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CEREBRAL PALSY
This document provides information about cerebral palsy (CP), including its causes, types, risk factors, diagnosis, and management. CP is a group of motor impairment syndromes resulting from early brain development disorders. It is the most common and costly form of chronic motor disability. The main types of CP are spastic, dyskinetic, ataxic, and mixed. Treatment involves physiotherapy, occupational therapy, speech therapy, surgery, and early intervention. While CP cannot be cured, early treatment and rehabilitation can help those affected realize their full potential.
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CEREBRAL PALSY
- 1. CEREBRAL PALSY Prepared by:Mohammed Ahmed Rajab
- 2. Introduction ◦ Historically knownas static encephalopathy ◦ A group of motor impairment syndromes resulting from disorders of early brain development. ◦ Often associated with epilepsy and abnormalities of speech, vision and intellect. ◦ However, many children and adult with CP function at a high educational and vocational level without sign of cognitive dysfunction
- 3. Epidemiology ◦ CP isthe most common and costly form of chronic motor disability ◦ Prevalence: 2/1000 ◦ Prevalence of CP is increased in low birth weight infants (<1000g) ◦ CP incidence higher in premature and twin birth
- 4. Aetiology •Infection - German measles -Shingles •Diabetes •Toxemia of pregnancy •Rh incompatibility •Asphyxia •Birth injury •Prematurity Caused by developmental, genetic, metabolic, ischemic, infections Antenatal factors (80%) Intrapartum (10%) Postpartum (10%) ◦ Very high fever ◦ Brain infection ◦ Head injury ◦ Lack of oxygen ◦ Poisoning ◦ Intracranial hemorrhage or blood clot
- 5. Risk Factors ◦ BeforePregnancy: - History of fetal wastage - Long menstrual cycle - Maternal thyroid disorder - Family history of mental retardation ◦ During Labor and Delivery: - Premature separation of placenta ◦ During Early Postnatal Period: - Newborn hypoxic ischemic or bilirubin (kernicterus) encephalopathy ◦ During Pregnancy: - Low socioeconomic status - Tx of mother with thyroid hormone, estrogen or progesterone - Maternal seizure disorder - Polyhydramnios - Eclampsia - Bleeding in 3rd trimester - Twin gestation - Congenital malformation - Fetal growth retardation - Abnormal fetal presentation
- 6. Physiologic identify forms ofmotor impairment Spastic CP Dyskinetic CP Ataxic CP Mixed CP Distribution identify location of musculoskeletal involvement Spastic diplegia Spastic quadriplegia Spastic hemiplegia Classification
- 9. Spastic CP ◦ Themost common form of CP (70- 80%) ◦ Due to injury to upper motor neurons of pyrimidal tract ◦ Often exhibit truncal hypotonia in 1st year of life
- 10. •Characterized by atleast 2 of following: -Abnormal movement pattern -Increased tone -Pathologic reflexes (Babinski, hyper-reflexia)
- 11. Dyskinetic CP ◦ 10-15% ◦Result of injury to basal ganglia (associated with kernicterus) ◦ Characterized by variable tonal abnormalities & involuntary movement (athetosis, chorea) ◦ Fewer seizures & >normal cognitive function
- 12. Ataxic CP ◦ <5%of CP cases – rare ◦ Results from cerebellar injury ◦ Abnormalities of voluntary movement and balance ◦ Wide-based, unsteady gait, abnormal muscle tone
- 13. Mixed CP ◦ 10-15%of all cases ◦ > 1 type of motor pattern is present & when 1 pattern does not clearly dominate another ◦ Associated with > complications: sensory deficits, seizures, cognitive- perceptual impairments
- 14. Dystonic CP ◦ Uncommon ◦Characterized by reduced activity and stiff movement (hypokinesia) and hypotonia
- 15. Choreoathetotic CP ◦ Rare ◦Caused by excess hyperbilirubinemia ◦ Dominated by increased and stormy movement (hyperkinesia) and hypotonia
- 16. Clinical Manifestations ◦ Spectrumof developmental abnormalities ◦ Mental retardation ◦ Epilepsy ◦ Motor handicap
- 17. •Visual, hearing, speech,cognitive & behavioral abnormalities
- 19. Diagnosis ◦ History andPE should preclude progressive disorder of CNS, degenerative disease, metabolic disorders, spinal cord tumor, muscular dystrophy ◦ MRI scan of brain or spinal cord ◦ Test of hearing and visual function ◦ Genetic evaluation
- 20. Management ◦ CP cannotbe cured ◦ Family support – educate parents
- 21. ◦ Adjunctive therapy: -Physiotherapy - Occupational therapy - Speech therapy ◦ Surgery ◦ Psychologist or psychiatrist
- 22. Nursing Manegment ◦ EarlyIntervention ◦ • The earlier disabled children are given rehabilitation and education, the better they are able to realize their full potential later in life. ◦ - Early intervention can have a really positive impact on a child’s life. ◦ Physiotherapy ◦ - Physiotherapy is extremely beneficial and the children love the interaction
- 23. ◦ Feeding ◦ •Three finger jaw control helps in swallowing ◦ • Speech therapy helps in better swallowing ◦ - Care and dignity when feeding a disabled child improve trust and ensure a healthy, happy child. ◦ Children with learning disabilities ◦ - Encourage appropriate use of the curriculum and teacher’s guide for mentally disabled children. ◦ - A teacher using teaching materials she has made herself and adapted to the individual needs of this child.
- 24. ◦ Children withhearing and visual impairments ◦ - Special technical skills and training are to be provided to help deaf or blind children. ◦ - Teaching self help skills through play for blind children.
- 25. ◦ Drugs: - OralDantrolene sodium, benzodiazepines, baclofen – treat spasticity - Botulinum toxin - Levodopa
- 26.