Motor Disorders

Cerebral Palsy - Brain's Motion Muddle

CP: A group of permanent, non-progressive motor disorders affecting movement & posture, from disturbances in the developing fetal/infant brain.

• Risk Factors: 📌 PREMATURE

  • Prematurity, Perinatal asphyxia
  • Rubella, Radiation
  • Eclampsia, Erythroblastosis fetalis
  • Multiple births
  • Antepartum hemorrhage
  • Toxins
  • Unexplained

• Classification:

  Type	Subtypes	Key Features
  Spastic	Diplegia, Hemiplegia, Quadriplegia	↑Muscle tone, hyperreflexia, UMN signs
  Dyskinetic	Athetoid, Dystonic	Involuntary movements, fluctuating tone
  Ataxic		↓Coordination, balance issues, wide-based gait
  Mixed	Combination of types	Varied presentation

• Clinical Features: Delayed motor milestones, abnormal tone (spasticity/hypotonia), persistent primitive reflexes, feeding difficulties.
• Management: Multidisciplinary: physiotherapy, OT, speech therapy, antispasmodics (e.g., baclofen), orthopedic surgery.

⭐ The most common form of cerebral palsy is spastic cerebral palsy (~80%), and among preterm infants, spastic diplegia is particularly prevalent.

DCD & Stereotypies - Coordination Quirks & Rhythms

• Developmental Coordination Disorder (DCD)
  • Motor skills (e.g., catching, writing) below age; appears clumsy.
  • Significantly impacts Activities of Daily Living (ADLs), academics, or play.
  • Not due to intellectual disability, visual impairment, or neurological conditions (e.g., Cerebral Palsy).
  • 📌 Difficult Coordination Disorder.
• Stereotypic Movement Disorder (SMD)
  • Repetitive, driven, purposeless motor acts (e.g., hand flapping, rocking, head banging).
  • Interferes with activities or causes self-injury.
  • Concern if: Persists >4 weeks, injurious, or functionally impairing. Not due to substance/other conditions.

⭐ DCD diagnosis: motor difficulties must significantly interfere with activities of daily living or academic achievement, and are not better explained by intellectual disability or visual impairment.

Tic Disorders & Tourette's - Unwanted Moves & Sounds

• Tics: Sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations.

  • Motor Tics: Simple (e.g., eye blinking, head jerking) or Complex (e.g., facial gestures, jumping).
  • Vocal Tics: Simple (e.g., throat clearing, sniffing) or Complex (e.g., words, echolalia, coprolalia - rare).

• Tourette Syndrome (TS):

  • Diagnostic Criteria (DSM-5):
    • Multiple motor tics AND ≥1 vocal tics (need not be concurrent).
    • Tics persist >1 year since first tic onset.
    • Onset before age 18 years.
    • Not attributable to substance or other medical condition.
  • 📌 Mnemonic: TICS (Time >1yr, Involuntary, Combination of motor/vocal, Start <18yrs).
  • Common Comorbidities: ADHD (most common, ~60%), OCD (~30-50%).

⭐ Tourette Syndrome is characterized by both multiple motor tics and at least one vocal tic, present for more than a year, with onset before the age of 18.

Motor Delay Approach - Spotting Stumbles Early

Motor delay: Significant lag in achieving milestones (e.g., >2 SD below mean or <5th percentile).

• Key Milestones (Approx. Age):
  • Head control: 2-3 months
  • Rolls over: 4-6 months
  • Sits unsupported: 6-8 months
  • Walks alone: 12-15 months
• Red Flags: 📌 REGRESS (Regression, Early rolling/handedness <18m, Gross motor only delay, Reflexes persistent [Moro >4-6m, ATNR >6m], Eyes abnormal, Stiff/floppy).
  • Other: Asymmetry, plateau/loss of skills.
• Brief DDx: Cerebral Palsy, Muscular Dystrophies, SMA, Genetic Syndromes.

⭐ Regression of previously achieved motor milestones is a significant red flag warranting prompt and thorough investigation.

High-Yield Points - ⚡ Biggest Takeaways

• Cerebral Palsy (CP) is a non-progressive motor disorder from perinatal brain injury; spastic type is most common.
• Developmental Coordination Disorder (DCD) involves impaired motor coordination affecting daily life, not due to other conditions.
• Tourette Syndrome: Multiple motor and ≥1 vocal tics for >1 year, onset <18 years.
• Gower's sign indicates proximal muscle weakness, classic in Duchenne Muscular Dystrophy (DMD).
• Spinal Muscular Atrophy (SMA) is a key cause of floppy infant due to LMN degeneration.
• Early intervention is critical for improving outcomes in motor disorders.