holding, 47, 67, 123breathing and swallowing coordination study, 11diaphragm

functions, 24–25hypotonia, 43spastic diplegia, 97spastic quadriplegia, 87

dyskinetic cerebral palsy, 180easy respirations, 24feeding and, 25hypotonia, 43, 45, 57internal intercostals, 25premature birth, 25ribcage, 24–25. See also Ribcagespastic cerebral palsy, 122–123spastic quadriplegia, 89vocalization and speech, 25

Ribcageadult skeletal anatomy, 230ataxic cerebral palsy, 203–205development, 24–25dyskinetic cerebral palsy, 162, 163hypotonia, 41–45, 57infants with typical development, 229–231spastic cerebral palsy, 115–116spastic diplegia, 95spastic quadriplegia, 86

SSagittal plane fl exion

dyskinetic cerebral palsy, 158spastic diplegia, 97spastic quadriplegia, 88

Scar tissue, 28School Function Assessment (SFA), 8Scoliosis

dyskinetic cerebral palsy, 166, 178–179spastic cerebral palsy, 116–118

SCPE (Surveillance of Cerebral Palsy in Europe), 2–3Seating systems, hypotonia intervention, 69, 184. See

also WheelchairSecondary impairments

dyskinetic cerebral palsy, 174, 177, 178hypotonia, 40, 46, 53, 54musculoskeletal system, 23, 24primary impairments vs., 18–19spastic cerebral palsy, 112spastic diplegia, 99–100

Selective motor controldefi ned, 21spastic cerebral palsy, 111

Sensory feedback, 22


Index 253

Sensory/perceptual systemsataxic cerebral palsy, 211–213audition, 9dyskinetic cerebral palsy, 174–177graviception, 9head and eye position, 9hypotonia, 53–54perceptual systems, 21–22proprioception, 9purpose of, 9sensory feedback, 22spastic cerebral palsy, 112–113spastic hemiplegia, 104tactile pressure, 9vision. See Visionvisual system, 21–22

SFA (School Function Assessment), 8Shoulders

hypotonia, 39, 42, 44infants with typical development, 229, 230spastic diplegia, 94–95spastic quadriplegia, 86–87subluxation and dislocation in hypotonia, 55–56

Sittingataxic cerebral palsy, 203, 206athetosis, 170dyskinetic cerebral palsy, 160, 163, 170, 172hypotonia, 43, 49infants with typical development, 231spastic cerebral palsy, 80spastic diplegia, 99, 170spastic hemiplegia, 106spastic quadriplegia, 86–87, 88, 90W-sitting

dyskinetic cerebral palsy, 165, 170spastic diplegia, 95, 101

Skin condition, 28Sleep

respiratory compromise during, 25sleep apnea and hypotonia, 58

Sound sensitivity, spastic cerebral palsy, 113Spastic cerebral palsy, 77–145

body structures and functions, 108–124 cardiorespiratory and muscle endurance, 123hips, 118–120joints, 118–121musculoskeletal system, 114–122neuromuscular system, 108–111physiological arousal and attention, 123respiratory system, 122–123ribcage, 115–116sensory/perceptual systems, 112–113swallowing, digestion, elimination, 123–124tongue, 122upper extremities, 122

case studiesspastic diplegia, 137–139

spastic hemiplegia, 142–145spastic quadriplegia, 131–133

defi ned, 77–78frequency of occurrence, 77hypertonia, defi ned, 77–78impairments, 109–111intervention strategies

spastic diplegia, 133–139spastic hemiplegia, 140–145spastic quadriplegia, 124–133

lordosis, 118pathophysiology, 78–79postural control and movement, 79–108

anticipatory control, 82–83characteristics, 79–80compensatory responses in sitting, 80reaching, 82–83sitting, 80spastic diplegia, 81, 92–102spastic hemiplegia, 80–81, 102–108spastic quadriplegia, 83–92walking, 82, 83

quadriplegia, defi ned, 77spasticity, defi ned, 77speech-language, 122–123stiffness, defi ned, 78symptoms, 3synergies, 111vision, 112

Spastic diplegiaabdominals, 97, 134activity limitations, 93, 96, 99, 101–102anticipatory responses, 81causes, 78–79defi ned, 77diaphragm, 97direction-specifi c activity, 80eyes, 92–93, 137head control, 92–93hips, 97, 100, 135–136intervention case study, 137–139intervention strategies, 133–139lower extremities, 99–102lower trunk, 96–99, 133–139neck control, 92–93pelvic girdle, 99–102postural control and movement, 81, 92–102ribcage, 95shoulders, 94–95sitting, 99, 170speech-language, 135standing, 93, 95, 100–101standing with altered alignment, 81stepping up, 210synergies, 101thoracic spine, 94–96tongue, 92


254 Index

upper extremities, 94–96walking, 100

Spastic hemiplegiaactivity limitations, 103, 105, 106, 108anterior postural sway, 81anticipatory responses, 81asymmetry, 102defi ned, 77eyes, 102–103feeding, 142functional limitations, 104–105, 106head control, 102–103hips, 107intervention case study, 140–145lower extremities, 106–108lower trunk, 105–106neck, 102–103pelvic girdle, 106–108postural control and movement, 80–81, 102–108reaching, 142sensory/perceptual systems, 104sitting, 106speech-language, 103thoracic spine, 103–105tongue, 103upper extremities, 104walking, 108, 140–141

Spastic infantile paralysis, 1Spastic quadriplegia

abdominals, 89activity limitations, 89–90causes, 78defi ned, 77diaphragm, 87digestion, 124eyes, 84feeding, 84, 130head, 83–84hips, 88, 90–91hypotonia vs., 90–91intervention case study, 131–133intervention strategies, 124–130lordosis, 88, 89lower extremities, 90–92lower trunk, 87–90neck, 83–84pelvic girdle, 90–92postural control and movement, 83–92reading, 128respiratory system, 87, 89ribcage, 86shoulders, 86–87sitting, 86–87, 88, 90speech-language, 84, 131–133standing, 128, 129swallowing, 123–124

synergies, 88–89thoracic spine, 86tongue, 84upper extremities, 85–87walking, 91

Spasticitycocontraction, 20. See also Cocontractiondefi ned, 77more spastic, 91, 95musculoskeletal system, 23visual intervention and motor performance, 22

Speech-languageataxic cerebral palsy, 203, 207, 214, 221–222dyskinetic cerebral palsy, 180, 187–188hypertonia, 187hypotonia, limitations of, 45hypotonia intervention, 63, 65, 67infants with typical development, 233oral motor skills, 27–28respiratory system and exhalation, 25spastic cerebral palsy, 122–123spastic diplegia, 135spastic hemiplegia, 103spastic quadriplegia, 84, 131–133vocalization and respiratory system, 25

Spinecervical spine

dyskinetic cerebral palsy, 157, 178hypotonia, 38–39spastic quadriplegia, 84

scoliosisdyskinetic cerebral palsy, 166, 178–179spastic cerebral palsy, 116–118

spastic cerebral palsy, 116–118Spontaneous general movements, 10Stability, defi ned, 9Stair climbing

ataxic cerebral palsy, 209, 210, 217hypotonia, 66

Standing. See also Walkingataxic cerebral palsy, 199, 208, 209, 219–220athetosis, 171diplegia and, 81dyskinetic cerebral palsy, 159, 160, 166, 170–171,

172, 185dystonia, 172hypotonia, 42, 46, 50infants with typical development, 231, 236, 237spastic diplegia, 93, 95, 100–101spastic quadriplegia, 128, 129

Stiffnessdefi ned, 78of joints, 19to learn motor skills, 20

Strabismus, 92, 174Strength of musculoskeletal system. See also


Index 255

Cardiorespiratory and muscle endurancedefi ned, 23force production, 23–24hypotonia, 57lack of, in children with cerebral palsy, 24spastic cerebral palsy, 121–122

Surgery as treatment, 1Surveillance of Cerebral Palsy in Europe (SCPE), 2–3Swallowing. See also Feeding

ataxic cerebral palsy, 215and breathing coordination, 11development of mechanism, 27dyskinetic cerebral palsy, 180, 181esophagus, 27hypotonia, 58–59nutrition and oral motor skills, 28spastic cerebral palsy, 123–124

Symmetrical tonic neck refl ex (STNR), 161Synergies

ataxic cerebral palsy, 199–200, 204, 210, 211defi ned, 21dyskinetic cerebral palsy, 174hemiplegia and, 80hypotonia, 52–53spastic cerebral palsy, 111spastic diplegia, 101spastic quadriplegia, 88–89

TTactile awareness, 22Tactile pressure, 9Tactile stimuli in dyskinetic cerebral palsy, 176Talking. See Speech-languageTask-specifi c anticipatory postural adjustments, 10Temporomandibular joints (TMJs), dyskinetic cerebral palsy, 158

Therapeutic cooling, 154Therapeutic intervention. See InterventionTherapy ball

dyskinetic cerebral palsy, 175, 182hypotonia intervention, 64, 69, 70spastic cerebral palsy, 110spastic diplegia, 135, 136spastic quadriplegia, 124, 126

Thoracic extensiondyskinetic cerebral palsy, 186–187hypotonia, 70spastic quadriplegia, 89, 126, 127, 130

Thoracic fl exionhypotonia, 44spastic diplegia, 93

Thoracic kyphosis in dyskinetic cerebral palsy, 178Thoracic spine

ataxic cerebral palsy, 203–205dyskinetic cerebral palsy, 160, 163hypotonia, 39, 41–46

infants with typical development, 229–231, 233spastic diplegia, 94–96spastic hemiplegia, 103–105spastic quadriplegia, 86

Tibia, 121Tongue

ataxic cerebral palsy, 200–203dyskinetic cerebral palsy, 158hypotonia, 40, 41infants with typical development, 228oral motor skills, 27spastic cerebral palsy, 122spastic diplegia, 92spastic hemiplegia, 103spastic quadriplegia, 84

Treatments for cerebral palsy. See InterventionTrunk control. See also Lower trunk

dyskinetic cerebral palsy, 187dystonia, 187hypotonia intervention, 60–62, 63infants with typical development, 235

Trunk rotation in infants with typical development, 234

UUpper extremities

adult skeletal anatomy, 230ataxic cerebral palsy, 203–205dissociation, 74dyskinetic cerebral palsy, 159–162, 164hand control studies, 11hypotonia, 41–45spastic cerebral palsy, 122spastic diplegia, 94–96spastic hemiplegia, 104spastic hemiplegia intervention case study, 142–

145spastic quadriplegia, 85–87

Upper lumbar extension position, hypotonia, 46–47

VVestibular information feedback to movement performance, 22

Vestibular system, affect of ataxia, 213Vision. See also Eyes

ataxic cerebral palsy, 211–212depth perception

hypotonia, 40spastic diplegia, 138spastic quadriplegia, 84

dyskinetic cerebral palsy, 163, 174–175dystonia, 175eyes, copy from mainhemianopia, 102hypotonia, 53–54infants with typical development, 228


256 Index

purpose of, 9spastic cerebral palsy, 112spastic diplegia, 92–93, 137spastic hemiplegia, 102–103

Visual systems, 21–22 eye extension, 21impairments in cerebral palsy, 21–22in infants, 21sensory feedback, 22

Vocalization. See Speech-languageVoluntary motor control of posture and movement, 19–20

WWalking. See also Standing

ataxic cerebral palsy, 202, 203, 205, 209dyskinetic cerebral palsy, 171–172gait analysis in hypotonia, 47hypotonia, 37, 47, 66

infants with typical development, 237spastic cerebral palsy, 82, 83spastic diplegia, 100spastic diplegia case study, 137–139spastic hemiplegia, 108, 140–141spastic quadriplegia, 91stair climbing. See Stair climbing

Wheelchairdyskinetic cerebral palsy, 165, 168–169for hypertonia, 184hypotonia seating systems, 69, 184

World Health Organization, ICF approval, 7Writing

children with typical development, 231hypotonia intervention, 68

W-sittingdyskinetic cerebral palsy, 165, 170spastic diplegia, 95, 101


from posture and movement of the child with cerebral palsy ... · spastic diplegia, 93, 96, 99,...

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