Page 28 - Handbook of Electronic Assistive Technology

Chapter 1 • Basic Neurosciences With Relevance to Electronic Assistive Technology 15

Postnatal:

• Meningitis.
• Acquired injury before the age of 2 years.

If CP is considered, there are a number of MRI-identified aetiological causes of the
nonprogressive disorder of the brain. Damage to the pathways of the brain or white
matter occurs in 45%, to the basal ganglia in 13%, focal infarct 7% and congenital mal-
formation 10% (NICE Guideline, 2017). White matter damage, including PVL is more
common in children born preterm and generally leads to an upper motor neuron dis-
order, a picture of high muscle tone, and spasticity, weakness and poor selective control
of muscle firing.
Basal ganglia damage is generally associated with a fluctuating tone disorder –
dyskinetic CP – and is often associated with a perinatal hypoxic/ischaemic event.
CP acquired after the neonatal phase is generally associated with infection, particularly
following meningitis.
When we look and discuss the pattern of CP we describe the following:
• Unilateral or bilateral nature.
• Predominant movement difficulty:
• Tone – high/hyper- (spastic), low/hypo- or mixed dystonic.
• Movement – hyper-, hypo- or dyskinetic.

The pattern of movement disorder is dependent on where the primary impairment is
within the brain:
• We grade severity of involvement on various functional scales. The most widely used of
these focuses on the gross motor abilities of the individual, the Gross Motor Functional
Classification System. This scores mobility on a scale of I–V (Palisano et al., 1997):
• I – Independent community walker.
• II – Mild limitation in independent walking, particularly on slopes and stairs.
• III – Independent walking for short distances; assisted walking or wheelchair use
mid- to long distance.
• IV – Independent mobility in manual or powered wheelchair; therapeutic walking at
best with support.
• V – No independent mobility – dependent on adults for all mobility needs.
• Other scored functional scales focus on areas of communication, nutrition and fine
motor ability.

There are unsurprisingly a wide variety of comorbidities (clinical difficulties) associ-
ated with the impairment of the brain, in particular epilepsy, chest and gastrointestinal
problems.
Movement, positioning, communication, comfort and sensory challenges for the indi-
vidual child or adult are all supported by numerous elements of rehabilitation engineering
and electronic assistive technology.